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2 Low-Dose Radiation Exposures and Health Effects
Pages 31-74

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From page 31...
... population. These are natural radiation sources, medical applications, occupational exposures, nuclear power routine operations and accidents, nuclear or radiological incidents, exposures from the nuclear weapons program, and nuclear waste.
From page 32...
... Population, Communities, Patients, or Workers, Following Different Exposure Sources Approximate Approximate Exposure Source Size of Exposed Annual Effective (exposed population) Population Dose Today Route of Exposurea Natural Sources (general U.S.
From page 33...
... 2.1 LOW-DOSE RADIATION SOURCES AND EXPOSURES The following sections illustrate common low-dose radiation sources and exposures to the U.S. population.
From page 34...
... Noncardiac 4 millionc 0.13 mSvc External interventional fluoroscopy Nuclear medicine 13.5 millionc 0.32 mSvc Internal (injection, inhalation, ingestion, absorption) Occupational Exposures Medical personnel, 3.86 milliond 0.6–3.1 mSvd External, internal commercial nuclear (inhalation, ingestion, and workers, DOE absorption)
From page 35...
... Radiation Information X-ray Acute -- Benefit-risk balance for a X-ray Acute -- procedure; need for regulation of patient doses or tracking of X-ray Acute -- exposures; communications X-ray Acute -- Alpha, beta, Acute Technetium-99; gamma iodine-123, -125, -129, and -131; xenon-133; iridium-192; actinium-225; astatine-211; fluorine-18; gallium-67; yttrium-90; radium-223, -224, and -225; ruthenium-106; lutetium-177 X-ray; alpha, Protracted Potassium-40; Revision of exposure limits for beta, neutron, uranium-238, radiation workers; informing and gamma -235, and -234; dose calculators for aircrews; and the decay setting exposure limits for aircrew; products of radiation compensation policies; uranium, such communications as thorium-232, -230, and -228; radium-224 and -226; and radon-220 and -222 Galactic cosmic; Acute or -- solar particle protracted events continued
From page 36...
... 36 REVITALIZE LOW-DOSE RADIATION RESEARCH IN THE UNITED STATES TABLE 2.1 Continued Approximate Approximate Exposure Source Size of Exposed Annual Effective (exposed population) Population Dose Today Route of Exposurea Nuclear Power Under 1 million within 5 <<0.01 mSv Internal (inhalation, Routine Operations miles; more than ingestion)
From page 37...
... Radiation Information Alpha, beta, Protracted Carbon-14; Acceptability of nuclear power gamma cobalt-60; and current and new reactor tritium; technologies; decommissioning; iodine-129 and implementation of permanent -131; krypton-85; solution for nuclear waste storage xenon-135; and disposal; emergency planning cesium-137 zoning; communications Alpha, beta, Acute and Incident- Appropriate protective actions; gamma protracted dependent but remediation and reoccupation depending on could involve activities; communications radiological americium-241; incident cesium-134 and -137; cobalt-60; iodine-129 and -131; plutonium-238, -239, and -240; polonium-210; strontium-90; uranium fission products; activation productsf Alpha, beta, Acute and Uranium-238, Dose reconstruction; radiation neutron, gamma protracted -235, and -234; compensation policies; plutonium-238, communications -239, and -240; iodine-129 and -131; americium-241; strontium-90; tritium; cesium-137; carbon-14; fission products; activation products continued
From page 38...
... ) is due to external exposure from terrestrial gamma and cosmic radiation and approximately half is due to internal exposure by inhalation of radon progeny and ingestion of radionuclides.1 Radiation exposure from natural sources varies globally and within a country depending on the geology and altitude where people live.
From page 39...
... Radiation Information Alpha, beta, Protracted Cesium-137; Cleanup activities; communications neutron, gamma strontium-90; technetium-99; tritium; plutonium-238, -239, -240; curium-242; fission products; activation products (nickel-63) effective dose to the populations due to background radiation is above 20 mSv are considered high background areas (Hendry et al., 2009)
From page 40...
... . Better designed nationwide registry-based studies of background radiation in the United Kingdom, France, Germany, and Switzerland have resulted in conflicting results with some showing an association of childhood leukemia and gamma radiation exposure (Kendall et al., 2013; Mazzei-Abba et al., 2021)
From page 41...
... Rare Earth Element and Lithium Mining New natural radiation exposure sources are becoming of concern for populations in the United States, notably the possible pollutants or 4 See https://cfpub.epa.gov/roe/indicator.cfm?
From page 42...
... REEs have become increasingly important resources for modern technological applications including those that support clean energy transition such as cellular telephones, computer hard drives, electric and hybrid vehicles, flat-screen monitors and televisions, and permanent magnets used for motors and wind farm operations. Similarly, demand for lithium, a key component of batteries used in hybrid and electric cars, is also increasing (Graham, 2021)
From page 43...
... population to radiation from medical diagnostic procedures increased sevenfold, primarily due to increased use of CT and nuclear medicine (NCRP, 2009a) , making it the biggest human-made source for radiation exposure to the U.S.
From page 44...
... . Globally, it was estimated that 1 million patients per year are exposed to cumulative effective doses of more than 100 mSv due to medical diagnostic procedures (Brambilla et al., 2020)
From page 45...
... For optimization, exams should use the lowest dose possible to achieve the desired clinical outcome. Despite these principles and several campaigns that reinforce them, including the Image Wisely and Image Gently campaigns,9 there are concerns about overutilization of medical diagnostic procedures such as CT scans.
From page 46...
... Currently there is a general resistance among medical professional organizations in the United States to track radiation exposures from medical diagnostic procedures for the purposes of patient dose and risk assessments (AAPM, 2021)
From page 47...
... These studies are important because the doses received have been accumulated as many low doses of radiation over protracted periods, often many years (Rühm et al., 2022) , and therefore are more relevant to public exposures compared to, for example, the higher and acute doses received by the Japanese atomic bombing survivors.
From page 48...
... radiology Breast 66,915 1,922 37 0.07 −0.005 Preston et al., technologists cancer mGy to 2016 0.19 U.S. nuclear Cancer 119,195 10,877 20 0.01 −0.02 Schubauerworkers mortality mSv to Berigan et al., 0.05 2015 UK national Cancer 167,003 13,985 25 0.012 0.005 Haylock et al., registry of incidence mSv to 2018 radiation 0.02 workers French Cancer 59,004 2,536 26 0.04 −0.04 Fournier et al., nuclear mortality mSv to 2016 workers 0.13 INWORKS Cancer 308,297 17,957 21 0.05 0.018 Richardson et mortality mGy to al., 2015 0.079 Million Cancer 135,193 8,445 52.6 0.01 –0.03 Boice et al., 2021 Person Study mortality mGy to (analysis 0.05 restricted to subpopulation of nuclear power plant workers)
From page 49...
... Radioactive sources from the life cycle of nuclear power plants stem from uranium mining, milling and mill tailings, power plant operation, and nuclear waste.13 Nuclear energy facilities are subject to and must comply with multiple engineering, regulatory, 12 See https://www.epa.gov/radiation/tenorm-oil-and-gas-production-wastes. 13 Other (non-nuclear)
From page 50...
... EPA sets the permissible annual dose equivalent to individual members of the public from a nuclear power plant at 0.25 mSv in a year but the U.S. NRC estimates that the average dose to members of the public living within a 50-mile radius of a nuclear power plant is much lower, about 0.0001 mSv.14 Populations living near nuclear facilities have expressed concerns about risks to their health from releases during routine operations of these facilities.
From page 51...
... In addition to concerns about health effects from nuclear power plant operations that need to be addressed, uncertainties about risks from low doses such as those resulting from routine nuclear power plant operations create major challenges to the U.S. government about the acceptability of nuclear power and its future in the country's energy mix.
From page 52...
... . Social stigma and self-stigma are well-documented consequences of radiation exposure among survivors of the Fukushima accident as well as among the Japanese atomic bombing survivors (Amano et al., 2021)
From page 53...
... . 2.1.5 Nuclear or Radiological Incidents The dose to affected populations and potential health impacts of a nuclear or radiological incident depend on a number of variables including the type of incident (i.e., a nuclear power plant accident, an unintentional radiation release from a radioactive source, or attack by terrorists using a radiological dispersal device [RDD]
From page 54...
... (2015) used the loss-of-life-expectancy measure to compare the risks of evacuation with the risks of radiation exposure caused by staying among nursing home residents and the staff members who cared for them following the Fukushima accident.
From page 55...
... According to the letter, the Government of Japan raised the public dose limit in the Fukushima Prefecture from 1 mSv per year to 20 mSv per year and stopped providing housing support to evacuees who refuse to return. The evacuees, however, especially those with small children, are concerned about risks associated with radiation exposures.
From page 56...
... Disagreement within the radiation community about health risks at low doses of radiation and the generally complicated terms and units used by experts to describe exposure may give the appearance of inconsistent public messaging and ultimately lead to loss of trust in those who deliver it (NASEM, 2019b)
From page 57...
... . The nuclear weapons program also resulted in radiation exposures to people employed in uranium mining and milling enterprises and their families from inhaled radon progeny and other hazards in the mines.
From page 58...
... DOE (2020a) found "no evidence to suggest that the containment structure represents a significant source of radiation exposure relative to other sources of residual radioactive fallout contamination on the atoll." The Marshallese government rebutted DOE's finding and noted that the agency is "downplaying" the risks and is declining to take responsibility for Runit Dome and its leaking contents.24 Human health studies on the impacts of nuclear weapons program activities are generally few and have inherent uncertainties, having been conducted decades after the initial exposures occurred when critical data on releases and exposures were often missing or were unreliable because of 23 Stakeholder engagement panel discussion with President Jonathan Nez, Navajo Nation; Jill Jim, Navajo Nation Department of Health; Mary Dickson, representative of downwinders of U.S.
From page 59...
... The Radiation Exposure Compensation Act (RECA, origin 1990; amended 2000, 2002) administered by the Department of Justice provides compensation to civilian onsite participants who were involved in aboveground nuclear weapons tests at various U.S.-owned test sites in the United States and overseas; down winders who at the time of the tests lived in parts of Nevada, Utah, and Arizona designated by RECA; and uranium miners, millers, and ore transporters who worked from 1942 to 1971, the last year of the federal government's procurement of uranium for atomic weapons.
From page 60...
... . • A study showed that the 1945 New Mexico Trinity Test resulted in doses <0.1 mGy for the vast majority of the population in the surrounding area and could be linked with 250 to 1,000 cancers due to radiation exposure from the fallout (Cahoon et al., 2021; Simon et al., 2020)
From page 61...
... . Others have stated that the assumption that even low doses of radiation carry risks make radiation contamination cleanup goals stricter, resulting in extraordinary cleanup costs (Cardarelli and Ulsh, 2018)
From page 62...
... members of the Yakama Indian nation, the Umatilla Tribe, the Wanapum, and the Nez Perce Tribe, and has impacted their cultures as they can no longer use the land for farming, hunting, fishing, or ceremonial purposes.26 Many of the impacted tribes are engaged with the federal government to develop strategies to restore the habitat of the Columbia basin, but unmet milestones and violated agreements27 create issues of distrust. Concerns about health effects from legacy waste continue to be raised by other communities near nuclear facilities that hold legacy waste and are still in the process of remediation.
From page 63...
... In 1978, DOE established the New Mexico Environmental Evaluation Group (EEG) to conduct an independent technical evaluation of the potential for radiation exposure to people near the Waste Isolation Pilot Plant (WIPP)
From page 64...
... As a result, there is increasing interest in the radiation research and radiation protection communities to better understand the risks and mechanisms of radiation effects at low doses and low dose rates. Research into the mechanisms of low-dose radiation effects has the potential to contribute to improved understanding of risks of adverse health outcomes in humans and into the factors that modulate these risks.
From page 65...
... . The key data on these observations derive from the Japanese atomic bombing survivor cohorts for individuals of all ages (see Section 4.5.6)
From page 66...
... of the survivors exposed in utero had died at the end of follow-up, so this cohort is expected to continue to provide valuable information on the effects of in utero exposure and cancer mortality later in life. Long-term excess occurrences of leukemia following in utero exposure in the atomic bombing survivor cohorts have not been observed, but these results need to be interpreted cautiously due to the shorter latency period between radiation exposure and leukemia compared with solid tumors.
From page 67...
... However, the effects of postnatal radiation exposure on neurological disorders including cognitive impairment at low doses and low dose rates are poorly characterized in part because of the difficulty in exploring cognitive deficits in experimental animals and because of the difficulty in discerning the subtle changes that need to be measured at low doses. Studies funded by the National Aeronautics and Space Administration documented some evidence of cognitive dysfunction in rodent systems, predominantly following high linear energy transfer (LET)
From page 68...
... (2020) demonstrated a linear association of Parkinson's disease incidence within the Mayak Worker study31 with cumulative dose from external radiation exposure to the brain above 100 mGy, and the risk estimate increased with increasing dose.
From page 69...
... . However, among the elderly atomic bombing survivors, response to vaccination did not appear to be impaired by radiation exposure early in life (Hayashi et al., 2018)
From page 70...
... (2018) that included data from the Japanese atomic bombing survivors, Chernobyl cleanup workers, medical workers, and radiotherapy patients suggested that the evidence of an increase in cataract formation at doses below 500 mGy was inconclusive.
From page 71...
... . 2.2.6 Heritable Genetic Effects A main concern of populations exposed to radiation, including the Japanese atomic bombing survivors, those exposed to radiation from the Chernobyl and Fukushima nuclear power plant accidents (Suzuki et al., 2018)
From page 72...
... . The investigators discuss that harsh living conditions and the limited socioeconomic resources available to heavily exposed atomic bombing survivors after the war might have led to an overestimate of genetic effects of radiation and suggest that additional insights on radiation and reproduction might be gained by using contemporary genomic methods to compare the DNA of parents irradiated by the bombings with that of their children (Yamada et al., 2021)
From page 73...
... . Today, in the absence of a mechanistic understanding of different low-dose and dose-rate radiation sources and their direct health effects, estimation of risks and decisions related to exposures from substantially different sources are often made using the same generic approach -- by relying on risk estimates derived from higher, acute, external exposures to radiation, largely of the Japanese atomic bombing survivors, and applying appropriate correction factors.
From page 74...
... In addition, this program can identify mechanisms for induction of these health effects, develop improved risk models for doses and dose rates at which direct measure ment of risks is not currently possible, and ultimately develop more individualized risk estimates.


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