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. 2019 Nov 20;9:17180. doi: 10.1038/s41598-019-53562-y

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Ultra-high dose rate (35 Gy/s) RT is more potent than conventional dose rate (0.1 Gy/s) RT in killing tumor cells, with no appreciable difference in modes of cell death. (a) Clonogenic survival curve of KPC cells treated with ultra-high dose rate shows enhancement factor at 10% surviving fraction (DEF₁₀) of 1.310 compared to conventional dose rate RT(0,2,4,6,8 Gy of radiation) (b) Clonogenic survival curve of Panc02 cells treated with ultra-high dose rate shows enhancement factor at 10% surviving fraction (DEF₁₀) of 1.365 compared to conventional dose rate RT(0,2,4,6,8 Gy of radiation) (c,d) The percentage of PBMCs undergoing early apoptosis, late apoptosis, and necrosis at 24 h and 72 h following ultra-high and conventional dose rate RT. Dose enhancement ratio at survival fraction (DER_SF0.1) of 10% was calculated by (radiation dose needed to kill 90% at high dose-rate)/(radiation dose needed to kill 90% with conventional dose rate). The radiation dose was calculated from the linear quadratic model based on the survival fraction at each dose. Data are derived from experiments conducted in sextuplicate.