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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States. Washington, DC: The National Academies Press. doi: 10.17226/26434.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States. Washington, DC: The National Academies Press. doi: 10.17226/26434.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States. Washington, DC: The National Academies Press. doi: 10.17226/26434.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States. Washington, DC: The National Academies Press. doi: 10.17226/26434.
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Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States Committee on Developing a Long-Term Strategy for Low-Dose Radiation Research in the United States Nuclear and Radiation Studies Board Division on Earth and Life Studies Prepublication Copy Consensus Study Report

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by a contract between the National Academy of Sciences and the Department of Energy. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26434 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2022 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States. Washington, DC: The National Academies Press. https://doi.org/10.17226/26434. Prepublication Copy

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. Prepublication Copy

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. Prepublication Copy

COMMITTEE ON DEVELOPING A LONG-TERM STRATEGY FOR LOW-DOSE RADIATION RESEARCH IN THE UNITED STATES JOE W. GRAY (NAM) (Chair), Oregon Health & Science University (emeritus), Portland SIMON D. BOUFFLER, UK Health Security Agency, Chilton, United Kingdom SHAHEEN A. DEWJI, Georgia Institute of Technology, Atlanta ANDREW P. FEINBERG (NAM), Johns Hopkins University School of Medicine, Baltimore, Maryland BENJAMIN FRENCH, Vanderbilt University, Nashville, Tennessee BERNARD D. GOLDSTEIN (NAM), University of Pittsburgh (retired), Pennsylvania JOHN D. GRAHAM, Indiana University, Bloomington ELIZABETH M. JAFFEE (NAM), Johns Hopkins University, Baltimore, Maryland EVAGELIA C. LAIAKIS, Georgetown University, Washington, District of Columbia LINDSAY M. MORTON, National Cancer Institute, Bethesda, Maryland DAVID B. RICHARDSON, University of California, Irvine DÖRTHE SCHAUE, University of California, Los Angeles RASHID A. SHAIKH, Health Effects Institute (retired), Cambridge, Massachusetts RICHARD L. WAHL (NAM),1 Washington University School of Medicine in St. Louis, Missouri GAYLE E. WOLOSCHAK, Northwestern University, Evanston, Illinois Staff OURANIA KOSTI, Study Director LAURA D. LLANOS, Finance Business Partner DARLENE GROS, Senior Program Assistant 1 Resigned from the committee effective September 2, 2021. Prepublication Copy v

  NUCLEAR AND RADIATION STUDIES BOARD WILLIAM H. TOBEY (Chair), Los Alamos National Laboratory, Los Alamos, New Mexico JAMES A. BRINK (Vice Chair), Massachusetts General Hospital, Boston SALLY A. AMUNDSON, Columbia University, New York, New York STEVEN M. BECKER, Old Dominion University, Norfolk, Virginia AMY BERRINGTON DE GONZÁLEZ, National Cancer Institute, Bethesda, Maryland MADELYN R. CREEDON, The George Washington University, Washington, District of Columbia SHAHEEN A. DEWJI, Georgia Institute of Technology, Atlanta PAUL T. DICKMAN, Argonne National Laboratory, Washington, District of Columbia ALLISON M. MACFARLANE, The University of British Columbia, Canada ELEANOR MELAMED, U.S. National Nuclear Security Administration (retired) PER F. PETERSON (NAE), University of California, Berkeley R. JULIAN PRESTON, Environmental Protection Agency, Chapel Hill, North Carolina MONICA C. REGALBUTO, Idaho National Laboratory, Idaho Falls HENRY D. ROYAL, Washington University School of Medicine in St. Louis, Missouri Staff CHARLES D. FERGUSON, Senior Board Director JENNIFER HEIMBERG, Senior Program Officer MICHAEL T. JANICKE, Senior Program Officer OURANIA KOSTI, Senior Program Officer LAURA D. LLANOS, Finance Business Partner DARLENE GROS, Senior Program Assistant LESLIE BEAUCHAMP, Program Assistant Prepublication Copy vi

  Acknowledgments A number of people and organizations contributed to the successful completion of this report. The committee wishes to thank the following individuals: Dr. Todd Anderson (Office of Biological and Environmental Research, Biological Systems Science Division, Department of Energy [DOE]) sponsored the study and provided information on activities related to low-dose radiation research. Dr. Anderson also served ably as the sponsor liaison to the committee and was effective in coordinating several information requests for the committee including on funding of DOE’s national laboratories to carry out low-dose radiation research and their capabilities. Dr. Steve Binkley (Office of Science, DOE) provided views on DOE’s potential role in the government- wide effort to coordinate low-dose radiation research in the United States. The speakers are too numerous to name here; all gave high-quality presentations during the public meetings listed in Appendix C, and many of them responded to follow-up questions from the committee. Dr. Guy Garty (Columbia University), Colonel (Dr.) Mohammad Naeem (Armed Forces Radiobiology Research Institute), Dr. Guy Savard (Argonne National Laboratory), Dr. Marcelo Vazquez (Loma Linda University Medical Center), Dr. Jason Weeks (National Aeronautics and Space Administration’s Johnson Space Center), and Dr. Michael Weil (Colorado State University) responded to the committee’s request for information on the characteristics and capabilities of the radiation facilities in their institutions. The committee found the responses comprehensive and a valuable asset to the radiation community and has included these responses in Appendix E. Ms. Lilly Adams (Union of Concerned Scientists) assisted National Academies’ staff with identifying individuals from the communities impacted by nuclear weapons production and testing and moderated the presentations and discussion during the committee’s October 28, 2021, meeting. Ms. Adams also coordinated follow-on communications with the impacted communities and advocacy groups. Ms. Lisa Meissner (Hobbs Straus Dean & Walker, LLP) coordinated with the Navajo Nation Office of the President and the Department of Health for presentations to the committee by Navajo President Jonathan Nez and Health Administrator Dr. Jill Jim. Ms. Lisa Robinson (Harvard T.H. Chan School of Public Health) assisted the committee with retrieving information on current and historic government processes for cost-benefit analyses and rulemaking. Mr. Armond Cohen (Clean Air Task Force) proposed several speakers for the committee’s meeting focused on risk communication and public engagement and provided comments in writing. Ms. Virgini Donaldson (CANDU Owners Group [COG]) facilitated the presentation on the COG-supported low-dose radiation program and access to its report. Dr. Kimberly Applegate (University of Kentucky, retired), Professor Perry Charley (Diné College), Ms. Barbara Hamrick (University of California, Irvine, Medical Center), Dr. Kathy Held (National Council on Radiation Protection and Measurements), Dr. Arjun Makhijani (Institute for Energy and Environmental Research), Dr. Noelle Metting (DOE, retired), Mr. John Tappert (U.S. Nuclear Regulatory Commission), and Colonel (Dr.) Alvin Young (U.S. Air Force, retired) provided comments in writing. Several members of impacted communities and advocacy groups provided detailed commentaries with recommendations for the committee’s consideration. Those members are as follows (in the order they signed the commentaries): Dr. Bemnet Alemayehu ( atural Resources Defense Council), Terrie Barrie (Alliance of Nuclear Worker Advocacy Groups), Mary Dickson (Utah Downwinders), Daniel Hirsch (Committee to Bridge the Gap), Keith Kiefer (, National Association of Atomic Veterans), Trisha Pritikin (Author, The Hanford Plaintiffs), Benetick Kabua Maddison (Youth, Climate, and Nuclear Issues), Dr. April L. Brown (Marshallese Educational Initiative), Beata Tsosie and Belin Prepublication Copy vii

viii Acknowledgments Marcus (Breath of My Heart Birthplace), Robert Alvarez (Consequences of Radiation Exposure), Jeff Carter (Physicians for Social Responsibility), Tina Cordova (Tularosa Basin Downwinders Consortium), Diane D’Arrigo (Nuclear Information and Resource Service), Dr. Thomas De Pree (Rensselaer Polytechnic Institute), Denise Duffield (Physicians for Social Responsibility–Los Angeles), Cindy Folkers (Beyond Nuclear), Susan Gordon (Multicultural Alliance for a Safe Environment), Dr. Robert M. Gould (San Francisco Bay Physicians for Social Responsibility), Wenonah Hauter (Food & Water Watch and Food & Water Action), Dennis Nelson (Support and Education for Radiation Victims), Mary Olson ( ender and Radiation Impact Project), Dr. Linda Marie Richards (Corvallis, Oregon), Anna Marie Rondon (New Mexico Social Justice and Equity Institute, Indigenous Lifeway, Inc.), Lukas Ross (Friends of the Earth), Adrian Shelley (Public Citizen, Texas), Chris Shuey (Southwest Research and Information Center), Tyson Slocum (Public Citizen), and Dr. Sasha Stiles (Atomic Workers Advocacy). The committee also thanks other individuals who provided comments in writing or during the committee’s public meetings. The committee is grateful to the staff of the Nuclear and Radiation Studies Board of the National Academies of Sciences, Engineering, and Medicine (the National Academies) for organizing and facilitating this study. Study director Dr. Ourania Kosti organized the committee meetings and assisted the committee with collecting the information it needed to write its report. Ms. Darlene Gros managed the logistics of the meetings, report review, and publication. Additional National Academies’ staff assisted with report production: Eric Edkin, Division on Earth and Life Studies, assisted with figure design, and Christopher Lao-Scott, National Academies’ Research Library, assisted with report production. Prepublication Copy

  Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: BEMNET ALEMAYEHU, Natural Resources Defense Council SALLY AMUNDSON, Columbia University KIMBERLY APPLEGATE, University of Kentucky (retired) AMIR BAHADORI, Kansas State University JAN BEYEA, Consulting in the Public Interest PAUL DICKMAN, Argonne National Laboratory AMY KRONENBERG, Lawrence Berkeley National Laboratory KERSTIN LINDBLAD-TOH (NAS), Broad Institute TIMOTHY MOUSSEAU, University of South Carolina SHEILA OLMSTEAD, The University of Texas at Austin ARISTIDES PATRINOS, New York University (retired) TRISHA PRITIKIN, Author, The Hanford Plaintiffs: Voices from the Fight for Atomic Justice (University Press of Kansas, 2020) STEVEN SIMON, National Cancer Institute (retired) JEFFREY ULLMAN (NAS/NAE), Stanford University RICHARD WAKEFORD, University of Manchester LANCE WALLER, Emory University LYDIA ZABLOTSKA, University of California, San Francisco Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by MARYELLEN GIGER, University of Chicago, and BARBARA HAMRICK, University of California, Irvine, Medical Center. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. Prepublication Copy ix

   

  Preface It has been an honor and privilege to chair the committee tasked with developing a strategy for low-dose radiation research in the United States. Throughout my career as a biomedical scientist, I have led large biomedical programs that have been at the forefront of scientific innovation in translational research with the goal of improving human health. Chairing this committee allowed me an opportunity to gain an appreciation of how scientific research can influence and guide policy decisions that impact the lives of the U.S. population. Ionizing radiation occurs in a wide range of medical, industrial, military, and commercial settings and the number of individuals exposed or potentially exposed to radiation in these settings is increasing. While these exposures may yield individual or societal benefit, they may also adversely affect human health. Past and present environmental exposures are especially concerning to some communities which are typically exposed involuntarily and may not receive or even agree with the presumed societal benefit. These include indigenous communities; atomic veterans; nuclear workers; uranium miners, millers, transporters, and their families; and those individuals or communities impacted by radioactive contamination or nuclear fallout due to nuclear weapons testing, offsite radiation releases from nuclear weapons production sites, and nuclear waste cleanup activities. Disparities in infrastructure, social and behavioral risk factors for disease, and complex environmental stressors exacerbate risks for disease to some community members and raise important health questions as to whether these communities are also at higher risk of developing disease from low-dose radiation exposures. These disparities also raise social questions regarding environmental injustice. It is imperative that risks to all exposed populations be known as well as is scientifically possible and that risk mitigation efforts be guided by that knowledge. Much of what we know about risk from low doses of radiation comes from epidemiological studies of exposed populations including the Japanese atomic bombing survivors, and occupationally and medically exposed individuals. These studies give most attention to cancer as the adverse health effect, but there is increasing evidence that low-dose radiation exposure may be associated with non-cancer health outcomes such as cardiovascular disease, neurological disorders, immune dysfunction, and cataracts. The present study focuses on developing a low-dose and low-dose-rate research strategy for the United States and is built on the concept that recent advances in epidemiology, biological understanding of disease occurrence, and computational and analytical technologies can be leveraged by a revitalized low-dose radiation research program to improve assessment and understanding of the risks of adverse health effects that result from the radiation exposures received by the U.S. population. Other fields embrace these advancements. Radiation research must do the same. During its seven public meetings, the committee received more than 80 presentations including from representatives of government and Congress, nongovernmental agencies, the national and international radiation research community, managers of the previous low-dose radiation program and collaborators, the U.S. biomedical research community, and, importantly, from impacted communities. The committee also received solicited and unsolicited information in writing. The presentations and recordings of the public meetings are posted on the National Academies’ study webpage2 and the written comments are available to the public upon request through the study’s public access file.3 2 See https://www.nationalacademies.org/our-work/developing-a-long-term-strategy-for-low-dose-radiation- research-in-the-united-states. 3 Inquiries and requests for the list of the public access file materials, can be made to the National Academies’ Public Access Records Office (see https://www8.nationalacademies.org/pa/managerequest.aspx?key=DELS-NRSB- 21-02). Prepublication Copy xi

xii Preface The committee and I clearly heard the concerns raised by some of the presenters about possible bias on the part of some of the committee members including myself as a result of my past work in the Department of Energy (DOE) supported national laboratories and publications on aspects of low dose radiation effects. We discussed these concerns at length and were mindful of them during our deliberations. It was our intent to develop a strategic research plan that was neutral in terms of the impact of the proposed research on assessment of radiation health risk and consequently its potential impact on radiation protection policy and practice in the United States. I believe that we succeeded in defining a research program that will provide the best possible information on risk so that risk mitigation efforts can be as scientifically well-grounded as possible. The committee also gave special attention to discovery or better quantification of health effects other than cancer that might be caused by low-dose radiation exposures. The essence of the proposed plan is captured in a list of nine findings and two recommendations. The committee recognized that, while DOE has been the historical research home for radiation research in the United States, other federal agencies in the United States and programs in other countries carry out or support low-dose radiation research. The committee identified eight essential elements of a low-dose radiation research program that should be considered during the development of a revitalized low-dose radiation research program in the United States. Coordination with other research efforts in low- dose radiation is an important one. I hope the audience of this report finds that this is an unbiased and forward-looking document that builds a strong case that a revitalized, focused, and comprehensive multidisciplinary low-dose radiation program that leverages advances in biotechnology and research infrastructure can provide evidence on risks at low doses of radiation for different health outcomes, thereby alleviating the need to rely on risk estimates derived from higher doses. Joe W. Gray, Chair Committee on Developing a Long-Term Strategy for Low-Dose Radiation Research in the United States Prepublication Copy

  Contents COMMON ACRONYMS AND ABBREVIATIONS ............................................................................ xv SUMMARY ................................................................................................................................................. 1 1 INTRODUCTION ............................................................................................................................ 10 Low-Dose Radiation Exposures to the U.S. Population, 12 Low-Dose Radiation Research in the United States, 15 Study Task and Approach, 19 Report Roadmap, 20 2 LOW-DOSE RADIATION EXPOSURES AND HEALTH EFFECTS ...................................... 22 Low-Dose Radiation Sources and Exposures, 26 Current Epidemiological Evidence on Low-Dose Radiation Health Effects, 43 Chapter Summary and Finding, 49 3 SCIENTIFIC BASIS FOR RADIATION PROTECTION........................................................... 50 The Radiation Protection Framework, 50 Agencies with Radiation Protection Responsibilities in the United States, 52 Science Behind Radiation Protection, 54 Potential Economic Impacts of the Low-Dose Radiation Research Program, 61 Chapter Summary and Findings, 63 4 STATUS OF LOW-DOSE RADIATION RESEARCH ............................................................... 65 Low-Dose Radiation Research in the U.S. Government, 65 Low-Dose Radiation Research in National Laboratories, 74 Low-Dose Radiation Research in Universities, 76 Support for Low-Dose Radiation Research by Other U.S. Entities, 76 Support for Low-Dose Radiation Research Internationally, 77 Chapter Summary, 85 5 PRIORITIZED RESEARCH AGENDA........................................................................................ 86 Low-Dose Radiation Research Challenges and Overview of Research Priorities, 86 Epidemiological Research Priorities, 89 Biological Research Priorities, 99 Research Infrastructure Priorities, 108 Estimated Timeline and Costs, 118 Comparison of the Committee-Recommended Research Agenda to Those of Other Entities, 123 Chapter Summary, Findings, and Recommendation, 124 6 ESSENTIAL COMPONENTS OF THE LOW-DOSE RADIATION PROGRAM ................. 127 Programmatic Commitment, 127 Independent Advice and Evaluation, 128 Transparency, 130 A Prioritized Strategic Research Agenda, 131 Research-Sponsorship Mechanisms, 131 Prepublication Copy xiii

xiv Contents Training, 134 Engagement and Communications with Stakeholders, 135 Coordination, 140 Department of Energy and Management of the Low-Dose Program, 143 Chapter Summary, Findings, and Recommendation, 146 REFERENCES ........................................................................................................................................ 149 APPENDIXES A Consolidated Appropriations Act, 2021....................................................................................... 191 B Committee and Staff Biographies ................................................................................................ 193 C Information-Gathering Meetings ................................................................................................. 199 D Projects Designated by the Department of Energy as “Low-Dose Radiation Projects” Carried Out at National Laboratories (2016–2021) ..................................................................... 204 E Unedited Responses from Radiation Facilities ............................................................................ 208 Prepublication Copy

  Common Acronyms and Abbreviations ABCC Atomic Bomb Casualty Commission ABM agent-based model ACERER Advisory Committee for Energy-Related Epidemiologic Research AEC Atomic Energy Commission AFRRI Armed Forces Radiobiology Research Institute AI artificial intelligence ALARA as low as reasonably achievable ALSDA Ames Life Sciences Data Archive ANL Argonne National Laboratory ANS American Nuclear Society AOP adverse outcome pathway ATLAS Argonne (National Laboratory) Tandem Linac Accelerator System BEIR Biological Effects of Ionizing Radiation BER Biological and Environmental Research program BEST Biomarkers, Endpoints and other Tools BMI body mass index BNL Brookhaven National Laboratory CANDLE CANcer Distributed Learning Environment CANDU CANada Deuterium Uranium CDC U.S. Centers for Disease Control and Prevention CERCLA Comprehensive Environmental Response, Compensation, and Liability Act CIF Community Involvement Fund CIRRPC Committee on Interagency Radiation Research and Policy Coordination CNSC Canadian Nuclear Safety Commission COG CANDU Owners Group COHERE Canadian Organization on Health Effects from Radiation Exposure CRESP Consortium for Risk Evaluation with Stakeholder Participation CT computed tomography DoD Department of Defense DOE Department of Energy DOE-BER Department of Energy’s Biological and Environmental Research DOE-EM Department of Energy’s Office of Environmental Management DTRA Defense Threat Reduction Agency EMR electronic medical record EPA U.S. Environmental Protection Agency ERR excess relative risk FAIR findable, accessible, interoperable, and reusable GAO U.S. Government Accountability Office GPU graphics processing unit Prepublication Copy xv

xvi Common Acronyms and Abbreviations HHS Health and Human Services HLG-LDR high-level group in low-dose radiation HPS Health Physics Society HRP Human Research Program HTAN Human Tumor Atlas Network HuBMAP Human BioMolecular Atlas Program ICGC International Cancer Genome Consortium ICRP International Commission on Radiological Protection IES Institute for Environmental Sciences IND improvised nuclear device INWORKS International Nuclear Workers Study IoMT Internet of Medical Things IoT Internet of Things ISCORS Interagency Steering Committee on Radiation Standards LANL Los Alamos National Laboratory LBNL Lawrence Berkeley National Laboratory LET linear energy transfer LLNL Lawrence Livermore National Laboratory LNT linear no-threshold LSS Life Span Study MD molecular dynamic MEI maximally exposed individual MELODI Multidisciplinary European Low-Dose Initiative ML machine learning MOU memorandum of understanding MRI magnetic resonance imaging MTA Monitoring and Technical Assistance NASA National Aeronautics and Space Administration NCI National Cancer Institute NCRP National Council on Radiation Protection and Measurements NEA/OECD Nuclear Energy Agency/Organisation for Economic Co-operation and Development NIAID National Institute of Allergy and Infectious Diseases NIEHS National Institute of Environmental Health Sciences NIH National Institutes of Health NIOSH National Institute for Occupational Safety and Health NORM naturally occurring radioactive material NSF National Science Foundation NSTC National Science and Technology Council OMB Office of Management and Budget ORNL Oak Ridge National Laboratory OSHA Occupational Safety and Health Administration PAG Protective Action Guide PDE partial differential equation PET positron emission tomography PNNL Pacific Northwest National Laboratory Prepublication Copy

Common Acronyms and Abbreviations xvii PSC posterior subcapsular PTM post-translational modifications PUMA Pooled Uranium Miner Analysis QALY quality-adjusted life year QST National Institutes for Quantum and Radiological Science and Technology RadBio-AI radiation biology research using artificial intelligence and machine learning RDD radiological dispersal device REAC/TS Radiation Emergency Assistance Center/Training Site REB Radiation Epidemiology Branch RECA Radiation Exposure Compensation Act REE rare earth element RERF Radiation Effects Research Foundation REVCA Radiation-Exposed Veterans Compensation Act RNCP Radiation and Nuclear Countermeasures Program SPEERA Secretarial Panel for the Evaluation of Epidemiological Research Activities TCGA The Cancer Genome Atlas TCR T-cell receptor TEI-REX Targeted Evaluation of Ionizing Radiation Exposure TENORM technologically enhanced naturally occurring radioactive material UNSCEAR United Nations Scientific Committee on the Effects of Atomic Radiation U.S. NRC United States Nuclear Regulatory Commission USCG United States Coast Guard VSL value of a statistical life WMD weapon of mass destruction Prepublication Copy

   

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Radiation exposure at low doses (below 100 milligray) or low-dose rates (less than 5 milligray per hour) occurs in a wide range of medical, industrial, military, and commercial settings. The effects of exposure at these levels are not fully understood, but there are long-standing concerns that such exposure could negatively affect human health. Although cancer has been linked to low-dose radiation exposure for decades, there is increasing evidence that low-dose radiation exposure may also be associated with cardiovascular disease, neurological disorders, immune dysfunction, and cataracts.

Recent advances in research, new tools, and a coordinated multidisciplinary research program could help fill knowledge gaps about the health impacts of low-dose radiation exposures. This report calls for the development of a U.S. research program to study how low doses of radiation affect cancer, cardiovascular disease, neurological disorders, and other disease risks. Research should also better define the impacts of radiation doses, dose rates, types of radiation, and exposure duration. The report estimates $100 million annually for the next 15 years would be required to conduct epidemiological and biological research, and to establish an infrastructure for research.

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