Appendix A
Study Methods
This appendix includes public meeting agendas, and a list of materials supplied to the committee by the National Aeronautics and Space Administration. The information-gathering sessions included public meetings and webinars held by the committee from January 2021 to April 2021, and they are listed in chronological order.
PUBLIC MEETING AGENDAS
January 25 and 26, 2021
DAY 1: Monday, January 25, 2021
11:00 AM |
Welcome and Opening Remarks to Public Audience
Hedvig “Hedi” Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
11:15 |
Session 1: Statement of Work
J. D. Polk, Chief Health and Medical Officer, National Aeronautics and Space Administration (NASA)
|
11:35 |
Discussion with Committee
Moderator: Hedi Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
12:00 PM |
Session 2: Background on NASA Radiation Standard
Edward Semones, Space Radiation Analysis Group, NASA Johnson Space Center Lisa Simonsen, Radiation Technology Integration, NASA HQ
|
12:45 |
Discussion with Committee
Moderator: R. Julian Preston, U.S. Environmental Protection Agency, Committee Vice Chair |
1:30 | Break |
1:45 |
Session 3: Health and Medical Risk Characterization at NASA
Erik Antonsen, Assistant Director for Human Systems Risk Management, NASA Johnson Space Center
|
2:10 |
Discussion with Committee
Moderator: Hedi Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
2:50 |
Closing Remarks
Hedi Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
3:00 | Adjourn Day 1 |
DAY 2: Tuesday, January 26, 2021
11:00 AM |
Welcome and Opening Remarks to Public Audience
Hedvig “Hedi” Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
11:15 |
Session 4: Sex Difference Considerations
S. Robin Elgart, Space Radiation Element Scientist, NASA Johnson Space Center Marisa Covington, Bioethics Director, NASA HQ
|
11:35 |
Discussion with Committee
Moderator: Hedi Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
12:00 PM |
Session 5: Cancer Incidence Within the Astronaut Corps
Mary Van Baalen, Lead, Lifetime Surveillance for Astronaut Health, NASA Johnson Space Center
|
12:20 |
Discussion with Committee
Moderator: Julian Preston, U.S. Environmental Protection Agency, Committee Vice Chair |
1:00 | Break |
1:15 |
Session 6: Astronaut Office Perspective
Serena Aunon-Chancellor, Astronaut
|
1:30 |
Discussion with Committee
Moderator: Hedi Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
2:00 |
Session 7: NASA Proposed Standards and Summary
David Francisco, Technical Fellow for Human Spaceflight Standards, NASA HQ J. D. Polk, Chief Health and Medical Officer, NASA HQ Edward Semones, Space Radiation Analysis Group, NASA Johnson Space Center
|
2:20 |
Discussion with Committee
Moderator: R. Julian Preston, U.S. Environmental Protection Agency, Committee Vice Chair |
2:50 |
Closing Remarks
Hedi Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
3:00 | Adjourn Meeting |
Monday, February 22, 2021
12:00 PM |
Convening Open Session and Welcome
Hedvig “Hedi” Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
12:05 |
NASA Overview
|
J. D. Polk, Chief Health and Medical Officer, NASA David Francisco, Technical Fellow for Human Spaceflight Standards, NASA HQ Edward Semones, Space Radiation Analysis Group, NASA Johnson Space Center |
|
12:30 |
Discussion with Committee
Moderator: Hedi Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair |
1:30 | Adjourn Open Session |
Wednesday, April 14, 2021
1:00 PM |
Convening Public Webinar and Welcome
Hedvig “Hedi” Hricak, Memorial Sloan Kettering Cancer Center, Committee Chair Gayle Woloschak, Northwestern University, Committee Member |
1:05 |
Overview of the International Commission on Radiological Protection’s (ICRP’s) Task Group 115 (TG115) Motivation, Agenda, and Future Plans
Werner Rühm, Helmholtz Zentrum München, Germany, TG115 Chair |
2:20 |
Overview of International Space Agencies Assessment of Dose and Risk for Astronauts
Marco Durante, GSI Helmholtz Center, Germany, TG115 Member |
1:40 |
Discussion with Committee and ICRP’s TG115 Members
Gayle Woloschak, Northwestern University, Committee Member |
ICRP discussants include
|
|
2:30 | Adjourn Open Session |
OVERVIEW OF DOCUMENTS PROVIDED BY NASA
The documents below were provided or submitted by NASA to the committee during the course of the study. Copies of the documents can either be found on the NASA website1 or are deposited in the study’s public access file.2
Materials Developed by NASA for the Committee
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Processes and Strategies Being Considered for Revising the NASA Space Permissible Exposure Limit for Spaceflight Radiation Exposure Standard, December 3, 20202
NASA provided an example of a modified standard that NASA is considering, as well as background information for the committee, including the specific factors NASA is considering in modifying the standard, why NASA is considering a change to the standard, and the existing NASA Space Permissible Exposure Limit for Spaceflight Radiation Exposure Standard, as well as background on the space radiation environment, international partner standards, and NASA standards.
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Background Information, January 21, 2021, White Paper2
NASA provided updated background information for the committee, including the specific factors NASA is considering in modifying the standard, why NASA is considering a change to the standard, and the proposed update to the NASA Space Permissible Exposure Limit for Spaceflight Radiation Exposure Standard, as well as background on the space radiation environment, international partner standards, and NASA standards.
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Proposed Standard Overview, Alternate Options, and Clarifications, February 2021, Revision A2
NASA provided clarifying material and an updated white paper based on questions and comments from the committee at the public meeting on January 25 and 26, 2021. The material provides more detail, comparison, explanation, context, and additional options for the NASA proposed update to the Space Permissible Exposure Limit for Spaceflight Radiation Exposure Standard for cancer mortality.
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1 These materials are available on nasa.gov. Links to specific NASA webpages are noted in footnotes.
2 Copies of documents in the public access file may be requested by contacting the National Academies’ Public Access Records Office (PARO@nas.edu).
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Questions and Answers Directed to NASA from the Committee, February 21, 20212
NASA provided answers to specific committee questions regarding the cancer risk model via email.
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Proposed Standard Overview, Alternate Options, and Clarifications, March 2021, Revision A2
NASA provided clarifying material and an updated white paper in response to additional questions posed by the committee at the February 2021 public session. The material provides more information on the proposed standard language, median versus mean, sex-averaged versus female-only calculations, risk communication, and the standards update process.
Supporting Materials Sent to the Committee by NASA
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Space Radiation Cancer Risk Projections and Uncertainties—20121,3
Report that documents NASA’s responses to the recommendations from the National Research Council’s (NRC’s) Space Science Board of the National Academy of Sciences review of the NASA Model 2010, published in March 2012. This includes several updates of the NSCR 2010 model and discussion of points of clarification.
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Report on Virtual Radiation Risk Panel, September 24, 20202
This report, prepared by Erik Antonsen, summarizes the results of an advisory panel of clinicians from reputable and leading academic centers who are well versed in cancer and other radiation health effects to individually advise Human System Risk Board on radiation risk characterization and the Health and Medical Technical Authority on how the standard can be aligned and viewed in context with the other clinical risks. The panel was held on August 21, 2020.
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Ensemble Methodologies for Astronaut Cancer Risk Assessment in the Face of Large Uncertainties, October 20201,4
Provides an overview of a new approach to NASA space radiation risk modeling that has successfully extended the current NASA probabilistic cancer risk model to an ensemble framework able to consider submodel parameter uncertainty (e.g., uncertainty in a radiation quality parameter) as well as model-form uncertainty associated with differing theoretical or empirical formalisms (e.g., combined dose-rate and radiation quality effects).
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3 See https://spaceradiation.jsc.nasa.gov/irModels/TP-2013-217375.pdf (accessed April 13, 2021).
4 See https://ntrs.nasa.gov/api/citations/20205008710/downloads/NASA-TP-20205008710.pdf (accessed April 28, 2021).
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Design for Ionizing Radiation Protection NASA-STD-3001 Technical Brief, October 15, 20201,5
During any mission, astronauts face threats of ionizing radiation from a variety of sources. Standards outlined in NASA-STD-3001 state that crews are not to be exposed to radiation that increases their risk of radiation-related mortality by 3 percent. Design choices and shielding strategies can be implemented to reduce the threat posed by radiation and ensure crew safety and health.
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Mission-Associated Summary of Health (M.A.S.H.) for Jane Astronaut Mars Expeditions 1002
Example M.A.S.H. document that provides a summary of test results and “details” pages containing test descriptions, the rationale for each MED-B, the preferred testing schedules, actual test dates, and select results for astronauts.
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Office of the Chief Health and Medical Officer Human Spaceflight Standards Newsletter, March 20212
March 2021 newsletter to all astronauts that provides updates on human spaceflight standards.
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5 See https://www.nasa.gov/sites/default/files/atoms/files/radiation_protection_technical_brief_ochmo_021420.pdf (accessed April 16, 2021).
TABLE A-1 starts on the next page.
TABLE A-1 Summary of Evidence on Sex-Specific Radiation Risk Estimates of Lung Cancer Mortality from Population Studies of Radiation Exposure
Type of Exposure | Studies | References | Mean Dose to the Lungs, Gya |
---|---|---|---|
High-dose rate (acute exposures delivered over a short period of time) | |||
Low- to medium-dose | A-bomb | Ozasa et al., 20121 | F/M: 0.2 (colon, whole cohort) |
High-dose | Studies of RT for cancer and benign diseases | Hodgkin lymphoma: Gilbert et al., 20032 | F/M: 25 (dose to specific site where LC was diagnosed) |
Peptic ulcer: Little et al., 2013,3 Carr et al., 20024 | F/M: 1.8 (for the left lung) 0.6 (for the right lung) |
||
Low-dose rate (protracted exposures) | |||
Low-dose | Occupational exposures | 15-country study: Cardis et al., 20075 – nuclear industry workers | F/M: 0.0194 Sv (average cumulative recorded whole-body external dose for the whole cohort) |
UK NRRW: Muirhead et al., 20096 – radiation workers | F/M: 0.0249 Sv (mean lifetime recorded whole-body external dose for the pooled cohort) | ||
Rocketdyne workers: Boice et al., 20117 –radiation workers | F/M: 0.019 Sv (mean combined dose to the lung from external and internal radiation) |
Number of Subjects | Number of Lung Cancer Deaths/Cases | Excess Relative Risk per gray (ERR/Gy) (95% CI) for Lung Cancera,b,c |
---|---|---|
F: 50,924 M: 35,687 |
F: 657 M: 901 |
F: 1.10 (0.68, 1.60) M: 0.40 (0.17, 0.67) |
Full study population: F: 132 M: 388 Exposed: F: 110 M: 307 |
Full study population: F: 44 M: 129 Exposed: F: 39 M: 107 |
F: 0.044 (–0.009, 0.53) M: 0.18 (0.063, 0.52) |
Full cohort: F: 788 M: 2,812 Exposed: F: 351 M: 1,389 |
Full cohort: F/M: 193 |
Full cohort: F/M: 0.559 (0.221, 1.021) Exposed: F/M: 1.724 (0.053, 417.1) |
F/M: 407,391 F: 40,739 M: 366,652 |
F: 65 M: 1,392 |
ERR/Sv F/M: 1.86 (90% CI 0.49, 3.63) F: –1.04 (90% CI <0, 11.1) M: 1.88 (90% CI 0.50, 3.66) |
F/M: 174,541 (<10% F) | F/M: 2,230 (trachea, bronchus, lung) | ERR/Sv F/M: 0.106 (–0.43, 0.79) (trachea, bronchus, lung) |
F: 466 M: 5,335 |
F/M: 214 | F/M: RR/100 mGy = 1.01 (0.89, 1.16) |
Type of Exposure | Studies | References | Mean Dose to the Lungs, Gya |
---|---|---|---|
Low-dose (continued) | Occupational exposures (continued) | Mayak: Gilbert et al., 20138 – workers of the plutonium production facility | Plutonium dose among exposed: Whole cohort: 0.115 F: 0.165 M: 0.093 External dose among exposed: Whole cohort: 0.397 F: 0.335 M: 0.418 |
Fernald: Silver et al., 20139 – uranium processing workers | Mean cumulative dose to lung (μGy) Females Caucasian Hourly: 67.9 Salaried: 296 Females non-Caucasian Hourly: 34.5 Salaried: 154 Males Caucasian Hourly: 1,552 Salaried: 388 Males non-Caucasian Hourly: 965 Salaried: 138 |
||
Mound Nuclear Facility: Boice et al., 201410 –workers in the nuclear weapons production facility |
F/M: 0.1 Sv (full cohort combined dose to the lung from internal and external radiation) | ||
Mayak and Sellafield pooled analysis: Gillies et al., 201711 – workers of plutonium production facilities | F/M plutonium dose: Mayak: 0.1756 Sellafield: 0.0055 F/M gamma exposure: Mayak: 0.455 Sellafield: 0.0725 |
Number of Subjects | Number of Lung Cancer Deaths/Cases | Excess Relative Risk per gray (ERR/Gy) (95% CI) for Lung Cancera,b,c |
---|---|---|
Full cohort: F: 3,703 M: 10,918 Positive plutonium dose: F: 1,971 M: 4,569 |
Full cohort: F: 40 M: 446 |
Plutonium lung dose: F, age 60: 24 (11, 56) M, age 60: 7.4 (5.0, 11) External lung dose: F/M: 0.13 (–0.04, 0.38) |
Overall: F: 952 M: 5,451 Females Caucasian Hourly: 153 Salaried: 731 Females non-Caucasian Hourly: 30 Salaried: 38 Males Caucasian Hourly: 3,440 Salaried: 1,771 Males non-Caucasian Hourly: 193 Salaried: 47 |
F: Hourly: 5 Salaried: 17 M: Hourly: 223 Salaried: 52 (trachea, bronchus, lung) |
External dose: M: ERR/100 mGy = 0.17 (−0.18, 0.68) Organ dose: M: ERR/100 μGy = 0.0021 (−0.00062, 0.0064) Radon decay products: M: ERR/10 WLM = −0.0061 (−0.013, 0.0046) |
Full cohort: F: 1,806 M: 5,463 Exposed: F: 973 M: 4,004 |
Full cohort: F/M: 310 Exposed: F/M: 204 |
F/M RR at 100 mSv: 1.00 (0.97, 1.04) |
F: 8,540 M: 37,277 |
F: 95 M: 1,100 |
Mayak, plutonium lung dose: F, at age 60: 11.62 (90% CI 6.93, 18.78) Mayak/Sellafield, plutonium lung dose: M, at age 60: 4.73 (90% CI 3.53, 6.18) Mayak/Sellafield, external lung dose: F/M, all ages: 0.37 (90% CI 0.22, 0.55) |
Type of Exposure | Studies | References | Mean Dose to the Lungs, Gya |
---|---|---|---|
Low-dose (continued) | Occupational exposures (continued) | UK NRRW: Haylock et al., 201812 – radiation workers | Total: 0.0253 Sv F: 0.0056 Sv M: 0.0275 Sv (mean lifetime recorded whole-body external dose for the pooled cohort) |
INWORKS: Richardson et al., 201813 – nuclear workers | Organ-specific cumulative external dose: F: 0.0048 M: 0.0228 |
||
Industrial radiographers: Boice et al., 201914 | External radiation and iridium-192 and cobalt-60 dose: F: 0.002 M: 0.012 |
||
Mound: Boice et al., 201914 – workers in the nuclear weapons production facility | Full cohort combined dose to the lung from internal and external radiation: F: 0.0249 M: 0.1129 |
||
Nuclear power plant: Boice et al., 201914 | Full cohort combined dose to the lung from internal and external radiation: F: 0.0179 M: 0.0413 |
||
NPP + IR: Boice et al., 201914 | Full cohort combined dose to the lung from internal and external radiation: F: 0.0061 M: 0.0278 |
||
U.S. radiation technologists: Velazquez-Kronen, 202015 | Full cohort cumulative dose to the lung from external exposure: F: 0.024 M: 0.026 |
Number of Subjects | Number of Lung Cancer Deaths/Cases | Excess Relative Risk per gray (ERR/Gy) (95% CI) for Lung Cancera,b,c |
---|---|---|
F: 16,437 M: 150,566 |
F/M: 3,058 | ERR/Sv F/M: 0.028 (–0.44, 0.63) (lung, trachea, bronchus) |
F: 40,035 M: 268,262 |
F/M: 5,802 | F/M: Maximum likelihood: 0.51 (90% CI 0.00, 1.09) F/M: Hierarchical Bayes: 0.56 (90% CI 0.08, 1.02) |
F: 12,933 M: 110,577 |
F: 55 M: 2,060 |
ERR/100 mGy F: –0.33 (–0.45, 0.21) M: 0.09 (0.02, 0.16) |
F: 971 M: 3,983 |
F: 21 M: 182 |
ERR/100 mGy F: –0.01 (–0.07, 0.07) M: 0.01 (–0.02, 0.04) |
F: 4,420 M: 130,773 |
F: 48 M: 3,337 |
ERR/100 mGy F: 0.80 (–0.96, 2.56) M: –0.05 (–0.10, 0.01) |
F: 17,353 M: 241,350 |
F: 103 M: 5,397 |
ERR/100 mGy F: 0.16 (–0.49, 0.81) M: 0.01 (–0.04, 0.06) |
F: 80,180 M: 25,888 |
F: 711 M: 379 |
ERR/100 mGy F: 0.06 (<0–0.23) M: –0.14 (<0–0.09) |
Type of Exposure | Studies | References | Mean Dose to the Lungs, Gya |
---|---|---|---|
Medium-dose | Radiation diagnostic exposures | Massachusetts TB fluoroscopy: Davis et al., 198916 | F/M: 0.84 (total lung tissue dose among exposed) |
Canadian TB fluoroscopy: Howe, 199517 |
F/M: 1.02 Sv (total lung tissue dose among exposed) | ||
Canadian TB fluoroscopy: Boice et al., 201914 |
Total lung tissue dose among exposed: F: 1.072 M: 1.038 |
Abbreviations: CI = confidence interval; ERR/Gy = excess relative risk per gray; ERR/Sv = excess relative risk per sievert; F = female; F/M = combined estimate for females and males; Gy = gray; IR = industrial radiographer; LC = lung cancer; M = male; NPP = nuclear power plant; RR/100 mGy = relative risk per 100 milligray; SMR = standardized mortality ratio; Sv = sievert; TB = tuberculosis.
a In this table, the committee chose to present the results as they appeared in original publications. While the majority of studies used absorbed doses to the lungs (in gray [Gy] or mGy), some used effective doses expressed in sievert (Sievert) and averaged over entire body. All estimates presented are in Gy, unless otherwise noted.
b All estimates presented are ERR/Gy, unless otherwise noted.
c ERR/Gy is a measure of effect per unit of radiation dose. While relative risks (RRs) are traditionally used to express risks in exposure categories compared to a reference category, excess RRs are frequently used in radiation epidemiology to express excess risks (risks above 1.0) per unit of dose (1 Gy is traditionally used as a reference category). In models with a linear relationship between exposure and outcome, an estimate of RR with a reference category of 1 Gy is equivalent to a RR/Gy = ERR/Gy + 1.0. For example, an ERR/Gy = 1.88 from Cardis et al., 2007, could be expressed as RR at 1 Gy = 1.88 + 1.00 = 2.88 (women exposed to a dose of 1 Gy have 2.88 times higher risk of lung cancer compared to women with no radiation exposure [dose = 0]). ERR/100 mGy could be expressed as ERR/Gy as follows: ERR/Gy = ERR/100 mGy × 10. For example, an ERR/100 mGy = 0.09 from Boice et al., 2019, could be expressed as ERR/Gy = 0.9.
Number of Subjects | Number of Lung Cancer Deaths/Cases | Excess Relative Risk per gray (ERR/Gy) (95% CI) for Lung Cancera,b,c |
---|---|---|
F: 6,513 M: 6,872 |
Exposed: F: 19 M: 50 Unexposed: F: 22 M: 104 |
Exposed: F: SMR = 0.8 M: SMR = 0.8 Unexposed: F: SMR = 1.0 M: SMR = 1.4 |
F: 31,917 M: 32,255 |
F: 266 M: 912 |
ERR/Sv: F: –0.08 (–0.10, 0.07) M: 0.02 (–0.01, 0.11) |
F: 31,787 M: 31,920 |
F: 266 M: 912 | ERR/100 mGy F: –0.007 (–0.015, 0.002) M: 0.002 (–0.003, 0.008) |
Table A-1 References
1. Ozasa, K., Y. Shimizu, A. Suyama, F. Kasagi, M. Soda, E. J. Grant, R. Sakata, H. Sugiyama, and K. Kodama. 2012. Studies of the mortality of atomic bomb survivors, Report 14, 1950–2003: An overview of cancer and noncancer diseases. Radiation Research 177(3):229–243.
2. Gilbert, E. S., M. Stovall, M. Gospodarowicz, F. E. Van Leeuwen, M. Andersson, B. Glimelius, T. Joensuu, C. F. Lynch, R. E. Curtis, E. Holowaty, H. Storm, E. Pukkala, M. B. van’t Veer, J. F. Fraumeni, J. D. Boice, Jr., E. A. Clarke, and L. B. Travis. 2003. Lung cancer after treatment for Hodgkin’s disease: Focus on radiation effects. Radiation Research 159(2):161–173.
3. Little, M. P., M. Stovall, S. A. Smith, and R. A. Kleinerman. 2013. A reanalysis of curvature in the dose response for cancer and modifications by age at exposure following radiation therapy for benign disease. International Journal of Radiation Oncology, Biology, Physics 85(2):451–459.
4. Carr, Z. A., R. A. Kleinerman, M. Stovall, R. M. Weinstock, M. L. Griem, and C. E. Land. 2002. Malignant neoplasms after radiation therapy for peptic ulcer. Radiation Research 157(6):668–677.
5. Cardis, E., M. Vrijheid, M. Blettner, E. Gilbert, M. Hakama, C. Hill, G. Howe, J. Kaldor, C. R. Muirhead, M. Schubauer-Berigan, T. Yoshimura, F. Bermann, G. Cowper, J. Fix, C. Hacker, B. Heinmiller, M. Marshall, I. Thierry-Chef, D. Utterback, Y.-O. Ahn, E. Amoros, P. Ashmore, A. Auvinen, J.-M. Bae, J. Bernar, A. Biau, E. Combalot, P. Deboodt, A. Diez Sacristan, M. Eklöf, H. Engles, G. Engholm, G. Gulis, R. R. Habib, K. Holan, H. Hyvonen, A. Kerekes, J. Kurtinaitis, H. Malker, M. Martuzzi, A. Mastauskas, A. Monnet, M. Moser, M. S. Pearce, D. B. Richardson, F. Rodriguez-Artalejo, A. Rogel, H. Tardy, M. Telle-Lamberton, I. Turai, M. Usel, and K. Veress. 2007. The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: Estimates of radiation-related cancer risks. Radiation Research 167(4):396–416.
6. Muirhead, C. R., J. A. O’Hagan, R. G. Haylock, M. A. Phillipson, T. Willcock, G. L. C. Berridge, and W. Zhang. 2009. Mortality and cancer incidence following occupational radiation exposure: Third analysis of the National Registry for Radiation Workers. British Journal of Cancer 100(1):206–212.
7. Boice, J. D., Jr., S. S. Cohen, M. T. Mumma, E. Dupree Ellis, K. F. Eckerman, R. W. Leggett, B. B. Boecker, A. Bertrand Brill, and B. E. Henderson. 2011. Updated mortality analysis of radiation workers at Rocketdyne (Atomics International), 1948–2008. Radiation Research 176(2):244–258.
8. Gilbert, E. S., M. E. Sokolnikov, D. L. Preston, S. J. Schonfeld, A. E. Schadilov, E. K. Vasilenko, and N. A. Koshurnikova. 2013. Lung cancer risks from plutonium: An updated analysis of data from the Mayak worker cohort. Radiation Research 179(3):332–342.
9. Silver, S. R., S. J. Bertke, M. J. Hein, R. D. Daniels, D. A. Fleming, J. L. Anderson, S. M. Pinney, R. W. Hornung, and C.-Y. Tseng. 2013. Mortality and ionising radiation exposures among workers employed at the Fernald Feed Materials Production Center (1951–1985). Occupational and Environmental Medicine 70(7):453–463.
10. Boice, J. D., Jr., S. S. Cohen, M. T. Mumma, E. Dupree Ellis, D. L. Cragle, K. F. Eckerman, P. W. Wallace, B. Chadda, J. S. Sonderman, L. D. Wiggs, B. S. Richter, and R. W. Leggett. 2014. Mortality among mound workers exposed to polonium-210 and other sources of radiation, 1944–1979. Radiation Research 181(2):208–228.
11. Gillies, M., I. Kuznetsova, M. Sokolnikov, R. Haylock, J. O’Hagan, Y. Tsareva, and E. Labutina. 2017. Lung cancer risk from plutonium: A pooled analysis of the Mayak and Sellafield worker cohorts. Radiation Research 188(6):645–660.
12. Haylock, R. G. E., M. Gillies, N. Hunter, W. Zhang, and M. Phillipson. 2018. Cancer mortality and incidence following external occupational radiation exposure: An update of the 3rd analysis of the UK National Registry for Radiation Workers. British Journal of Cancer 119(5):631–637.
13. Richardson, D. B., E. Cardis, R. D. Daniels, M. Gillies, R. Haylock, K. Leuraud, D. Laurier, M. Moissonnier, M. K. Schubauer-Berigan, I. Thierry-Chef, and A. Kesminiene. 2018. Site-specific solid cancer mortality after exposure to ionizing radiation: A cohort study of workers (INWORKS). Epidemiology 29(1):31–40.
14. Boice, J. D., Jr., E. D. Ellis, A. P. Golden, L. B. Zablotska, M. T. Mumma, and S. S. Cohen. 2019. Sex-specific lung cancer risk among radiation workers in the million-person study and patients TB-Fluoroscopy. International Journal of Radiation Biology 7:1–12.
15. Velazquez-Kronen, R., E. S. Gilbert, M. S. Linet, K. B. Moysich, J. L. Freudenheim, J. Wactawski-Wende, S. L. Simon, E. K. Cahoon, B. H. Alexander, M. M. Doody, and C. M. Kitahara. 2020. Lung cancer mortality associated with protracted low-dose occupational radiation exposures and smoking behaviors in U.S. radiologic technologists, 1983–2012. International Journal of Cancer 147(11):3130–3138.
16. Davis, F. G., J. D. Boice, Jr., Z. Hrubec, and R. R. Monson. 1989. Cancer mortality in a radiation-exposed cohort of Massachusetts tuberculosis patients. Cancer Research 49(21):6130–6136.
17. Howe, G. R. 1995. Lung cancer mortality between 1950 and 1987 after exposure to fractionated moderate-dose-rate ionizing radiation in the Canadian fluoroscopy cohort study and a comparison with lung cancer mortality in the atomic bomb survivors study. Radiation Research 142(3):295–304.
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