“…Remarkably, protons are usually low‐LET radiation, and their biological effects are approximately identical to photons (the RBE is 1.1; Saager et al, 2018), whereas the biological effects of carbon ions are more pronounced than protons (the RBE is ∼2.3; Si et al, 2019). Unlike low‐LET IR, which produces sparse ionising events randomly distributed throughout the cell to eventually induce less complex DNA damage (Lorat, Timm, Jakob, Taucher‐Scholz, & Rübe, 2016), high‐LET IR predominantly deposits a high energy density at the end of the range (the Bragg Peak), causing more extensive damage, and often, fateful biological consequences (Liu et al, 2018; Zhao et al, 2017). High‐LET radiation contributes to clustered DNA damage, a DNA lesion complex that includes two or more individual lesions within a few helical DNA turns, which is largely responsible for the deleterious effects of high energy IR (Park, Peoples, Madugundu, Sanche, & Wagner, 2013; Q. Zhang et al, 2016).…”