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Skin dose enhancement from the application of skin-care creams using FF and FFF photon beams in radiotherapy: A Monte Carlo phantom evaluation

  • Skin-care cream is commonly applied to relieve skin redness in radiotherapy. However, using cream on the patient under the photon field would increase the skin dose in delivery. The aim of this study is to evaluate the dependences of skin dose enhancement on different beam and cream variables using Monte Carlo simulation. Using a solid water phantom with water-equivalent bolus, PMMA layer and cream layer, we irradiated it by 6 MV photon beams. Skin doses were calculated by varying the beam quality (flattening-filter (FF) and flattening-filter-free (FFF)), beam angle (0°–80°), skin-care cream type (water-based and silicon-based) and cream thickness (0–3 mm) using the EGSnrc Monte Carlo code. The densities of the water- and silicon-based cream were 0.92 and 1.14 g/cm3. The dose enhancement factor (DEF) defined as the ratio of the skin dose with skin-care cream to the skin dose without cream was calculated. It is found that the FF photon beam had higher DEF value than the FFF. For the water-based cream of 3 mm, the DEF for the FF beam was about 22.1% higher than that of the FFF. While for the silicon-based cream with the same thickness, the DEF was 24.2% higher. DEF value also increased with the beam angle. The DEF values were from 1.4 to 2.52 (water-based cream) and 1.42 to 2.68 (silicon-based cream) when the beam angle was increased from 20° to 80° using the 6 MV FF beams. Similarly, for the 6 MV FFF beams, the DEF values increased from 1.29 to 2.07 and 1.30 to 2.18 for the water- and silicon-based cream. These simulation results showed that the skin dose enhancement increased with an increase of beam angle, cream thickness, cream density, and the irradiation of FFF photon beams.

    Citation: Megha Sharma, James C. L. Chow. Skin dose enhancement from the application of skin-care creams using FF and FFF photon beams in radiotherapy: A Monte Carlo phantom evaluation[J]. AIMS Bioengineering, 2020, 7(2): 82-90. doi: 10.3934/bioeng.2020008

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  • Skin-care cream is commonly applied to relieve skin redness in radiotherapy. However, using cream on the patient under the photon field would increase the skin dose in delivery. The aim of this study is to evaluate the dependences of skin dose enhancement on different beam and cream variables using Monte Carlo simulation. Using a solid water phantom with water-equivalent bolus, PMMA layer and cream layer, we irradiated it by 6 MV photon beams. Skin doses were calculated by varying the beam quality (flattening-filter (FF) and flattening-filter-free (FFF)), beam angle (0°–80°), skin-care cream type (water-based and silicon-based) and cream thickness (0–3 mm) using the EGSnrc Monte Carlo code. The densities of the water- and silicon-based cream were 0.92 and 1.14 g/cm3. The dose enhancement factor (DEF) defined as the ratio of the skin dose with skin-care cream to the skin dose without cream was calculated. It is found that the FF photon beam had higher DEF value than the FFF. For the water-based cream of 3 mm, the DEF for the FF beam was about 22.1% higher than that of the FFF. While for the silicon-based cream with the same thickness, the DEF was 24.2% higher. DEF value also increased with the beam angle. The DEF values were from 1.4 to 2.52 (water-based cream) and 1.42 to 2.68 (silicon-based cream) when the beam angle was increased from 20° to 80° using the 6 MV FF beams. Similarly, for the 6 MV FFF beams, the DEF values increased from 1.29 to 2.07 and 1.30 to 2.18 for the water- and silicon-based cream. These simulation results showed that the skin dose enhancement increased with an increase of beam angle, cream thickness, cream density, and the irradiation of FFF photon beams.



    We study the following first-order coupled nonlinear system,

    {z(t)=f(t,z(t),w(t)),w(t)=g(t,z(t),w(t)), (1.1)

    with t[0,T] (T>0) and f,g:[0,T]×R2R L1-Carathéodory functions, together with the boundary conditions

    z(0)=z(T),w(0)=w(T). (1.2)

    The motivation for the study of systems (1.1) and (1.2) arise from the application of nonlinear models to several phenomena in different domains of life, namely population dynamics [1], neuroscience [2], biological systems [3], ecology [4], electronic circuits [5], celestial mechanics [6], among others.

    Periodic solutions are usually found in differential equations. For example:

    In [7], the authors present sufficient conditions for the solvability of a class of singular Sturm-Liouville equations with periodic boundary value conditions. The problem describes the periodic oscillations of the axis of a satellite in the plane of the elliptic orbit around its center of mass.

    In [8], the authors study the stability of two coupled Andronov oscillators sharing a mutual discrete periodic interaction. The study was motivated by the phenomenon of synchronization observed in Huygens' clocks [9].

    In [10], the authors prove the existence of positive periodic solutions in a generalized Nicholson's blowflies model, using Krasnoselskii cone fixed point theorem.

    In [11], it is considered the dynamics of hematopoietic stem cell populations under some external periodic regulatory factors at the cellular cycle level. The existence of periodic solutions in the respective nonautonomous differential system is typically associated to the presence of some hematological disease.

    However, nonlinear systems with non-oscillatory nonlinearities can hamper the search for periodic solutions.

    To overcome that difficulty, in [12] the authors use well-ordered lower and upper solutions to guarantee the existence of solutions of a first-order fully coupled system. In [13], the authors introduce the idea of well-ordered coupled lower and upper solutions, to obtain an existence and localization result for periodic solutions of first-order coupled non-linear systems of n ordinary differential equations.

    Motivated by these works, in this paper we present some novelties: A new translation technique to deal with lower and upper solutions, not necessarily well-ordered; A method to provide sufficient conditions to obtain existence and localization results, combining the adequate coupled lower and upper solutions definition with the monotonicity of the nonlinearities.

    This work is organized as follows. In Section 2 we present the definitions and the solvability conditions for problems (1.1) and (1.2). In Section 3, we present the main results regarding the existence and localization of solutions for the problem, using the lower and upper solutions technique, together with Schauder's fixed point theorem, and a numerical example. In Section 4 we adapt the solvability conditions of Section 2 to the lack of monotonicity criteria in the nonlinearities. We find coupled lower and upper solutions for the original problem. Finally, in Section 5, we present an application to a real case scenario of population dynamics.

    In this work we consider the space of continuous functions in [0,T], (C[0,T])2, with the norm (z,w)=max{z,w}, with u=maxt[0,T]|u(t)|.

    So, (C[0,T])2 is a Banach space.

    The nonlinearities assumed will be L1Carathéodory functions, that is:

    Definition 2.1. The function h:[0,T]×R2R, is a L1Carathéodory if it verifies

    (i) for each (y1,y2)R2, th(t,y1,y2) is measurable in [0,T];

    (ii) for almost every t[0,T], (y1,y2)h(t,y1,y2) is continuous in R2;

    (iii) for each L>0, there exists a positive function ψLL1[0,T], such that, for max{yi,i=1,2}<L,

    |h(t,y1,y2)|ψL(t), a.e. t[0,T]. (2.1)

    A key argument in this work is the lower and upper solutions method, but not necessarily well-ordered as it is standard in the literature. This issue is overcome by a new type of lower and upper solutions' definition with some adequate translations:

    Definition 2.2. Consider C1-functions αi,βi:[0,T]R, i=1,2. The functions (α1,α2) are lower solutions of the periodic problems (1.1) and (1.2) if

    {α1(t)f(t,α01(t),α02(t)),α2(t)g(t,α01(t),α02(t)), (2.2)

    with

    α0i(t):=αi(t)αi, i=1,2, (2.3)

    and

    αi(0)αi(T), i=1,2. (2.4)

    The functions (β1,β2) are upper solutions of the periodic problems (1.1) and (1.2) if

    {β1(t)f(t,β01(t),β02(t)),β2(t)g(t,β01(t),β02(t)),

    with

    β0i(t):=βi(t)+βi, i=1,2, (2.5)

    and

    βi(0)βi(T), i=1,2.

    By solution we mean (C1[0,T])2 functions verifying (1.1) and (1.2). The existence tool is the Schauder's fixed-point theorem (Theorem 2.A of [14]):

    Theorem 2.1. Let Y be a nonempty, closed, bounded and convex subset of a Banach space X, and suppose that P:YY is a compact operator. Then P has at least one fixed point in Y.

    This method allows to obtain an existence and localization result for periodic non-trivial solutions in presence of well ordered lower and upper solutions:

    Theorem 3.1. Let (α1,α2) and (β1,β2) be lower and upper solutions of (1.1) and (1.2), respectively. Assume that f is a L1-Carathéodory function in the set

    {(t,y1,y2)[0,T]×R2:α01(t)y1β01(t)},

    g is a L1-Carathéodory function in

    {(t,y1,y2)[0,T]×R2:α02(t)y2β02(t)},

    with

    f(t,y1,y2) nondecreasing in y2, (3.1)

    for fixed t[0,T] and y1R, and

    g(t,y1,y2) nondecreasing in y1,

    for fixed t[0,T] and y2R. Then problems (1.1) and (1.2) has, at least, a solution (z,w)(C1[0,T])2 such that

    α01(t)z(t)β01(t),α02(t)w(t)β02(t), for all t[0,T].

    Proof. For i=1,2, define the continuous functions δ0i:[0,T]×RR, given by

    δ01(t,z)={α01(t)ifz<α01(t),zifα01(t)zβ01(t),β01(t)ifz>β01(t), (3.2)

    and

    δ02(t,w)={α02(t)ifw<α02(t),wifα02(t)wβ02(t),β02(t)ifw>β02(t),

    and consider the auxiliary problem composed by

    {z(t)+z(t)=f(t,δ01(t,z),δ02(t,w))+δ01(t,z),w(t)+w(t)=g(t,δ01(t,z),δ02(t,w))+δ02(t,w), (3.3)

    together with the periodic boundary conditions (1.2).

    Step 1. Integral form of (3.3) and (1.2).

    The general solution of (3.3) and (1.2) is

    {z(t)=et(Cz+t0esq1(s,δ01,δ02)ds),w(t)=et(Cw+t0esq2(s,δ01,δ02)ds),

    with

    q1(s,δ01,δ02):=f(s,δ01(s,z(s)),δ02(s,w(s)))+δ01(s,z(s)),q2(s,δ01,δ02):=g(s,δ01(s,z(s)),δ02(s,w(s)))+δ02(s,w(s)). (3.4)

    and, by (1.2),

    {Cz=eT1eTT0esq1(s,δ01,δ02)ds,Cw=eT1eTT0esq2(s,δ01,δ02)ds.

    Therefore, the integral form of (3.3) and (1.2) is

    {z(t)=et(eT1eTT0esq1(s,δ01,δ02)ds+t0esq1(s,δ01,δ02)ds),w(t)=et(eT1eTT0esq2(s,δ01,δ02)ds+t0esq2(s,δ01,δ02)ds). (3.5)

    Define the operator T:(C[0,T])2(C[0,T])2 such that

    T(z,w)(t)=(T1(z,w)(t),T2(z,w)(t)), (3.6)

    with

    {T1(z,w)(t)=et(eT1eTT0esq1(s,δ01,δ02)ds+t0esq1(s,δ01,δ02)ds),T2(z,w)(t)=et(eT1eTT0esq2(s,δ01,δ02)ds+t0esq2(s,δ01,δ02)ds). (3.7)

    Following Definition 2.1, the norm of the operator T, defined in (3.6), is given by

    T(z,w)=maxi=1,2{T1(z,w),T2(z,w)}=max{maxt[0,T]|T1(z(t),w(t))|,maxt[0,T]|T2(z(t),w(t))|}. (3.8)

    Step 2. T has a fixed point.

    The conditions for Theorem 2.1 require the existence of a nonempty, bounded, closed and convex subset D(C[0,T])2 such that TDD.

    As f, g are L1-Carathéodory functions, by Definition 2.1, there are positive L1[0,T] functions ψiL,i=1,2, such that

    |f(t,δ01(t,z),δ02(t,w))|ψ1L(t),|g(t,δ01(t,z),δ02(t,w))|ψ2L(t),a.e.t[0,T], (3.9)

    with

    L:=max{|α01(t)|,|α02(t)|,β01(t),β02(t)}. (3.10)

    Consider the closed ball of radius K,

    D:={(z,w)(C[0,T])2:(z,w)K}, (3.11)

    with K given by

    K=max{eT1eT(T0ψ1L(s)ds+LT),eT1eT(T0ψ2L(s)ds+LT)}. (3.12)

    For t[0,T],

    |T1(z,w)(t)|=|et(eT1eTT0esq1(s,δ01,δ02)ds+t0esq1(s,δ01,δ02)ds)|eT1eTT0|es||q1(s,δ01,δ02)|ds+t0|es||q1(s,δ01,δ02)|dseT1eTT0|q1(s,δ01,δ02)|dseT1eTT0(|f(s,δ01,δ02)|+L)ds=eT1eT(T0|f(s,δ01,δ02)|ds+LT)eT1eT(T0ψ1L(s)ds+LT)K. (3.13)

    Similarly,

    |T2(z,w)(t)|<eT1eT(T0ψ2L(s)ds+LT)K,t[0,T]. (3.14)

    Since T1 and T2 are uniformly bounded, so is T.

    Consider t1,t2[0,T] and t1<t2, without loss of generality. Then,

    |T1(z,w)(t1)T1(z,w)(t2)|=|et1(eT1eTT0esq1(s,δ01,δ02)ds+t10esq1(s,δ01,δ02)ds)et2(eT1eTT0esq1(s,δ01,δ02)ds+t20esq1(s,δ01,δ02)ds)|=|(et1et2)(eT1eTT0esq1(s,δ01,δ02)ds+t10esq1(s,δ01,δ02)ds)et2t2t1esq1(s,δ01,δ02)ds|t1t20, (3.15)

    proving that T1 is equicontinuous.

    In the same way, it can be proved that |T2(z(t1),w(t1))T2(z(t2),w(t2))|t1t20.

    Therefore, T is equicontinuous.

    By (3.12), it is clear that TDD, then, by Schauder's Fixed Point Theorem, T has a fixed point (z(t),w(t))(C[0,T])2, which is a solution of (3.3) and (1.2).

    Step 3. The pair (z(t),w(t)), solutions of (3.3) and (1.2), is a solution of the initial problems (1.1) and (1.2).

    To prove that (z,w)(C[0,T])2 is a solution of the original problem (1.1), (1.2), it is enough to prove that

    α01(t)z(t)β01(t),α02(t)w(t)β02(t),t[0,T]. (3.16)

    In the first case, suppose, by contradiction, that there exists some t[0,T] such that

    z(t)<α01(t),

    and define

    mint[0,T](zα01)(t):=z(t0)α01(t0)<0. (3.17)

    If t0]0,T[, then

    (z)(t0)=(α01)(t0), (3.18)

    and, by (3.17) and (3.1) and Definition 2.2, the following contradiction with (3.18) holds:

    (z)(t0)=f(t0,δ01(t0,z(t0)),δ02(t0,w(t0)))+δ01(t0,z(t0))z(t0)=f(t0,α01(t0),δ02(t0,w(t0)))+α01(t0)z(t0)>f(t0,α01(t0),δ02(t0,w(t0)))f(t0,α01(t0),α02(t0))α1(t0).

    If t0=0, then, by (1.2) and Definition 2.2,

    z(0)α01(0)=z(T)(α1(0)α)=z(T)α1(0)+αz(T)α1(T)+α=z(T)(α1(T)α)=z(T)α01(T).

    Then, by (3.17),

    z(0)α01(0)=z(T)α01(T),

    and

    (z)(T)(α1)(T)0. (3.19)

    Therefore, by (3.17) and (3.1) and Definition 2.2,

    (z)(T)=f(T,δ01(T,z(T)),δ02(T,w(T)))+δ01(T,z(T))z(T)=f(T,α01(T),δ02(T,w(T)))+α01(T)z(T)>f(T,α01(T),δ02(T,w(T)))f(T,α01(T),α02(T))α1(T),

    which contradicts (3.19).

    Therefore, z(t)α01(t),t[0,T]. The same arguments can be used to prove the other inequalities of (3.16).

    Example 3.1. Consider the following system, for t[0,1],

    {z(t)=w(t)(z(t))3,w(t)=1t+arctan(z(t))43w(t), (3.20)

    together with the periodic boundary conditions (1.2).

    The functions αi,βi:[0,1]R, i=1,2, given by

    α1(t)=t2,β1(t)=2t2,α2(t)=t21,β2(t)=1t,

    are, respectively, lower and upper solutions of problems (3.20) and (1.2), according to Definition 2.2, with

    α01(t)=t4,α02(t)=t22,

    and

    β01(t)=4t2,β02(t)=2t.

    The above problem is a particular case of (1.1) and (1.2), where

    f(t,z(t),w(t))=w(t)(z(t))3,

    and

    g(t,z(t),w(t))=1t+arctan(z(t))43w(t).

    As the assumptions of Theorem 3.1 are verified, then the system (3.20), (1.2) has, at least, a solution (z,w)(C[0,1])2 such that

    t4z(t)4t2,t22w(t)2t,t[0,1], (3.21)

    as shown in Figure 1.

    Figure 1.  (z,w)-solution localization.

    Moreover, this solution is not trivial, since constants are not solutions of (3.20).

    In this section we present a technique to deal with the lack of monotonicity requirements in Theorem 3.1 on the nonlinearities, by defining coupled lower and upper solutions αi and βi, conveniently, as in the next definition:

    Definition 4.1. Consider the C1-functions αi,βi:[0,T]R, i=1,2. The functions (α1,α2) are coupled lower solutions of the periodic problems (1.1) and (1.2) if

    {α1(t)f(t,α1(t),α2(t)),α2(t)g(t,β1(t),α2(t)),

    and

    α1(0)α1(T),α2(0)α2(T).

    The functions (β1,β2) are coupled upper solutions of the periodic problems (1.1) and (1.2) if

    {β1(t)f(t,β1(t),β2(t)),β2(t)g(t,α1(t),β2(t)),

    and

    β1(0)β1(T),β2(0)β2(T).

    Theorem 4.1. Let (α1,α2) and (β1,β2) be lower and upper solutions of (1.1) and (1.2), respectively, according to Definition 4.1, such that

    α1(t)β1(t) and α2(t)β2(t),t[0,T].

    Assume that f is a L1-Carathéodory function in the set

    {(t,y1,y2)[0,T]×R2:β1(t)y1α1(t)},

    g is a L1-Carathéodory function in

    {(t,y1,y2)[0,T]×R2:α2(t)y2β2(t)},

    with

    f(t,y1,y2) nonincreasing in y2, (4.1)

    for t[0,T], y1R, and

    g(t,y1,y2) nondecreasing in y1, (4.2)

    for t[0,T], y2R. Then problems (1.1) and (1.2) has, at least, a solution (z,w)(C1[0,T])2 such that

    β1(t)z(t)α1(t),α2(t)w(t)β2(t), for all t[0,T]. (4.3)

    Remark 4.1. This method relating the definition of coupled lower and upper-solutions, and the monotonicity properties of the nonlinearities, can be applied to other types of monotonicity.

    Proof. For i=1,2, define the continuous functions δi:[0,T]×RR, given by

    δ1(t,z)={β1(t)ifz<β1(t),zifβ1(t)zα1(t),α1(t)ifz>α1(t),

    and

    δ2(t,w)={α2(t)ifw<α2(t),wifα2(t)wβ2(t),β2(t)ifw>β2(t),

    and consider the auxiliary problem composed by

    {z(t)+z(t)=f(t,δ1(t,z),δ2(t,w))+δ1(t,z),w(t)+w(t)=g(t,δ1(t,z),δ2(t,w))+δ2(t,w), (4.4)

    together with the periodic boundary conditions (1.2).

    Problems (4.4) and (1.2) can be addressed using the arguments for the proof of Theorem 3.1. The corresponding operator has a fixed point (ˉz,ˉw).

    The delicate step, however, is to show that (ˉz,ˉw) is a solution of (1.1) and (1.2), such that

    β1(t)ˉz(t)α1(t),α2(t)ˉw(t)β2(t),t[0,T]. (4.5)

    To prove the case for β1(t)ˉz(t),t[0,T], we suppose, by contradiction, that there exists some t[0,T] such that

    ˉz(t)<β1(t),

    and define

    mint[0,T](ˉzβ1)(t):=ˉz(t0)β1(t0)<0. (4.6)

    If t0]0,T[, then

    ˉz(t0)=β1(t0), (4.7)

    and, by (4.6), (4.1) and Definition 4.1, the following contradiction with (4.7) holds:

    ˉz(t0)=f(t0,δ1(t0,ˉz(t0)),δ2(t0,w(t0)))+δ1(t0,ˉz(t0))ˉz(t0)=f(t0,β1(t0),δ2(t0,w(t0)))+β1(t0)ˉz(t0)>f(t0,β1(t0),δ2(t0,w(t0)))f(t0,β1(t0),β2(t0))β1(t0).

    If t0=0, then, by (1.2) and Definition 4.1,

    ˉz(0)β1(0)=ˉz(T)β1(0)ˉz(T)β1(T).

    Then, by (4.6),

    ˉz(0)β1(0)=ˉz(T)β1(T),

    and

    ˉz(T)β1(T)0. (4.8)

    But by (4.6), (4.1) and Definition 4.1,

    ˉz(T)=f(T,δ1(T,ˉz(T)),δ2(T,w(T)))+δ1(T,ˉz(T))ˉz(T)=f(T,β1(T),δ2(T,w(T)))+β1(T)ˉz(T)>f(T,β1(T),δ2(T,w(T)))f(T,β1(T),β2(T))β1(T),

    which contradicts (4.8).

    Therefore, ˉz(t)β1(t),t[0,T]. The same arguments can be applied to prove the inequality ˉz(t)α1(t).

    Using the same technique, one can prove that

    α2(t)ˉw(t)β2(t),t[0,T].

    In [15], the authors present an analysis of the dynamics of the interaction between criminal and non-criminal populations based on the pray-predator Lotka-Volterra models. Motivated by this work, we consider a variant of the constructed model with a logistic growth of the non-criminal population and a law enforcement term, that is,

    {N(t)=μN(t)(11KN(t))aN(t)C(t),C(t)=γC(t)lcC(t)+bN(t)C(t), (5.1)

    where C and N are, respectively, the criminal and non-criminal population as functions of time, μ is the growth rate of N in the absence of C, a and b are the variation rates of N and C, respectively, due to their interaction, γ is the natural mortality rate of C, K is the carrying capacity for N in the absence of C, and lc is the measure of enforced law on C.

    We note that the interaction term could have different effects in each of the populations, hence, the, eventually, different multiplying factors a and b.

    As a numerical example, we consider the parameter set:

    μ=2.5, a=0.1, b=0.01,γ=2.5, K=8, lc=5. (5.2)

    We choose a normalized period T=1, representing the evolution dynamics in one year, and the periodic boundary conditions

    N(0)=N(1),C(0)=C(1). (5.3)

    Notice that the problem (5.1) and (5.3), with (5.2), is a particular case of (1.1) and (1.2) with

    f(t,N(t),C(t))=2.5N(t)(118N(t))0.1N(t)C(t),g(t,N(t),C(t))=2.5C(t)5C(t)+0.01N(t)C(t),

    and the quadratic functions

    α1(t)=t2+t+10, α2(t)=3t2+3t1,β1(t)=t2+5, β2(t)=4t2+t+4,

    are, respectively, coupled lower and upper solutions of (5.1) and (5.3), for the parameters (5.2), according to Definition 4.1.

    As all the assumptions of Theorem 4.1 are verified, then there is at least a solution (N,C) of (5.1), moreover,

    t2+5N(t)t2+t+10,

    and

    3t2+3t1C(t)4t2+t+4.

    The only constant solutions (N,C) admissible by problem (5.1) are (0,0), (750,0), (0,2318.75) and (750,2318.75), which are beyond the lower and upper bounds αi,βi. Hence, the region of solutions shown in Figure 2 contains only non-trivial solutions.

    Figure 2.  (N,C)-solution localization.

    The existence of periodic solutions for problems where the nonlinearities have no periodicity at all is scarce in the literature, not only on differential equations but also on coupled systems of differential equations. This work aims to contribute towards fulfilling this gap, by presenting sufficient conditions to guarantee the existence of periodic solutions in the presence of lower and upper solutions and some adequate monotonicity properties on the nonlinearities.

    The localization ensured by the lower and upper solutions method has been undervalued, as well as the estimation and some qualitative properties that it provides for the oscillation and variation of the solutions. The introduction of a practical example, and an application to a real social phenomenon, was intended to stress the potentialities of this technique.

    In the literature, in general, the lower and upper solutions method requires the well-ordered case, that is, the lower function below the upper one, and a specific local monotonicity on the nonlinearity. This work suggests techniques to overcome both restrictions, so that the search for functions that verify lower and upper solutions properties becomes easier.

    For the first issue, we apply a translation, such that, regardless of the order relation between the lower and upper solutions, the shifted functions are always well-ordered.

    Section 4 presents a technique that combines the definition of coupled lower and upper-solutions (Definition 4.1) with the monotonicity properties verified by the nonlinearities. In this way, this method can be applied to other problems where the different types of monotonicity hold.

    This work research was supported by national funds through the Fundação para a Ciência e Tecnologia, FCT, under the project UIDB/04674/2020.

    The authors declare no conflicts of interest.


    Acknowledgments



    The authors would like to thank Amir Owrangi of UT Southwestern Medical Centre for assistance in the phase-space files and photon energy spectra of the FF and FFF photon beams used in the Monte Carlo simulations.

    Conflict of interest



    The authors have no potential conflict of interest on financial or commercial matters associated with this study.

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