I n particle (proton or heavy-ion) therapy, the patient treatment planning includes assessments of radiation dose and radiation quality. Distributions of the absorbed dose and the relative biological effectiveness (RBE), a quality index, in the patient provide essential information in the treatment planning. To facilitate these assessments, the International Atomic Energy Agency and the International Commission on Radiation Units and Measurements (ICRU) have jointly recommended the reporting and recording of isoeffective doses in the treatment plan.[1] The isoeffective dose, that is, the product of absorbed dose and isoeffective weighting factor, of particle beam is defined as the equivalent dose of photon beam under the same irradiation conditions (e.g., 2 Gy per fraction, 5 daily fractions per week, etc.). The key factor determining the isoeffective weighting factor is the RBE. While absorbed dose relates to the total energy deposition in a macroscopic volume of the irradiated tissue, radiation quality regards the single-event energy deposition in a microscopic volume of the biologically sensitive target. [2] When compared to photon beams, particle beams have distinct spatial distributions on the energy depositions in both the macroscopic and microscopic volumes. [3] Such distributions are responsible for the different biological consequences in the tumor and healthy cells during radiotherapy. The macroscopic distribution, that When compared to photon beams, particle beams have distinct spatial distributions on the energy depositions in both the macroscopic and microscopic volumes. In a macroscopic volume, the absorbed dose distribution shows a rapid increase near the particle range, that is, Bragg peak, as particle penetrates deep inside the tissue. In a microscopic volume, individual particle deposits its energy along the particle track by producing localized ionizations through the formation of clusters. These highly localized clusters can induce complex types of deoxyribonucleic acid (DNA) damage which are more difficult to repair and lead to higher relative biological effectiveness (RBE) as compared to photons. To describe the biological actions, biophysical models on a microscopic level have been developed. In this review, microdosimetric approaches are discussed for the determination of RBE at different depths in a patient under particle therapy. These approaches apply the microdosimetric lineal energy spectra obtained from measurements or calculations. Methods to determine these spectra will be focused on the tissue equivalent proportional counter and the Monte Carlo program. Combining the lineal energy spectrum and the biological model, RBE can be determined. Three biological models are presented. A simplified model applies the dose-mean lineal energy and the measured RBE (linear energy transfer) data. A more detailed model makes use of the full lineal energy spectrum and the biological weighting function spectrum. A comprehensive model calculates the spectrum-averaged yields of DNA damages caused by ...