Impact of nuclear fragmentation and irradiation scenarios on the dose‐averaged LET, the RBE, and their relationship for H, He, C, O, and Ne ions

Secondary fragments can substantially affect the dose-averaged LET and the RBE, even in proton beams. The dose-averaged LET, including or not the contributions from secondary fragments, was generally unable to adequately capture RBE variations across different scenarios. A more comprehensive approach, considering microdosimetric distributions, is necessary to accurately describe RBE variations in ion therapy.