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A measure of radioresistance, this ratio quantifies the increase in dose needed to achieve a given level of cell kill in a hypoxic population, compared to one that is fully oxygenated.

At high enough LET, OER approaches unity, making cell kill independent of oxygenation.

Dubbed "kill-painting", the approach achieved its goal of uniform cell killing in a phantom tumour in initial tests. "We are able to exploit the advantages of actively scanned particle beams much better, providing optimal irradiation of tumours with heterogeneous radiosensitivities," said senior author Emanuele Scifoni, from the GSI Helmholtz Centre for Heavy Ion Research in Darmstadt.

In doing so, it avoids the dip in cell killing observed in hypoxic subvolumes when plans are optimized simply according to dose (weighted by relative biological effectiveness) (Sci. Led by Marco Durante, director of Biophysics at GSI, the researchers began with a series of in vitro cell survival experiments measuring oxygen enhancement ratios (OER).

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