Impact of fluorescence emission from gold atoms on surrounding biological tissue-implications for nanoparticle radio-enhancement

The addition of gold nanoparticles within target tissue (i.e. a tumour) to enhance the delivered radiation dose is a well studied radiotherapy treatment strategy, despite not yet having been translated into standard clinical practice. While several studies have used Monte Carlo simulations to investigate radiation dose enhancement by Auger electrons emitted from irradiated gold nanoparticles, none have yet considered the effects due to escaping fluorescence photons. Geant4 was used to simulate a water phantom containing 10 mg ml(-1) uniformly dispersed gold (1% by mass) at 5 cm depth. Incident monoenergetic photons with energies either side of the gold K-edge at 73 keV and 139.5 keV were chosen to give the same attenuation contrast against water, where water is used as a surrogate for biological tissue. For 73 keV incident photons, adding 1% gold into the water phantom enhances the energy deposited in the phantom by a factor of approximate to 1.9 while 139.5 keV incident photons give a lower enhancement ratio of approximate to 1.5. This difference in enhancement ratio, despite the equivalent attenuation ratios, can be attributed to energy carried from the target into the surrounding volume by fluorescence photons for the higher incident photon energy. The energy de-localisation is maximal just above the K-edge with 36% of the initial energy deposit in the phantom lost to escaping fluorescence photons. Conversely we find that the absorption of more photons by gold in the phantom reduces the number of scattered photons and hence energy deposited in the surrounding volume by up to 6% for incident photons below the K-edge. For incident photons above the K-edge this is somewhat offset by fluorescence. Our results give new insight into the previously unstudied centimetre scale energy deposition outside a target, which will be valuable for the future development of treatment plans using gold nanoparticles. From these results, we can conclude that gold nanoparticles delivered to a target tumour are capable of increasing dose to the tumour whilst simultaneously decreasing scatter dose to surrounding healthy tissue.