Search Results (284)

The effective suppression of inflammation using disease-modifying therapies is essential in the treatment of multiple sclerosis (MS). Anti-CD20 monoclonal antibodies are commonly used long-term as maintenance therapies, largely due to the lack of reliable biomarkers to guide dosing and evaluate treatment response. However, prolonged use increases the risk of infections and other immune-mediated side effects. The unique ability of brain-derived blood extracellular vesicles (EVs) to cross the blood–brain barrier and reflect the central nervous system (CNS) immune status has sparked interest in their potential as biomarkers. This study aimed to assess whether blood-derived L1CAM⁺ EVs could serve as biomarkers of treatment response to rituximab (RTX) in patients with relapsing-remitting MS (RRMS). Serum samples (n = 25) from the baseline (month 0) and after 6 months were analyzed from the RTX arm of the ongoing randomized clinical trial OVERLORD-MS (comparing anti-CD20 therapies in RRMS patients) and were compared with serum samples from healthy controls (n = 15). Baseline cerebrospinal fluid (CSF) samples from the same study cohort were also included. EVs from both serum and CSF samples were characterized, considering morphology, size, and concentration, using transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). The immunophenotyping of EV surface receptors was performed using flow cytometry with the MACSPlex exosome kit, while label-free quantitative proteomics of EV protein cargo was conducted using a proximity extension assay (PEA). TEM confirmed the presence of EVs with the expected round morphology with a diameter of 50–150 nm. NTA showed significantly higher concentrations of L1CAM⁺ EVs (p < 0.0001) in serum total EVs and EBNA1⁺ EVs (p < 0.01) in serum L1CAM⁺ EVs at baseline (untreated) compared to in healthy controls. After six months of RTX therapy, there was a significant reduction in L1CAM⁺ EV concentration (p < 0.0001) and the downregulation of TNFRSF13B (p = 0.0004; FC = −0.49) in serum total EVs. Additionally, non-significant changes were observed in CD79B and CCL2 levels in serum L1CAM⁺ EVs at baseline compared to in controls and after six months of RTX therapy. In conclusion, L1CAM⁺ EVs in serum showed distinct immunological profiles before and after rituximab treatment, underscoring their potential as dynamic biomarkers for individualized anti-CD20 therapy in MS. Full article

Using the behavioral model of engagement in health services, the current study assessed client characteristics that may contribute to treatment duration in trauma-focused psychotherapy in a community clinic setting. Participants (n = 893) were adults ages 18–78 years old (M = 36.36, SD 12.37). Demographic data (e.g., age, income) and health profile questionnaires assessing trauma and depression symptoms were collected at intake and every three sessions thereafter to track health outcome progress. Logistic regression models assessed factors associated with treatment duration at three time points: treatment initiation (0–2 sessions), treatment engagement (3–5 sessions), and treatment sustainment (6–8 sessions). For this sample, 38.6% ended treatment at the treatment initiation phase. Lower education level and higher quality of social relationships was predictive of ending treatment. In the engagement phase, 29.2% of the remaining participants (n = 548) ended treatment before six sessions, but there were no predictors of ending. During the sustainment phase, 31.7% ended treatment. African American race was associated with ending at this phase. In total, 70.3% of participants ended treatment before nine sessions. Participants who remained in treatment through the sustainment phase showed significant improvement in trauma and depression symptoms at each of the previous treatment phases, providing evidence of a dose response effect. Lower education, higher quality of social relationships, and African American race were associated with leaving treatment early. Many participants ended treatment before nine sessions, but those that completed treatment experienced improvement in symptoms to sub-clinical levels. Full article

The Fricke gel dosimeter, a hydrogel-based chemical dosimeter containing dissolved ferrous sulfate, measures 3D radiation dose distributions by oxidizing Fe²⁺ to Fe³⁺ upon irradiation. This study investigates the variation in Fricke yield, G(Fe³⁺), from a radiation–chemical perspective in both standard and gel-like Fricke systems of varying viscosities, under low- and high-linear energy transfer (LET) conditions. We employed our Monte Carlo track chemistry code IONLYS-IRT, using protons of 300 MeV (LET~0.3 keV/µm) and 1 MeV (LET~25 keV/µm) as radiation sources. To assess the impact of viscosity on G(Fe³⁺), we systematically varied the diffusion coefficients of all radiolytic species in the Fricke gel, including Fe²⁺ and Fe³⁺ ions. Increasing gel viscosity reduces Fe³⁺ diffusion and stabilizes spatial dose distributions but also lowers G(Fe³⁺), compromising measurement accuracy and sensitivity—especially under high-LET irradiation. Our results show that an optimal Fricke gel dosimeter must balance these competing factors. Simulations with lower sulfuric acid concentrations (e.g., 0.05 M vs. 0.4 M) further revealed that G(Fe³⁺) values at ~100 s are nearly identical for both low- and high-LET conditions. This study underscores the utility of Monte Carlo simulations in modeling viscosity effects on Fricke gel radiolysis, guiding dosimeter optimization to maximize sensitivity and accuracy while preserving spatial dose distribution integrity. Full article

Background/Objectives: Despite progress in secondary prevention, people with chronic coronary syndrome (CCS) still face a residual risk of ischemic events. Antithrombotic therapy reduces this risk and helps stabilize chronic cardiovascular disease. Studies have shown that combining low-dose rivaroxaban with aspirin—an approach called dual-pathway inhibition (DPI)—can lower this risk and reduce major adverse cardiovascular events (MACEs). However, researchers have not yet gathered enough real-world data to confirm the efficacy and safety of this strategy. The DUTCH CCS registry aims to collect real-world data on how effective and safe low-dose rivaroxaban combined with aspirin is for patients with CCS in The Netherlands. The study aims to provide insights into the outcomes, benefits, and risks of DPI in a real-world setting, beyond the scope of controlled clinical trials. Methods: The DUTCH CCS registry operates as a national, multicenter, prospective observational study. It enrolls 1000 patients with CCS who receive rivaroxaban (2.5 mg twice daily) and aspirin (80 mg or 100 mg once daily). The study targets individuals at high ischemic risk due to coronary artery disease (CAD) and follows a single-arm design. Researchers will measure the primary efficacy endpoint by tracking MACEs, clinically driven coronary, peripheral, or carotid revascularization, and stent thrombosis over one year. They will assess the primary safety endpoint by recording major bleeding events at one year. The team will collect data at both 3-month and 1-year follow-ups. Conclusions: As an observational study, this registry is not designed to establish causality. However, it seeks to improve our understanding of how DPI performs in real-world secondary prevention for CCS patients. The results may help update treatment guidelines and inform clinical decisions in everyday practice. Full article

Path tracking is an essential task for autonomous driving (AD), for which controllers are designed to issue commands so that vehicles will follow the path of upper-level decision planning properly to ensure operational safety, comfort, and efficiency. Current path-tracking methods still face challenges in balancing tracking accuracy with computational overhead, and more critically, lack consideration for Motion Sickness (MS) mitigation. However, as AD applications divert occupants’ attention to non-driving activities at varying degrees, MS in self-driving vehicles has been significantly exacerbated. This study presents a novel framework, the Hybrid Supervised–Reinforcement Learning (HSRL), designed to reduce passenger discomfort while achieving high-precision tracking performance with computational efficiency. The proposed HSRL employs expert data-guided supervised learning to rapidly optimize the path-tracking model, effectively mitigating the sample efficiency bottleneck inherent in pure Reinforcement Learning (RL). Simultaneously, the RL architecture integrates a passenger MS mechanism into a multi-objective reward function. This design enhances model robustness and control performance, achieving both high-precision tracking and passenger comfort optimization. Simulation experiments demonstrate that the HSRL significantly outperforms Proportional–Integral–Derivative (PID) and Model Predictive Control (MPC), achieving improved tracking accuracy and significantly reducing passengers’ cumulative Motion Sickness Dose Value (MSDV) across several test scenarios. Full article

Enterococcus faecalis (E. faecalis) is one of the most detected bacteria in persistent apical periodontitis (PAP), with alkaline tolerance enabling post-treatment survival. In this study, we will investigate how alkaline conditions alter proteomic and metabolomic profiles of E. faecalis membrane vesicles (MVs) and preliminarily investigate the role of MVs of E. faecalis in the regulation of macrophage inflammatory response. E. faecalis MVs were characterized using transmission electron microscopy and nanoparticle tracking analysis under varying pH conditions. MVs’ proteomic and metabolomic profiling across pH levels was compared. The effects of E. faecalis MVs on human dTHP-1 macrophages were evaluated using CCK-8 metabolic activity assays and ELISA-based quantitative analysis of inflammatory cytokines. In this study, the presence of E. faecalis MVs was verified, and the alkaline environment of pH 9.0 did not alter their production. Through proteomic and metabolomic analysis, we observed that ATP synthase and stress proteins, as well as lysine degradation and tryptophan metabolism pathways, were significantly enriched in the MVs at pH 9.0. Finally, we observed that both E. faecalis MVs at pH 7.0 and pH 9.0 could dose-dependently inhibit the activity of dTHP-1 cells. E. faecalis MVs promote the secretion of IL-6, TNF-α, IL-1β, IL-1ra, and TGF-β by macrophages. Compared to pH 7.0, pH 9.0 E. faecalis MVs have a reduced effect on IL-1ra and TGF-β secretion. Additionally, we observed a significant increase in the IL-1β/IL-1ra ratio after treatment with E. faecalis MVs. Our study indicated that E. faecalis can produce MVs in pH 7.0 and pH 9.0 environments. ATP synthase, stress proteins, as well as lysine degradation and tryptophan metabolism pathways, were significantly enriched in pH 9.0 MVs. Furthermore, E. faecalis MVs could promote inflammatory responses in macrophages and dose-dependently inhibit the viability of dTHP-1 cells. Full article

Studies in animals and humans suggested that the tonic dopamine inhibition of prolactin release may be estimated by submaximal prolactin stimulation by thyrotropin-releasing hormone (TRH), the mini-TRH test. Because patients with schizophrenia may be more vulnerable to stress-induced elevations of prolactin, great care was taken to avoid stress-induced increases in prolactin, including applying local anaesthesia before blood extraction in our psychotic patients. Basal prolactin levels were in the reference range in all psychotic patients studied by us and were not higher in male patients than in normal men. Results of the mini-TRH test suggested that in acute patients with non-affective psychoses, everyday memory problems, non-paranoid delusions, and first-rank symptoms, but not other Comprehensive Psychopathological Rating Scale (CPRS) positive symptoms, could correlate with decreasing dopamine transmission in lactotrophs. In acute patients with first-episode schizophrenia, increasing negative disorganisation symptoms might correlate with increasing dopamine transmission. In first-episode patients, a hypersensitivity of the TRH response was detected, which could indicate that variability in the basal prolactin levels may confound the interpretation of the mini-TRH response. To avoid that, a smaller dose of TRH was recommended in first-episode patients. Studies using other estimates of basal dopamine release suggested that striatal dopamine transmission reflected delusions and hallucinations but not other Positive and Negative Symptom Scale (PANSS) positive symptoms. Including a wide range of symptoms in the PANSS positive scale may reduce its specificity for assessing basal dopamine transmission, although the scale remains useful for tracking treatment response. Full article

Background and Objectives: Extracellular vesicles (EVs) derived from mesenchymal stem cells have gained much attention as potential therapeutic agents in many diseases, including hearing disorders such as sensorineural hearing loss (SNHL). EVs inherit similar therapeutic effects, including the stimulation of tissue regeneration from the parental cells. The aim of our study was to isolate EVs produced by MSCs and use them to treat inner ear cells in culture to evaluate their protective potential against the damaging effect of an ototoxic drug. Materials and Methods: We isolated MSC-derived EVs by precipitation and characterized them by number, size, and morphology using nanoparticle tracking analysis and TEM, evaluated the protein concentration by BCA assay and the presence of EV markers CD9, CD63, and CD81 by the Dot Blot immunoblotting method. HEI-OC1 inner ear cell line was treated with EVs either alone or followed by Cisplatin. We assessed the uptake of EVs in HEI-OC1 cells by fluorescence microscopy after PKH26 labeling, ROS production by the DCFDA (dichlorfluorescein diacetate) assay, cellular viability by Alamar Blue assay, and apoptosis with the Annexin V/Propidium Iodide method. Results: The isolated EVs had mean dimensions of 184.4 nms and the concentration of the EV suspension was 180 × 10⁶ particles/mL. TEM analysis showed intact vesicular structures with lipid-bilayer membranes having similar sizes with those measured by NTA. The PKH26-labeled EVs were observed in the HEI-OC1 cells after 24 h incubation, the amount increasing with the concentration. EVs reduced ROS production and increased the number of viable cells both alone and as pretreatment before Cisplatin, dose-dependently. Cells in early apoptosis were inhibited by EVs, while those in late apoptosis were enhanced, both with and without Cisplatin. Conclusions: EVs secreted by MSC protected HEI-OC1 cells against Cisplatin toxicity, reduced ROS production, and stimulated cell viability and the elimination of damaged cells by apoptosis, protecting the HEI-OC1 cells against Cisplatin-induced damage. Full article

Monte Carlo simulation relies on pseudo-random number generators. In general, the quality of these generators can have a direct impact on simulation results. The GATE toolbox, widely adopted in radiotherapy, offers three generators from which users can choose: Mersenne Twister, Ranlux-64, and James-Random. In this study, we used these generators to simulate the head of a medical linear accelerator for 6 MV photons in order to assess their potential impact on the results obtained in radiotherapy simulation. Simulations were conducted for four different field openings. The simulations included a linac head model and a water phantom, all components of the head of the medical linear accelerator, and a water phantom placed at a distance of 100 cm from the electron source. Statistical analysis based on normal probability and Bland–Altman plots were used to compare dose distributions in the voxelized water phantom obtained by each generator. Experimental data (dose profiles, percentage dose at depth, and other dosimetric parameters) were measured using an appropriate quality assurance protocol for comparison with the different simulations. The evaluation of dosimetric criteria shows significant variations, particularly in the physical penumbra of the dose profile for large fields. The gamma index analysis highlights significant distinctions in generator performance. In all simulations, the average time of the primary particle generation rate, number of tracks, and steps in the simulation of different random number generators showed differences. The Mersenne Twister generator was distinguished by high performance in several aspects, particularly in terms of execution time, primary particle production, track and step production flow rate, and coming closer to the experimental results. Regarding computational time, the simulation using the Mersenne Twister generator was about 18% faster than the one using the James-Random generator and 27% faster than the simulation using the Ranlux-64 generator. This suggests that this generator is the most reliable for accurate and fast modeling of the medical linear accelerator head for 6 MV energy. Full article

Objectives: This study aim to determine the characteristics, roles, responsibilities, and challenges of informal caregivers for adult patients in Saudi Arabia. Methods: Adult patients who have informal caregivers were invited to participate in a cross-sectional study. The inclusion criteria were patients who were 18 years old or older and permanent Saudi residents. A self-administered online questionnaire was used to identify patients’ demographics, roles, responsibilities, and care challenges. Data collection lasted four months. Percentages, means, and standard deviations were reported in the analysis. Results: The study included 276 participants, mostly female (68.8%), with a mean age of 55.21 years (SD = 20.3). Over half were married (56.2%) and not employed (81.9%). Common chronic diseases were diabetes and hypertension, with 55.8% using up to five medications. Caregivers were mainly sons or daughters (62%) living with the patient (84.1%). The top caregiver tasks were escorting patients to appointments (63.4%), scheduling doctor appointments (60.1%), and tracking medication refills (59.4%). Common challenges included caregivers lacking time (45.3%), inconsistent care (35.9%), financial constraints (27.5%), and caregivers missing doses (27.9%). The top not encountered challenges were inappropriate medication storage (78.3%), communication barriers (74.3%), improper disposal of injections (72.5%), medication management errors (71.4%), and lack of empathy (70.3%). Conclusion: This study highlights the vital role of informal caregivers in managing chronic illnesses in Saudi Arabia. Informal caregivers face challenges such as time constraints and financial limitations. The findings emphasize the need for better support systems, including training programs and improved access to healthcare resources, to enhance care quality for patients. Full article

Objectives: The purpose of this study was to analyze image quality and radiation exposure of thoracic computed tomography angiography (CTA) in children with congenital heart diseases (CHDs) using either manual contrast medium (CM) injection or automated power injectors with bolus tracking. Methods: A total of 137 thoracic CTAs of 120 consecutive pediatric patients were included in this retrospective study. We analyzed the method of CM administration (power injection with bolus tracking (PI) or manual injection (MI)), injection routes, volumes and flow rates of CM. For the evaluation of objective image quality, attenuation values in the heart chambers and great thoracic vessels were determined by region-of-interest (ROI) analysis and signal-to-noise (SNR) and contrast-to-noise (CNR) ratios calculated thereof. Visual image quality was assessed by two blinded readers (four-point Likert-scale) analyzing the presence of artifacts and the depiction of relevant anatomical structures. Effective radiation doses were calculated with dose length products and specific conversion factors. Results: CM administration was performed using PI in 119/137 CTAs, whereas MI was conducted in 18/137. The smallest size of peripheral venous cannulas was 24 gauge in 36/137 (26.3%) cases. Overall mean CM volume was 17 mL ± 16 mL (mean ± SD). In PI, the mean flow rate of CM was 1.52 ± 0.90 mL/s with a range between 0.5 and 5.0 mL/s. When comparing the overall PI population and an age-, size- and weight-matched PI subpopulation (18 cases) with the MI population, attenuation values in Hounsfield units (HU) and CNR values were significantly higher in the PI groups than in the MI group for each relevant cardiac structure (left ventricle, right ventricle, ascending aorta and pulmonary trunk, p = 0.02–0.001). Overall image quality and depiction of cardiac structures were rated significantly better in CTAs with PI (interquartile ranges: “good” to “excellent” (Likert 3–4)) in PI compared with CTAs acquired with MI (interquartile ranges: “fair” to “good” (2–3)) in MI by both readers (p < 0.001). The inter-observer reliability was strong, with a Kendall’s Tau-b correlation coefficient of τ = 0.802 (p < 0.001). The mean effective radiation dose (E) did not differ significantly when comparing the stratified samples (i.e., the matched PI subgroup and the MI group; 0.5 (±0.3) mSv in both, p = 0.76). There were no complications associated with the CM injections for both application approaches. Conclusions: Automated contrast agent applications with power injectors and bolus tracking ensure better image quality in pediatric CTA, even when low volumes and flow rates need to be applied. There is a slight increase in radiation associated with bolus tracking. This approach represents a suitable imaging technique for the work-up of congenital heart disease. Full article

Linear accelerator–magnetic resonance (linac-MR) hybrid systems allow for real-time magnetic resonance imaging (MRI)-guided radiotherapy for more accurate dose delivery to the tumor and improved sparing of the adjacent healthy tissues. However, for real-time tumor detection, it is unfeasible for a human expert to manually contour (gold standard) the tumor at the fast imaging rate of a linac-MR. This study aims to develop a neural network-based tumor autocontouring algorithm with patient-specific hyperparameter optimization (HPO) and to validate its contouring accuracy using in vivo MR images of cancer patients. Two-dimensional (2D) intrafractional MR images were acquired at 4 frames/s using 3 tesla (T) MRI from 11 liver, 24 prostate, and 12 lung cancer patients. A U-Net architecture was applied for tumor autocontouring and was further enhanced by implementing HPO using the Covariance Matrix Adaptation Evolution Strategy. Six hyperparameters were optimized for each patient, for which intrafractional images and experts’ manual contours were input into the algorithm to find the optimal set of hyperparameters. For evaluation, Dice’s coefficient (DC), centroid displacement (CD), and Hausdorff distance (HD) were computed between the manual contours and autocontours. The performance of the algorithm was benchmarked against two standardized autosegmentation methods: non-optimized U-Net and nnU-Net. For the proposed algorithm, the mean (standard deviation) DC, CD, and HD of the 47 patients were 0.92 (0.04), 1.35 (1.03), and 3.63 (2.17) mm, respectively. Compared to the two benchmarking autosegmentation methods, the proposed algorithm achieved the best overall performance in terms of contouring accuracy and speed. This work presents the first tumor autocontouring algorithm applicable to the intrafractional MR images of liver and prostate cancer patients for real-time tumor-tracked radiotherapy. The proposed algorithm performs patient-specific HPO, enabling accurate tumor delineation comparable to that of experts. Full article

The dependence of polyethylene deformation on applied mechanical stress under varying load conditions and radiation doses was investigated experimentally. Obtained results reveal significant alterations in the mechanical properties of polyethylene following irradiation with krypton ions at doses of 1.5 × 10⁶, 1.6 × 10⁷, 5.0 × 10⁸, and 1.0 × 10⁹ ions/s. The stress–strain curves obtained for both the unirradiated and irradiated samples are numerically modeled using frameworks developed by the authors. The findings indicate that irradiation with krypton ions at an energy level of 147 MeV exerts a pronounced impact on the deformation and strength characteristics of polyethylene. Notably, increasing the radiation dose to 10⁹ particles/s results in a 2.5-fold increase in the rate of mechanical stress. Furthermore, the degree of deformation distortions in molecular chains induced by high-energy Kr¹⁵⁺ ion irradiation has been quantified as a function of irradiation fluence. Increasing the irradiation fluence from 10⁶ ion/cm² to 10⁷ ion/cm² causes only minor variations in deformation distortions, which are attributed to the localized isolation of latent tracks and associated changes in electron density. A comparative analysis of the mechanical behavior of irradiated polymer materials further revealed differences between ion and electron irradiation effects. It was observed that Teflon films lose their plasticity after irradiation, whereas polyethylene films exhibit enhanced elongation and tearing performance at higher strain values relative to their non-irradiated counterparts. This behavior was consistently observed for films irradiated with both ions and electrons. However, an important distinction was identified: high-energy electron irradiation degrades the strength of polyethylene, whereas krypton ion irradiation at 147 MeV does not result in strength reduction. Full article

Egypt must present a more thorough and accurate picture of the state of the air, as this can contribute to better environmental and public health results. Hence, the goal of the current study is to map and track the spatiotemporal air quality over Egypt’s Qena Governorate using remote sensing data. The current investigation is considered a pioneering study and the first attempt to map the air quality index in the studied area. Multisource remote sensing data sets from the Google Earth Engine (GEE) were used to achieve this. The first is Sentinel-5P’s average annual satellite image data, which were gathered for four important pollutants: carbon monoxide (CO), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and ozone (O₃) over a six year period from 2019 to 2024. The second is the MODIS aerosol optical density (AOD) product satellite image data from the GEE platform, which calculate the average annual particulate matter (PM_2.5 and PM₁₀). All mentioned pollutant images were used to calculate the air quality index (AQI) and aggregated air quality index (AAQI). Lastly, we used Landsat’s average yearly land surface temperature (LST) retrieval (OLI/TIRS). The aggregated air quality index (AAQI) was computed, and the U.S. Environmental Protection Agency’s (USEPA) air quality index (AQI) was created for each pollutant. According to the data, the AQI for CO, PM_2.5, and PM₁₀ in the research region ranged from hazardous to unhealthy; at the same time, the AQI for NO₂ varied between harmful and unhealthy for sensitive groups, with values ranging from 135 to 165. The annual average of the AQI for SO₂ throughout the studied period ranged from 29 to 339, with the categories ranging from good to hazardous. The constant AQI for ozone in the study area indicates that the ozone doses in Qena are surprisingly stable. Lastly, with a minimum value of 265 and a maximum of 489, the AAQI ranged from very unhealthy to dangerous in the current study. According to the data, the area being studied has poor air quality, which impacts the environment and public health. The results of this study have significant implications for environmental sustainability and human health and could be used in other areas. Full article

Background: Radiotherapy technology has undergone significant advancements, driven by the pursuit of improved tumor control probabilities and reduced normal tissue complication probabilities. This has been achieved primarily through innovative approaches that prioritize high dose conformity on complex treatment targets. The CONVERAY project introduces a groundbreaking teletherapy system featuring a convergent X-ray beam, which enables highly conformal dose distributions by converging photons to a focal spot, thereby achieving exceptionally high fluence rates. Methods: Customized Monte Carlo subroutines have been developed to simulate particle fluence and associated dosimetry effects for the CONVERAY device. This simulation approach facilitated a detailed, step-by-step characterization of radiation fluence and interaction processes, enabling seamless integration with a conventional clinical linear accelerator head. Key physical properties of the radiation beam have been comprehensively characterized for various CONVERAY configurations, providing a solid foundation for evaluating the corresponding dosimetry performance. Results: Monte Carlo simulations successfully tracked the phase state of the CONVERAY device, characterizing the influence of individual components on convergent photon beam production. Simulations evaluated dosimetry performance, confirming the device’s capability to achieve high dose concentrations around the focal spot. Preliminary tests on realistic scenarios (intracranial and pulmonary irradiations) demonstrated promising spatial dose concentration within tumor volumes, while gantry rotation significantly improved dose conformation. Conclusions: This proof-of-concept Monte Carlo study of the CONVERAY prototype provided critical insights into the generation of convergent X-ray beams, validating the device’s ability to achieve its primary objective. Notably, simulation results reveal the potential for exceptionally high dose concentrations within complex treatment volumes, demonstrating promising dosimetry performance. Full article