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At these energies, the photoelectric effect significantly increases absorbed dose to bone compared to soft tissue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used EGSnrc MC simulations to investigate bone dose enhancement during radiotherapy with the Sensus SRT\u2010100 machine. Simulated beams were validated against laboratory measurements and compared to a commercial treatment planning system (SmART\u2010ATP). Transmission simulations indirectly predicted bone dosage. Simulated beams were utilized as a mock treatment plan from a human cone\u2010beam computed tomography (CBCT) image.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>EGSnrc accurately modeled the Sensus SRT\u2010100 beams (100, 70, and 50 kVp) with a root mean square error (RMSE) of percentage depth dose ratios between Monte Carlo predictions and lab measurements of 1.66, 0.47, and 0.99, respectively. PDDs from simulations of a water phantom with bone slabs showed peak doses at water\u2013bone interfaces relative to surface doses. At 0.3\u00a0cm depth bone slab, doses reached 410%, 490%, and 510% for 50, 70, and 100 kVp, respectively. At 1.5\u00a0cm depth, doses were 140%, 215%, and 270%. At 2.5\u00a0cm depth, peak doses were 74%, 130%, and 170% for 50, 70, and 100 kVp, respectively. A simulated treatment plan (4\u00a0Gy surface dose) using a CBCT of a human head predicted the dose to the skull to be around 20, 19, and 15\u00a0Gy for the 100, 70, and 50 kVp beams, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The study demonstrated EGSnrc's efficiency in conjunction with SmART\u2010ATP for treatment planning. MC simulations effectively quantified bone dose enhancement during superficial x\u2010ray radiotherapy, highlighting its importance in treatment planning and dose calculations. Clinicians should consider measuring bone depth prior to treatment to avoid excessive bone dose.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.70062","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T16:59:53Z","timestamp":1741712393000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Monte Carlo modeling of radiation dose from radiation therapy with superficial x\u2010rays"],"prefix":"10.1002","volume":"26","author":[{"given":"Reham","family":"Barghash","sequence":"first","affiliation":[{"name":"Environmental and Radiological Health Sciences Colorado State University  Fort Collins USA"},{"name":"College of Applied Medical Sciences King Saud bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"},{"name":"King Abdullah International Medical Research Center King Saud bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiffany W.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Colorado State University  Fort Collins USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7872-420X","authenticated-orcid":false,"given":"Amber R.","family":"Prebble","sequence":"additional","affiliation":[{"name":"Veterinary Teaching Hospital Colorado State University  Fort Collins USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Del","family":"Leary","sequence":"additional","affiliation":[{"name":"Environmental and Radiological Health Sciences Colorado State University  Fort Collins USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010016\u20100753\u20100"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00066\u2010004\u20101191\u20108"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20140686"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893\u2010021\u201001427\u20105"},{"key":"e_1_2_11_6_1","volume-title":"Gunderson and Tepper's Clinical Radiation Oncology 5th Edition","author":"Tepper J","year":"2020"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2019.02.005"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(95)00280\u2010C"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u2010717X\u20105\u2010105"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v15i1.4502"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2017.750"},{"issue":"12","key":"e_1_2_11_12_1","first-page":"12","article-title":"Superficial radiation therapy for the treatment of nonmelanoma skin cancers","volume":"8","author":"McGregor S","year":"2015","journal-title":"J Clin Aesthet Dermatol"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1369953"},{"key":"e_1_2_11_14_1","volume-title":"The Physics of Radiation Therapy (5th ed.)","author":"Khan FM","year":"2014"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.53347\/rID-29684"},{"key":"e_1_2_11_16_1","volume-title":"Emergency Radiology: Case Studies","author":"Schwartz DT","year":"2008"},{"key":"e_1_2_11_17_1","volume-title":"Introduction to Radiological Physics and Radiation Dosimetry","author":"Attix FH","year":"2008"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.595545"},{"key":"e_1_2_11_19_1","unstructured":"SeltzerS Tables of x\u2010ray mass attenuation coefficients and mass energy\u2010absorption coefficients NIST standard reference database 126. 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