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Soirces Effects Amd Riscks Chernobyl ONU Report - 1988 - Report PDF
Soirces Effects Amd Riscks Chernobyl ONU Report - 1988 - Report PDF
AND RISKS
OF IONIZING RADIATION
United Nations Scientific Committee on the Effects of Atomic Radiation
1988 Report to the General Assembly, with annexes
UNITED NATIONS
SOURCES, EFFECTS
AND RISKS
OF IONIZING RADIATION
United Nations Scientific Committee on the Effects
of Atomic Radiation
1988 Report to the General Assembly, with annexes
UNITED NATIONS
New York, 1988
NOTE
The report of the Committee without its annexes appears as Official Records of the
General Assembly, Forty-third Session, Supplement No. 45 (A/43/45).
The designations employed and the presentation of material in this publication d o
not imply the expression of any opinion whatsoever on the part of the Secretariat of the
United Nations concerning the legal status of any country, territory, city or area. or of its
authorities, or concerning the delimitation of its frontiers o r boundaries.
Page
Report of the United Nations Scientific Committee on the Effects of Atomic
Radiation to the General .4ssembly . . .. . . . . . . . . .. . .. .. . . . . ..
. . .. . . . .. . . . .
Scientific Annexes. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . ........
Annex A. Exposures from natural sources of radiation . . . . . . . . .. . ... . . .. .
Annex B. Exposures from nuclear power production . . . . . . . . . . . . . . . . .. .. .
Annex C. Exposures from medical uses of radiation.. . . . . . .. . . . .. . . .. . ...
Annex D. Exposures from the Chernobyl accident . . . . . . . . . . . . .......... .
Annex E. Genetic hazards.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . ....
Annex F. Radiation carcinogenesis in man. . . . . .. . . . . . . . .. . . . . . . . . . . . .. .
Annex G. Early effects in man of high doses of radiation
and Appendix: Acute radiation effects in victims of the Chernobyl
nuclear power plant accident . . . .. .. . . . . . . . .. . . .
Report of the United Nations Scientific Committee
on the Effects of Atomic Radiation
to the General Assembly
CONTENTS
1. This is the tenth in a series of substantive reports Republic of Germany) and A. Hidayatalla (Sudan):
of the United Nations Scientific Committee on the thirty-sixth and thirty-seventh sessions: B. Lindell
Effects of Atomic Radiation (UNSCEAR)" to the (Sweden), K.H. Lokan (Australia) and J. Maisin
General ~ s s e m b l The
~ ~ . preparation of this Report (Belgium). The names of those experts who attended
a n d its scientific annexes took place from the thirty- the thirty-first to the thirty-seventh sessions of the
first to the thirty-seventh sessions of the Committee. Committee in an official capacity as representatives o r
The material of this report was developed at annual members of national delegations are listed in Appendix I.
sessions of the ~ o m m i r t e e based
, on i o r k i n g papers
prepared by the Secretariat that were modified and
3. In approving this Report. and assuming therefore
amended from one session to the next according to the
full responsibility for its content, the Committee
Committee's requests. During the period of prepara-
wishes to acknowledge the help and advice given by a
tion of this K e ~ o r t .which contains seven scientific
small group of consultants who assisted in the
annexes. another Report containing three scientific
preparation of the test and scientific annexes, upon
annexes was completed at the thirty-fifth session of
appointment by the Secretary-General. Their names
the Committee. These two reports, referred to as the
are given in Appendix 11. The) were responsible for
1986 and 1988 R e ~ o r t s .constitute the latest com-
the preliminary reviews and evaluation of the technical
prehensi\e assessment by the Committee of the
information received by the Committee or available in
sources. effects and risks of ionizing radiation.
the open scientific literature, on which rest the final
deliberations of the Committee. Additional assistance
2. The follo\ving members of the Committee served
and financial support for the preparation of some of
as Chairmen, Vice-Chairmen and Rapporteurs, respec-
the scientific annexes were offered to the Committee
tively. at the following sessions: thirty-first session. Z.
by various international and national organizations.
Jaworowski (Poland), D. Beninson (Argentina) and T.
The Committee would like to express its gratitude t o
K u n ~ a t o r i(Japan); thirty-second and thirty-third ses-
these organizations, which are listed in the relevant
sions: D. Beninson (.4rgentina). T. Kumatori (Japan)
annexes.
a n d A. Hidayatalla (Sudan); thirty-fourth and thirty-
fifth sessions: T. Kumatori (Japan), A. Kaul (Federal
4. The sessions of the Committee held during the
OThe United Sations Scientific Comm~tteeon the Effects o i period under review \rere attended b\ representatives
Atomic Radiation was established by the General Asaembl) at of the United Nations Environment Programme
11s tenth sesslon in 1955. Its terms o i reference are set out In (UNEP), the World Health Organization (WHO), the
resolution 913 (X). It was or~ginally composed of the folloulng
Member States: Argentina. Australia. Belg~urn. Hra7il. Canada.
Food and Agriculture Organization of the United
Czechoslovakia. Egypt. France, India. Japan. Mexico. Sweden. Nations (FAO). the International Atomic Energy
Union of S o ~ i e tSocialist Republics. lJnited Kingdom of Great Agency (IAEX), the International Commission on
Britain and Northern Ireland and United States of America. The Radiological Protection (ICRP) and the International
membership of the Committee was subsequentl\. enlarged b) the Commission on Radiation Units and measurements
General .Assembly in its resolution 3154C (XSVIII) to lnclude
Germany. Federal Republic of. Indonesia. Peru. Poland and Sudan. (ICRU). The Comn~itteeLvishes to acknowledge their
By resolution .\/RES/31/6ZB the General .Assembly increased the contributions to the discussions.
membership of the Committee to a maximum of 21 and invited the
People's Republic of China to become a member.
h ~ r e v i o u ssubstantive reports of the United Nation* Sclcnttfic
5 . Reports received by the Committee from Member
Commitlee on the Effects of Atomic Radiation to the General States of the United Nations and members of the
Assembly arc to be foulld in Official Records 01' the General specialized agencies and the International Atomic
.-2ssembly. Thirteenth Session, Supplenlent No. 17 (A/3838): ibid., Energy Agency, as well as from these agencies
Se\,enteenth Session. Supplement So. 16 (A/52161; ibid.. Nineteenth themselves, during the period from 19 .4pril 1986 to
Session. Supplement S o . 14 (A/58l4): ibid.. Twenty-first Session.
Supplement No. I4 (A/63 14): ibid.. Twenty-fourth Session. Supple- 17 June 1988 are listed in Appendix 111. Reports
ment No. 13 (A/7613): ibid.. Twenty-seventh Session. Supplement received before 19 April 1986 were listed in previous
No. 25 (A/8715); ibid.. Thirty-second Session. Supplement 10 Reports of the Committee to the General Assembly.
(A/32/40); ibid.. Thiny-seventh Session. Supplement S o . 45 This information received officially by the Comn~ittee
(A/37/45): ibid.. Forty-first Session. Supplement No. 16 (A/4 1/16).
These documents are referred to as the 1958. 1962. 1964. 1966. 1969.
ivas supplemented by, and interpreted with the help
1972. 1977. 1982 and 1986 Reports. respectivrl>. The 1971 Rrpt>rt of, many other data available in the current scientific
with scientific annexes \vas published as: lonizlng Radlat~on:Levels lirerature or, in a few cases, from unpublished
and Effects. \.'olume I: Le\,els. Volume 11: Effects (United Sations conlmunications by individual scientists
Publication. Sales No. E.72.IX.17 and 18). The 1977 Report w ~ t h
scientific annexes was published as: Sources and Effects of lonl7ing
Radiation (United Nations Publication. Sales No. E.77.1X.I). The 6. In the following Report the Committee summarizes
1982 Report with scientific annexes tvas published as: Ionizing the main conclusions of the specialized studies under-
Radiation: Sources and Biological Effects (United Nations Publica-
tion. Sales No. E.82.IX.X). The 1986 Repon with scientific annexes
taken, also in the light of previously released substan-
was published as: Genetic and Somatic Effects of Ionizing Radiation tive documents. The material is presented a t the most
(United Nat~onsPublication, Sales No. E.86.1X.9). general level possible, in view of the difficult concepts
a n d notation that characterize this field. After a will be issued as a United Nations sales publicationr.
chapter summarizing the developments and trends This practice is intended to achieve widerdissemination
that have become apparent throughout the years, the of the findings for the benefit of the international
highlights and conclusions to be drawn from the most scientific community. The Committee wishes t o draw
recent studies in the fields of radiation physics and the attention of the General Assembly to the fact that
biology are presented. This main text is followed by the main text of the Report is presented separately
the supporting scientific annexes, which are written in from its scientific annexes simply for the sake of
a format a n d a language that are essentially aimed a t convenience. It should be understood that the scientific
specialists. data contained in the annexes are of great importance
because they form the basis for the conclusions of the
7. Following established practice, only the main text report.
of the Report is submitted to the General Assembly,
while the full Report. including the scientific annexes, CUnited Nations Publication. Sales No. E.88.IX.7.
I. HISTORICAL REVIEW
A. GENERAL CONSIDERATIONS radiation that concerns the Committee. the absorption
process consists in the removal of electrons from the
atoms. producing ions. lonizing radiation may be
8. Throughout the thirty-three years of its existence. produced in man-made devices, such as x-ray tubes. o r
the Committee has assertively attempted to provide it may come from the disintegration of radioactive
the best possible estimates of: (a) doses received by the nuclides. the phenomenon that is called radioactivity.
world's population in the past, a n d expected to be While nuclides such as these occur naturally. they may
received in the future, from various natural and man- also be produced artificially. as in nuclear reactors.
made sources of radiation, and (b) risks of induction The two basic quantities in the assessment of radiation
of various types of harm by radiation, both in the levels and effects are the activity of a radioactive
short term and the long term. by individuals directly material and the radiation dose. The Committee uses
receiving such doses or by their descendants over the system of radiation quantities and units adopted in
many generations. 1980 by the International Commission o n Radiation
Units and Measurements (ICRU).
9. With the passing of time and the increase in
number and complexity of the Reports issued by the
Committee, it is becoming increasingly difficult, even 1. Activity
for the specialists, to trace back to earlier publications
the development of the main ideas underlying the 12. The acriviry of a radioactive material is the
Committee's assessments and how these assessments number of nuclear disintegrations per unit time. The
have changed with time and as a result of increasing unit that the Committee used for this quantity u p t o
scientific knowledge. It would seem useful, therefore, and including its 1977 Report was the curie (Ci),
to make available in compact, summary form the which is 37 billion (3.7 10l0) disintegrations per
main conclusions reached in the fields mentioned second, a number which was originally introduced
above. This summary is intended to serve a number of because it is the approximate activity of 1 gram of
purposes. First, it will inform the General Assembly radium-226.
about the Committee's work and its findings. Second,
for the Committee's membership which has been 13. The present unit of activity has been given the
changing gradually over the years, it will form a record special name becquerel (Bq). One becquerel is one
of how the Committee's thinking has evolved. Lastly, it disintegration per second.
will be placed at the disposal of the international
scientific community, for whom UNSCEAR Reports 13. The word radioactivity denotes the phenomenon
a n d scientific annexes have become a basic reference. of radioactive disintegration. It is not a synonym for
"activity", nor should it be used t o mean "radioactive
10. What follows in this chapter is therefore a material".
summary of the Committee's assessments in the fields
of dose estimation (which pertains closely to the
subjects of physics) and risk assessment (which involves 2. Radiation dose
physical as well as radiobiological and medical con-
siderations). It aims at giving an account of both the 15. The term radiation dose can mean several things
general principles underlying the estimates and the (e.g., absorbed dose. dose equivalent o r effective dose
conclusions reached, in a language that is as plain as equivalent). The absorbed dose of radiation is the
the complexity of the subjects allows but without energy imparted per unit mass of the irradiated
much of the discussions supporting the choices made material. Up t o and including the 1977 Report, the
at any particular time. or this, as well as for other Committee used the rad as the unit of absorbed dose
technical and methodological details, reference is (1 rad = 0.01 joule/kg). The present unit of absorbed
made to the Reports to the General Assembly issued dose is joule/kg. for which the special name gray (Gy)
from 1958 to 1986. A complete list of these publica- is used. Thus. 1 rad = 0.01 joule/kg = 0.01 Gy.
tions issued by the Committee appears in footnote b
to paragraph 1 of this Report. Current assessments are 16. Different types of radiation have different Rela-
examined in more detail in the following chapter 11. tive Biological Effectiveness (RBE). The RBE of one
type of radiation in relation to a reference type of
radiation (usually x or gamma) is the inverse ratio of
B. CONCEPTS, QUANTITIES AND UNITS the absorbed doses of the two radiations needed to
cause the same degree of the biological effect for
which the RBE is given.
I I. Radiation is a transport of energy through space.
In traversing material, radiated energy is absorbed. In 17. When the first UNSCEAR Reports were prepared,
the case of ionizing radiation, which is the type of the International Commission on Radiological Protec-
tion (ICRP) had recommended certain values of RBE The potential alpha energy concentration in air is
for the purposes of radiation protection. The absorbed expressed in J/ml or in the older unit, the it-orking
doses of various radiations were multiplied by these l e ~ e l(WL), where 1 WL = 2.08 J/m'. For radon
values to arrive at doses weighted for the purposes of in equilibrium with its decay product, this corresponds
radiation protection (e.g., for comparison with dose to a concentration of 3700 Bq/m3. Exposure to the
limits). The unit of this weighted absorbed dose was decay products is customarily expressed in terms of
called rem. the lc~orking le\'el t?~otzrlr(WLhl) or. as is now also
common, Bq h/m3.
18. The use of the term RBE in two contexts.
radiation protection (where it only meant the standard 23. In the 1958 R e ~ o r tof the Committee. the word
values recommended by ICRP) and in radiobiology "dose" was used loosely, and the quantity meant had
(where it meant the most likely value in a given to be inferred from the units used (roentgen. rad or
exposure situation for a specified biological effect), rem). In the UNSCEAR 1962 Report, doses \\.ere
caused some problems. ICRP and ICRU therefore sometimes ex~ressedin rad. sometimes in rern. How-
decided to establish a new quantity, the dose equivalenr. ever, in the next five Reports (up to and including the
This would be the product of the absorbed dose and a 1977 Report), the approach \vas more stringent. The
so-called quality factor (first denoted QF and later Q), absorbed dose was used consistently and the dose
and its unit would be the rem. The quality factor \stas equivalent \vas deliberately avoided. The main reason
given by ICRP as a function of the capacity of each fir this was that one use of the physical and biological
radiation to produce ionization, expressed as the information was to provide a basis for estimates of
linear energy transfer (LET). For practical applica- RBE and therefore also to evaluate the appropriateness
tions, ICRP suggested that it would sufiice to use of the recommended values for Q. To present doses as
approximations of average values, i.e.. one unique dose equivalents would have been to beg the issue.
value of QI: (Q) for each type of radiation. It Sometimes, however, exposures had to be expressed in
suggested values of Q = 1 for x rays, gamma rays and roentgen because this was how the original data had
beta particles, Q = 10 for fast neutrons (changed to been presented.
Q = 20 in 1985). Q = 10 for alpha particles (changed
to Q = 20 in 1977), and Q = 20 for heavy particles. 24. With the UNSCEAR 1982 Report, the practice
The Committee has also used these factors but changed. The Committee had gradually become more
continued to use Q = 10 for fast neutrons. concerned with risk estimates and was not satisfied
with merely reporting levels of absorbed dose. One
19. In the UNSCEAR Reports, when doses are reason for this was the growing evidence that radon
expressed in rern, the ICRP values of "RBE (protec- daughter products caused lung cancer and that these
tion)", Q F or Q have been used in most cases. daughter products were present in high concentra~ions
however, when authors express doses in rem, they may in dwellings. Previously. dose contributions from
have used the primary, LET-related definition of QF types of radiation with RBEs other than unity had not
(Q). been considered important and the presentation of
absorbed doses was thought to be sufficient. Noiv, the
20. When the Committee began in 1982 to apply the situation was different. While i t was recognized that
new international unit system and the absorbed dose the dose equivalent was a quantity designed for
was given in Gy instead of rad. the new unit for dose radiation protection and that the Q values recommen-
equivalent was named the sieverr (Sv). ded by ICRP might differ from the true values of
RBE, the dose equivalent was still believed to give a
2 1. In addition to absorbed dose and dose equivalent. better indication of risk than the absorbed dose.
there is a third quantity that may be meant when an
author speaks of radiation dose, namely. the e.rposure.
Exposure is the total electrical charge of ions of one 3. Development of dosimetric concepts
sign produced in air by electrons liberated by x or
gamma rays per unit mass of irradiated air. Since the 25. Paragraphs 25-4 1 review historical development
exposure is a measure of the ionization that x- or of other concepts and quantities used by the Com-
gamma-radiation would produce in air. it is therefore mittee. When the UNSCEAR 1958 Report was issued.
only applicable for those types of radiation. The unit two biological effects were prominent: leukaemia and
of exposure is couiomb/kg, but the old unit, the hereditary harm. For that reason, priority was given
roenrgen ( R ) is still in use. One roentgen is equal to to calculating dose in the red bone marrow and
2.58 lo-" coulomb/kg. The word "exposure" is also gonads. In the case of dose in the gonads, it was
used in this Report in its common meaning of being obvious that the dose would be relevant to risk
exposed to something, e.g., a radiation source. assessment only if it were calculated for individuals
young enough to expect children. In the case of dose
22. In this latter meaning, the exposure to radon in the bone marrow, the question arose whether the
decay products can be expressed in two different ways: mean dose or the peak dose would be relevant; the
as the amount of inhaled decay products, taking into ensuing discussion led to the concept of mean marrow
account their potential to emit radiation energy, or as dose.
the product of the time during which the decay
products were inhaled and their concentration in the (a) The genericall)+sign rficanr dose
inhaled air. The potential alpha energy of the inhaled 26. I t was realized early that for most populations
decay products may simply be expressed in joule (J). the medical uses of x rays were the main source of
man-made exposure. However, dose distribution within the per caput dose rates delivered to the world's
a patient is very uneven, so the dose assessment is not population as a result of a specific practice, e.g., a given
easy. In addition, the age distribution in exposed series of nuclear explosions. The actual exposures may
patient groups differs from that in the general occur over many years after the explosions have taken
population. T o solve these problems, the Committee place and may be received by individuals not yet born
derived the concept of generically significao dose at the time of the explosions." This definition was
(GSD), defining it as "the dose which. if received by repeated in subsequent Reports and a stricter mathe-
every member of the population, would be expected to matical presentation was given in 1969 and 1977. It
produce the same total genetic injury to the popula- should be mentioned that when the integration of the
tion as d o the actual doses received by the various average dose rates is carried out not to infinity but
individuals". On the basis of this definition, the only to some specified time, one is dealing with
Committee developed a formula and an assessment truncated dose commitments.
procedure for estimating the genetically significant
dose from various types of x-ray examinations. This is (dl CoNecrive doses and collecrive dose commitnrents
described in detail in the 1958. 1962 and 1972 Reports.
3 1. The use of the dose commitment concept did not
(b) The mean nrarrolcvdose carry any implication of assunlptions with regard to
the dose-response relation at the low doses of radiation
27. Assuming that the mean dose in the active (red) that were assessed for the environmental contamina-
bone marrow would be the quantity relevant to tion; it was merely a mathematical device for adding
assessing the leukaemia risk and using information on inevitable dose contributions.
the distribution of active marrow in the skeleton. this
quantity was assessed for various types of x-ray 32. Another concept is the collecrive dose. Assuming
examinations. While it was recognized that this would a proportionality between dose increments and result-
not be the relevant quantity if the dose-response ing increments in the risk of harm, the expected
relationship was non-linear or showed a dose threshold. number of harmfully affected individuals would be
it was equally clear that if the relationship was linear proportional to the collective dose, since the latter is
and showed no threshold. yet another quantity, the defined as the product of the number of exposed
per cuput mean marrow dose in a population would be individuals and their average radiation dose. Before
of interest, and this quantity was assessed in the 1977, the Committee hesitated t o assess collective
UNSCEAR 1958 Report. doses. because doing so would have implied an
unproven dose-response relation. In its 1977 Report,
(c) The dose contt~~irntent however, the Committee assessed collective absorbed
doses from \,arious sources and practices. Where a
28. Nuclear test explosions in the atmosphere intro-
practice was expected to cause exposures over future
duced time elements that made this source of radiation
years, the collecrive dose conrrnirn~enr was assessed.
different from, for example, medical exposures. in the
This is simply the total collective dose expected from a
sense that the period of practice and the period of
given practice over all future time.
exposure were different. After each nuclear explosion.
some long-lived radionuclides were released that will (e Transfer coefficienrs
persist in the biosphere for many years, causing
radiation exposures. T o have presented the annual 33. Dose commitments from practices causing environ-
doses caused by the tests that had been carried out up mental contamination are proportional t o the amount
to the time the UNSCEAR 1958 Report was drafted of the relevant radionuclides that have been released
would not have given the full picture: namely, it into the environment. Thus, the assessment involves
-
would not have shown that the contamination was the study of a chain of events starting from the
expected to last for a long time, thus committing primary injection of radioactive material into, for
mankind to exposures in future years. The situation example, the atmosphere and ending with the eventual
was described by diagrams in the UNSCEAR 1958 irradiation of body tissues. This chain of events can be
Report. These diagrams showed the doses to be represented schematically:
expected under various assumptions about the period lnhalarton
of future resting.
Input - Atmosphere - Earth's surface - Diet - Tissue - Dose
29. In the UNSCEAR 1962 Report, the Committee
introduced the concept of dose commirmenr. The dose
commitment from one year of practice is the sum of
(0) (1)
a)
(?I
Exlcrnal ~rradia~ion
57. In 1970. the world-wide total installed capacity 60. The problem posed b radon \vas recognized
for generating electric energy in nuclear reactors was more clearly in the UNSCEAR 1982 Report, \\here
about 20 GW. Over the next ten years. nuclear electric the effective dose equivalent was calculated. The
generation increased by more than 10 G W installed various steps in the fuel cycle were together estimated
capacity per year, to reach 144 G W in 1981. This to cause 5.7 man Sv/GW year (0.57 man rem/M\ir
rapid introduction of nuclear power on a large scale year), excluding global distribution. About 2 man
warranted assessments by the Committee starting with Sv/GW year were estimated to be caused by global
its 1972 Report. Facing a situation similar to that distribution from tritium and krypton-85. Occuparional
which i t had faced with the nuclear explosions, the exposure was estimated to contribute somewhat less
Committee realized its assessment of future doses than 30 man Sv/GW year. The total estimate was
would depend on the assumptions it made about the therefore about 35 man Sv/GW year (3.5 man rem/MW
continuation and extension of the practice of nuclear year), somewhat lower than the 1977 estimate.
energy generation. It is interesting to note that. at that
time, the projections for expansion which the Com- 61. In addition, however, the Committee expected a
mittee quoted were an order of magnitude higher than contribution from the very long-lived radionuclides
turned out to be the case. carbon-14 (half-life 5,700 years) and iodine-129
(1.6 lo7 years): from radon emanation primarily
58. Thus. in addition to assessing of dose commit- controlled by thorium-230 (8 l ( r years); and from
ments and collective dose commitnients per year of long-litred actinides leaking from high-level waste
practice at the current rate, the Committee therefore repositories. With the exception of carbon-14. these
also estimated these quantities per unit of electric nuclides were not expected to cause any significant
energy produced, i.e.. per M W year. The main cumulative collective dose over any 1000-year period
contributions to the collective dose commitment were (carbon-14, however, u~ouldgive 10 man Sv/GW year
believed to come from global contamination by during the first 100 years). But. over 1 million years.
tritium and krypton-85 released during the reprocess- assuming a world population of lot0 persons, the
ing of spent fuel and from local exposures near the collective dose from the long-lived radionuclides was
power stations. The total was assessed a t about 0.4 estimated a t about 3.400 man Sv/GW year:
Radon from mill tailings 2,800 and the reduction of fluoroscop~time. This. in effect.
Uranium from mill tailings 460 was a protection recommendation, released before
Carbon- 14 110 ICRP had issued any special recommendations on the
High-level waste 30 protection of patients.
Iodine- 129 28
66. Medical exposures were next reviewed in the
The corresponding doses to any one individual over a UNSCEAR 1971 Report. The emphasis was still on
lifetime would be negligible. e,g.. conipared to the the genetically significant dose, and the values now
doses from natural background radiation, the large assessed ranged from 5 to 75 mrad per year. although
numbers being due merely to the long time periods. It the number of x-ray examinations was reported to
is not a scientific question to what extent exposures have increased by between 2 and 6 per cent per year.
over such time periods are relevant in decision-making. The Committee felt that. finally, enough information
was available from industrialized countries to provide
62. Using the concept of incomplete (truncated) dose a basis for attempting to eliminate unnecessary ex-
commitment and assuming future annual nuclear posures. I t noted that a large proportion of the world
energy generation of 10,000 GW years. the Committee population did not have easy access to modern x-ray
finally projected the annual per caput effective dose facilities and the health benefits they would provide.
equivalent t o be 25 microsievert i.e.. about 1 per cent
of the annual dose from natural background radiation. 67. In the UNSCEAR 1977 Report. the Committee
discussed the problems of comparing doses from
esposures t o sources as diverse as natural radiation.
1. Medical esposures nuclear explosions, nuclear power production a n d
medical exposures. With regard to the latter, the
63. In 1957, when it was preparing the UNSCEAR organ doses caused by diagnostic radiology range
1958 Report, the Committee issued an important from a few niillirad to a few tens of rad and are
statement: "It appears most important . . . that usually delivered at high dose rates. The dose distribu-
medical irradiations of any form should be restricted tion is uneven, both within the body and in the
t o those which are of value a n d importance, either in population. Moreover, the emphasis that had so far
investigation or treatment. so that irradiation of the been put on the genetically significant dose might have
population may be minimized without any impairment hidden the possibility of substantial exposures of other
of the efficient medical use of radiation." The state- organs. so the Committee extended its assessments to
ment also solicited further information on medical include organs other than the gonads and the active
exposures, which were recognized to constitute a bone marrow.
substantial proportion of the total radiation received
by mankind. 68. In its attempts to find bases for dose compari-
sons. the Committee looked for, but failed to find, a
64. In the UNSCEAR 1958 Report. the Committee satisfactory way of combining doses to various organs
gave priority to the assessment of genetically significant into some weighted whole-body dose that would be of
dose. It was realized that the highest genetically relevance in cancer risk assessments. As a compromise.
significant doses were caused by diagnostic x-ray in the UNSCE.4R 1982 Report, the Committee decided
exposures, which, at that time, were frequently carried to assess the effective dose equivalent, which, in spite
out with fluoroscopy rather than with radiography. of its shortcomings, best suited its purposes.
Diagnostic procedures were classified into 23 types,
and the exposure data for these were presented for a 69. The 1982 assessment confirmed that medical
few countries. permitting comparisons of doses between esposures constitute the largest man-made contribu-
the various procedures. In addition, crude estimates tion t o radiation doses received by the population a n d
were made of the per caput mean marrow dose from that in some industrialized countries. this contribution
these procedures. More than 80 per cent of the approaches the dose received from natural sources.
genetically significant dose was found to be contributed However, the Committee reminded the reader that
by only six o r seven procedures, which together made medical exposures differ from other man-made ex-
up only about 10 per cent of all procedures. The data posures in that the practice directly benefits those who
indicated that it might be possible to reduce the doses are exposed. The yearly number of diagnostic x-ray
considerably, simply by careful attention to techniques. examinations was now found t o vary between 300 a n d
The total genetically significant dose from x-ray 900 examinations per year and per thousand inhabi-
procedures ranged from 17 t o 150 mrem per year in tants in industrialized countries. excluding mass sur-
the various national estimates. veys and dental examinations. X-ray examinations
contribute the major portion of the collective effective
65. In the UNSCEAR 1966 Report, the Committee dose equivalent from medical procedures; radiation
continued its review of the national data that had been therapy and nuclear medicine contribute only a minor
submitted. Detailed data were available from 12 coun- portion.
tries. The results were similar t o those in the UNSCEAR
1958 Report. The values of the genetically significant 70. The Committee expressed disappointment that
doses now assessed ranged from 7 t o 58 mrem per very little information was available for the two thirds
year. Ways of reducing patient doses were discussed, of the world's population that live in countries where
a n d the most effective protective measures were listed, radiological examinations are an order of magnitude
such as the use of the smallest possible radiation field less frequent than in the more developed countries.
For developed countries, the Committee estimated the distribution of doses within the exposed occupational
annual collective effective dose equivalent from medical groups was mostly log-normal, and on this basis a
procedures at about 1000 man Sv per million of reference dose distribution was defined. T o avoid the
population, i.e.. about 50 per cent of the exposure problems of determining the actual number of workers
from natural sources. exposed and therefore, also, average doses, the Com-
mittee emphasized collective doses, the values of
which would be largely independent of the administra-
5. Occupational exposures tive requirements on the degree of monitoring. The
Committee also calculated the fraction of the collec-
7 1. The Committee discussed occupational exposures tive dose accounted for by annual individual doses
in the UNSCEAR 1958, 1972. 1977 a n d 1982 Reports exceeding 1.5 rad. The submitted data were analysed
a n d pointed out repeatedly that the data that had been on this basis. For most occupations, the mean dose
submitted were, for a number of reasons, difficult to b a s was 0.1-1 rad per year. A detailed mathematical
analyse. The doses reported are those measured description of the log-normal distribution and of the
by personal dosimeters, a n d the quantity measured reference distribution was given. The collective dose
depends on both the type of dosimeter and on its from each step of the nuclear fuel cycle was calculated,
calibration. These recorded doses depend on the with the doses from all steps adding up to about
location of the dosimeter on the body. and it must be 4 man rad/MW year (see section I.C.3). The collective
assumed that they approximate a uniform whole-body absorbed dose in the lungs of uranium miners was
dose. The number of persons occupationally exposed es~imatedto be 0.1 man rad/MW year, and examples
is not the same as the number of persons monitored, of high radon levels in non-uranium mines were
the difference depending on national requirements for reported.
radiation monitoring. The objective of most monitor-
ing programmes is not to provide data for purposes 75. In its 1982 Report. the Committee continued the
such as those of the Committee, but to check that analysis on the basis of more data. It noted with
authorized dose limits are not exceeded. So-called satisfaction that its 1977 proposal for methods of
investigation levels are usually applied, below which analysis had been adopted by several organizations
doses are ignored or recorded as zero. Little informa- and that the arrangement of submitted data had been
tion is therefore available for the low-dose region. influenced by the proposal, thus facilitating the
analysis. However, the Conlmittee now found that its
72. The treatment of the subject in the UNSCEAR suggestion of a reference radiation dose distribution
1958 Report tvas brief. The number of workers in the had sometimes been misinterpreted, so it limited its
medical field in countries that had submitted data was presentation to the average dose, the collective dose
estimated to be between 0.2 and 0.7 per thousand of and the fraction of the collective dose exceeding
the total population. The treatment of occupational 15 mSv (corresponding to the previous 1.5 rad).
exposures in the UNSCEAR 1962 Report was brief as
well. The number of dental workers was found to be 76. For countries with a high standard of medical
about twice the number of medical tvorkers, while the care, medical workers were found to receive a collec-
number of persons occupationally exposed in indus- tive dose equivalent of about 1 man Sv per million of
tries o r in research was substantially lower. The population. The number of workers in the nuclear
contribution of occupational exposures to the annual industry had increased substantially since 1977.
genetically significant dose was estimated at 0.2-0.5 Occupational exposures in each step of the nuclear
mrem. fuel cycle were assessed more fully, indicating that the
total collective effective dose equivalent might be near
73. At the time of the UNSCEAR 1972 Report. there 30 illan Sv/GW year (3 man rem/MW year). However,
was still very little published data on occupational half of this came from fuel reprocessing and nuclear
exposures. The number of workers in the medical field research. and it was uncertain whether such high
could now be narrowed down to 0.3-0.5 per thousand contributions should be expected also in the future. In
in the countries for which data were at.ailable, and the reactor operation, the highest exposures were to
total number of persons reported a s occupat~onally maintenance workers and radiation protection staff
exposed was 1-2 per thousand of the total population. during special maintenance operations.
The mean recorded dose for most workers exposed to
radiation was found to be between 0.2 and 0.6 rad per
year, but mean doses as high as 2.7 rad were reported 6. Miscellaneous exposures
from some industrial radiography workers. The annual
dose to cretvs of supersonic aircraft was assessed to be 77. In addition to the main radiation sources dis-
about 1 rem. Occupational exposures in the nuclear cussed thus far, a few other sources were identified by
po\rrer industry were expressed per unit electric energy the Committee as far back as in the UNSCEAR 1958
produced and were calculated to be 2.3 man rad/MW Report. Then. as now, they were referred to as
year (1.6 man rad from fuel reprocessing and 0.7 from miscellaneous sources. Mentioned in the UNSCEAR
reactor operation). 1958 Report were watches with radio-luminescent
paint, television sets that could produce soft x rays
74. In the 1977 Report, an Annex was devoted to and shoe-fitting equipment that used x-ray fluoros-
occupational exposures. For the first time. the Com- copy. None of these sources was expected to cause a
mittee systematically reviewed the purposes and genetically significant dose exceeding 1 mrem per year.
methods of assessment. It was found that the although the shoe-fitting machines could cause high
local doses. The UNSCEAR 1962 Report mentioned commitment of 300,000 man Sv. predominantly from
enhanced cosmic radiation to passengers in aircraft but the use of gypsum in dwellings: the total contribution
considered the dose insignificant. The total genetically from other uses was thought to be only 6,000 man Sv.
significant dose from all miscellaneous sources was
not expected to exceed 2 mrem per year, the largest
contributor to which was radioactive watches. 7. Accidents and incidents
78. In the UNSCEAR 1972 Report, a full Annex 81. The Committee discussed radiation accidents in
dealt with the miscellaneous sources. Incidents. trans- the UNSCEAR 1962, 1972. 1977 and 1982 Reports. In
portation accidents and loss of radioactive material 1969, it reviewed the eight major accidents known to it
were mentioned as additional sources of public ex- at the time; these had caused at least four deaths.
posure. .4 number of radioactive consumer goods Seven of the accidents were criticality accidents (five
were also described. such as radioluminescent time- in the United States, one in the USSR and one in
pieces and other self-luminous devices, ceramic glazes Yugoslavia). The eighth accident involved pulsed x rays
containing uranium, and thoriated electrodes in weld- from an unshielded electronic tube at a radar station.
ing rods. Radioactive substances in patients released The course of the accidents and the clinical symptoms
from hospitals, pace-makers with nuclear batteries, of the exposed persons u'ere discussed in Some detail.
a n d demonstration materials in schools were also men-
82. In the 1972 Report. accidents were treated only
tioned. Television sets were again discussed, particularly briefly. The Committee noted that about 100 incidents
the colour ones. whose cathode-ray tubes operate on
in connection with the transpon of radioactive material
higher voltages. Finally. it was recognized that enhanced
had been reported throughout the world from 1954 t o
levels of natural radiation could cause problems, as,
1968. There had been fourteen accidents involving
for example. d o radioactive building materials. In
aircraft carrying nuclear weapons o r components of
later Reports this would become an important topic,
nuclear weapons. TWO nuclear submarines had dis-
no longer treated as a miscellaneous source.
appeared, and a plutonium-238 isotopic generator had
burned up in the upper atmosphere. A number of
79. In the UNSCEAR 1977 Report, the miscellaneous
incidents had also been reported wherein radioactive
sources were discussed in an Annex dealing with
material had been lost or stolen. An analysis of 115
technologically enhanced levels of radiation. One of
radium incidents occurring from 1966 to 1969 showed
the many consumer products added to the list was
that 55 per cent of the incidents were losses. In
ionization-chamber smoke detectors. However. the
another study of 299 incidents involving the loss o r
discussion centred on enhanced exposures to natural theft of radium. 66 per cent of the sources were
radiation. Enhanced exposures to cosmic rays in
recovered. The same Report also briefly discussed
aircraft, including supersonic transports, and in space-
occupational accidents, showing that they had been
craft, were discussed in detail. Another subject was
particularly frequent in x-ray analytical work and in
public exposure due to natural radionuclides emitted
industrial radiography.
from coal-fired power plants. A third subject was
exposures due t o the industrial use of phosphate 83. In the UNSCEAR 1977 Report, the Committee
products containing uranium-238 and radium: in thih for the first time discussed accidents at nuclear power
case, the exposure pathways were via phosphate plants. In its review of the collective dose commit-
fertilizers and by the use of waste gypsum as a ments from the various steps in the nuclear fuel cycle.
building material. Normal exposures from radioactive the Committee approached the difficult problem of
building materials. whether direct (by gamma-radiation) dose commitments from accidents that had not yet
o r indirect (by radon daughter products), were dealt occurred. Any nuclear power programme is also a
with in the discussion on natural sources. commitment to a certain accident probability, s o in
that sense, the Committee said, there is also an
80. In the UNSCEAR 1982 Report. again. miscel- accident dose commitment.
laneous sources were considered together uith tech-
nologicall> modified exposures to natural radiation. 84. In 1982, the Committee observed that there had
Essentially the same consumer products were discussed so far been only two reactor accidents known to have
as in the previous reports. I t was noted that the caused measurable irradiation of the public: one at a
radium in wrist-watches had now almost entirely been military plant at Windscale, United Kingdom, in 1957.
replaced by tritium. thereby eliminating the external and one at a nuclear power station at Three Mile
exposure and limiting the annual effective dose equi- Island, Pennsylvania. United States. in 1979. The
valent t o the Lvearer from leakage tritium to less than collective whole-body dose from the latter accident
1 microsievert. The average effective dose equivalent had been estimated between 16 and 35 man Sv within
to air passengers passing x-ray fluoroscopic scanners 50 miles, most of i t due to xenon-133. and about of
was estimated to be much lower still, about 7 nano- equal magnitude outside 50 miles. The collecti\~e
sievert per scan. Exposures from coal-fired power plants effective dose equivalent from the Windscale accident
were reassessed and the collective effective dose had been estimated at about 1,300 nlan Sv, of which
equivalent commitment was estimated to average 2 man almost half was due to iodine isotopes and thyroid
Sv/GW year (this is 50 per cent of the local and irradiation. The Committee decided that the probabi-
regional collective dose from the same energy produc- listic approaches, which predict the risk from reactor
tion in nuclear power stations, see Table 6). The 1977 prcgrammes by extrapolating into the future, should
production of phosphate rock was estimated to have not be used as a basis for estimating future compo-
resulted in a collective effective dose equivalent nents of collective dose commitment.
85. In another part of the UNSCEAR 1982 Report, in its early assessments of radiation-induced hereditary
the Committee reviewed information on occupational risk in the 1950s were those that had emerged from
accidents. It tabulated those accidents on which it had the extensive investigations in Drosophila, the pre-
received data or which had been reported in the open liminary results in mammals, particularly the mouse.
literature. The Committee noted that the serious and the sparse human data. Two of these principles
accidents had occurred early in the development of were the following: (a) mutations, induced o r sponta-
nuclear technology and that not one serious accident neous, are generally harmful, and (b) mutations
had been reported in reactor operation since the mid- induced by radiation increase linearly with dose
1960s. Radiation accidents in other industries had without a threshold.
caused one death since 1960; this death occurred in
1975 in an irradiation facility with cobalt-60. As had 89, In the light of new data from studies on male
been noted in the earlier Reports, industrial radio- mice showing that a chronic gamma dose u a s onl?
graphy seemed to have a special potential for accidents. about one third a s effective as the same dose given at
Some severe injuries had occurred when persons a high dose rate (and even more reduced in f e n ~ a l e
picked up lost radiography sources without being mice), the UNSCEAR 1962 Report suggested that the
aware of the danger. previously used doubling dose of 30 roentgen would
probably be too lo\v by a factor of 3 ro 4. With
confirmation and extension of these results and other
data showing that the interval between irradiation and
D. RISK ASSESSMENTS conception had a dramatic effect on mutation fre-
quency in female mice (all mutations were found in
the progen) conceived during the first se\.en weeks
1. Hereditary harm after irradiation), the Committee in 1966 abandoned
the doubling dose approach in favour of other
86. The methods used so far to quantify genetic risk methods, two of which will be mentioned here. In one.
can be broadly grouped under two headings: the the estimated rate of induction of dominant visible
doubling dose (or relative mutation risk) method and mutations in mice (range: to lo-' per locus a n d
the direct (or absolute mutation risk) method. The rad) was multiplied by the assumed number of loci
doubling dose method aims at expressing the risk in determining dominant disorders in man (50-500) to
relation to the natural prevalence of genetic diseases in obtain the total risk (5 to 5 In the other, the
the general population; the direct method aims at esrimated rate of induction of recessive visible muta-
expressing absolute risk in terms of expected increases tions in mice (lo-- per locus and rad) was multiplied
in the prevalence of genetic diseases. Oiving t o the by the estimated total number of gene loci in man
paucity of direct human data on radiation-induced (20,000) to obtain an estimate of total risk from the
genetic damage leading to disease states, the rates of induction of these point mutations (2 The risk
induction for the pertinent kinds of genetic damage to first generation offspring was then computed as a
(mutation and chromosomal aberrations) are based on fraction (2-5 per cent) of the above figure.
experimental data in animals. These rates are con-
verted, using a number of assumptions and reduction 90. In the UNSCEAR 1972 Report the interest of the
factors, into the expected number of additional cases Committee in the doubling dose method was revived
of genetic disease in man. but was given a low profile. The doubling dose was
taken to be 100 rad, and the number of extra cases of
87. T o apply the doubling dose method, one needs: severe hereditary diseases per million live births and
(a) a n estimate of the doubling dose, i.e.. the radiation rad of lotv-LET radiation was estimated to be about 300
dose that will produce as many mutations as those for the irradiation of parental males; of these, six to
occurring spontaneously in a given generation: I5 cases occurred in the first generation and the rest
(b) information on the prevalence of naturally occur- occurred in subsequent generations.
ring genetic diseases in the population and the extent
to which these are maintained by mutation; and (c) an 91. By 1977 new data on the natural prevalence of
estimate of the dose received by the population. Over genetic and partially genetic diseases had been obtained.
the years the doubling dose estimates have been based Furthermore, data that had been obtained in the mid-
o n experimental data obtained in the mouse; the 1960s on the induction of dominant mutations having
prevalence figures for naturally occurring genetic dis- their primary effect in the mouse skeleton had been
eases are those collected in several epidemiological extended in the mid-1970s, demonstrating transmis-
studies. With the doubling dose method, the risk is the sion. By 1982, new data o n the induction of another
product of the prevalence of naturally occurring kind of dominant mutation, namely, those that cause
genetic diseases, the mutation component, the reci- cataracts in the eye of the mouse, became available.
procal of the doubling dose and the dose sustained by All these data allowed the Committee to arrive at
the population. direct estimates of genetic risks. It is worth noting that
from 1977 onwards, both the doubling dose method
88. Over the past three decades, there have been and the direct method have been used.
shifts in emphasis in the use of these methods and
there have also been a number of refinements, as 92. In 1977, using a doubling dose of 100 rad. the
extensively discussed in Annex E. The principles that Committee estimated that, if a population is con-
guided UNSCEAR, as well as other scientific bodies. tinuously exposed to low-LET radiation at the rate of
1 rad per generation, there will be a total of about 185 94. The risk estimates made using direct methods
cases of liendelian, chromosomal and other diseases from 1977 up to 1986, are given in Table 2: they
per million live births at equilibrium. of which about include risks from (a) the induction of genetic changes
one third would appear in the first generation. The having dominant effects in the first-generation progeny
first-generation increase was estimated to be about (i.e., dominant mutations, as well as recessive muta-
one third of that at equilibrium. tions. deletions and balanced reciprocal translocations
with dominant effects) and (b) unbalanced products of
93. These estimates. as well as those arrived at in the balanced reciprocal translocations. which may lead to
1982 and 1986 Reports. are summarized in Table I: congenitally malformed children.
for convenience, they are expressed on a per Sv basis.
It can be seen that (a) for dominantly inherited 95. The first of these estimates (item ( a ) in the
diseases, the estimates have remained essentially un- paragraph 94) is based on dominant skeletal and
changed; (b) the estimates for chromosomal diseases cataract mutations in mice and the second (item (b) in
have become lower, this being a consequence of that paragraph) on primate cytogenetic data. The
having excluded diseases attributable to numerical estimates based on experience in mice d o not include
anomalies (such as Down's syndrome), for which induced genetic changes so severe as to cause death
there is still no good evidence of induction by before they can be detected. It can be seen that the
radiation; and (c) while in 1977 and 1982 the changes in risk estimates from 1977 to 1986 are
Committee had provided estimates of risk for con- relatively small. Furthermore. a comparison of these
genital anomalies and other multifactorial diseases estimates with those arrived at using the doubling
using certain assumptions, in 1986, concerned about dose method (Table 1) for the first generation reveals
persistent uncertainties over the assumptions used, it that they are of the same order of magnitude. in spite
no longer did so. of the different assumptions and reduction factors.
T a b l e 1
Estimates of the rlsk of severe genetlc dlsease per mllllon llve blrths
In a populatlon exposed to a genetlcally slqnlflcant d o s e equlvalent
of 1 Sv per qeneratlon of low-dose-rate, low-dose lrradlatlon,
according to the doubllng d o s e method
(bared on UNSCEAR 1977. 1982 and 1986 Reports)
1977
Autosomal domlnant and X-llnked 10000 2000 10000
Autosomal recesslve 1100 Relatlvely sllght Very slow
Increase
-
1982
Autosomal domlnant and X-llnked 10000 1500 10000
Autosomal recesslve 2500 Relatively sllght Very slow
Increase
Chromosomal
Due to structural a n o m l l e s 400 240 400
Due t o numerlcal anomalles 3000 Probably very small
1986
Autosoma1 domlnant and X-llnked 10000
Autosomal recessive 2500
Chr0m0~0~1
Due to structural anomalies 400 240 400
Due to numerlcal anomalies 3400 Probably very small
-
Note: The derlvatlon of t h e above figures Is glven In Annex E;
see also paragraph 93.
T a b l e 2
Hales remales
-
1977
Induced mutations havlng dominant effects 2000 None gtven
Unbalanced products of lnduced
chromosomal rearrangements 200- 1000 None given
1982
Induced mutatlons havlng domlnant effects 1000-2000 0-900
Unbalanced products of lnduced
chromosomal rearrangements 30-1000 0-300
1986
Induced rnutatlons having domlnant effects 1000-2000 0-900
Unbalanced products of lnduced
chromosomal rearrangements 100-1500 0-500
S u m r y o f t h e Comnlttee's e r t l m a t e s o f f a t a l cancer r l s k c o e f f l c l e n t s
( p e r cent per Sv)
Esttmated t o t a l - 1 .O-2.5
a/ Per year.
h/ Numbers w l t h l n parentheses r e f e r t o t o t a l lncldence. t h e f a t a l \ t y r l 5 k not
having been e s t i m a t e d .
119. Many of the same criteria were used in 1962 in interplay of cell killing and tissue kinetics. and the
classifying the somatic effects into early and late quantitative relationships between them and the time
effects, with the result that effects very different in of appearance and degree of the non-stochastic
nature from tumours and leukaemia, such as lens clinical damage. The most general conclusions drawn
opacification. induction of sterility o r non-specific life by the Committee pertained to the existence of a dose
shortening, ended up being classified together with threshold for the induction of these effects and the
them just because they also appeared late. The variability of this threshold according t o the type of
UNSCEAR 1962 Report contained no important effect. The Annex also contained a detailed analysis of
departures from the generalizations described above, how the dose threshold for each specific type of effect
particularly with respect to the form of the dose-effect would be expected to vary as a function of the
relationships. the uncertainties as t o the precise form important radiobiological variables such as radiation
of these relationships at doses below those tested quality, dose. dose rate, dose fractionation and pro-
directly. and the pronounced dependence of the effects traction.
on the irradiation dose rate.
(b) Pre-natal irradiation
120. Twenty years elapsed between that Report and
the next one. released in 1982, when an extensive 122. The earliest mention that the tissues of the
Annex discussed the non-stochastic effects of radiation embryo and foetus could be particularly sensitive to the
on normal tissues. The new treatment reflected the action of radiation and that the exposure of pregnant
impressive advances in the understanding of somatic mothers might cause teratological effects to be induced
effects that had taken place during the interim. The in the product of' conception dates from the first
very title of the Annex implied that there had been a UNSCEAR Report (1958). Also, the fact that there
re-classification of the effects into the stochastic and are critical periods in development. during which
the non-stochastic. To the first class belong those some structures may be particularly vulnerable t o the
effects for which only the probability of induction is a specific action of internal or external irradiation. was
(linear) function of dose; to the second belong those already recognized at that time. Finally, it also dis-
effects for which severity (as well as probability. for a cussed the shape of dose-effect relationships for effects
given severity) is a (sigmoid) function of dose. The in utero, without specifying the nature of the effects o r
Report discussed mainlv the effects of irradiation of their induction mechanisms, although implying that
single tissues and organs; it reviewed a large body of the relationships would be of the threshold type.
human data interpreted in the light of experience
gained in experimental animals. 123. The UNSCEAR 1962 Report reiterated the
notion of the special sensitivity of embryonic and
121. The Committee considered the nature of these foetal structures, pointing out that minor injuries
effects, their pathogenesis as it results from the during development could be amplified by the growth
of the relevant structures to produce major anomalies. relationships showed that these were mostly curvilinear.
From data on the pre-implanted mouse it was inferred The Committee confirmed its previous risk assessment
that doses of 0.25 Gy to the embryo could be lethal to for mental retardation and suggested. on the basis of
40 per cent of the animals. The Committee also mouse data, that the risk coefficient for the increment
concluded. on the basis of the fairly large set of of embryonic killing soon after fertilization could be
experimental results then available. that irradiation taken at 1 per cent per roentgen.
during major organogenesis ~ o u l cause
d developmental
malformations and that there was a good correspond- 127. From this review the Committee concluded t hat
ence between the malformed structures of animals and although data in man on the induction of malforma-
man for corresponding stages in development. In man. tions by radiation were very scarce, the data on other
malformations were found more frequently in the animal species were s o unanimous and uniform in
central nervous system, the eye and the skeleton. indicating a pronounced sensitivity to such effects that
the human species could not be regarded as a n
124. In the context of a special discussion of the exception. While the Committee found it impossible.
effects of radiation on the nervous system, contained given the paucity of human data, to derive reliable.
in the UNSCEAR 1969 Report, the Committee paid quantitative estimates of risk from pre-natal human
special attention to the damage caused in the brain irradiation at conlparable developmental stages. par-
structures of the developing mammal. I t confirmed ticularly at low doses and dose rates it could on the
that pre-natal irradiation during the time when the basis of experimental animal data exclude that the
relevant structures are undergoing differentiation could sensitivity of the human species might be a factor of
produce severe developmental anomalies. Depending 10 higher than expected.
on the time of the irradiation, specific anomalies
(microcephaly. encephalocele. hydrocephalus) could
be produced in man, probably following thrcshold- 4. Other types of harm
type kinetics as a function of dose. Disorganization of
the cortical architectilre tvas described in animals, 128. At various times and in different Reports, the
accompanied by functional impairment in the form of Committee gave special attention to types of harm not
loss of visual. olfactory and distance discrin~ination. easily classifiable into one of those treated above. One
Other learning processes were impaired in animals such harm is the shortening of life-span, which was
after doses of 1 Gy or more had been administered said in the UNSCEAR 1958 Report to result from a
during the second or third week of pregnancy in rats: number of acute or late radiation-induced changes,
effects o i doses below 0.5 Gy were regarded as both specific, such as leukaemia in radiologists, o r
uncertain. Although changes in conditioned reflexes pathologically diffused in all organs or tissues. These
had been described in animals irradiated near-term latter conditions were thought to accelerate the
with doses as low as 0.01 Gy, the relevance of these normal aging processes and so were termed non-
effects to risk estimation in man was also doubtful. In specific, life shortening.
man, the Committee recognized snlall head size and
the induction of mental retardation as true effects. but 129. The Committee carried out a special study of
i t could not detect any correlation between such the so-called aging effects of radiation and presented
morphological and functional abnormalities and struc- the results in the UNSCEAR 1982 Report. There
tural changes in the central nervous system. The seemed to be insufficient grounds to define aging in
Committee even ventured to derive a risk coefficient precise, biological terms, which would allow postulat-
for mental retardation in the survivors of Hiroshima ing non-specific effects of radiation at low doses and
and Nagasaki: I per thousand a n d rad for doses over dose rates that might cause an animal to prematurely
50 rad deli\.ered at high dose rates. age. The Committee therefore focused on the life-
shortening action of radiation, an effect that can be
125. Recognizing the importance o i keep~ng the more objectively defined. At the doses of greatest
effects of radiation on growth and development under interest for practical purposes. that is, those well
observation because of their relevance to the general below the LD,, range and down to the smallest doses
population and to female workers. the Committee and dose rates. evidence showed overwhelmingly that
undertook another review of this subject in .Annex J irradiated animals live. on the average, fewer years
of the LINSCEAR 1977 Report. This review centred than non-irradiated controls.
on experimental animal data. which was the only
information available, and o n the mechanisms whereby 130. This life-shortening effect has precise relation-
effects are induced in utero: it also described dose-time ships with dose and time. A very large body of
relarionships obtained from the more quantitative evidence in experimental animals allowed the Report
data. to conclude that at low to intermediate doses and dose
rates, life shortening is essentially due to the induction
126. The Annex J of the UNSCEAR 1977 Report of malignancies at a rate above the natural rate
generalized the so-called "periods of maximum sensi- characteristic of the species investigated. This con-
tivity" of the various anatomical structures. to coincide clusion applies to experimental animals and. as far as
with the growth spurt; it also generalized across could be judged from limited human experience, also
species the notion that lethal effects were typical for to man.
the pre-implantation period, teratogenic effects for the
major organogenesis period and growth disturbances 131. In the UNSCEAR 1969 Report. the Committee
for the foetal period. An analysis of the dose-effect presented a special study of the effects of radiation o n
the nervous system. That review also covered aspects system has large, built-in safety factors that allow it to
of morphological and functional disturbances produced withstand and recover from substantial injury by
by irradiation during the pre-natal stages. Irradiation of radiation. The Committee reported that at whole-
the nervous system can cause effects in adults only at body doses around 0.1 Gy, damage to the immune
high doses, in which case there are profound structural system could be obsented but that such damage did
and functional alterations. It was recognized. however, not cause great concern. Whole-body doses higher by
that for doses as low as 0. I Gy or less, reactions of a an order of magnitude could increase susceptibility to
"physiological nature" could be induced. The most infection, while doses of 2 or more Gy could
remarkable finding remained the striking difference in significantly increase the risk of mortality from
sensitivity between the pre- and post-natal stages, the infection. For non-stochastic effects, these conclusions
former being much more vulnerable than the latter. still appear to be valid.
132. The same Report contained a separate Annex 134. Another special study was carried out of the
on the induction of chromosomal aberrations in possible interaction between radiation and other
human germinal and somatic cell lines. The induction agents that are widely distributed in the environment.
of chromosomal aberrations in somatic cells is an This study too, was contained in the UNSCEAR 1982
interesting effect by virtue of its potential use as an in Report. In it, the Committee paid particular attention
vivo dosimeter and its biological significance with to exposure conditions that affect large numbers of
respect to the causation of (or correlations with) people. thereby substantially changing average risk
induction of malignancies. The Annex covered in coefficients.
depth the dose-time relationships for the induction of
chromosomal damage and the variability of aber- 135. The Committee found that for effects of wide
rations as a function of other physical and biological practical significance (induction of cancer, genetic
agents. It concluded that, aside from its practical effects or developmental abnormalities). there was
applications in biological dosimetc. chromosomal little systematic information to substantiate claims of
analysis could be of little use in assessing the risk of non-additive interactions between radiation and other
neoplastic. imniunological or life-shortening effects of agents. The theoretical analyses. which were accom-
radiation. Risk estimates would continue to be based panied by illustrative examples from experimental or
on the observed incidences of the specific clinical epiden~iological work, treated this matter in all its
conditions as a function of dose, a conclusion that complesity: The different natures of the interacting
remains true to this day. agents. their different mechanisms of action, the
different dose levels and the different ways of ad-
133. The UNSCEAR 1972 Report contained a special ministering the doses could all give rise to a variety
study on the effects of radiation on the immune of possible interactions, in the additive. inhibiting or
response wherein the Committee, mostly on the basis synergistic sense. but only one case of synergism
of esperimental data. tried to discuss the role the appeared to be well documented, that between tobacco
immune system plays in the development of early and smoke and radon decay products in uranium miners.
late radiation effects, essentially those of the non- This synergism prevents the direct extrapolation of
stochastic type. The study concluded that the immune findings in the miners to the general population.
136. This chapter describes the Committee's findings constant in space and time and practically independent
and conclusions in its most recent Reports. For the of human practices and activities. This is true, for
most subjects the latest account is the one contained example, of the doses received from the ingestion
in the present (1988) Report, but for some subjects of potassium-40. an element that is homeostatically
that are not reported here, e-g., exposures from controlled and also of doses from the inhalation and
nuclear explosions, the latest account is contained in ingestion of cosmogenic radionuclides, which are
the UNSCEAR 1982 Report. relatively homogeneously distribured over the surface
of the globe. Other contributions depend strongly on
human activities and practices and are therefore
widely variable. The doses from indoor inhalation of
A. RADIATION LEVELS AND DOSES radon and thoron decay products are exan~ples:
building design. as well as the choice of building
1. Natural sources of radiationd materials and of ventilation systems, influences the
indoor levels, so that as techniques and practices
137. The assessment of the radiation doses in humans evolve, the doses received from radon will also
from natural sources is of special importance because change. Between those extreme types of exposure.
natural radiation is by far the largest contributor to there are some intermediate types: external doses from
the collective dose received by the world population. cosmic rays, which are affected by human practices
The natural radiation sources are classified into: and are quite predictable but uncontrollable (except
(a) external sources of extraterrestrial origin (that is, by moving to an area where the dose is lower): doses
cosmic radiation) and radiation of terrestrial origin from the inhalation and ingestion of long-lived nuclides
(that is, the radioactive nuclides present in the crust of of the uranium-238 and thorium-232 decay series.
the earth, in building materials and in air) and which make a small contribution to the total dose
(b) internal sources. comprising the naturally occur- from natural sources and are relatively constant in
ring radionuclides that are taken into the human space; and doses from external irradiation by terres-
body. trial sources, which are also significantly altered by
human activities and practices, especially through
138. Some of the contributions to the total exposure indoor exposure.
from the natural radiation background are quite
dThis subject is reviewed extensively in A n n e x A, "Exposures 139. The Committee has re-assessed the doses received
from natural sources of radiation". globally from natural radiation sources (Table 4). The
T a b l e 4
Source of lrradlatlon
External Internal Total
Cosmlc rays
Olrectly lonlzlng component
Neutron component
Cosmogenlc radlonuclldes
Prlmordlal radlonuclldes:
Potass lum-40
Rubldlum-87
Uranlum-238 serles:
Uranlum-238 t o uranlum-234
Thorlum-230
Rad lum-226
Radon-222 t o polonlum-214
Lead-210 t o polonlum-210
Thorlum-232 serles:
Thorlum-232
Radlum-228 t o radlum-224
Radon-220 t o thalllum-208
25
the year 2000, although still somewhat speculative, 151. To assess the collective doses corresponding to
amount to around 500 GW, a further growth of 80 per the normalized releases. the Committee had previously
cent from present capacity. specified hypothetical sites with broadly representative
characteristics for each stage of the fuel cycle: mining
147. The nuclear fuel cycle includes several steps: and milling, enrichment and fabrication, reactor
mining and milling of uranium ores; enrichment of the operation and reprocessing. The Committee also
isotopic content of uranium-235 for some types of assumed that the environment receiving the releases
reactors; fabrication of fuel elements; production of from each model facility was a hypothetical environ-
energy in the reactors: reprocessing (although this is ment containing the main features of existing sites. so
not always undertaken) of irradiated fuel and recycling that the most common pathways to man are included.
of the fissile and fertile nuclides recovered: transpor- The Committee has used the same models again
tation of nuclear n~aterialsbetween fuel cycle installa- because i t believes they are still adequate for the
tions; and, finally, the disposal of radioactive wastes. purpose and because doing so allows the current
Although most of the radioactive materials associated impact to be compared with the pre\,iously assessed
with nuclear power production are present in the impact of 1974- 1979.
irradiated fuel, small amounts are released K O the
environment in effluents at each of the steps in the 152. Uranium mines give rise to effluents. which
cycle. Most of these releases are only of local and when operating consist mainly of ventilation air in the
regional concern, because the radionuclides have short case of underground mines and of releases into the pit
half-lives and are limited in their environmental in the case of surface mines. Further effluents are
mobility. However, some nuclides, because of their produced during milling operations to extract the
long half-lives or rapid transfer through the environ- uranium. The stockpiles of ore and other extracted
ment. may contribute to the irradiation of man on a materials are the source of airborne emissions when
global scale. the mine is operating, and this source persists even
after the mine has been closed. The tailings that are
148. For each step in the fuel cycle and its associated discharged from the mills also become long-term
release of radioactive materials, the Committee has sources of airborne emissions. The most important
evaluated the doses to workers within nuclear installa- radionuclide in all these airborne releases is radon-
tions and ro members of the public. In its evaluations, 222. Using the same general models as in the
four population groups have been considered: those UNSCEAR 1982 Report doses have been assessed
exposed in normal conditions because of their work both for the operational period and for the long term
within the fuel cycle; the population living within (10' years). Doses from fuel fabrication and transport
about 100 km of the plant; the population within a have also been assessed. but since these are so much
few thousand kilometres; and, finally, the world smaller than the doses from other conlponents of the
population. nuclear fuel cycle. they are not considered separately.
149. The concentrations of radionuclides in effluents 153. During operation of nuclear power stations and
are generally low, and i t is hardly feasible and not reprocessing plants, solid wastes are produced and
practicable to monitor members of the population have to be disposed of. For purposes of analysis, these
for uptake of radionuclides. Instead. environmental wastes have been characterized in terms of volumes
modelling has been used by the Committee to estimate and activity concentrations of important radionuclides
doses at long distances from the plant. The transfer of per unit energy generated. Two typical disposal
radionuclides through environmental media can be facilities of the shallow land burial type were specified
predicted from measured values obtained by monitor- and terrestrial dispersion models used to calculate the
ing foodstuffs and water and from experimental release rates of radionuclides and the resulting effec-
studies. tive dose equivalents.
150. The starting point for environmental modelling 154. The only operating commercial fuel reprocessing
at long distances is data on the quantities and plants are at Sellafield in the United Kingdom and at
composition of radiozctive materials emanating from Cap de la Hague and Marcoule in France. The
various nuclear installations. This information is Committee assessed in the UNSCEAR 1982 Report
usually available to the Committee from those coun- the impact of reprocessing using a notional plant
tries having nuclear power programmes and has been representative of plants that would be reprocessing
collected for the six-year period 1980-1985. Since the oxide fuel in the future. At present the throughput of
size of a particular stage in the nuclear fuel cycle is fuel at the three reprocessing plants represents an
proportional to the nuclear generating capacity served energy output equivalent to about 5 per cent of that
by the stage, the releases have been nornlalized per generated by nuclear power. The Committee has
gigawatt year of generated electric energy, enabling therefore decided to assess the impact of the actual
comparisons to be made and to facilitate the use of reported discharges from these commercial reprocess-
averages over all plants of a similar conceptual design; ing plants and weight the resulting collective doses by
the results are not representative of a specific site, but the fraction of fuel reprocessed to obtain values of
they d o give an idea of the impact of each type of exposure per G W year generated.
facility. Averaging over all energy production and for
all plants of a particular type accounts also for 155. Calculations of collective dose to the world's
releases that may arise during maintenance shut- population and various subgroups require assumptions
downs, when little or no electricity is generated. to be made about the size of these populations, their
dietary and other habits, and agricultural and fishing 4. Medical exposures
practices. The broadly representative values of these
parameters previously used by the Committee have 160. Good data on the frequency of examinations
been retained to evaluate the radiological impact of and absorbed doses from medical examinations come
each stage of the fuel cycle. mainly from the well-developed countries, which
comprise less than 25 per cent of the world's popula-
156. The estimates of collective effective dose equi- tion. There are fragmentary data on examination rates
valent to local and regional populations and to the or number of diagnostic units and little or no data on
global population from widely dispersed radionuclides absorbed doses for approximately another 25 per cent
are given in Table 6. Occupational exposures per GM' of the population. For 50 per cent of the world's
year are approximately three times those received by population there are no data at all. For this reason,
the local and regional population. the Committee has developed a modelling approach
based upon the good correlation that exists in most
countries between population per physician (about
157. Estimates of dose to the public have been which there is more information) and the medical uses
reduced. partly because discharges to the environment of radiation.
from reactors have generally decreased and also the
estimate for carbon-14, which accounts for half the
public exposure from routine reactor releases, is much 161. Access of populations in the world to radio-
lower than the estimate in the UNSCEAR 1982 Repon diagnosis is very uneven: one x-ray machine is shared
due to new, lower measured values ofcarbon- 14 releases by fewer than 2.000 people in some countries and by
from heavy-water reactors. 100.000-600.000 people in other countries. The fre-
quency of procedures is also very uneven: 15-20 pro-
cedures per year are carried out per 1.000 population
158. The annual esposure received by the world's in some countries and 1,000-2.000 procedures per
population from the release of radionuclides that year in others. At the present time, there are about
become globally dispersed is currently much less than 5 lo9 people in the world, and some estimates are that
that received by local and regional populations. Only more than three quarters of the world's population
if the current levels of discharge of these radionuclides have no chance of receiving any radiological examina-
continued and all fuel from all reactors were reproces- tion, regardless of what disease they have.
sed could the global component of the annual
collective effective dose equivalent eventually equal
the local and regional components. 162. While absorbed dose data exist for many
standard radiographic and nuclear medicine proce-
dures, information now available suggests that the
159. The collective and per caput doses from nuclear previous absorbed dose estimates for the world
power production may be compared to the doses to population may be somewhat low. An important
the world population from natural sources of radia- reason for this is the widespread use of fluoroscopy in
tion. The more immediately delivered component of developing countries. There are also large numbers of
the normalized collective effective dose equivalent malfunctioning machines. which produce high doses.
commitment has been estimated to be 4 man Sv per Neither of these factors was widely appreciated in the
GW a from radionuclides in the effluents of nuclear past.
fuel cycle installations. For the present annual nuclear
power production of about 190 GW year, the annual 163. The collective effective dose equivalent from
collective dose is assessed to be 760 man Sv. Dividing diagnostic x-ray procedures is far greater than that
by the world population of 5 lo9 gives an annual per from dental or diagnostic nuclear medicine examina-
caput dose estimate of 0.15 microsievert. The doses
are around 0.01 per cent of the collective and per f T h ~ ssubject is reviewed extensively in A n n e x C. "Exposures
caput doses from natural background sources. from medlcal uses of radiation".
O v e r next Over
100 years all tlme
Total 24 230
a/ O v e r 10.000 years.
tions. The per caput annual effective dose equiLPalent and to medical personnel (average annual doses in the
is likely to be no loiver than 0.4 mSv (the Committee's range of 0.3 to 3 mSv, and a collective dose of about
previous estimate) and may be as high as 1.0 mSv. I man Sv per million of population, cf. also para-
Similarly, the annual genetically significant dose may graph 166; in developed countries an average occupa-
range from 0.1 to 0.3 mSv. However, considering the tional dose of about 1 microsievert per examination)
age structure of the population, the effective dose are included along with exposures of the general
equivalent may overestimate the detriment. This would public in the respective Annexes dealing with these
be particularly true in countries where the older subjects.
portion of the population receives most of the medical
irradiation. 168. Exposures of radiation workers are subject to
detailed regulatory control in all countries and in the
164. The world-wide collective effective dose equi- majority of cases the doses are but a small fraction of
valent is estimated to be between 2 and 5 lo6 man Sv. established limits. partly as a result of the current
Of this, 90-95 per cent is attributable to diagnostic A- emphasis on optimizing radiation protection. The
ray procedures. Dental radiography, nuclear medicine collective effective dose equivalent commitment per
and radiation therapy (ignoring target doses) together unit of electricity generated to workers in all nuclear
contribute onl) 5-10 per cent of the collective dose. In fuel cycle installations is estimated to have changed
developed countries, the contribution to the collective little from the commitment previously estimated by
effective dose equivalent is about 0.001 man Sv per the Committee, but such stability is only to be
examination. expected if reductions in exposures are balanced by
the greater numbers of workers employed in the
165. There are many possibilities for reducing dose expanding industry.
without jeopardizing the benefits of the radiological
practices. In the developed countries, it may be 169. Occupational exposure from medical practices
possible to reduce the per caput effective dose includes the contributions from diagnostic x-ray pro-
equivalent by half. In the less-developed countries, the cedures, dental radiography, nuclear medicine and
use of radiography rather than fluoroscopy, appro- radiation therapy. The average annual collecti\.e effec-
priate collimation, proper film developing, as well as tive dose equivalent from occupational exposures in
the calibration and maintenance of equipment. would these practices is about I man Sv per 106 population.
reduce the dose per examination: however, the fea- I n spite of the increase in the medical uses of radiation
sibility and costs of these measures are not known. in most countries, the limited trend data indicate that
The geneticall) significant dose can be significantlj both individual and collective annual occupational
reduced through the use of gonadal shielding. a doses are decreasing by 10-30 per cent every decade.
practical. loiv cost method. Still, the collective effec- For developed countries, the average occupational
tive dose equivalent may increase as x-ray examina- exposure is about 1 rnicrosievert per esamination.
tions become more widely available in a number of
countries, and such an increase may in fact be
appropriate. 6. Miscellaneous exposures
166. The frequency and total use of medical irradia- 170. Exposures from niiscellaneous sources of radia-
tion is expected to increase over the nest several tion are evaluated by the Committee whenever
decades because of the aging of the world's population. warranted by new information or new developments.
the growth of this population, and urbanization in the The latest assessment. in the UNSCEAR 1982 Report,
developing countries. By the year 2000, the collecrive dealt with \various consumer devices that contain
dose will probably have increased by 50 per cent. and radioactive materials and with electronic and electrical
by 2025 i t may have more than doubled. equipment that emit x rays. Indiiidual exposures to
these various sources were generally very small. The
Committee believes that assessment to be still valid
5. Occupational exposuresr and feels that no new evaluation is required.
167. Two categories of workers are exposed to
radiation: workers in the nuclear industry and in the 7. Accidents
medical field, ivhere radiation sources are managed,
and workers in occupations where higher background 171. With the large size of the nuclear industry in
radiation levels are encountered (air crews and non- some countries and the large number of radiation
uranium miners are examples). The Committee gave a sources used for industrial and medical purposes,
full assessment of occupational exposures in the accidents are boand to happen. The accidents that
UNSCEAR 1982 Report. Updated estimates of ex- have occurred have generally been criticality and other
posures to workers in nuclear fuel cycle activities industrial accidents that exposed one or a few workers;
(average annual doses in the range of 3 to 8 mSv for transport accidents, including also accidents involving
reactor operation, and a collective dose of 12 man Sv satellites, aircraft and submarines; losses or thefts of
for each G W year of electric energy generated, in total radiation sources: and reactor accidents.
for all work in the whole nuclear fuel cycle. cf. Table 6)
CThis subjec~is reviewed in Annex B. "Exposures from nuclear 172. Three reactor accidents have caused measurable
power production" and in Annex C. "Exposures from medical uses exposures of the public: Windscale in 1957. Three
of radiation". Mile Island in 1979, and Chernobyl in 1986. The
28
Chernobyl nuclear reactor accident was a significant northern hemisphere. The extent to which such a wide
event and is discussed in detail in two Annexes region could be affected by an event of this type uras
(Annex D, "Exposures from the Chernobyl accident" unanticipated. Intensive monitoring was undertaken
and Annex G, "Early effects in man of high doses of to evaluate the radiation levels.
radiation").
175. I t was apparent soon after the arrest of releases
173. In all, six notable accidents have occurred from the reactor that the radiological impact of the
since 1982, when the Committee last dealt with this accident, from the point of view of individual risk.
subject: would be insignificant outside a limited region hithin
1983: Constituyentes, Argentina. An accidental the USSR. either because contamination levels were
prompt critical excursion occurred during a generally ION. or because remedial actions to ban the
configuration change in a critical assembly, consumption of particularly contaminated foodstuffs
resulting in the death of an operator. who was prevented high exposures.
only 3-4 metres a\ira!.. The dose to the victim
was estimated to be 5-20 Gy from gamma rays 176. The accident at the Chernobyl reactor occurred
and 14-17 Gy from neutrons. in the course of a low-power engineering test, during
1983: Ciudad Juarez, Mexico. An improperly disposed which safety systems had been switched off. The
of cobalt-60 source found its way into a scrap uncontrollable instabilities that developed caused es-
metal shipment, contaminating the delivery plosions and fire. which damaged the reactor and
truck, the roadsides and the processed steel into allowed radioactive gases and particles to be released
which the scrap was incorporated. Some 300-500 into the environment. The fire was extinguished and
individuals were exposed, ten to doses of 1-3Gy. the reactor core sealed off by the tenth day after the
There were no deaths. accident.
1984: Mohammedia. Morocco. A source of iridium- 177. The death toll within three months from the
192 used to make radiographs of welds at a accident was 30 members of the reactor's operating
construction site became detached from the staff and the fire-fighting crew. TWOdied immediately.
take-up line to its shielded container. The source 28 died from radiation injury. Radiation doses to the
dropped to the ground and was noticed by a local population were well below the doses that could
passer-by, who took i t home. Eight persons. an cause immediate effects. Local residents were evacuated
entire family. died from the radiation over- from a 30 km exclusion zone surrounding the reactor.
exposure ivith doses of 8-25 Gy. Agricultural activities \\ere halted and a large-scale
1986: Texas, United States. An accident at a linear decontamination effort has been undertaken.
accelerator caused two deaths from over-
exposure. 178. The initial release of radioactive materials from
1986: Chernobyl, USSR. The accident at the nuclear the accident spread with winds, in a northerly direc-
po\ver station resulted in two immediate deaths tion. Subsequent releases dispersed towards the west
of reactor operating personnel from the explo- and south-west and in other directions as well. Deposi-
sion. About 145 firemen and emergency wor- tion on to the ground was governed primarily by
kers suffered acute radiation sickness: 28 of rainfall, which occurred sporadically at the time in
them died during the three months following Europe. The deposition pattern and the associated
the accident. There were 30 deaths in all; one transfer of radionuclides to foods and irradiation of
worker died from mechanical injury and one individuals was very inhomogeneous, necessitating a
from burns. Local residents, none of whom regional approach for dose calculations.
received high exposures. were evacuated. The
widespread dispersion of the released materials 179. Measurements since the accident have shown
caused low exposures, primarily to populations that the radionuclides contributing most significantly
of the western part of the USSR and other to doses are iodine- 131, caesium- 134 and caesium- 137
European countries. mainly by external irradiation from deposited material
1987: Goiania, Brazil. A caesium-137 source was and by ingestion of contaminated foods. The Com-
dismantled in a residential area causing some mittee's dose assessment takes most account for these
240 people to become contaminated. Fifty-four important radionuclides and pathways.
of them were hospitalized and four died.
180. Detailed information was available to the Com-
mittee to calculate first-year radiation doses in the
8. The Chernobyl accidenth USSR and all European countries. To extend these
results and to estimate the projected doses from
174. The accident at the Chernobyl nuclear reactor deposited materials, wider regions were evaluated.
in the USSR. which occurred on 26 April 1986, caused Since there is insignificant interhemispheric mixing of
extensive contamination in the local area and resulted material released into the troposphere, southern hemi-
in radioactive material becoming widely dispersed and sphere countries could only have been affected through
deposited in European countries and throughout the imported food; this possibility is accounted for in the
assessment by considering total food production as
hThis subject is reviewed extensively in Annex D. "Exposures well as local consumption in northern hemisphere
from the Chernobyl accident". countries.
Figure I. Country average first-year committed effective dose equivalent from the Chernobyl accident.
=
c
LLI a
I-
committed effective dose equivalents in 34 countries g 1.0 - u
are illustrated in Figure I. The highest values are for P:
Bulgaria, Austria. Greece a n d Romania. followed by 5 0.9 - v,
CO
E
2
2
other countries of northern, eastern and southeastern
Europe. Countries further to the ulest in Europe and 0.8 -
also countries of Asia, North Africa, North and
Central America were less affected. which is in accord 5 O'' -
with the deposition pattern. $ 0.6 -
-
3
T a b l e 7
Estimates of rlsk of severe senetlc disease per mllllon llve blrths
In a population exposed to a qenetlcallv slqnlflcant dose equlvalent
of 1 Sv per generatlon of lou-dose-rate, low-dose Irradlatlon,
accorrllnq to t h e doubllng dose method
(based on t h e UNSCCAR 1986 Report and subsequent work)
Congenltal anomalies
Other multlfactorlal dlseascs
60000
600000 1 Not estlmated a/
Early actlng domtnants
Heritable tumours ] Unknown Not estlmated a/
Totals of estlmated rlsk 1700 1400 12000
231. The 1986 data showed that mental retardation 135. When it uses the term "risk" (in a quantitative
is the most likely type of developmental abnormality sense) the Comrnittee means the probability of a
to appear in the human species. In essence, analysis as harmful event, e.g., a radiation-induced death and
a function of time showed that the probability of often espresses this probability in per cent. The
radiation-related mental retardation is essentially zero number of projected events in a population is espressed
with exposure before eight weeks from conception, is either as cases per thousand or cases per million. The
maximum with irradiation between eight and 15 weeks, term "risk coefficient" is used in a general way to
and decreases between 16 and 25 weeks. After 25 weeks indicate the risk per unit dose (risk per gray in the
and for doses below 1 Gy. no case of severe mental case of absorbed dose or risk per sievert in the case
retardation had been reported. On the assumption that of effective dose equivalent). Since the relationship
the induction of the effect is linear with dose (as the between dose and risk is not always proportional, it is
data seemed to indicate), the probability of induction sometimes necessary also to specify the dose or dose
per unit absorbed dose was estimated at 0.4 per Gy at range for which the coefficient is valid.
the time of the peak sensitivity and at 0.1 per Gy
between 16 and 25 weeks from conception. 236. In addition to estimating risk, the Comrnittee
has also estimated the projected number of years of
232. Using all the data available, the Committee life lost in an exposed population due to radiation-
attempted to derive quantitative risk estimates for the induced mortality. This quantity and also the projected
radiation effects for which there is positive evidence number of' cases or deaths in an exposed population
or, at least, reasonable presumption of induction. In are sometimes called measures of collective detriment.
addition to mental retardation, these effects include
mortality and the induction of malformations, leukae-
mia and other malignancies. Under a number of 1. Hereditary harm
qualifying assumptions, the Committee estimated that
a dose to the conceptus of 0.01 Gy delivered over the 237. Genetic risk coefficients may be defined to
whole pregnancy u70uld add a probability of adverse apply either to the gonad dose equivalent or the
health effects in the live born of' less than 0.002. The effective dose equivalent. It is also necessary to decide
normal risk of a non-irradiated live born carrying the whether they s h o ~ ~ lapply
d to genetically significant
same conditions is about 0.06. Information becoming doses (i.e., doses to reproductive individuals) or
available suggests that the risk estimates in the last average doses to the population at large. Opting for
two paragraphs may need substantial revision down- the latter might seem absurd from the scientific point
ward (particularly in the low-dose ranges). The Com- of view. but sometimes only average doses or total
mittee intends to review this in the near future. collective doses are known; moreover, risk coefficients
for cancer often apply to average doses.
T a b l e 8
Revlsed q e n e t l c r i s k c o e f f l c l e n t s a/
( p e r cent p e r Sv)
Multlpllcatlve Addltlve
rlsk projectlon rlsk projectlon
model mode 1
Bladder
Breast a/
Colon
Lung
nultlple myeloma
Ovary a_/
Oesophagus
Stomach
T a b l e 10
Esttmates of protected llfetime rlsks
for 1000 persons (500 males and 500 females),
exposed to 1 Gy o f hlqh dose rate low-LET radtatlon
(based upon the populatlon of Japan)
248. The problems in deriving risk coefficients that Table 9 and Table 10 for low doses and low dose
a r e also applicable at low doses are the same as rates. The Committee considered that such a factor
before. Such risk coefficients can only be inferred certainly varies very widely with individual tumour
from the observed values at moderate to high doses. type and with dose rate range. However. an appropriate
In 1977, when the total cancer risk coefficient at high range to be applied to total risk for low dose and low
doses was estimated to be about 2.5 per cent per dose rate should lie between 2 and 10. The Committee
sievert, the Committee pointed out some of the intends to study this matter in detail in the near
uncertainties; these included the fact that this estimate future.
was an underestimate because no projection had been
made into the future, but it was also an overestimate
in the sense that the risk per unit dose at low doses 250. The Committee has not presented risk estimates
was believed to be lower than the estimates for high for high-LET radiation in general in this Report
doses. (except for the exposure to radon of uranium miners).
For low doses of external high-LET radiation it would
249. In this Report, the problems in deriving risk be necessary t o multiply the risks for low-LET
coefficients at low doses and for low dose rates radiation by an appropriate quality factor. No dose o r
remain. The Committee agreed that there was a need dose rate reduction factor is considered necessary for
for a reduction factor to modify the risks shown in high-LET external radiation at low doses.
time explicitly presented collective dose assessments
for various sources and practices. At the same time,
25 1. The product of risk coefficients appropriate for however, it also drew comparisons on the basis of
individual risk and the relevant collective dose will equivalent periods of natural background exposure. In
give the expected number of cancer deaths in the the UNSCEAR 1982 Report, the Committee included
exposed population, provided that the collective dose more information on the ways in which individual
is at least of the order of 100 man Sv. If the collective exposures vary, and it assessed collective dose com-
dose is only a few man Sv, the most likely outcome is mitments. In the summary and conclusions, the
zero deaths. collective dose equivalents were translated into equi-
valent periods of natural background radiation.
252. The Committee has also assessed the person
years lost per unit collective dose because of radiation- 256. From this short review i t can be seen that
induced cancer mortality. The results at high doses comparison with the natural background dose rate has
and high dose rates of low-LET radiation are sum- always played an important role in the Committee's
marized in Table 10. The total loss amounts to about presentation of its assessments. When, in 1958, the
I person year per man Gy. with both projection Committee estimated the number of affected persons,
models. it drew a comparison with the natural occurrence of
cancer and hereditary disease. Since then. per caput
and collective doses have been compared with the
corresponding doses caused by natural radiation.
D. COMI'ARISON OF EXPOSURES
T a b l e 11
Source or practlce
Per caput iyplcal Hilllon Equlvalent
(World (exposed man Sv years of
populatlon) lndlvlduals) background.
&/ The addltlonal long-term collectlve dose comnltments from radon and
carbon-14 for nuclear power productlon and carbon-14 for test exploslons
are glven In parentheses.
represent contributions to present individual life-time Indeed, the physical quantities used by the Committee
doses primarily from strontium-90 and caesium-137. reflect such assumptions. For example, the effective
Because the Chernobyl accident led to doses mainly in dose equivalent, by definition, includes weighting
Europe, the collective effective dose equivalent com- factors that depend o n subjective judgements a s to
mitment rather than the global per caput dose is what constitutes radiation-induced harm. For each
presented. further step in processing the basic information. non-
scientific judgements are likely to be needed or implied.
6 . Direct comparison of detriments 268. Next, the way in which the basic scientific facts
are presented influences the impression they give. For
example, thousands of cancer deaths from a single
265. In this Report, the Committee has reviewed the
accident would undoubtedly be a high number of
existing knowledge on radiation risks and has ventured
deaths. However. since such deaths could be expected
to indicate the magnitude of the risk factors for low
to occur over a long period of time, the annual
doses as well as for high doses. The Committee has
incidence will be low. This means a very small increase
also assessed the collective doses from various sources
of the normal incidence of cancer, an increase which is
and practices. It is tempting to combine the estimates
not expected to be noticeable in health statistics. This
and calculate the expected number of cases of cancer
shows that it is possible. by selecting the form of
a n d hereditary disease.
presentation, to convey different impressions.
266. Many estimates of this type, with different 269. Lastly, there is the great uncertainty of such
degrees of reliability. depending o n the risk coefficients estimates. It was stressed in section 1I.C that the risk
assumed, and with widely different purposes on the coefficients for cancer at low doses can only be
part of those who made them, have been reported. inferred from observations at high doses and that the
The results have been very scattered. depending on the risk coefficients for hereditary effects are not even
general assumptions. The Committee hesitates. for a deduced from observations in man. Even though the
number of reasons, to add its own detriment assess- Committee believes that its estimates are the best that
ments to those already provided for the various can be given at the current state of knowledge, it must
sources of radiation. qualify them by drawing attention t o the underlying
assumptions and uncertainties. Unfortunately. any
267. First, the Committee needs to bear in mind the estimate of a finite number of cancer deaths is soon
terms of reference under which it operates: its purpose taken out of context and the qualifications forgotten.
is to evaluate doses, not to make value judgements or
engage in setting standards. As is made clear by the 270. For these reasons, the Committee prefers to
discussion in section II.D.4, even those assessments of follow its previous practice of comparing collective
risk that purport to be scientific involve assumptions dose commitments from the main radiation sources
a n d decisions that are not. strictly speaking, scientific. rather than estimated detriments.
Appendix I
ARGENTINA JAPAN
D . Beninson (Representative). D. Cancio. A.J. Gonzalez, T. Kumatori (Representative). H. Matsudaira (Representa-
E. Palacios tive). T. Tcrasima (Representative). A. Kasai. A. Yamato
AUSTRALIA
MEXICO
K.H. Lokan (Representative)
E. Araico (Representarive). J.R. Ortiz Magaiia (Representa-
BELGIUM tive)
M. Errera (Representative). J. Maisin (Representative),
J.B.T. Aten, P. Lohman. F.H. Sobels, A.D. Tates PERU
L.V. Pinillos Ashton (Representative). M. Zaharia (Repre-
BRAZIL sentative)
E. Penna Franca (Representative), L.R. Caldas (Representa-
tive) POLAND
Z. Jaworowski (Representative), J. Liniecki (Representative),
CANADA
Z. Szot
E.G. Letourneau (Representative), A.M. Marko (Represen-
tative). W.R. Bush. G.C. Butler, B.C. Lentle. D.K. Myers
SUDAN
CZECHOSLOVAKIA A. Hidayatalla (Representative), A.A. Yousif
h1. Klimek (Representative)
SWEDEN
CHINA
B. Lindell (Representative), G. Bengtsson, K. Edvarson.
Wei Liixin (Representative), Li Deping. Wu Dechang L.-E. Holm, K.G. Liining. S. Mattsson, J.O. Snihs,
J . Valentin, G . U'alinder
EGYPT
S. El-Din Hashish (Representative), H . Roushdy (Represen-
tative), hi. El-Kharadly UNION O F SOVIET SOCIALIST REPUBLICS
L.A. llyin (Representative), A. Guskova (Representative),
FRANCE K.M. Barkchudarov, V. Denim. E. Golubkin, D.F. Khokh-
H. Jammer (Representative). A. Bouville. R. Coulon. lova. A.A. Moiseev, Yu.1. Moskalev. V. Pavlinov.
M. Bertin, B. Dutrillaux, J. Lafuma. G . Lernaire. R. Masse. 0 . Pavlovsky. 0. Piatak. V.V. Redkin, V.A. Shevchenko
P. Pellerin, M.R. Tubiana, G . Uzzan
L. R. Anspaugh
B. G. Bennett
A. Bouville
R. H. Clarke
F. Fagnani
L. Frittelli
A. Hagen
J. Hendry
B. Lindell
F. A. Mettler
M. Morrey
0.Pavlovsky
W. J . Schull
G . Silini
F. D. Sowby
K. Sankaranarayanan
G . A . M. Webb
I;. Weiss
Appendix I11
A/AC.82/G/L.
1732 United Kingdom of Environmental radioactivity surveillance programme:
Great Britain and results for the UK for 1984
Northern Ireland
1733 Japan Radioactivity Survey Data in Japan
Number 72, March 1985
1734 Japan Radioactivity Survey Data in Japan
Number 73, June 1985
1735 United States Environmental Measurements Laboratory:
of America A compendium of the EML's research projects related
to the Chernobyl nuclear accident
1736 United States Environmental Measurements Laboratory:
of America The high altitude sampling program: radioactivity in
the stratosphere
1737 Japan Radioactivity Survey Data in Japan
Number 74, Sept. 1985
1738 Japan Radioactivity Survey Data in Japan
Number 75. Dec. 1985
1739 Union of Soviet Assessment of population doses from x-ray
Socialist Republics examination in the USSR (1970-1980)
1740 Union of Soviet Genetic effects of radionuclide decay
Socialist Republics
1741 Union of Soviet Acute radiation effects in man
Socialist Republics
1742 Union of Soviet Production and release of carbon-14 in nuclear power
Socialist Republics stations with RBMK reactors
1743 Union of Soviet Body burden of fallout caesium-137 in the inhabitants
Socialist Republics of Moscow 1980- 1983
1744 Union of Soviet Radiation doses to the far north inhabitants
Socialist Republics
1745 Union of Soviet Occupational exposure of radiographic workers
Socialist Republics
1746 Japan Radioactivity Survey Data in Japan
Number 76, March 1986
1747 Japan Radioactivity Survey Data in Japan
Number 77. June 1986
1748 Japan Radioactivity Survey Data in Japan
Number 78, October 1987
1749 Japan Radioactivity Survey Data in Japan
Number 79, October 1987
1750 Union of Soviet Proposals for setting possible intake limits for
Socialist Republics transuranium radionuclides absorbed from the gastro-
intestinal tract
1751 Union of Soviet The evaluation of non-stochastic effects in man from
Socialist Republics low doses of internal irradiation
Documcnr Counrry Tirlc
1752 Union of Soviet Tritium production in LWGR power plants and its
Socialist Republics release into the environment
1753 Union of Soviet Medical treatment in the case of uranium intoxication
Socialist Republics
1754 Union of Soviet Dynamics of effective dose equivalent from intake of
Socialist Republics strontium-90 and cacsium- 137
1755 Union of Soviet Specificactivities of natural radionuclides in building
Socialist Republics materials used in the Soviet Union
ANNEX A
CONTENTS
Paragraphs Paragraphs
1 -
----
Total
Charged particles
--......Neutrons
0 ' 1 2 3 4 5 6
ALTITUDE (km)
Figure II. Varlatlon of the annual eftective dore equivalent from the ionizing
component and the neutron component of cosmic mdlatlon as a function of altitude.
( B a d on [B38])
cally on both sides of a 30 cm thick tissue-equivalent component H,, in pSv, as a function of altitude z (km)
slab. This translates into a quality factor of 3.8. In was expressed as
Japan. Nakamura et al. [N20] also derived from 0 ) exp (-1.6492) +
k , ( z ) = ~ ~ ([0.205
measured neutron energy spectra a dose equivalent 0.795 exp (+0.45282)] (1.1)
rate of 3.3 nSv h-l. which is an overestimate of the
effective dose equivalent rate, as it was determined and, for the neutron component H ~as.
using the conversion factors from flux density to H,(z) = ~ ~ (exp0 (1.042)
) (1.2)
maximum dose equivalent given in ICRP Publication
21 [I 141. Nakamura et al. [N20] also indicated that the for z < 2 km, and as
calculated spectra of O'Brien led to values of 2.2 nSv h-'
H,(z) = ~ ~ (r1.98
0 )exp (0.698z)I (1.3)
a t the surface of a 30 cm body phantom and of
1.4 nSv h-' on average over the phantom. These for z > 2 km. The value used in [B38]for ~ ~ (is 0similar
)
figures are consistent with the estimate of 2.4 nSv h-I to the figure of 240 pSv a-ladopted in this Annex, while
that was used in the UNSCEAR 1982 Report and the value for H,(o) is the same.
reflect the variability associated with the choice of
geometry used t o calculate the effective dose equi- 21. For the purpose of this Annex. the distribution of
valent. Neglecting the shielding effect of building the effective dose equivalent from cosmic radiation over
structures, the annual effective dose equivalent for the the globe was recalculated. using the annual sea-level
neutron component is estimated to be about 20 pSv at effective dose equivalents of 240pSv for the ionizing
sea level. component and 20pSv for the neutron component.
~ i ~ I1~showsr e th; variation of the annual effective
19. On the basis of radiobiological considerations,
the ICRP issued in 1985 an interim recommendation dose equivalent with altitude obtained from equations
according to which the value of the quality factor for (1.1), (1.2) and (1.3). It is worth noting that the dose
neutrons was to be increased by a factor of 2 [I12]. equivalent from the neutron component, which is small
This recommendation, however, has not been followed at sea level. increases more rapidly than the dose
in most countries and has not been confirmed by the equivalent from the ionizing component and becomes
ICRP. The value of the quality factor for neutrons has more important at altitudes above 6 km. The distribu-
not been modified in this report. tion of the collective effective dose equivalent as a
function of altitude. presented in Figure 111, indicates
(c) Disrriburion of doses that although about one half of the collective dose
equivalent is received by people living at altitudes below
20. The distribution of the effective dose equivalent 0.5 km, a contribution to the collective dose equivalent
from cosmic radiation over the globe was estimated by of about 10% is received by populations living at
Bouville and Lowder [B38] using tabulated data on altitudes above 3 km. There are large countries with
terrain heights on a 1" by l o grid [G22], combined mountains and sea borders, like the Soviet Union and
with population data [UT]. On the basis of information the United States, where the population-weighted dose
in [L14]. [03], [N20] and [H15], the variation of the from cosmic rays differs only slightly from the dose at
annual effective dose equivalent from the ionizing sea level because the bulk of the population in each of
ALTITUDE (km)
Figure Ill. Dlrtrlbutlon of the collective etfectlve dose equivalent from cormlc
radlatlon as a functlon of altltude.
(Based on [B38])
those countries lives at low altitudes [FIO, 0121. In on average for British aeroplanes, with a maximum of
countries like Ethiopia, Islamic Republic of Iran, around 40pSv h-' [P14]. Annual dose equivalents
Kenya or Mexico, however, large cities are situated on received by the technical and cabin crew for the period
elevated plateaux, accounting for relatively high ex- 1979-1983 were on average about 2.5 mSv. with
posures. Figure IV presents the distribution of the possible maxima of I5 mSv [P14]. For a given flight.
collective dose equivalent and the variation of the per doses received by passengers are about the same as in
caput dose equivalent as a function of latitude. The subsonic flights since the higher dose rates incurred
population of the northern hemisphere accounts for during a supersonic flight are compensated for by the
about 90% of the total collective effective dose equi- shorter travel time.
valent. The per caput effective dose equivalent for the
world's population is found to be 355pSv, the ionizing 23. Using statistical data on air transportation, the
and neutron components contributing about 300 and collective dose equivalents incurred by the passenger
55 pSv, respectively. and flight personnel of civil aviation may be estimated.
The number of passenger kilometres flown in 1984.
(d) Elevaled exposures excluding Chinese airlines, was 1.3 lo'? [I1 51. Assuming
an average speed of 600 km h-' at an altitude of 8 km
22. Elevated exposures result from prolonged presence and an effective dose equivalent rate of 2pSv h-I at
at high altitudes. Populations living in high-altitude that altitude, the annual collective dose equivalent is
cities like Bogoti, Lhasa or Quito receive annual found to be 4.300 man Sv. Published estimates [Vl,
effective dose equivalents from cosmic radiation in W17] are 3.500 man Sv for the world population and
excess of 1 mSv. Passengers and crew members aboard no more than 1.600 man Sv for flights in the United
commercial aircraft are exposed to much higher dose States, while the collective dose equivalent to the flight
rates. which vary according to the flight altitude and, to crews would be up to 65 man Sv. Taking the ratio of
a smaller extent. the latitude and solar activity. the annual collective dose equivalent to the passengers
Assuming that the average altitude of commercial and to the flight crews in the United States as a guide.
subsonic flights is 8 km, the average dose equivalent rate the annual collective dose equivalent for the flight
would be about 2pSv h -' from equations (1.1) and crews of the world would be about 170 man Sv.
(1.3). the neutron component contributingabout 60% of
the total. Taking the annual number of hours spent 24. While travelling in space. astronauts are subjected
flying by crew members to be 600 h, the corresponding to primary cosmic-ray particles, radiation from solar
annual effective dose equivalent is about 1 mSv. A small flares and the intense radiation present in the two
fraction of commercial transport is conducted with radiation belts. Radiation doses received by astronauts
supersonic aircraft, which fly at an altitude of about represent one of the most important constraints to
15 km. Dose equivalent rates received during supersonic long-term manned space activities [B17]. Reported
transport have been reported to be about 1 1 pSv h-' on dose equivalents (assumed to be effective dose equi-
average for French aeroplanes [S64] and about 9pSv h-' valents) to astronauts from recent United States
NORTH SOUTH
LATITJDE
Figure IV. Dlslrlbulion of the annual effective dose equivalent from cosmic radlatlon as a
lunction of latitude.
(Based on [B38])
manned space missions range from 0.5 to 5 mSv B. TERRESTRIAL SOURCES O F RADIATION
[B18]. Similar information is available for Soviet
missions [Vl]. In a majority of cases, individual 26. Terrestrial sources of radiation are the very long-
effective dose equivalents did not exceed 5 mSv per lived radionuclides that have existed within the earth
flight; however. for prolonged orbital flights, i.e.. since its formation several billion years ago and have
those lasting longer than one month. the effective dose not substantially decayed. The most important of
equivalent exceeded 10 mSv and reached 55 mSv for these so-called primordial radionuclides are O ' K (half-
expedition IV on board Salut-6, which lasted 175 days life = 1.28 lo9 a), "Rb (half-life = 4.7 1010 a). "'U
rv11. (half-life = 4.47 lo9 a ) and ?':Th (half-life = 1.41 loL0a).
238Uand ?'-Th head series of 14 and 1 1 significant
radionuclides, respectively. (Figures V and VI) that
2. Internal irradiation also contribute to the doses from terrestrial sources.
Other radionuclides, such as those present in the 235U
decay series, have been neglected, as they contribute
25. A large number of cosmogenic radionuciides are
little to the total dose from natural background.
produced in the stratosphere and upper troposphere
by the interaction of cosmic rays with the nuclei of
27. The ubiquitous presence of the primordial radio-
atoms present in the air (e.g.. nitrogen. oxygen and
nuclides and of their decay products in the environ-
argon). The production and distribution of these
ment (air. water, soil, rocks, foodstuffs) and in
nuclides in the environment was reviewed by the
humans results in external and internal radiation
Committee in the UNSCEAR 1977 Report [U?]. Only
doses.
four cosmogenic radionuclides ('H, ''C, 'Be and '2Na)
are of importance from the viewpoint of radiation
doses to man. Together they deliver annual doses 1. External irradiation
from internal irradiation ranging from 5 to 25 p G y in
the various organs and tissues of interest. The annual (a) E.~posureoutdoors
effective dose equivalents are estimated to be 0.01 pSv
for 'H, 3 ~ S for
V 'Be, 12 pSv for I4C and 0.2 pSv for 28. Activity mass concentrations of primordial radio-
"&a. Because of the relative homogeneity of the nuclides in rocks are usually higher in igneous rocks
cosmic-ray flus over the earth's surface, the variability than in sedimentary ones, while metamorphic rocks
of the annual doses from the cosmogenic radionuclides have concentrations typical of the rocks from which
is expected to be low. they are derived. There are. however, exceptions, a s
t
2 1 8 ~ ~ 214~0 210~o
(3.05 min)
2148i
a
214~b 206~b
(26.8 m i n ) (22.3 a ) (stable)
certain sedimentary rocks, notably some shales and by the Ministry of Public Health from 1981 to 1985,
phosphate rocks, are highly active. The activity mass using sodium iodide crystals and ionization chambers
concentrations in soil, which are directly relevant to in 21 provinces, five autonomous regions and the
outdoor exposure, are thought to be largely determined cities of Beijing, Tianjin and Shanghai. Detailed
by the activity mass concentrations in the source rock. preliminary results are found in a special issue of the
The average activity mass concentrations of 40K, 233U Chinese Journal of Radiological Medicine and Protec-
and Z3ZTh in soil and the corresponding absorbed dose tion [C19] and a summary has been prepared by
rates in air 1 m above the ground surface are given in Wang Qiliang et al. [W21]. Population-weighted
Table 3 [B32]: the calculations are for a soil density of means of the absorbed dose rates in air are presented
1.6 g cm-' and a water content of 10% and are based in Table 5: the value for the country as a whole is
on the assumption that all decay products of 238Uand reported to be about 80 nGy h-I, which is in the upper
232Thare in radioactive equilibrium with their precur- range of the levels observed in the world. These results
sors. The average outdoor terrestrial absorbed dose led to a large soil-sampling programme that showed
rate in air from gamma-radiation I m above the that the average concentrations of 40K, 238Uand 232Th
ground surface is 44 nGy h-I. The results of a large in soil in China are indeed higher than the estimates
soil sampling programme recently carried out in the by UNSCEAR of the world averages by a factor of
United States are in fairly good agreement with the about 2 [W21]. Independent survey programmes of
activity concentrations given in Table 3 [M 101. outdoor gamma-radiation have also been undertaken
in China by the National Environmental Protection
29. Large-scale surveys, using different methods and Agency [L18] and by the Ministry of Nuclear Industry
types of instrumentation, have been or are being [G29]. A comparison of the results obtained for the
carried out in a number of countries in order to same areas [P22] shows discrepancies that may have
estimate average nation-wide exposures to outdoor arisen from the energy dependence of the various
external gamma-radiation. The results for 23 countries types of dosimeters used in the surveys and from the
or areas, representing about one half of the world estimation of the cosmic-ray dose rates which were
population, are summarized in Table 4. Country- subtracted from the readings. The average absorbed
averaged outdoor absorbed dose rates in air are found dose rates in air in the cities, provinces and auto-
to range between 24 and 85 nGy h-I, with an arith- nomous regions investigated by the Ministry of Public
metic mean of 55 nGy h-'. Health [W21] were found to be lower than those
measured by the National Environmental Protection
30. It is to be noted that the two most populated Agency and the Ministry of Nuclear Industry. the
countries in the world, China and India, have recently relative differences ranging from 11% to 63% [P22].
published the results of extensive surveys. In China, Since the survey of the Ministry of Public Health is
about 40,000 outdoor measurements were carried out the only one completed at the time of publication of
this Annex, its results have been incorporated without tion-weighted mean for all countries except China is
modification; however, it should be kept in mind that 72 nGy h-' and becomes 110 nGy h-I if China is
the gamma doses for China may be revised in the near included.
future.
36. In previous UNSCEAR Reports, use was made
31. In India, 214 locations scattered all over the of the indoor-to-outdoor ratio, under the assumption
country were monitored with thermoluminescent dosi- that the relationship between the indoor and the
meters. The national mean value of the outdoor outdoor absorbed dose rates depends essentially on
absorbed dose rate in air due to natural radiation the type of building materials used and their origin. If
(terrestrial sources of radiation and cosmic radiation) the building materials are of local origin, it may be
is estimated to be 785pGy a-I [N19]. Assuming a expected that the value of the indoor-to-outdoor ratio
mean dose rate from cosmic rays of 300 pGy a-I yields of the absorbed dose rates in air lies between 1 and 7,.
an average absorbed dose rate in air from the because of the change in source geometn and the
terrestrial component of 55 nGy h-I. presence of doors and windows. Calculations taking
into account the thickness and the dimensions of the
32. In the UNSCEAR 1977 Report [U2]. the Com- walls yield ratios of 1.35 for typical brick dwellings
mittee adopted a value of 50 nGy h-I for the popula- and 1.48 for concrete buildings [Kl I].
tion-weighted average absorbed dose rate in air over
37. Country-averaged indoor-to-outdoor ratios.
the world and estimated that 95% of the world's
derived from the results presented in Tables 4 and 6.
population residing in areas of usual naturai radiation
range from 0.8 to 2.0. with an average of 1.3. This
live where the outdoor absorbed dose rate in air from
figure, combined with an average outdoor absorbed
the primordial radionuclides lies between 30 and
dose rate in air of 55 nGy h-I. yields an average
70 nGy h-I. As shown in Table 4, the available data
indoor absorbed dose rate in air of 72 nGy h-I, in
base is currently much larger than i t was in 1977. The
close agreement with some of the values obtained by
population-weighted average absorbed dose rate in air
the first method. In this Annex, the mean indoor
for the countries in Table 4 is 63 nGy h-I. This is
absorbed dose rate in air from terrestrial sources of
likely to be an overestimate because of the probable
radiation is taken to be 70 nGy h-l.
bias in the Chinese measurements. When the Chinese
data are not taken into account. the population- 38. Elevated external dose rates indoors may arise
weighted average absorbed dose rate in air is reduced from high concentrations of natural radionuclides in
to 53 nGy h-I. An intermediate figure of 55 nGy h-' is building materials. These building materials may be
adopted in this Annex as the mean absorbed dose rate of natural origin (concrete based on alum shale,
in air outdoor from terrestrial sources of radiation. granite, lithoid tuff) or result from industrial processes
(phosphogypsum, red mud). As discussed in the
33. There are regions in the world where the usual UNSCEAR 1982 Report, the resulting exposures,
range of variation of outdoor terrestrial radiation calculated with pessimistic assumptions, range between
doses is substantially exceeded. The best documented 100 and 2.000 nGy h-I.
of those regions are in Brazil and India. In the coastal
areas of Kerala and Tamil Nadu in India, there are
patches of sand containing monazite with thorium (c) Annual effective dose equivalents
concentrations ranging between 8% and 10.5% by from gamma terresrrial radiarion
weight. The absorbed dose rates in air in the high 39. The value of the quotient of effective dose
radiation areas of Kerala vary between 150 and equivalent rate to absorbed dose rate in air is taken, as
1,000 nGy h-I; in Tamil Nadu, these may reach about in the UNSCEAR 1982 Report. to be 0.7 Sv per Gy for
6,000 nGy h-I [S69]. I n Brazil, outdoor absorbed dose environmental exposures to gamma rays of moderate
rates of 130-1.200, 220-4,200 and 110-1,000 nGy h-' energy. This value is assumed to apply equally to males
were measured in Guarapari, Meaipe and P o ~ o sde and females and to the indoor and outdoor environ-
Caldas, respectively [P24]. ments. Taking the outdoor occupancy factor to be 0.2,
the annual effective dose equivalent from outdoor
(6) Exposure indoors terrestrial gamma-radiation is found to be
55 (nGy h-I) X 0.7 (Sv Gy-I) X 8,760 (h a-I) x 0.2 =
34. Knowledge of radiation levels in buildings is
important in the assessment of population exposures, 70 pSv
as most individuals spend a large amount of time For indoor exposure, using an occupancy factor of 0.8,
indoors. Large-scale surveys of indoor exposures to the annual effective dose equivalent is
gamma external radiation have recently been conducted 70 (nGy h-') X 0.7 (Sv Gy-') X 8,760 (h a-') X 0.8 =
in several European countries as well as in China; the 340 pSv
results are summarized in Table 6. An estimation of
the world distribution of exposures may be derived 40. The total (outdoor plus indoor) annual effective
from the results presented in Table 6 or, as in previous dose equivalent from terrestrial radiation, averaged
UNSCEAR Reports. from the indoor-to-outdoor ratios. over the world's population, is 410pSv. Using the
information presented in Table 3 as a guide, the
35. Estimates of average indoor absorbed dose rates contributions of 'OK and the radionuclides of the 238U
in air are between 23 and 120 nGy h-', most values and 232Th decay series to the total annual effective
being in the narrow range of 60-95 nGy h-I (Table 6). dose equivalent from gamma terrestrial radiation
The arithmetic mean is about 70 nGy h-'. The popula- would be 150, 100 and 160 pSv, respectively.
2. Internal irradiation (i) Uranium-238 subseries (23BU,234Th,U4mPa,UIU)
79- The dosimetric coefficients of Table 12 have been 85. Radon enters the atmosphere mainly by crossing
used to estimate average annual doses from inhalation the soil-air interface, but there are a number of other
of thoron decay products. Average annual doses in the secondary sources. such as the ocean, ground water,
lungs are 5 pGy outdoors and about 40pGy indoors. natural gas, geothermal fluids and coal combustion.
Annual doses in other organs and tissues are lower. The atmospheric concentrations of radon at ground
The annual average effective dose equivalent resulting level are governed by the source term-the exhalation
from outdoor and indoor inhalation of thoron is rate-and by atmospheric dilution processes, which
estimated to be 160pSv. are both affected by meteorological conditions. The
degree of radioactive equilibrium between radon and
80. Because of the few data available, the distribu- its decay products in the atmosphere at ground level
tion of individual exposures, as well as the reliability also depends to a large extent upon the meteorological
of the estimated mean value, is difficult to assess at conditions.
present.
86. When 226Radecays in soil particles, the resulting
C. SUMMARY atoms of ?'IRn must first escape from the soil particles
to air-filled pores and move through these pores in
81. A summary of the various contributions to the order to enter the atmosphere. The escape from the
annual effective dose equivalent from natural sources soil particles to the air-filled pores is thought to be
of radiation is given in Table 1. In order of importance, mainly the result of recoil of the radon atoms
inhalation of short-lived decay products of radon following the decay of :16Ra [MI]: if they lie close to
comes first, with the average annual effective dose the surface of individual grains, they may be ejected
equivalent estimated to be 1,100pSv. A detailed into the pores between the grains. In comparison, the
discussion on the environmental behaviour of radon contribution from diffusion through the solid mineral
and of its dosimetry is provided in chapter 11. The grains is less important, as most of the radon atoms
second most important pathway is external irradiation. decay before escaping. The fraction of radon formed
accounting for nearly 800 pSv, divided approximately in the soil that escapes into the pores is known as the
equally between cosmic radiation and terrestrial sources. emanating power, coefficient, ratio or fraction; reported
Less significant are the ingestion of O ' K (180,uSv). values range from about 1% to 80%.
inhalation of decay products of thoron (160 pSv) and
internal irradiation from 2'oPb-"0Po (120pSv). The 87. In order to enter the free atmosphere. the radon
other natural radionuclides contribute little to the total gas must diffuse through the pores of the material,
annual effective dose equivalent, which is estimated to and a fraction of it will reach the surface before
be 2,400 pSv. decaying. The diffusion path is tortuous and, of
course, some radon atoms will be ejected into closed
82. The variability around the mean dose from pores from which they cannot escape. Movement of
natural sources of radiation is dominated by the radon radon atoms may be caused by diffusion or convec-
component, as the indoor radon concentrations span tion. Convective movements, induced by pressure
over four orders of magnitude. differences created by meteorological conditions, vary
with time and cannot be readily quantified. The 89. The concentrations of radon in air vary depending
diffusion process is described mathematically by the on the place, time. height above the ground and
definition of an effective diffusion coefficient that meteorological conditions. Because the source of radon
includes an allowance for the convoluted path. As in is the soil and radon has a rather short physical half-
the UNSCEAR 1982 Report (Annex D , paragraph life, the radon concentration is in general constantly
58). the area exhalation rate. defined as the activity decreasing with height. The geographical location is
transfer rate per unit area at the soil-air interface, is important: radon concentrations are as a rule lower
expressed as over locations, such as islands and Arctic areas, which
have less soil capable of emanating radon than over
= A RnFrCsoil.~a~so~l
L ~ n (2.1) continental temperate regions.
where R is the area exhalation rate in Bq m-* s-I; i.,,
is the decay constant of 222Rn(2.1 lom6s-I); F, is the 90. Detailed information on the variations of radon
emanating power: Clod.b is the activity mass concen- concentration at ground level over time was obtained
tration of Iz6Rain soil (Bq kg-I): p,, is the soil density from a six-year record of hourly radon measurements
(kg m-)); and LRnis the diffusion length of radon in made at Chester. New Jersey, United States [F7]. T h e
soil (m), which can be expressed mathematically as the arithmetic mean for the six years of operation was
square root of AeM/iRnprotl.pswhere A,ff is the effective found to be 8 Bq m-3 and the hourly data and three-
bulk diffusion coefficient (m2 s-I) and p,,,,.,, is the soil hour averages of radon concentrations were log-
porosity. normally distributed. A seasonal pattern of a summer
maximum and a winter minimum was observed over
88. Published information on experimental values of the period 1977-1982 with little variation from year
R, F,, ACrr
and p,,,,,, is summarized in Table 13. Using to year [F7]. The seasonal maximum in August was
the representative values given in Table I3 for F,, Aen a factor of 3 higher than the February minimum
and P,,,~~,,,and assuming a 226Raactivity mass concen- (Figure VII). The diurnal variation (Figure VIII)
tration In soil of 25 Bq kg-' (Table 3) and a soil shows a maximum in the night and a minimum at noon.
density of 1.6 lo3 kg m-3. the diffusion length of radon The diurnal maximum is a factor of 2 greater than the
LRnis approximately 1 m and the area exhalation rate minimum. The three-hour average radon concentra-
is 1.7 lo-? Bq m-' s-I. in agreement with the estimated tions were tested for correlation with five meteorological
area-weighted average per unit area for soil. based on parameters measured at the site-temperature. dew-
direct measurements, of 1.6 lo-? Bq m-: s-' [Wl]. point temperature, wind speed. atmospheric pressure
Over the ocean, the area exhalation rate is about two and precipitation-but no significant correlation was
orders of magnitude lower than that for soil. found [F2].
I I I I I I I I I I I t I
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
MONTH
Fsorl.pr L ~ n . r o l l LC
sinh (- )I (2.3)
Fslab.pr LRnshb L~n.slab
where R is the area exhalation rate from uncovered
soil (equation 2.1). Other formulations can be found
in the literature on the subject (see. for example,
[B26]). Taking the values already given in preceding
paragraphs for the various parameters yields
0.2
RT = 1.7 Bq m-2 s-I / [cosh (-) t
0.15
0.15 X 1 0.2
sinh (-)I = 1.2 Bq m-' s-I (2.4)
0.2 X 0.15 0.15
1 ' ' I I I I 1 I 1 I I
o t 1 I I I I 1
rlednesdaylThursday Friday Saturday Sunday Monday Tuesday
(14-20 July 1982)
a. SUMPMONITOR
8000 i
C. SOIL PROBE
8000 1
o ! I I I I I 1 I
Wednesday Thursday Friday Saturday Sunday Monday Tuesday
(14-20 July 1982)
Flgure XII. Variation with tlme In a rlngle-famlly house with a basement ol (a) radon
entry rate; (b) the radon concentratlon In the basement sump; and (c) In the roll adjacent
to the house.
IN41
(6) Building marerials respectively. The rate of entry of radon resulting from
exhalation from building materials may be expressed
106. A fraction of the radon activity produced by as
decay of 2'6Ra in building materials enters buildings U,, = N / V (2R,SF +- R,S,) (2.9)
by diffusion. The area exhalation rate can be expressed
as where N is the number of seconds per hour; V is the
R = j - ~ n ~ b , : l l d C b u , l d . R a F r L ~ n t a n(LII/LRR)
h (2.6) volume of the reference house (250 m3); S F is the
surface area of its floor or ceiling (100 m-): S, is the
which is an equation very similar t o that related to soil surface area of its external walls ( I00 m2); and RLand
(equation 2. I ) , the only difference being the introduc- R, are the area exhalation rates from concrete and
tion of a hyperbolic term to account for the fact that brick. respectively.
diffusion takes place in a medium of finite thickness.
In equation (2.6). R is the area exhalarion rate 11 1. The rate of' entry of radon from the floor and
(Bq m-' s-'1; F, is the emanating power; pburldis the the ceiling of the reference house would amount to
density of the building material (kg m-9: CbulldR4 is about 6 Bq ni- h - I, while the contribution from the
the activity mass concentration of ::6Ra in the external walls would be about 0.4 Bq m - ' h - ' . The
building material (Bq kg- I): L,, is the diffusion length contribution from radon exhalation from the building
(m); a n d Lhis the half-thickness of a slab of building materials to the radon concentration in the reference
material (m). house is thus estimated t o be 6.4 Bq n1-' if the air
exchange rate is taken to be 1 h 'I.
107. The mass activity exhalation rate, expressed
in Bq kg-) s-I and defined as 112. Considerably greater values of the rate of entry
of radon are expected to be obtained uhen building
materials with high 226Raconcentrations and normal
is the quantity usually determined in laboratory emanating power are extensively used. Examples ofsuch
measurements [JI]. The area exhalation rate from a building materials are granite, Italian tuff and alum-
wall o r a floor made of building material of half- shale lightweight concrete. Among these materials,
thickness L,, diffusion length LRnand density p,_,,, Swedish alum-shale lightweight concrete has the highest
can then be expressed as '26Ra concentrations (about 1,300 Bq kg-' on average)
[S19, S20] and probably the highest ?"Rn mass
exhalation rate (440pBq k g 1s - ' i n Table 16). Assuming
108. Information on the mass exhalation rate. the a density of 2 lo3 kg m-3 and a diffusion length of
diffusion length, the emanating power and the '26Ra 7.4 lo-' m (as measured in [J?]), a 0.2 m thick slab of
activity mass concentration in building materials is 100 ni2 would lead to a rate of entry of radon of about
presented in Table 16. Concrete and brick are probably 80 Bq m-' h-I in the reference house.
the two most tvidely used building materials, at least
in the temperate latitudes. Table 16 shotvs that even 113. Techniques for reducing the radon entry rate
though the '26Ra concentrations in concrete seem to due to exhalation from building materials have been
be lower than those in brick, the 222Rnmass exhala- investigated. In Swreden, aluminium foil has been
tion rates appear to be higher for concrete than for applied to the walls of houses built with aerated
brick. This is because of the high values of the concrete based on alum shale [S19]; the results showed
emanating power for concrete, with o r without fly ash, a 50% reduction in the radon entry rate. In the United
in comparison to those for brick. The results presented States. various radon sealants have been tested under
for gypsum (Table 16) are difficult to analyse because conditions representative of normal construction con-
the few measurements available give either high or IOU ditions [EZ].The radon exhalation rate was reduced
values of the emanating pourer. Further measurements from 20% to 80%. depending on the surface coating
are necessary to clarify this point. used. Because of the trapping of radon decay products
in the wall, there is a relatively small increase in the
109. s o m e data on the emanating power of the external gamma dose rate [EZ,M8]. It was also noted
concrete components are given in Table 16. Cement that any cracks that later developed in a sealant such
a n d fly ash have low emanating powers, probably due as paint may lead to leaks that negate a large portion
to their crystalline nature. Differences in the moisture of the sealing effectiveness of the paint [Ml9].
content of the materials studied may also account in Similarly, the radon exhalation rate from any unpainted
part for the wide disparity in the results of exhalation areas may be increased as they offer to radon a path
measurements from different countries [Nl]. I t is of least resistance in comparison with painted areas
worth noting that the exhalation rate from concrete [A I I].
should not be derived from the emanating power of its
constituents, as chemical changes occur during manu- (c) Outdoor air
facturing.
114. Air exchange between the outdoor and the
110. The adopted reference values for the parameters indoor environments brings some outdoor radon into
of interest in the calculation of the area exhalation buildings. Air exchange arises from natural ventilation
rate from concrete and brick are indicated in Table 16. through open doors a n d windows, mechanical ventila-
F o r building material with a thickness of 0.2 m, the tion and infiltration, the uncontrolled leakage of air
reference area exhalation rates would be 2 mBq m-' through cracks in the building envelope. Unless
s-I and 0.3 mBq m-l s-I for concrete and for brick, otherwise stated, air exchange in this Annex is
assumed to consist of infiltration only. Outdoor radon ing value in Sweden has been found to be 38 kBq m-'
can play a significant role in the indoor radon entry [K24]. In the United States. the geometric mean radon
rate if the house is poorly sealed. The radon entry rate concentrations in municipal ground-water supplies in
resulting from the infiltration of outdoor air may be the central part of the United States and in Texas were
written as found to be about 4 kBq m-3 [P3. W3] and 5 kBq m-I
[W3]. respectively. I t was tentatively estimated in the
U O=~zOUI"~. (2.10) UNSCEAR 1982 Report (Annex D, paragraph 163)
where ,z, is the radon concentration in outdoor air that between 1% and 10% of the world's population
(Bq ~ n - ~E.), :is the air exchange rate (h-I); and (1 is the consumes water containing radon concentrations of
fraction of the air exchange rate involving outdoor air, the order of 100 kBq m-j or higher, drawn from
which in all cases is close to I . Assuming an outdoor relatively deep wells. For the remainder, who consume
concentration of 5 Bq m-' (see paragraph 92). an air water from aquifers or surface sources. the weighted
exchange rate of I h-I and a value of 1 for a, the world average concentration is probably less than
radon entry rate would be 5 Bq h ! mP3. I t is worth 1 kBq mP3.
noting that the radon entry rate resulting from the
infiltration of outdoor air is proportional to the air 118. The radon entry rate due to water degassing
exchange rate. may be expressed as
U,=~~Q,E/V (2.11)
(d) Cl'awr
where x , is the radon concentration in water (Bq m I);
115. Radon contained in water is to some extent Q, is the amount of water used per unit time (m3h- I ) ;
transferred into room air as a result of agitation or E is the degassing efficiency; and V is the volume of
heating. Radon concentrations are as a rule much the reference house (m'). Assuming a radon concen-
lower in surface ivater than in ground water. In water- tration of 1,000 Bq m-3 in tap-water. a degassing
saturated soil with a density of 1.6 lo3 kg m--?, efficiency of 0.5, a water use rate of 0.07 m' h i .
porosity of 20% and emanating power of 20% a 226Ra corresponding to 0.4 m' per day for each of the four
activity mass concentration of 25 Bq kg-' yields at persons living in the reference house. the radon entry
equilibrium a I"Rn concentration in ground water of rate is estimated to be about 0.1 Bq m-j h-I; the
corresponding mean radon concentration is 0.1 Bq m-'
25 Bq kg-Ix 1.6 lo3 kg nl-?x 0.2/0.2 = 4 lo4 Bq m-3 in the reference house, with a very uneven distribution
In surface water, radon concentrations are expected to within the dwelling, the highest concentrations being
be similar to those of ?26Ra,that is, about 10 Bq m-!. expected in the rooms where radon is released
(bathrooms and kitchen). In any case. average radon
concentrations in tap-water do not bring a significant
116. The release of radon from water to air depends contribution to the total radon entry rate in buildings,
upon the circumstances in which the water is used, as except. however, when the water contains high con-
the degassed fraction increases considerably with centrations of radon. Figure XI11 shows the variation
temperature [G5]. Studies of radon transfer from tap- of concentrations in indoor air for a house with a
water to indoor air reported a use-weighted transfer radon concentration in tap-water of about 2 MBq m-'
efficiency of 0.5-0.6 and an average water use of [G6]; the peaks are associated with periods of high use
0.2-0.4 m3 per day and 'per person [G5, P2]. Degassing of water in the house. The integrated radon concentra-
of radon from tap-water has been found to lead to tions represented by each of the peaks in Figure XI11
elevated indoor radon concentrations in Canada [M7], are 200-400 Bq h m--'. Assuming that the characteristics
Finland [C2] and the United States [G6]. Taking the of the surveyed house are the same as those of the
air-to-water concentration ratio to be typically lo-" reference house yields a water use of 0.05-0.1 m3 per
[C6]. an indoor air concentration of 400 Bq m-j is peak.
obtained if the radon concentration in water is
4 MBq m-3. High concentrations in water are usually (E) Natural gas
associated with deep wells drilled in granitic areas;
the highest reported concentrations in water are 119. Natural gas is sometimes mentioned as a
14 MBq rn-) in Canada [M7]. 77 MBq m-' in Finland potential significant source of indoor radon. The
[S68] and about 20 MBq m-3 in the United States [G6, radon concentration in natural gas at production wells
S181. The use of aeration can reduce the radon varies from undetectable values to levels of about
concentration in water by a factor of about I00 [C2]. 50 kBq m--' [G7, H2, 53,W4]. The industrial process-
ing of natural gas involves the removal of impurities
117. Measurements of radon concentrations in water and separation of hydrocarbons. Some of these
have mostly been undertaken in regions where high hydrocarbons are bottled under pressure for sale as
levels were suspected. Measurements intended to liquefied petroleum gas (LPG) while others may be
estimate the weighted average radon concentration in used for fuel. Some of the radon activity contained in
water for a country or a community are rare. Results the processed natural gas decays during the transit
of that nature are only available for Finland, Sweden time between processing and use, or while it is stored
and the United States. In Finland, the population- in the bottles. When natural gas is burned in houses
weighted average has been estimated to be 25 kBq m-j for cooking or space heating the radon that is released
for drinking water distributed by water-supply plants may enhance the radon level indoor if the appliances
[A2, C2], and about 60 kBq m-3 when the contribu- are unvented. If the combustion products are vented
tion of private wells is included [K4]. The correspond- outside the house, this radon source is neghgible.
-4:WPU
I
O:WPM
I
!zOoJU 4:WAU 0:W Arc l:WPL( 4:W PU 0:WPu Zm
T I M E OF DAY
Figure XIII. Variation of the radon concentration in indoor alr of a house wlth radon concenlralion in water
of about 2 MBq m-1
[G61
120. The radon entry rate from the use of natural is negligible o r the ventilation system in the basement
gas may be expressed as is separate from that of the living areas of the
(2.12) building.
U n g = x n g ~ n 1gV
0 I 15 March
I
:6 tlarch
I
1 7 :,larch
I
18 March
f
19 March
Figure XV. Variation of the ventilation rate in an occupied house. The wind-speed data represent obse~ations
at a weather station 20 krn away from the house.
IN61
(b) Radon decay products
128. When an atom of 2'8Po is formed through the
decay of radon, it is a free ion. Molecules of water
vapour or trace gases coalesce almost immediately
around the ion. forming a molecular cluster of 2-20 n m
in diameter (Figure XVIII). The ion and the cluster
are usually referred to as free, uncombined o r un-
Fargo attached decay products. Unattached 218Pois highly
Portland mobile and, after 10-100 s, it attaches to an aerosol
Charleston particle (normal size in the range of 50-500 nm: see
Colorado Springs
Figure XIX); the other options offered to unattached
'18Po are to plate out on the indoor surfaces, to be
transported outdoors with the outgoing air o r to
decay into unattached *I4Pb.Attached 2'8Pois relatively
immobile and its plate-out on indoor surfaces is
sometimes ignored. The various processes are illustrated
in Figure XIX. The attached and the unattached decay
products are often distinguished by their environmental
0.1 1 .o 10 behaviour and deposition pattern in the respiratory
A I R EXCHANGE RATE (!I-') system. In a series of air samples, the position and size
Figure XVI. Scatter plot of radon-222 concentratlons versus
of the peak related to the unattached fraction may
air exchange rate for 58 houses in four cities. Measurements vary for reasons not yet completely elucidated [K 163.
were made during a four- to five-month period between
November 1981 and May 1982. 129. Upon alpha decay of attached Z16Po.the decay
ID21 product ?14Pbthus created may remain on the aerosol
o r indoor surface o r become unattached as the result
of its recoil energy. Subsequently, the behaviour of
127. Even though equation (2.14) is very simple and ?I4Pb is similar to that of ?I8Po. Upon the decay of
can be used to derive a typical value of the mean indoor attached *I4Pb, the *I4Bi created typically remains
radon concentration (for example, %,= 55 Bq mP3 attached. since the recoil energy irom beta decay is
with the radon entry rates given in Table 17 and not sufficiently large to promote detachment. The
i., = 1 h-I), it is clear that the prediction of the actual indoor behaviour of the radon decay products is
radon concentration (and of its variation as a function illustrated in Figure XX, where subscripts 1, 2 and 3
of time) in a given building cannot at this stage be relate to decay products 218Po. 214Pb and :IJBi,
made with accuracy. Figure XVII shows that the respectively, and superscripts fr, a and s designate the
variation of the indoor radon concentration over one unattached state, the attached state and the presence
week has no consistent pattern [ G I I]. Further theore- on indoor surfaces [B I]. Dotted lines denote the
tical and experimental work (as in [B26]) is required processes that have been neglected in this treatment.
to derive the values of x,. U and i., from the This model of indoor behaviour of radon decay
measurements of environmental and technological products was first proposed by Jacobi [J4] and has
parameters. subsequently been extended and modified by a number
o L a I I I I I I
12h 24h 12h 24h 12h 24h 12h 24h 12h 24h 12h 24h 12h
14 December 15 December 16 December 17 December 18 December 19 December 20 December 1977
o*rra-
PLATEOUT
Flgure XVIII. Histograms of size distribution of radon decay Flgure XIX. The basic processes lnfluendng the activity
products. balance of radon decay products.
[GI11 [PSI
I RADON I N D O O R S
I
I
I
Flgure XX. Flow chart of radon decay product behaviour under maraga
condltlons.
[Bll
of researchers. notably Porstendorfer et al. [P4. PSI, tions indoor and outdoor for different ventilation
Shimo et al. [S46, S48, S49] and Bruno [Bl]. The rates [P5]. For high ventilation rates, the particle
plate-out rate constant of unattached radon decay concentration ranges between lo4 and 10' cm-3 and is
products can be expressed as i. = v,S/V. where v, is about the same indoors and outdoors. For low
r
the deposition velocity (m h- ), S the total surface ventilation rates, the indoor particle concentration
area in the room and V the volume of the room. The typically ranges from 2 10' to 2 lo4 cm-3 [PSI. There-
deposition velocity is about 2 m h-I for unattached fore the attachment rate X is expected to vary from
daughters in still air [G12, K5, P5]. The surface to 10 h-I to 500 h-I, according to the indoor particle
volume quotient S/V is estimated to range from 3 to concentration. Average values between 20 and 50 h-'
6 m-I in rooms of dwellings if the furniture is taken may be expected in closed rooms with low ventilation
into account [PSI. The plate-out rate constant would rates [P5].
therefore be about 10 h-I in still air. In ventilated
rooms. the deposition velocity increases with the air 132. The probability for recoil detachment from
speed so that the plate-out rate constant is expected to aerosol particles upon alpha decay, also called recoil
range from 10 to 30 h-I in dwellings. Values reported factor, has been studied from the theoretical and
in the literature on the subject range from 2 h-I to experimental point of view by Mercer [M4]. The recoil
200 h-I [I7, I9,J4, K5, K 17, P4, S 1I, S44, L+'5]. energy possessed by a daughter product after alpha
decay is about 100 keV, corresponding to a range of
130. The deposition velocity for attached daughters about 0.1 pm in solid material. For a typical aerosol
is approximately two orders of magnitude less than of median diameter 0.2 pm, the recoil factor is about
that for unattached decay products. leading to plare- 0.8 [M4]. Upon beta decay, the recoil energy is only a
out rate constants of 0.1-0.3 h-I [K5, P5]. Conse- few electron volts. yielding a recoil factor of 0.01-0.02
quently, plate-out of attached decay products is [P4]. The detachment from walls and other surfaces
negligible as a removal mechanism relative to decay has not been examined in detail in any work to date; it
and ventilation. would be expected that 25-50% of deposited activity
could re-enter the room air mainstream upon alpha
131. The attachment rate X to aerosol particles has decay [Bl, MI].
been shown by Porstendorfer and Mercer [P6] to be a
linear function of the particle concentration 133. As already indicated. the equilibrium factor F is
X=pZ (2.15) defined as the ratio of the equilibrium equivalent
radon activity concentration to the radon activity
where p is the attachment coefficient in cm3 h ' and Z concentration:
is the particle concentration in ~ m - Reported
~. values of F = CYeq.Rn)/%ttn (2.16)
the attachment coefficient range from 1.8 lo-' cm' h-I with
to 7.4 10-?cm3h'-I [P5]. For indoor air. an average xcq,Rn = 0 . 1 0 5 +
~ ~0 . 5 1 6 +
~ ~0 . 3 7 9 ~ ~
attachment coefficient of 5 10-'cm3 h-I may be assumed
[P5]. The aerosol concentration indoor depends mainly where 2,. x2 and x3 represent the activity concentra-
on the outdoor particle concentration, the ventilation tions of polonium-218, lead-214 and polonium-214,
rate and the indoor sources of particles. Figure XXI respectively. The unattached fraction f, is usually
presents the measured variation of aerosol concentra- defined as the ratio of the equilibrium equivalent
radon concentration in the unattached state and of the
total:
Outdoors
It is also, however, sometimes defined as the ratio of
O Indoors
the equilibrium equivalent radon concentration that is
in the unattached state and of the radon concentra-
tion:
--a' 6 Thc fact that two different definitions may be used for
- 00
caoo~
O0%
0 Ba. sa
0 4
the same quantity leads to a certain amount of
ambiguity in the interpretation of the results reported
==='oaoo0 in the literature when the definition used is not clearly
specified. The same ambiguity exists when the un-
WINDOW CLOSED Y11100U SLIGHTLY OPtll attached fraction of a given decay product of radon is
reported, as the denominator of the equation call be
the radon activity concentration, the total equilibrium
equivalent radon activity concentration, or the equi-
librium equivalent radon activity concentration of the
lo3 1 decay product under consideration. In this Annex, it is
h i2 i 6 zb 4 4 b12
I
i6 20 24 assumed in all cases that the denominator of the
23 June 1983 24 June 1983 equation consists of the equilibrium equivalent radon
TINE OF DAY (hour) concentration, as, for example, in equation (2.17).
Figure XXI. Diurnal variation of aerosol concentrations out-
doors and indoors of a buildlng for different ventilation rates. 134. Bruno [BI] used the results of the survey
[PSI conducted by George et al. [GI I] on long-term
average concentrations of radon and radon decay 136. The influence of the particle concentration on the
product in 21 houses in the New York area to derive equilibrium factor is further illustrated in Figure XXIII
the best fit for the attachment rate and the plate-out [S43], which shows the results of a study in which the
constant rate. Assuming a ventilation rate of 1 h-I, equilibrium factor increased from 0.1 t o 0.8 as the
an equilibrium factor of 0.5 and a relatively high particle concentration varied from 1,000 to 25,000 cm-'.
unattached fraction of 0.07, Bruno obtained i p , = 8 h-I a range typical of the indoor environment. Because of
and X = 45 h-I, as shown in Figure XX, and indicated the great influence of the aerosol concentration in
that the model would be more accuratelv validated buildings on the equilibrium factor and on the
with the help of simultaneous measurements of unattached fraction, it is recommended that more
ventilation rate. radon concentrations and concentra- simultaneous measurements of the equilibrium factor
tions of attached and unattached 21BPo[B I]. and the aerosol concentration be conducted.
Flgure XXV. Median radon concentration levels In dlflerent 169. Information of the type presented in Figures
types of houses. XXV, XXVI and XXVII can be combined to estimate
~ 1 5 1 refined annual absorbed doses from inhalation of
o Indoors
Indoors ( a i rcondi t i o n e d )
1 I I 1 I I I I I I 1 I I
0 2 4 6 8 10 12 14 16 18 20 22 24
TIPE (hour)
Flgure XXVI. Diurnal variation of indoor radon-222 concentrations.
[C161
- Indoors a t home
- 1
..... Indoors elsewhere
----- Out o f doors
- I
L - - - - - - - - - - - - - - - - - .............
-I
- - - - -,...............
L
I..
I
p.r.n.-.r..tl I1
I I I I
Flgure XXVII. Average occupancy over a whole year In the Unlted Klngdorn.
P231
radon decay products. Further refinements, which 173. Although the reported activity mass concentra-
could not be implemented at present because of tions range over two or three orders of magnitude. the
insufficient information, would take into account the averages from the various countries are in fairly good
age distribution of the populations exposed. urban agreement. Figure XXVIII shows, for example, the
versus rural population distribution, as well as seasonal 23XUlevels measured in 800 samples of coal mined in
variations and the latitudinal distribution of the radon the United States [W12]; they range from 1 to
concentrations. 1,000 Bq kg-'. In this Annex, as in the UNSCEAR
1982 Report, it will be assumed that the average
activity mass concentrations of "OK,"SU and 23?Thin
111. INDUSTRIAL ACTIVITIES coal are 50, 20 and 20 Bq kg-'. respectively. and that
the decay products of ?"U and ?j2Thare in radioactive
equilibrium with their precursor.
170. The industrial processes considered are those
that bring to the surface of the earth materials 174. The uses of coal in OECD countries are listed
containing above average concentrations of the natural in Table 23. together with the amounts involved in
radionuclides, such as geothermal work or phosphate
mining, and those which treat material containing
average or above average amounts of the natural
radionuclides and concentrate them in one or more
products or by-products, such as coal burning or the
production of fertilizer from phosphate rock. In these
industrial processes, the hazard from radiation is
generally small compared to that from other chemical
substances; therefore, radiation is not systematically
monitored. Assessment of such exposures is usually
based on sketchy information derived from isolated
surveys. The only assessment at the national scale that
was available to the Committee is that of the
Netherlands [P26]. In this. the naturally occurring
radioactive materials discharged to the environment
by non-nuclear industries in the Netherlands was
estimated using a crude model based on radionuclide
concentrations in raw materials, mass flow, and infor-
mation on the technologies used in industrial pro-
cesses. The annual effective dose equivalents received
by members of the public in the Netherlands were
estimated to be about 40pSv on average, and about
0.7 mSv for individuals of the critical group consisting
of consumers of large amounts of fish [P26].
600
lndustry (including r a i l w a y s )
Donies t i c [ 550
Figure XXIX. Smoke: trends in emissions and average urban concentrations in the United Kingdom.
tUl61
consumption and that its ash content is 13%, about resulting reductions in the radon concentrations in
280 million tonnes of coal ash are produced annually model dwellings have been calculated by Stranden
in coal-fired power stations. Taking the average [S28] to be 3 Bq rn-' in a wooden dwelling and
activity mass concentrations of natural radionuclides 10 Bq m-j in a concrete dwelling. The corresponding
in coal to be 50 Bq kg-' for O ' K and 20 Bq kg-' for reduction in effective dose equivalent from indoor
?JbUand for '32Th, the average activity mass concen- exposure to radon decay products would be 90pSv
trations of 'OK, 238U and "?Th in coal ash are per year in a wooden building and 300 11Sv per year in
estimated to be 400. 150 and 150 Bq kg-'. respectively. a concrete dwelling. I n other controlled studies [U6.
Compared with normal soil, the average activity mass V3], the substitution of varying amounts of ordinary
concentration of O' K is similar, but those of ="U and cement with fly ash cement yielded no significant
232Thare six times higher. change in the radon exhalation rate from the concrete
obtained, in comparison with ordinary concrete.
193. Coal ash is used in a variety of applications. the
largest of which is the manufacture of cement and 196. The conflicting evidence may be attributed to
concrete. I t is also used as a road stabilizer, as road differences in the properties of the components used in
fill. in asphalt rnix and as fertilizer. Data on the concrete, their relative activity mass concentrations of
various uses of coal ash in several countries have been 226Raor the manufacturing process. I t seems that for a
reported [G20]. It can be estimated that about 5% of given activity mass concentration of 22bRa,the radon
the total ash production from coal-burning power exhalation rate of fly-ash is usually lower than that of
stations is used for constructing dwellings: this repre- concrete, so that enhanced indoor exposures to radon
sents an annual usage of 14 million tonnes. decay products may arise only when fly ash with a
high activity mass concentration of ::('Ra is mixed
194. The use of coal ash in building materials may with concrete.
result in changes in the indoor doses ouing to external
irradiation and to inhalation of radon decay products. 197. In this Annex. the use of fly ash in building
With respect to external irradiation. Siotis and Wrixon materials is assumed to result only in additional
[S5], assuming that the use of concrete containing fly exposures from external irradiation. Annual additional
ash for constructing dwellings would result in an effective dose equivalents of 30pSv i n wooden dwellings
additional activity mass concentration of 22bRa in and 70 jtSv in concrete dwellings are adopted as
concrete of 13 Bq kg-', calculated that the additional representative values on a world-wide basis. Taking
effective dose equivalent from indoor exposure would the amount of fly ash concrete to be 1.3 tonnes in a
amount to 20 11Sv per year. Stranden [S28], on the wooden house and 4 tonnes in a concrete building (as
basis of additional activity mass concentrations of in [S28]), the additional effective dose equivalents
10 Bq kg-I of lz6Raand 8 Bq kg-' of 232Th,estimated normalized per unit mass of fly ash concrete are found
that the additional absorbed dose in air would be to be 23 and 18 pSv a-' per tonne for wooden and
90pGy per year in concrete houses and 40pGy per concrete dwellings, respectively. Using an intermediate
year in wooden houses. These figures would be value of 20pSv a-I per tonne and assuming that an
reduced to 70 and 30uSv for concrete and wooden average of four persons live in each house and that the
houses, respectively. if the conversion coefficient from lifetime of the house is 50 years, the collective effective
absorbed dose in air to effective dose equivalent were dose equivalent commitment arising from external
taken to be 0.7. irradiation attributable to the annual use of fly ash for
constructing the dwellings is estimated to be about
195. There are conflicting views on the impact of the 5 lo-'.
use of fly ash on the dose from inhalation of radon
decay products. Siotis and Wrixon [S5] measured the 198. The use of fly ash as a component of cement
radon exhalation rates of concrete blocks made by a and concrete for constructing dwellings represents
cement manufacturer under controlled conditions only a small fraction of the total use of coal ash. The
using cement containing varying proportions of fly Committee has not found any published information
ash of high 226Raactivity mass concentration (330 and on doses arising from other uses of fly ash (as a road
800 Bq kg-'). The concrete blocks containing fly ash stabilizer, in asphalt mix, as fertilizer, etc.).
were found to present radon exhalation rates higher
than those of concrete blocks without fly ash. Siotis 199. The large fraction of coal ash that does not find
and Wrixon [SS] estimated. on the basis of these a commercial application is usually dumped in the
measurements, that the additional radon concentra- vicinity of the power plant. Two disposal methods are
tion in a model dwelling would be 1.5 Bq m-j. used. Ash mixed with water in a ratio of 2 to 3 is
resulting in an effective dose equivalent due to indoor piped as slurry to lagoons created by adding walls to
exposure to radon decay products of about 40 pSv per or otherwise modifying existing topographic features.
year. Radon concentrations in Polish dwellings built When a lagoon is filled, it is allowed to drain and, if
with concrete blocks made almost entirely of fly ash necessary, another lagoon is created on top. For dry
were found to be higher than those in dwellings built ash dumps, the ash is conditioned with water to
with concrete blocks containing no fly ash [B14]. reduce dust and transported to the dumping site. The
Stranden [S28], however, observed lower radon exhala- choice of disposal method depends on economic and
tion rates from concrete blocks containing 5% fly ash environmental factors [U16]. When the dumping is
than from ordinary concrete blocks; the two types of finished, most dry ash dumps are covered by topsoil
blocks had been especially constructed for the experi- and converted into areas for agricultural or recreational
ment and differed only in the inclusion of fly ash. The use.
200. The main potential radiation hazards from ash 204. Annual individual effective dose equivalents
disposal arise from resuspension and from contamina- resulting from inhalation of short-lived decay pro-
tion of surface and underground water either as a ducts of radon is estimated to be of the order of
result of leaching. i.e., as certain compounds are l0pSv at 1 km from the stack of a 100 M W geothermal
washed out of the ash by percolating rain water. or as plant. The average additional radon concentration
a consequence of the physical erosion of the ash would be about 0.1 Bq m-', compared with a back-
surface during run-off. Dose assessments taking into ground concentration of 1-10 Bq m-'. Measurements
account these processes are lacking. conducted near the Larderello plant in Italy and near
other geothermal power plants in New Zealand and
the United States failed to distinguish between the
1. Summary contribution of the radon activity from the plant and
that from background [A 16. G18, S59. WZO].
201. Radiation exposures resulting from the various
steps in the coal fuel cycle are summarized in Table 30.
The exposures are expressed in terms of collective 2. Oil-fired power plants
effective dose equivalent commitments per year of
practice around the ~ ~ o r l dThe . highest exposures 205. As shown in Table 31, oil has a large number of
seem to stem from the use of coal in homes and the applications, the most important being road transport,
use of fly ash in concrete. It should be borne in mind generation of electric power and domestic heating.
that these estimates are fraught with large uncertainties Approximately 3 1012kg of crude petroleum was
that are difficult to quantify. produced in the world in 1980. In power plants, about
2 lo9 kg of oil is needed to produce I G W a of elec-
trical energy. As the ash content of oil is very low,
B. OTHER ENERGY PRODUCTION oil-fired power plants are usually not equipped with
efficient ash removal systems. From measurements in
202. The other types of energy production considered two oil-fired power plants in France. normalized
in this section are geothermal energy and combustion atmospheric discharges of about 200, 300, 150 and
of oil and natural gas. 1,000 MBq per G W a for Z'8U, 226Ra,13'Th and 40K,
respectively, have been estimated [A8]. These are very
similar to the normalized discharges of coal-fired
1. Geothermal energy power plants fitted with efficient aerosol control
devices. Measurements of activity mass concentrations
203. Geothermal energy is produced in Iceland, of 232Th,22bRa.210Pband O ' K in fuel ash from oil-
Italy. Japan, New Zealand. the USSR and the United burning power stations of the USSR led to the same
States. In 1980. i t amounted to only 1.5 GW a of conclusion [B13]. The collective effective dose equi-
electrical energy production. but its relative importance valent commitment per unit electrical energy generated
may grow in the future. Geothermal energy makes use has been found to be about 0.5 man Sv per GW a.
of hot steam or water derived from high-temperature Assuming that 15% of the world-wide production of
rocks deep inside the earth. Most of the activity found crude petroleum is burned in electric power plants, the
in geothermal fluids is due to the uranium decay resulting annual collective effective dose equivalent
chain. Isotopes of solid elements may cause problems commitment would be about 100 man Sv. The annual
regarding water pollution or land disposal but only individual effective dose equivalent to a member of
radon. which is released into the atmosphere when the the critical group, calculated in the same way as for a
water or steam contacts the air, is considered here. coal-fired power plant. would be about 1 pSv.
From measurements of radon in geothermal fluids in
Italy [G18, M151, the annual releases of radon have 206. Information on radiation exposures of workers
been estimated to be I I0 TBq from the 400 MW in the oil industry is scarce. Kolb and Wojcik [K22.
Larderello plant, 7.0 TBq from the 15 MW plant at K23] measured a median ZZbRaconcentration of
Piancastagnaio and 1.5 TBq from the 3 MW plant 4.500 Bq m-' in thermal brine, which is raised to the
at Bagnore. The annual release of radon from the surface together with oil. This brine can be used for
1 1 units of the Geysers Pourer Plant in the United the extraction of oil from its deposits without any
States, which has a net capacity of 502 MW of elcc- radiation problem as long as the radium activity
trical energy, was assessed to be 21 TBq [A16]. These remains in solution. Salt from oversaturated brine is
figures point to an average atmospheric discharge per often precipitated after expansion, however. and scale
unit energy generated of about 150 TBq per GU' a. is formed on the inner walls of tubing, pumps and
The corresponding collective effective dose equivalent separation and storage tanks [K23, S601. Such deposits
commitment per unit energy generated is estimated to can be detected with common radiation protection
be about 2 man Sv per G W year if it is assumed that instruments; activity mass concentrations of up to
the equilibrium factor between radon and its short- lob Bq kg of 226Raand l2%a have bcen detected i n
lived decay products is 0.8, the population density some samples. Under normal conditions of operation,
around the plant is 100 km-', the effective dose the annual effective dose equivalent for maintenance
equivalent per unit activity inhaled is 1.1 Sv Bq-I personnel resulting from external radiation from such
and that indoor and outdoor concentrations are the sources is estimated to be less than 5 mSv [K23].
same. The annual world-wide production of geo-
thermal energy would yield a collective effective dose 207. Oil shale is currently being considered for the
equivalent commitment of approximately 3 man St'. production of synthetic oil that could be burned in
power plants. Oil shale is a sedimentary rock contain- 211. The radon concentrations around a gas-fired
ing kerogen, an organic substance originating from power plant are expected to be, in most cases,
micro-organisms that accumulated in what were once undistinguishable from background; the individual
large shallow lakes. When the rock is heated to a doses are expected to be trivial.
temperature of at least 400' C to bring about pyrolysis
of the kerogen, synthetic shale oil is produced. The
production of shale oil involves the processing of vast 4. Peat
amounts of material. Retorting 1 tonne of shale can
yield 110 Litres of retort water, 0.8 tonne of spent shale 212. Peat is burned for energy production in several
and 1-40 m' of retort gases [F6]. countries. notably in Finland and Sweden [E9, E10,
M311. Natural radionuclides are carried into the peat
208. In the rich shale deposits of Colorado, Wyoming bogs by flowing surface and ground water and then
and Utah, known as the Green River formation, as adsorbed to peat matter. In Sweden, the normal "'U
well as in Estonian shale. measured radionuclide activity mass concentration in dried peat is about
concentrations of raw oil shale (about 60 Bq kg-I of 40 Bq kg-', but some samples have shown concentra-
?38U,25 Bq kg-' of 232Th.500 Bq kg-' of 'OK) corres- tions up to 500 Bq kg-'; in one extreme case, the '"U
pond fairly closely to those observed in typical soils concentration was more than 10,000 Bq kg-' [E9]. In
[G19]: Antrim shales from the eastern United States Finland, samples of peat used as fuel in a power plant
and Moroccan shales show higher uranium concentra- showed concentrations of 16 Bq kg-' 30 Bq kg-]
tions (about 350 Bq kg-]) [G19]. After retorting, of 210Pb,5.3 Bq kg-' of 22BRaand 28 Bq-kg-] of O 'K
nearly all of the activity content is found in the spent [M31]. Since the ash content of peat normally lies
shale, with a marked increase with decreasing particle between 3% and 8% [M31], the concentrations of
size for most radionuclides. Average concentrations in natural radionuclides in peat ash are about 20 times
the respirable fraction of spent shale from the Green those in peat.
River formation are about 150 Bq kg-' of 'jbU,
130 Bq kg-' of 2'6Ra. 220 Bq kg-' of 210Pb,40 Bq kg-I 2 13. There is little information on the environmental
of 232Thand 740 Bq kg-' of "OK [G19]. Atmospheric discharges of natural radionuclides from peat power
discharges from an oil shale plant producing enough plants. Assuming that 5 lo9 kg of peat is needed to
oil to generate 1 GW a of electrical energy have been produce 1 GW a of electrical energy and using an
estimated to be about 290 MBq of '38U, 250 MBq of average 238Uconcentration in peat of 40 Bq kg-' and a
'"Ra, 430 MBq of :I0Pb, 90 MBq of 23'Th and dust control efficiency of 99%. as well as the general
1,500 MBq of 'OK [G19]. This is again very similar to assumptions used for coal-fired power plants, the
the normalized discharges from a coal-fired power normalized collective effective dose equivalent commit-
plant equipped with an efficient ash removal system. ment is tentatively estimated to be 2 man Sv per G W a.
The collective dose equivalent commitment per unit In the long term. storage and disposal of uranium-rich
electrical energy generated would be about 0.5 man Sv peat ash may have the greatest impact [E9].
per GI%'a.
209. In 1980. the world-wide production of natural 214. Radiation exposures attributable to natural
gas amounted to about 1012m3. Like oil, natural gas radionuclide discharges from various systems of elec-
has many fields of application. Its uses in OECD tricity production are summarized in Table 33. The
countries are summarized in Table 32, the major uses exposures are expressed i n terms of collective effective
being domestic heating, generation of electric power dose equivalent commitments for one year of practice
and as a source of heat in various industries. As dis- throughout the world and are normalized to the
cussed previously in this Annex. radon concentrations generation of 1 G W a of electrical energy. The highest
in natural gas may vary widely around a typica! value radiation exposures result from the use of coal.
of 1,000 Bq m-" Since about 2 lo9 m3 of natural gas
must be burned in order to produce 1 GW a of
electrical energy, the corresponding radon emission is C. USE O F PHOSPHATE ROCK
approximately 2 TBq.
215. Phosphate rock is the starting material for the
210. The corresponding collective effective dose equi- production of all phosphate products; it is the main
valent commitment per unit energy generated is source of phosphorus for fertilizers. The world pro-
estimated to be about 0.03 man Sv per GW a. The duction of phosphate rock was about 130 million
assumptions for this estimate are that the equilibrium tonnes in 1982 [F9], the main producers being China.
factor between radon and its short-lived decay pro- Morocco, the USSR and the United States. There are
ducts is 0.8, the population density around the plant is three types of phosphate rock: (a) phosphate rock of
100 km-', the effective dose equivalent per unit sedimentary origin: this type, which covers 85% of
activity is 1.1 Sv Bq-I and indoor and outdoor current needs for phosphorus, comes from deposits
concentrations are the same. Assuming that 15% of spread almost throughout the world, but especially in
the world production of natural gas is burned in Morocco and Florida (United States) [Ill]; (b) phos-
electric power plants, the resulting collective effective phate rock of volcanic origin: the principal deposit of
dose equivalent commitment per year of practice this type is found in the Kola peninsula (USSR);
would be about 3 man Sv. (c) phosphate rock of biological origin: the accumulated
droppings of marine birds have given rise to deposits is produced as waste or by-product. Thermal process
of guano. from which the leached phosphoric acid has plants produce elemental phosphorus, which is in turn
recombined with calcium from the underlying rock to used primarily for the production of high-grade
give tricalcium phosphate. phosphoric acid, phosphate-based detergents, a n d
organic chemicals. Waste and by-products of the
216. Activity mass concentrations of natural radio- thermal process are slag and ferrophosphorus.
nuclides in phosphate rock were reviewed by UNSCEAR
in its 1977 and 1982 Reports [U2, UI]. Activity mass 223. The drying and grinding operations that follo\v
concentrations of lJ2Th and 40Kin phosphate rocks of phosphate rock mining and beneficiation produce
all types are similar to those observed normally in soil, significant quantities of particulate material [U9].
whereas concentrations of 23sUand its decay products Very limited data are available on actual field measure-
tend to be elevated in phosphate deposits of sedi- ments of radioactive materials from drying a n d
mentary origin. A typical concentration of in grinding operations. Measurements made by the United
sedimentary phosphate deposits is 1,500 Bq kg-'. North States Environmental Protection Agency (EPA) [PI61
American phosphate presents the highest concentra- were summarized in the UNSCEAR 1982 Report [Ul].
tions of 238U.followed by north African phosphate. EPA has since established the parameiers of a
Uranium-238 and its decay products are generally reference phosphate rock d ~ i n gand grinding plant
found in close radioactive equilibrium in phosphate [U9]. which it used to calculate the emissions of
ore. radioactive materials into the atmosphere (see Table 34);
they correspond t o a particulate emission rate of
217. Exposures of members of the public result from about 0.1 kg per tonne of phosphate rock throughput
the following: (a) effluent discharges of radioactive and to radioactive equilibrium of ?'W with its solid
materials of the 238Udecay series into the environment decay products. The atmospheric release of 222Rnhas
from phosphate rock mining and processing: (b) use not been estimated by EPA: assuming an activity mass
of phosphate fertilizers: and (c) use of by-products concentration of226Rain phosphate ore of 1.500 Bq kg-'
a n d wastes. and, conservatively, a 100% release of :"Rn, would
yield 1.5 MBq per tonne of phosphate rock.
218. Occupational exposures mainly occur during
mining, processing and transportation of phosphate 224. Some phosphate rock must be calcined before it
rock, as well as during transportation and utilization can be processed. The need for calcining is determined
of phosphate fertilizers. primarily by the amount of organic material in the
beneficiated rock, In the calcining operation, the rock
is heated to about 800" C to remove unwanted
1. Effluent discharges during phosphate industrial hydrocarbons. Because calciners operate at a higher
operations temperature than driers, they have the potential for
volatilizing 2'0Pb a n d rloPo. Atmospheric releases
2 19. Phosphate industrial operations can be divided from elemental phosphorus plants, which are mainly
into mining and milling of phosphate ore, phosphate attributable to the operation of calciners, have been
product manufacture by the wet process (in wet- measured in the Netherlands and the United States
process phosphoric acid plants) and phosphate pro- [B3 1, U9, U 10, U11, U12]. Estimated annual values
duct manufacture by the thermal process (in elemental are presented in Table 34. Discharges of *lOPb a n d
phosphorus plants). 210Poare about two orders of magnitude higher than
those of other solid radionuclides of the 23Wdecay
220. The technique used to mine phosphate ores series. Analyses of particles collected from the calciner
varies from area to area depending on the type of off-gas streams at two plants in the United States
deposit. In Florida phosphate ore is mined using the showed that most of the 210Poactivity was associated
strip-mining technique. which involves stripping the with submicron particles and that the dissolution rate
overburden and mining the matrix with draglines of both Z1OPband 210Poin simulated lung fluid was
creating mine cuts from 15 to 20 m in depth [R5]. very small [U 10, U I I].
Overburden is stored near mine cuts and used as
backfill as subsequent cuts are made. Structures later 225. Results of measurements at calciners at wet-
built on reclaimed land may exhibit elevated radon process phosphoric acid plants are not yet available
concentrations, as discussed later in this Annex. [U9]. .4tmospheric discharges of natural radionuclides
at two wet-process phosphoric acid plants not equipped
221. After mining, beneficiation, which is a physical with calciners, however, have been published by EPA
separation process using screen flotation to remove [PSI and summarized in the UNSCEAR 1982 Report
non-phosphate components, is applied to phosphate [Ul]. EPA has since defined the parameters of a
ores not rich enough in P,O,. Exposures resulting reference wet-process phosphate fertilizer plant that
from mining and beneficiation have not been assessed. are used to estimate the annual discharges of natural
radionuclides into the atmosphere (Table 34). Those
222. After phosphate rock has been mined and discharges result from the production processes of
beneficiated, it is usually dried and ground t o a phosphate fertilizers a n d apparently do not include
uniform particle size to facilitate processing. Wet the discharges due t o ore drying and grinding.
process plants produce phosphoric acid, the starting Releases of 226Raare estimated to be lower than those
material for ammonium phosphate and triple super- of 238U and 230Th because radium is chemically
phosphate fertilizers; in that process, phosphogypsum separated from uranium and thorium in the digestion
of phosphate rock and goes predominantly to phospho- of rock phosphates. In Dutch wet-process phosphoric
gypsum. acid plants. higher than average external radiation
doses in air, ranging from 2 to 100 pGy h-I, have been
226. Annual airborne discharges, normalized to the detected in the vicinity of some piping and vessels near
production or processing of one tonne of phosphate gypsum filters [LIS]. Analysis of scaling samples
rock, are presented in Table 35. The normalized revealed activity mass concentrations of IZ6Raof up to
discharges apply mainly to the operation of phosphate 0.4 MBq kg-'; the potential radiation doses. attribut-
industrial plants in the United States and may not be able to external exposure and to inhalation of IZ6Ra
representative of the world-wide situation. Estimates during periodic cleaning, have been estimated in eight
of collective dose commitments corresponding to the phosphoric acid plants to be less than 2.2 mSv per
normalized discharges have been calculated using the year [L15]. In the Federal Republic of Germany,
methods described in the section on coal-fired power Pfister and Pauly [PI51 estimated individual and
plants and are also presented in Table 35. collective external exposures for the small group of
persons who handle rock phosphates as part of their
227. Rough estimates of the collective dose commit- job; their results correspond. in terms of effective dose
ments resulting from the world-wide operation of equivalent, to individual exposures of 200 pSv a-' and
phosphate industrial facilities. using the experience of collective exposures of 0.5 man Sv a-I. Extrapolating
the United States as a guide, are presented in Table 36. to the world's population by scaling over the phosphate
The corresponding collective effective dose equivalent fertilizer consumption results in an annual collective
commitment is about 60 man Sv per year of practice. effective dose equivalent of approximately 20 man Sv.
Exposures attributable to inhalation of phosphate
rock, however. have not been taken into account.
228. Environmental concentrations of natural radio-
nuclides and assessments of maximum individual
doses have been published for a few plants. At a
distance of about 2 krn from an elemental phosphorus 2. Use of phosphate fertilizers
plant in the Netherlands, the activity concentrations of
2'0Pb and *loPo in surface air have been found to 232. The world consumption of phosphate fertilizers
be about 0.1 and 0.4 mBq m-' above background, was about 30 million tonnes of P20, in 1982 [F9]. The
respectively [D7]. For the same plant. the estimated application rate of fertilizers depends on. among other
maximum annual individual effective dose equivalents things, the type of soil and the type of crop. The
due to atmospheric discharges are about 40pSv [B31, average consumption of phosphate fertilizer per unit
S50]. In the United States, the atmospheric releases area of agricultural land varied in 1982 from 3.6 kg
from the six elemental phosphorus plants in operation P 2 0 5per hectare in the developing countries to 10.9 kg
in 1983 were estimated to result in annual lung dose P20, per hectare in the developed countries. the world
equivalents for nearby individuals ranging from 0.05 average being 6.7 kg P20, per hectare [F9].
to 6 mSv [U9].
233. Activity mass concentrations of natural radio-
229. Discharges of radioactive materials into surface nuclides in phosphate fertilizers have been reviewed in
water have also been. occasionally reported. In the the UNSCEAR 1982 Report [Ul]. For a given
Netherlands, about 50 GBq of 2'0Pb and 30 GBq of radionuclide and type of fertilizer. the activity mass
210Powere discharged from an elemental phosphorus concentrations vary markedly from one country to
plant into the Scheldt estuary [B31]. In that country, another, depending on the origin of the components.
all phosphogypsum produced by fertilizer plants (2 General features are that the activity mass concentra-
million tonnes per year) is also disposed of into the tions of O
' K and of 212Thand its decay products are
Rhine 15 km from the North Sea [K19]; these annual always low and that the activity mass concentrations
discharges, which contain about 0.4TBq of of the radionuclides of the "'U decay series are
2 TBq of lZ6Ra.0.7 TBq of "OPb and 2 TBq of Z'OPo. 5-50 times higher than in normal soil. The degree of
are estimated, in a preliminary assessment, to result in radioactive equilibrium between 238Uand its decay
maximum individual effective dose equivalents of products in a given type of fertilizer depends essentially
150 pSv per year and annual collective effective dose on the relative contribution of phosphoric acid, since
equivalents to the Dutch population of 170 man Sv phosphoric acid usually has a very low IZ6Raconcen-
from ingestion of seafood; the main contributor to the tration. For the purposes of this Annex, it is assumed
dose is 2'0Po [K19]. In France, over 3 million tonnes that "OTh and "'U are in radioactive equilibrium with
of phosphogypsum was dumped into the Seine estuary "'U and that "OPb and 210Po are in radioactive
[PI81 but the corresponding radiation exposures have equilibrium with 226Ra. Table 37 presents average
not been estimated. activity mass concentrations of 238U and n6Ra in
phosphate fertilizer from four countries [D8,M21,
230. In other countries, such as India and the United P15, U131: the levels range from 1,700 to 9,200 Bq
States, phosphogypsum is retained in sludge ponds or per kg P205for 238Uand from 480 to 1,700 Bq per kg
stockpiles near phosphate fertilizer plants; occasional P20, for "6Ra. Typical values are 4,000 and 1,000 Bq
drainage or seepage of radioactive materials into per kg P20, for 238Uand 226Ra,respectively.
nearby surface water has been reported [A 14. P 171.
234. Since the activity mass concentrations of 238U
23 1. Limited information is available on occupational and Iz6Ra in phosphate fertilizers are several times
exposures attributable to processing and transport higher than in normal soil, they constitute an additional
source of radiation exposure for workers and members 3. Use of by-products and wastes
of the public.
238. The main by-products resulting from phosphate
235. The annual application of phosphate fertilizers industrial activities are phosphogypsum in wet-process
can be calculated to represent less than 1% of the fertilizer plants and calcium silicate slag in thermal
normal soil content of 238U [M21, PIS]. Assuming an process plants. Significant radiation exposures may
accumulation of lI6Ra in the soil during the past occur if such by-products are used in the building
80 years, Pfister and Pauly [PIS] have estimated that industry. Another source of exposure stems from the
the mean additional absorbed dose in air above reclamation of land on which phosphate mining has
fertilized fields is about 0.8 nGy h-I, a small fraction been completed and houses have been built. Since new
of the normal natural background from terrestrial information on radiation exposures has not been
sources of 50 nGy h-'. Small additional doses also made available to the Committee in the past few
occur from ingestion of foodstuffs grown on fertilized years, the following is, to a large extent, a summary of
agricultural areas: Drichko et al. [D8] have shown the corresponding section in the UNSCEAR 1982
that although the transfer coefficient of 226Rafrom Report [Ul].
soil to plants is practically the same whether 226Rais
included in fertilizer or soil structures, the activity 239. Large quantities of phosphogypsum (about
mass concentrations of ?'OPb and 2'0Po in the aerial 100 million tonnes per year) are produced in wet-
parts of plants seem to be independent of the process phosphoric acid plants. The activity mass
corresponding activity mass concentrations in soil; concentrations of 226Ra in phosphogypsum, which
this implies the predominance of the air-to-vegetation depends on the origin of the phosphate ore processed.
transfer for such radionuclides. is typically about 900 Bq kg-I [Ul, U2]. Most of the
phosphogypsum is considered waste and is either
stored in ponds or stacks or discharged into the
236. The collective dose commitments incurred after aquatic environment.
application of phosphate fertilizers have been roughly
evaluated by comparison with the activity mass
240. In the United States. a small amount of
concentrations of natural radionuclides in soil and the
phosphogypsum (about 0.6 million tonnes per year) is
corresponding dose rates. Table 38 shows the results
used in agriculture to improve water movement in
obtained under the following assumptions: the avail-
saline-alkaline soil and as a substitute for lime o r
ability to plants of natural radionuclides is the same limestone in alkaline soil [L16, PIS].
whether in fertilizer or in the normal constituents of
the soil: the ploughed layer of soil is 0.3 m deep: the
241. Phosphogypsum is also used as a substitute for
deposited activity becomes unavailable to the vegeta-
natural gypsum in the manufacture of cement. wall-
tion with a mean life of 100 years for the long-lived
board and plaster. Japan phased out its production of
natural radionuclides: the fraction of time spent by the
natural gypsum in 1976 and is currently recycling
populations exposed on or near fertilized fields is 1%;
about 3 million tonnes of phosphogypsum per year
and one tonne of phosphate rock produces, on
[PIS]. In Japan, approximately one half of the by-
average. 0.3 tonne of PIO, in phosphate fertilizer. It
product gypsum is used as cement set-retardant; the
can be inferred from Table 38 that the collective other half is used to make wallboard and plaster. In
effective dose equivalent commitment per unit of
Western Europe, about 10% of the phosphogypsum
phosphate rock is approximately 8 lo-' man Sv t - I .
production, that is 2.5 million tonnes, was used in
Taking the world-wide production of phosphate rock 198 1as by-product [P 181. Phosphogypsum is commonly
to be 120 million tonnes, the collective effective dose used in construction blocks for floors and walls and in
equivalent commitment resulting from the world-wide partition blocks for interiors in north Africa, the
use of phosphate fertilizers during one year is roughly Mediterranean countries and the Middle East. I t will
estimated to be 10,000 man Sv. be assumed in this Annex that 5 million tonnes of
phosphogypsum, representing 5% of the world-wide
237. Occupational exposures arising from external annual production. is used annually as building
irradiation during transport, storage and application material in dwellings.
of phosphate fertilizer were assessed by Pfister and
Pauly [PI51 and reviewed in the UNSCEAR 1982 242. O'Riordan et al. [OS] estimated the additional
Report [Ul]. Mean additional absorbed dose rates in doses that would be received by the occupants of a
air ranging from 20 to 200 nGy h-I were measured for residential building in which 4.2 tonnes of by-product
various transport and loading operations, with peak gypsum would have replaced the established materials;
values of 800 nGy h-1 [P15]. From the number of the additional absorbed dose rate in air was calculated
workers involved or the time spent in the various to be 0.07 pGy h-I; the additional radon concentra-
operations considered, a total annual collective effec- tion, using an air exchange rate of I h-I. was
tive dose equivalent of 1.3 man Sv can be derived estimated to be about 10 Bq m-3, resulting in an
[PIS]. A rough estimate of about 50 man Sv for the annual effective dose equivalent of 0.6 mSv. If it is
collective effective dose arising from occupational assumed that 5% of the by-product gypsum is used as
exposure to external irradiation resulting from world- building material in dwellings, on average four persons
wide handling of phosphate fertilizers can be inferred live in the dwellings and the mean life of the dwellings
from the results of Pfister and Pauly, using the is 50 years, the collective effective dose equivalent
consumption of phosphate fertilizers as a reference commitments resulting from one year of world-wide
scale. use of phosphogypsum in the building industry are
estimated to be 10' man Sv from external irradiation conducted since the 1960s. This section is devoted to
and 2 10' man Sv from internal irradiation. These the discussion of occupational exposures in non-
estimates are highly uncertain and need to be con- uranium mines other than coal mines, which are
firmed by measurements in dwellings that have been considered in another part of this Annex.
constructed using known amounts of phosphogypsum.
248. Measured concentrations of radon and radon
243. Calcium silicate slag may be used as a com- decay products are presented in Table 40. The
ponent for concrete. Measured activity concentrations potential alpha energy concentrations of radon decay
in slag samples range from 1.300 to 2,200 Bq kg-' of products range from 0.02 to more than 300 pJ m-',
Z2bRa [ B l l . M161. Results from a n indoor survey and there is no simple relationship between radon
indicate that the gamma absorbed dose rate in air can decay product concentration and type of mine. Mines
be as high as 0.3pGy h-I above background in extracting from sedimentary deposits usually have low
dwellings construcred with 43% by weight slag in radon decay product concentrations but this is not
concrete slabs [B I I]. In a similar survey carried out in always true. Mines associated with igneous intrusions
Canada, absorbed dose rates of up to 0.2pGy h-I imply high uranium content and therefore high radon
were obtained [M 161. decay product concentrations. although ventilation
can obscure this relationship. Geological and hydro-
244. Residents in structures built on reclaimed phos- geological characteristics may also be of importance.
phate land in Florida, United States may also be Convective movements of air and water resulting from
exposed to significant radiation doses. About 600 km2 pressure differences between the mine and its environ-
of Florida land has been mined for phosphate rock in ment explain large radon entry rates into the mine
the past 80 years. About 200 km2 of the land has been [22]. Detailed studies of the characteristics of non-
reclaimed to various degrees. The equilibrium equi- uranium mines in countries of the European Economic
valent radon concentrations in houses built on reclaimed Community show that the primary indicator of high
land were found t o range from 4 to 500 Bq m-3 with a radiation exposures is a radon concentration in
weighted average of about 40 Bq m-', which is estimated exhaust air in excess of 400 Bq m-3 1221.
to be 26 Bq m-j above normal concentrations in
houses in that area [G21]. This average additional 249. Occupational exposures attributable t o radiation
concentration results in an annual effective dose in non-uranium mines have decreased with time [D6,
equivalent of approximately 1.6 mSv. An experimental S34. S351, as monitoring has led to action being taken
investigation and remedial action programme was to relieve high exposure situations. Personal dosimetry
carried out involving 10 houses and a mobile home on is now being used in Polish non-uranium mines [CIS]
land that had phosphate mineralization o r had been and is envisaged in Italy [S37] and the United
affected by phosphate mining activities and for which Kingdom [M 181.
the annual average radon equilibrium equivalent
concentration was believed to be in excess of 100 Bq m-3 250. The degree of equilibrium between radon decay
[S5 I]. products and radon in non-uranium mines has been
investigated in several countries. Measurements in an
4. Summary
Italian lead mine at a location representative of the
245. Table 39 summarizes the radiation exposures radiological characteristics of the mine show an
attributable to the use of phosphate rock, expressed in average value of 0.70 with a range of 0.50-0.85 [S37].
In 15 mines in the Federal Republic of Germany, the
terms of collective effective dose equivalent commit-
ment resulting from one year of practice. The total equilibrium factor was found to vary from 0.28 t a 0.82
collective effective dose equivalent commitment is with a rather flat distribution [K15]. In Norway, the
mean value of 210 measurements of the equilibrium
estimated to be 300,000 man Sv, essentially from the
factor in different mines was 0.46. with a minimum of
use of by-product gypsum in dwellings.
0.08 and a maximum of 0.93 (S381. A typical value of
the equilibrium factor in non-uranium mines seems to
be 0.6 with large variations around this figure.
D. NOK-URANIUM ORE MINING
.4ND PROCESSING
25 1. Stranden and Berteig [BZO, S38] have established
246. Because of the presence of radon in confined empirical relationships between theequilibrium factor F
spaces, metal and non-metal mining results in occu- and the activity concentrations~of the individual radon
pational exposures. Ventilation of mine air, in turn, decay products "'Po, IL4Pband 2MBinormalized t o
results in environmental discharges of radon and radon that seem to apply to most mining conditions
exposures of members of the public. Ore processing when the value of F is in the range of 0.1-0.7:
gives rise to additional environmental discharges of %(2'ePo)/ %(:lzRn) = 1.1 FO-55
natural radionuclides. Occupational exposures and ~ ( ~ l ~ /Pxb( )= ~ R =~ )1.0 F0.94
exposures of members; of the public are discussed
below. ~ ( ~ l ' B i/) %(12=Rn)= 0.77 F1.I2
273. As the activities of 238Uand 232Thper unit mass 276. Individual exposures resulting from industrial
of lead ore are similar t o the corresponding values in activities are generally small in comparison t o the
normal soil. the atmospheric emissions of natural overall exposure from natural sources of radiation.
radionuclides estimated for a reference plant process- Their importance can best be characterized in terms
ing annually 0.22 million tonnes of lead [U9] are fairly of collective effective dose equivalent commitments.
small (about 1 GBq of 2'0Pb and of 2 1 0 P ~ )The . Table 49 provides estimates of collective effective dose
resulting collective effective dose equivalent commit- equivalent commitments arising from one year of
ments per year of release from the reference plant are practice for most of the activities considered. Because
less than 0.1 man Sv. of the scarcity, o r lack, of data for the industrial
activities listed in the table, most of the estimates are
(0 Other meral and non-nteral mining very tentative. The total collective effective dose
equivalent commitment arising from one year of
274. Annual radon releases into the atmosphere have practice is less than 5 1 0 man Sv, representing a per
been reported for a few other United States mines: caput effective dose equivalent commitment of about
30 GBq for a limestone mine. 70 GBq for a fluorspar I00 11Sv.
T a b l e 1
Source of lrradlatlon
External Internal Total
lrradlatlon lrradlatlon
Cosmlc rays
lonlzlng component
Neutron component
Cosmogenlc radlonuclldes
Prlmordlal radlonuclldes
1;-40
Rb-87
U-238 serles:
U-238 * U-234
7h-230
Ra-226
Rn-222 + Po-214
Pb-210 + Po-210
Th-232 serles:
Th-232
Ra-228 -. Ra-224
Rn-220 + Tl-208
Roof
12
10
8
5
4
2
Basement
T a b l e 3
Estlmates of outdoor absorbed dose rate In alr from terrestrlal radlatlon sources
1 m above ground level obtalned in larue-scale surveys
Absorbed dose
Country Year Number of rate in alr
or reported measurements (nGyh-I)
area Type of survey and instrumentation used Ref.
Average Range
Number of
City. measurements Indoors Outdoors
provlnce or
autonomous
reglon Gamna Cosmic rays Gamna Cosmlc rays
Indoors Outdoors rays (lonlzlng rays (lonlzing
component) component)
R e s u l t s o f l a r q e - s c a l e s u r v e y s o f I n d o o r absorbed dose r a t e l n a l r
due t o qamM t e r r e s t r l a l r a d l a t l o n
---
Absorbed dose r a t e
I n a l r (nGy h - 1 )
Country Year Nuniber o f Type o f Comnents Ref.
reported dwelllngs bulldlng
Populatlon-
Average w e i g h t e d p/
Annual Intake ( B Q )
Source
Inhalation lngestlon
U-238 serles:
U-238 0.01 5
Th-230 0.01 2
Ra-226 0.01 15
Rn-222 200000 300
Pb-210 4 40
Po-210 0.3 40
Th-232 serles:
Th-232 0.01 2
Ra-228 0.01 15
Rn-220 100000
T a b l e 8
U-238 serles:
U-238 7 2 15 50 50 2 2 5 3 2
lh-230 0.3 0.3 20 20 70 0.3 0.3 10 7 0.3
Ra-226 2.7 2.7 2.7 170 170 2.7 2.7 2.7 2.7 2.i
Rn-222 - look/
Pb-210 200 200 200 3000 3000 140 200 200 200 200
PO-210 200 200 100 2400 2400 110 200 200 200 200
Th-232 serles:
Th-232 0.15 0.15 20 6 24 0.15 0.15 3 2 0.15
Ra-228 0.5 0.5 15 50 50 0.5 0.5 10 5 0.5
(Th-228)
Rn-220 40 c_/ - -
lh-232 rerles:
Th-232
Ra-228,Ra-224
Rn-22O+Pb-208
a/ lncludlng doses resultlng from the formation of Rn-222 and Its short-llved decay
products In the body by decay of Ra-226 (retentlon factor of one thlrd).
b/ Tracheo-bronchlal tree.
c_/Lungs.
d_/ Contrlbutlons to the annual effective dose equlvalent ( ~ S V ) .
T a b l e 10
Polonlum-210
concentratlon
Perlod of Number of ( ~ 8 9m-3)
Country and place measurements samples Ref
Mean Range
- -
Flnland
Nurmljarvl 32, dally [MI) 1
Helslnkl 32. dally [Mill
France
loulouse 37. monthly In121
Germany. Federal Rep.
Munich-Neuherberg 207. weekly [u131
Unlted Klngdom
Harwell 4. dally [86I
Chl lton 41, monthly I P7 I
Sutton 5. monthly [OSI
Unlted States
Boulder 15. dally [PSI
USSR
Vl lnlus ? Quoted
In [ P 9 ]
3. monthly 1~91
Potentlal alpha energy ratto of thoron and radon decay products
in duelllngs
T a b l e 12
Lungs 0.25 14 78 25
Red bone marrow 0.02 0.8 4.5 1.4
Bone Ilntng cells 0.18 9 50 16
L l ver 0.02 1 5.6 1.8
Kldneys 0.10 b 34 11
Spleen 0.004 0.2 1.1 0.4
Other soft ttsrues 0.002 0.1 0.6 0.04
Repre-
Parameter Symbol Unl t Reported range sentative Ref.
va 1ue
T a b l e 11
------ A
T a b l e 15
Radlum-226 Radon-222
activlty Concentratlon
Sol 1 type mass
concentrat \ o n
(Bq k g - \ ) (k8g m-3)
Radon-222 s o u r c e c h a r a c t e r l s t l c s f o r b u l l d l n q m a t e r i a l s
Concrete
Heavy c o n c r e t e USSR
Lightwelght concrete USSR
Ord\nary concrete Sweden
Aerated concrete
based on alum s h a l e Sweden
Alum-shale c o n c r e t e Denmark
f l y - a s h concrete (4%) USA
Fly-ash concrete Greece
Concrete Hungdry
Concrete Oenmark
Concrete Norway
Concrete Greece
Concrete USA
Concrete USA
Concrete USA
(Adopted reference
value)
Brlck
Red b r l c k USSR
Re0 b r l c k Hungary
Red b r l c k Poland
Red b r l c k USA
BrlCk Denmark
8rlck Norway
Brlck Greece
Slllcon brlck Poland
Adobe b r l c k USA
(Adopted reference
value)
Gypsum
Gypsum USA
Gypsum board Denmark
B y - p r o d u c t gypsum
(apdtl te) Poland
B y - p r o d u c t gypsum
(phosphor\ t e ) Poland
L i g h t w e l g h t expanded
c l a y aggregate Norway
Sand USA
USA
Gravel USA
- -
a/ C a l c u l a t e d f r o m d a t a g i v e n I n t h e r e f e r e n c e . assumlng a d l f f u s l o n l e n g t h o f 0 . 2 m.
T a b l e 17
Source
Estlmated
arlthmettc mean Typlcal range
Underlvlna sol1
0lff;ston 1.7
Pressure-driven f l o w 40
BulldIna materials 6.4
Outdoor -at r
Water
Natural gas 0.3 0- 1
T a b l e 18
tqulllbrlum factor F
Number of
Country duelllngs Average Range Ref
Canada
March Tounshlp [L)I
13 cltles 0.19-0.67 b/ [Mb]
[S441
1 Inland 0.30-0.63 [Msl
Germany. Federal
Republlc of
Italy
Netherlands
Norway
Sweden
Unlted Klngdom
Unlted States
New Jersey
Radon and equlllbrlum equivalent concentrations obtdlned In recent larqe-scale lndoor surveys
Poland 201 Apartments Radon and radon Hatlon-wlde 1918 9 (mean) 4 (mean) Log-normal 1 [GI31
daughters. grab population range 0.4-17
sanpllng In the worst exposure 8 9 m - 3 (Eft)
ventllatlon condltlons
Sweden 5 Detached houses 1 2 2 (mean) Log-normal [SB.
bullt before 1915 6 5 (medlan) 5421
191 Apartments bullt Radon, passlve 2 - n e t Hatlon-wlde 1982 8 5 (mcan) 105 (mean) Log-normdl
before 1915 exposure. 1 In bedroom. populatlon 4b (medlan)
1 In llvlng room exnoIure
96 OetdChed houses 59 (mean) Log-nor~l
bullt 1978-1980
Cornwalland
other uranl-
ferous regfons
700 Homes Grab sampllnq of radon
and radon daughters
plus ventllatlon rate
Setrch for
problem areas
1985? 1 4 0 (medlan)
In llvlng.
rooms
14 (medlan)
In llvlng-
rows
Og ..
Log-normal
3.2
5.2
o g (an)
[YE.
821.
09 1
plus I-year exposure
wlth pdsslve (tEC)
radon detectors
T a b l e 21
lnhalatlon
Radon gas 0.005 0.04 0.2 Decay of radon and
decay products in the
same tlssue; solubll\ty
factor of 0.4
Radon decay
products ( L E C )
1 ndoor s
Ingestion
Radon gas 0.0001
waier consumption rate
= 0.5 1 d-1
T a b l e 22
World . 31 0 0 100
T a b l e 23
Dornestlc 20
Comerclal/publlc servlce 7
Power statlons 835
Coke ovens 21 1
Iron and steel Industry 5
Chernlcal lndustrles 22
Other lndustrles 77
Rall transport 0.2
Other 55
Total
T a b l e 24
T a b l e 25
Domestic and
manufactured fuels 15.0 4.7 0.7 4.5
Pouer stations 73.1 17.1 12.5 80.1
Cdrbonlzatlon (coke. . . . ) 17.5 6.0 1.1 7.1
Other Industry 12.1 9.6 1.2 7.7
0ther.lncludIngexport 1.5 6.3 0.1 0.6
Welghted
Total 119.2 average 15.6 100.0
13.2
T a b l e 26
Total emissions
Ortgtn lo6 kg x of
total
Domest ic 3 37 74
Comnerclal/publlc service 12 3
Power stations 28 6
Other Industry 68 15
Rall tranrport 10 2
U-238 Th-232
Fly-ash decay series decay serles
removal K-40 Reference
efflclency
(X) U-238 Ra-226 Pb-210 Po-210 Th-232 Th-228
Canada a/
Nantlcoke, 4000 HW 99.5 350 100 100 300 300 70
France ? 3500 7000 7000 6000
Germany, Federal Rep. of
Brown coal
Bituminous coal
Bltumlnous dry ash
removal 99
Bltumlnous llquld ash
remova 1 99 500 300 2000 6000 200 200 [HI?]
lndla 95 31 0 0 0 6400 10000
Italy
Llgnlte. 250 HW [Dl .GI61
Llgnlte, 7 0 MU [Dl ,6161
Coal, 1280HW [01 .tlb]
USSR
Zaporozhje b/ 1200 MW [Ibl
(old)
1000 nw [I61
(modern)
Unlted Ktngdom. 2000 MU [ c9 I
[C141
United States ~4141
~ 7 1
M-1, 510 Mu r/ [US1
M-2. 450 HW r/ [US1
M-3. 125 MW c/ [US1
M-4, 12.5 MU c/ [US I
Mllllken, 270 MW (K141
Model plant (modern) [Us1
Model plant (1970) [US I
Model plant (modern) [BE]
Model plant (1972) [eel
UHSCEAR 1982 Report 97.5 4000 1500 1500 5000 5000 1500 1500 [Ul]
lhls Annex
modern
old
Internal External
lnhalatlon lrradlatlon lrradlatlon
Radlonucllde durlng the due to due to Total
cloud deposlted deposited
passage activity actlvlty
15
17
60
1.3
t daughters 0.1
-r Po-210 14
290
+ daughters 60
+ daughters
T a b l e 29
Internal External
lnhalatlon lrradlatlon lrradlatlon
Radlonuc l lde durlng the due to d u e to Total
cloud deposlted deposlted
passage actlvlty actlvlty
U-238
U-234
Th-230
Ra-226
Rn-222 daughters
+
Pb-210 4 Po-210
Th-232
Ra-228 * daughters
Rn-220 + daughters
a_/ Uslng emlsslon control devlces that allow only about 0.5% of the
fly-ash produced to escape.
T a b l e 30
T a b l e 31
Gas/dlesel oil
Llquefled gases
Comnerclal/publ\c servlce Gas/dlesel oil
Power statlons Residual fuel oll
lron and steel Industry Resldual f u e l oll
Chemlcals Industry Resldual fuel oil
Other lndustrles Resldual fuel oil
Alr transport Jet fuel
Road transport Motor gasol lne
Rallways Gas/d\esel 011
T a b l e 32
Uses of natural g a s i n O E C D l g u n t r l e s . 1%
[U151
Energy Share
(PJ) (XI (XI (X) (XI
p~ - ~
Domes t Ic 7980
Comnerclal/publlc servlce 4310
Power statlons 5850
Natural gas extractlon 2340
Petroleum reflnerles 670
lron and steel Industry ]
Chemicals Industry ] 10000
Other lndustrles 1
Other 1550
Collective e f f e c t l v e Normallzed
dose equlvalent collectlve effectlve
T y p e of comnl tment dose equivalent
plant p e r y e a r of p r a c t l c e corm1 tment
( m a n Sv) ( m a n S v p e r G W a)
Coal-fired
01 I-f ired
Natural gas
Geothermal
Peat
T a b l e 34
E s t l m a t e d atmospheric d l s c h a r q e s f r o m p h o s p h a t e i n d u s t r i a l p l a n t s
Annual R a d l o n u c l l d e d l s c h a r g e s ( G B q a-l)
lnput of Ref.
T y p e of plant phosphate
and location rock U-238 7h-230 Ra-226 Rn-222 Pb-210 Po-210
(106 t) a/
O r e drying a n d g r l n d l n g
Unlted States.
reference p l a n t 2.7
Elemental p h o s p h o r u s p l a n t
Vlisslngen, N e t h e r l a n d s 0.75
Unlted S t a t e s
Pocatello, I d a h o j
Soda S p r i n g s , I d a h o j
Sllver B o w , M o n t a n a ] -4
K t . Pleasant, Tenn. ]
Columbia, T e n n . 1
Coiumbta. Tenrr. 1
Wet-process f e r t l l l z e r p l a n t
Unlted States.
reference p l a n t 1
a/ Atmospherlc d l s c h a r q e s of R n - 2 2 2 e s t l m a t e d by U N S C E A R .
T a b l e 35
Radlonucllde AIrborne
discharge Red Gastro- Other
Lungs Bone bone Llver Kldneys Spleen lntesttnal soft
(Bq t-l) surfaces marrow tract tlssues
Total
Total
Pb-210 20
Po-210 20
External Irradlatlon
Total
Pb-210 800
Po-210 4000
External lrradiatlon
Total
Bq/kg P20s
Country Ret
T d b l e 38
Internal irradlatlon
Lungs 1
Bone surfaces 20
Red bone marrow 3
LI ver 1
Kidneys 10
Other tissues 1
External irradldtlon
All tissues
T a b l e 39
Potentlal Annual
alpha potential
Country Year Radon energy alpha Type of mlne Ref.
concen- concen- energy
tratlon tratlon exposure
of radon
(Bq m-3) (uJ m-3) (mJ)
p/ Range of means.
b/ Wlnter measurements.
c/ Assumlng an average equlllbrlum factor of 0.7.
a/ Average exposures decreaslng wlth time from 20 mJ ln 1970 to 3 mJ In 1980.
T a b l e 41
RADIATION CHARACTERISTICS
1: sedlmentary
2: sedlmentary
3: sedlmentary
4: lgneous
5: redlmentary
6: lgneous
7: sedlmentary
8: lgneous
OCCUPATIONAL DOSES
a/ Assumlng a 4 n geometry.
b/ Assumlng an ore dust concentratlon of 3.8 mg m-3.
T a b l e 42
Annual d t m o s ~ h e r l c releases
(Mas)
Rad l o-
nuc l lde
Ulne Ulll Smelter
T a b l e 43
T a b l e 44
Radtonucltde actlvltles per untt mass
In surveyed alumlna plant process samples
[ ~ s ,uei
T a b l e 45
Radlo-
nucllde Alumina Red mud Alumlnlum
kllns kllns reduction
plant
T a b l e 46
Ore 30
Concentrate 24
T a b l e 47
Estimated atmospheric releases of natural rad\onuclldes
from copper ore mlnlng dnd processins facllltles
[A7, U81
T a b l e 48
Estimates of per c a ~ u tannual effective dose e ~ u l v a l e n t s
and of ranges, excluding extreme values,
for the most Important natural sources of radlatlon
Annual effective
dose equlvalent ( ~ S V )
Source of lrradlatlon
Mean Typlcal range
External
Cosmlc rays 360
Terrestrlal sources 410
Internal
K-40 180
U-238 + Ra-226 20
Rn-222 + Po-214 11 0 0
Pb-210 + Po-210 120
Th-232 + Ra-224 20
Rn-220 + 11-208 160
Coal combustlon
Power plants 2000 60
Domestlc homes 2000-40000
Coal mlnlng 0.5-10 2000
Use of coal ash ln the bulldIng lndustry 50000
Geothermal energy production 3
011 combustlon In power plants 100
Natural gas combustlon In pouer plants 3
Phosphate lndustrlal operattons 60 20
Use of phosphate fertlllzers 10000 50
Use of phosphogypsum in houses 300000
Non-uranlum mining smal l 20000
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ANNEX B
CONTENTS
Paragraphs Paragraphs
INTRODUCTION ....................... 1-20 D . Solid ~ a s t disposal
e ........... 122- 145
1 . Solid waste production .... 122- 128
1. .MINING AND MILLING ........ 21-37 2. Solid waste disposal facili-
ties ..................... 129-135
A . Effluents .................... 22-30 3. Collective dose commit-
B . Local and regional collective dose ments ................... 136-145
commitments ................ 3 1-32
C . Occupational exposures ....... 33-37 IV . FUEL REPROCESSING ......... 146-178
A . Effluents .................... 148-161
I1. URANILhI FUEL FABRICATION 38-49
B . Local and regional collective dose
A. Effluents .................... 42-44 commitments ................ 162- 170
B. Local and regional collective dose I . Krypton-85 .............. 163
commitments ................ 45-16 2. Tritium and carbon-I? .... 164-165
3. Other atmospheric releases 166
C. Occupational exposures ....... 47-49
I 4 . Liquid effluents .......... 167- 170
C . Occupational exposures ....... 17 1- 172
Ill . REACTOR OPERATION .......
D . Solid waste disposal ........... 173-178
.A . Effluents ...................
1 . Fission noble gases .......
2 . ?ictivation gases .......... V . COLLECTIVE DOSE COMMIT-
.;. Tritium ................. SIENTS FROM GLOBALLY DIS-
4 . Carbon-I4 .............. PERSED RADIONUCLIDES ..... 179-190
5 . Iodine ..................
6 . Particulates in airborne
.\ . Krypton-85.................. 182
effluents ................ B . Tritium ..................... 183-184
-. Liquid effluents .......... C . Carbon-14 .................. 185-187
B . Local and regional collective dose D . Iodine-129 .................. 188-190
commitments ................
I . Fission noble gases . . . . . . .
2 . .Activation gases . . . . . . . . . . VI . TRANSPORT ................... 191-193
3 . Tritium .................
4. Carbon-I4 . . . . . . . . . . . . . . VII . SUMMARY .................... 194-198
5. Iodine ..................
6. Particulates in airborne Pages
effluents ................
7 . Liquid effluents ..........
Tables ............................... 163
YEAR
11. There have been a number of attempts to 18. With regard to assessing occuparional exposures,
generate rigorous definitions of the waste categories the relationship between measurements of external
generally referred to as low-, intermediate- and high- irradiation made in radiation fields by film, thermo-
level wastes [I 131. Although precise definitions have luminescent or other personal dosimeters and the
been agreed for particular purposes, the schemes pro- absorbed doses in the tissues and organs of the body
posed have not been universally satisfactory. None the was discussed in the UNSCEAR 1982 Report. The
less, the general characteristics of the three waste types Committee adopted the convention that all numerical
are reasonably well established. results reported by monitoring services represent the
average absorbed dose in the whole body, recognizing
that these are almost always readings from the
12. High-level wastes (HLW) are primarily the spent
dosimeters that are r e ~ o r t e d without
. consideration of
fuel elements or the solidified Lvaste products from
the relationships to the absorbed doses in organs and
reprocessing. They have high activity concentrations
tissues of the body. In this Annex the Committee
of both actinides and fission products and are
adopts a similar convention; but to simplify com-
significantly heat-generating. As file1 elements are a
parisons, and because most exposures are to penetrat-
significant potential source of fissile material, they will
ing gamma-radiation, the numerical result is taken to
usually be stored in the short-to-medium term rather
represent the effective dose equivalent, Exposures of
than disposed of. Occasionally, other waste streams
with high activity concentrations are also regarded as -
uranium miners to radon and its daurrhters are also
expressed in terms of effective dose equivalent.
H L W , but the quantities of activity in them are
relatively small.
19. The characteristics of occupational dose distri-
butions identified by the Committee as of interest
13. Intermediate-level wastes (ILW) are defined to were: ( a ) the annual average effective dose equivalent
some extent by exclusion from the other two cate- Hefh which is related to the average level of individual
gories: t h e contain either actinides or long-lived risk: this average has generally been calculated for all
beta/gamma emitters in quantities that are not negli- individuals monitored in a given occupational group;
gible o r substantial activity concentrations of shorter- (b) the annual collective effective dose equii.alent, Serf,
lived beta/gamma enlitters and are not significantly which is related to the impact of the practice: (c) the
heat-generating. collective effective dose equivalent distriburion ratio,
defined as the ratio of' the annual collective effective
14. Low-level wastes (LLW)contain primarily reason- dose equivalent delivered at annual effective dose
ably short-lived beta/gamnia emitters in low-to- equivalents exceeding 15 mSv to the total collective
moderate activity concentrations. They may contain effective dose equivalent. This is related to the
actinides or long-lived beta/gamma emitters but only proportion of workers exposed to higher levels of
in very small quantities. individual risk. These characteristics may be obtained
for any form of the dose distribution, ~vhetheror not
15. There will be other categories of materials that it exhibits a log-normal o r other defined response over
are uncontaminated, even though they were generated a n part of thc effective dose equivalent range. The
a t a nuclear site or are of such a low level of activity collcctivc cffectivr dose equivalent i h usually calculated
concentration that they can be exempted from the from collated dosimetry results using the definition
requirements for storage and disposal as radioactive
waste. The rationale for such exemption is that the
radiological impact of uncontrolled disposal of these where N , is the number of individuals in the effective
materials is insignificant [I14. N7]. These wastes are dose equivalent range i for tvhich HCil.,is the mean
not considered part of this study. as their potential for annual effective dose equivalent. The annual average
radiological impact is by definition very lo\\ in effective dose equivalent, R,,,-,is giiten by
comparison with that from the other waste categories.
16. In this preliminary assessment of doses fro111 where N is the total number of ivorkers monitored.
disposed wastes. only LLW and some categories of
ILW are considered to be disposed of by shallow land 20. The normalized measure of the impact of the
burial. All other Ivastes are stored under conditions various components of the nuclear fuel cycle is the
such that the doses to members of the public are collective effec~ive dose equivalent per unit electric
essentially zero. and doses to occupational workers energy generated. This is calculated as an average o \ e r
are included in those assessed for other operations at a complete power programme o r over several years to
the same sites. avoid anomalies such as those connected with the
shut-down of reactors for maintenance. The results for
17. The Committee presented detailed comprehensive doses from occupational exposures and to the local.
revie~vs of occupational exposures. including those regional, and global populations exposed as a result of
from the nuclear fuel cycle, in both the UNSCEAR effluent discharges to the environment may be taken
1977 Report [U2] and the UNSCEAR 1982 [GI] to be a relative measure of the health impact of
Report. In this Annes the data on occupational nuclear power production.
I. MINING AND MILLING 25. The processing of uranium at the mill was
described in the UNSCEAR 1982 Report, as were the
21. Uranium mining operations involve the removal broad characteristics of the tailings piles, where most
from the ground of large quantities of ore containing of the activity not extracted as usable uranium resides.
uranium a n d its daughter products at concentrations This activity is predominantly ?j0T'hand its daughters.
between a tenth and a few per cent U,O,. These There are airborne emissions during operation of a
concentrations are several thousand times the concen- mill. mainly of :?:Rn together with :3wU. :jOTh. 22bRa
tration of these nuclides in the rest of the natural and ?I0Pb. The ranges of airborne release rates for a
terrestrial environment. Uranium is mainly mined typical mill estimated in the UNSCEAR 1982 Report
using underground or open-pit techniques, other are shown in Table 5.
methods such as heap leaching accounting for only a 26. During operation of a mine. there are stockpiles
few per cent of the world production. The quantities of ore and piles of sub-ore. overburden and waste
produced during the period 1980-1984 are given in rock. After closure there will typically be a pile of
Table 3. Milling operations involve the processing of overburden, possibly covered by sub-ore, in case
these large quantities of ore to extract the uranium in a processing of this becomes economically viable in the
partially refined form, often known as yellow-cake. This future. These also act as sources of airborne emissions.
is further refined. converted and enriched, iS necessary. principally of Z22Rn.An estimate of the radon emana-
before fabrication into fuel elements. Uranium mills tion rate from waste rock per 1% ore grade in the
tend to be located near mines to minimize transporta- United States is 100 Bq m-Z s-' [N4]. The number of
tion. The number of mills operating is related to inactive mines in the United States was estimated to
uranium demand. be about 1,250 surface and 2,000 underground in 1980
[H9]. Some useful measurements have been made of
radon emanation rates under d n conditions over a
A. EFFLUENTS wide range of ore grades in the Northern Territory of
Australia [L2. M5]. These suggest that a radon
22. The predominant gaseous effluent from active exhalation rate of 50 Bq m-I s-I per 1% ore grade
uranium mines is ?::Rn in the ventilation air from is widely applicable: this figure is equivalent to
underground mines or released into the pit from 0.5 Bq m-' s-I per Bq g-I.
surface mines. In a study covering 27 mines [J2] this
accounted for 9 7 4 of the radon released. A recent 27. Extraction of uranium during milling is clearly
study [N5] has also shown that for some surface made as con~pletea s possible but cannot reach 100%.
mines. especially where a large volume of overburden Typically, the residual tailings from the mill will
has to be removed to expose the ore, waste rock piles contain from 0.001 to 0.01% U,O,. depending on the
formed a source of radon of a magnitude con~parable grade of ore and the extraction process. Tailings are
to that of the pit. Release rates per unit inass of ore discharged from mills into impoundmenrs, the charac-
were estimated in the UNSCEAR 1982 Report at teristics of which depend on the local climate and
about 1 GBq I - I from underground mines and about geology [TI]. From the point of view of estimating
0. I GBq t-' from surface mines. In general, however, effluents, the major differences are whether the tailings
the ore from underground mines was estimated to pile is wet or d r j and whether it has been covered. All
have about 10 times the uranium concentration of that tailings piles act as sources of airborne releases,
from surface mines; the normalized radon emission although if they are completely covered by water, the
was thus taken for both types to be 1 GHq t - I of ore rates can be e\tremely I O N . Estimates of radon
for I%, uranium oxide in the ore. Particulates in emanation for a number of typical mill tailings areas
airborne dust contain "1 and its d a u g h ~ e r sand and impoundments are shown in Table 6. Most of
sometimes "'Th and its daughters. these are taken from an extensive study by the Nuclear
Energy Agency (NEA) [NS]. The radon exhalation
rate per unit area and specific activity of ?IbRa was
23. The results of measurements o r estimates of estimated in the UNSCEAR 1982 Report at about
either total radon emission rates o r normalized radon 1 Bq m-: s-I per Bq g-I of ??"Ra in the tailings, although
emission from a number of mines are given in Table 4. it Has noted that the rate could vary from effectively
The data for underground mines relate to the ventila- zero to an order of magnitude higher than the above
tion air from the shaft, those for surface mines. to the figure. I t has been suggested that a more realistic
mine pit. The results support retention of an overall figure \vould be 0.2-0.5 Bq m-' s-I per Bq g-' [S12].
normalized radon emission of I GBq t-' of ore for Iq For comparison, 0.015 U,O, ore contains approxi-
uranium oxide in the ore. mately I Bq g-' of "bRa. Detailed measurements have
been carried out o n seven tailings dams in South
23. The uranium requlrements per unit elcctrlc energ) Africa [A7]. giving a mean radon exhalation rate of
generated vary someu.hat between current designs of 0.4 Bq n ~ - :s-' per Bq g-I for a radium concentration
thermal reactors: but the heavy metal requlrements ranging from 0.2 to 0.7 Bq g-I. Measurements on
are generall) in the range of 150-250 t (GW'a ) I . The tailings in the Elliot Lake area of Canada [B26]
grade of ore mined at present is usually betueen 0.1 sho\ved a range from 0.2 to 7.6 Bq m-' s-I per Bq g-I.
a n d 1% U:O,. Taking a typical value for underground Experimental investigations on t u o types of bare dry
mines from the United States of 0.2% [El], the tailings in Australia [S13] showed exhalation rates
normalized radon releases are about 70 TBq (GU' a)-'. from 0.3 to 0.7 Bq m-2 s-I per Bq g-I; these were reduced
This is the same value that was estin~ated in the by a factor of 3 for 1 m dry cover and by more than a
UNSCEAR 1982 Report. factor of I O for 1 m moist cover.
28. In considering the longer-term impact of effluents trristics typical of a semi-arid area and an effective
from tailings piles. i t must be assumed that activity release height of 10 m. The atmospheric dispersion
concentrations from uranium nuclides remain prac- model was described in the UNSCEAR 1982 Report
tically constant indefinitely, due to their long half- and in the original reference [CI]. The resultant
lives. The rest of the activity in the tailings is collective effective dose equivalent commitments per
dominated by :'OTh, which has a half-life of 80,000 a. unit activity released are shown in Table 8. with the
The radionuclides in the decay chain from Z30Thwith exception of the figure for radon. This has been
the greatest radiological significance are '26Ra, which reduced for the reasons discussed in Annex A which
can be leached out by water access, 2'0Pb and 222Rn, have led to a reduction in the dosimetric coefficient
which can escape into the air. for outdoor air from 17 to 9 nSv h-' per Bq m-'.
These figures have been used in this Annex t o estimate
29. At present, tailings have tended to be kept in the normalized collective effective dose equivalent
open. uncontained piles or behind engineered dams or conlmitnlents from current atmospheric releases which
dikes with solid or water cover. I t is- likely, however. is about 0.3 man Sv ( G W a)-'. The doses from liquid
that some further engineering will be carried out to effluents are negligible by comparison.
minimize the release of radionuclides from the aban-
doned piles. Such techniques were analysed in the 32. Using the figure estimated for the ini~ialrate of
NEA study [N5] for a number of sites. The radon flux exhalation of radon from a typical tailing pile leads to
density varied by factors of more than lo6. dependent an annual release of about 1 TBq ha-'. The propuc-
o n the treatment assumed, showing that this is clearly tion of a mine generates about 1 ha ( G W a)-' ' of
a crucial parameter in the assessment of the impact of tailings, so the releases during a period of five years,
tailings piles. The options assumed for one typical site corresponding to the duration taken for the current
in an arid region and the relative radon flux densities discharge, would add a normalized collective effective
assumed to result are shown in Table 7. Similar dose equivalent commitment of 0. I man Sv ( G W a)-'.
reductions in radon emission have been found using The rate of release as a function of' time is assumed to
covers of various types [H 101. Assuming some reason- be constant, and given the very long duration of the
ably impermeable cover is used, the radon exhalation source. the normalized collective effective dose equi-
rate from a typical tailings pile is taken to be valent commitment is proportional to the duration
10"q m-' a-I. This is less than the figure assumed for considered reasonable for assuming the release. Taking
emanation from the unstabilized material stockpiled this period to be lo4 years for the sake of illustration,
around working mines and comparable with the value the result is an estimated 150 man Sv ( G W a)-'. An
expected to be achieved in the United States [E4]. The alternative perspective on this component can be
cover is assumed to provide some protection against obtained by assessing the truncated collective effective
erosion. s o that the radon exhalation rate remains dose equivalent commitments up to different times.
essentially constant with time. Otherwise. an increase Some examples of the results of such calculations for
of u p to double the initial rate of emanation from a the various coverings described in Table 7 are shown
bare pile could have been expected over a period of in Table 9, taken from the same study [N5].
about lo4 years [N5]. As can be seen from the results
of the UNSCEAR 1977 and UNSCEAR 1982 Reports,
these are critical assumptions in determining the
overall impact of the fuel cycle. C. OCCUPATIONAL EXPOSURES
30. Mine and mill sites in dry areas give rise to 33. The main source of radiation exposure of under-
effectively no liquid effluents. For those in wet ground uranium miners is radon and its daughters.
climates. however, run-off water will contain radio- The annual average exposure of underground miners
nuclides and may need trealrnent before release into was taken to be 1.5 WLM in the UNSCEAR 1982
watercourses. The most important radionuclide in Report; this was converted to an annual effective dose
liquid effluents is 226Ra. and typical releases at wet equivalent of about 13 mSv. Surface miners have a
sites were estimated in the UNSCEAR 1982 Report to lower exposure to radon and daughters, with annual
be 1 GBq (GW a)-'. A review by Kaufmann [K5] doses estimated to be about 3-4 mSv, but they and
suggests values of the order of 0.1 GBq ( G W a)-', underground miners are exposed through inhalation
given normal procedures for water treatment. of dust containing uranium and its daughters. Both
underground and surface miners are also exposed to
some external gamma radiation. The estimate of
B. LOCAL AND REGIONAL COLLECTIVE annual doses for underground miners was rather
DOSE COMMITMENTS broad in the UNSCEAR 1982 Report, 1-10 mSv; that
for surface miners was taken to be 1-2 mSv. Where the
31. In the dose estimation procedure used in the authors have not carried out their own conversions,
UNSCEAR 1982 Report, the typical characteristics of use has been made of the conversion coefficients given
a mine and mill site in terms of population density, by the International Commission on Radiological
rainfall, farming, etc. were first established. The Protection [I121 between committed effective dose
population densities used were 3 k m 2 for 0-100 km and equivalent and time integrated equilibrium equivalent
25 km-' for 100-2.000 km. A deposition velocity of radon daughter concentration in air of 17 nSv h-' per
rn s-I was taken for particulate releases. The Bq m-' o r 10 mSv WLM-I, where 1 WLM is one
collective dose for radon release was then calculated working month (170 ha) of exposure to a potential
using an atmospheric dispersion model with charac- alpha-energy concentration of 2.08 lo-' J m-' [IIO].
34. Exposure of uranium miners to radon and The contribution from workers at mills to the collec-
daughters has been monitored by a combination of tive effective dose equivalent per unit electric energy
measurement of levels in air at a variety of places generated is so small that in the UNSCEAR 1982
through the mine and estimates of the time spent by Report it was not included as a separate item. This
miners in those places. In recent years, however, there situation does not appear to have changed.
has been considerable development work on dosi-
meters suitable for monitoring of radon daughter
exposures for individual underground uranium miners. 11. URANIUM FUEL FABRICATION
Some recent results for underground uranium miners
are shown in Table 10. The United States data for 38. The uranium ore concentrate produced at the
1980, assumed to be primarily for underground mills is further processed and purified and converted
miners. are from a very general summary prepared by to uranium tetrafluoride (UF,), and then to uranium
the Environmental Protection Agency [E3]; those for hexafluoride (UF,), if it is to be enriched in the
198 1 and 1982 relate only to the mines in New Mexico isotope 215U. before being converted into uranium
[SS]. The data for Canada (A41 include exposures at oxide or metal and fabricated into fuel elements.
the uranium mills associated with the mines. Data can Natural uranium, containing 0.7% :3SU, is used in
be clearly separated into underground and a surface graphite o r heavy water moderated reactors. Enrich-
mine for the Canadian mines, and the results for the ments of 2-5% are required for light ivater reactors
surface mine at Key Lake [A41 are shown in Table 11. (LWRs) and advanced gas cooled reactors (AGRs).
A comparison between mine company records and
exposures based on measurements by inspectors for 39. T o produce natural uranium metal fuel, the
1979 and 1980 in the United States showed reasonable uranium tetrafluoride is compressed with shredded
agreement [C7]. In this study the annual average magnesium and heated. and the resulting reduced
effective dose equivalent to underground workers in uranium is cast into rods that are machined and
61 mines from exposure to radon and daughters was inserted into cans. Natural uranium oxide is sintered
estimated to be in the range of 18-29 mSv, depending into pellets and clad in zirconium alloy for HWR fuel
on the assumptions made in deducing the personnel pins. For LWR and AGR fuel, the UF, is converted
exposures from the measurements in working areas. into the gaseous form UF,. The first type of enrich-
This is somewhat higher than the estimates given in ment piant to be developed con~n~ercially employed
Table 10. the gaseous diffusion process. In this, the UF, diffuses
through a porous membrane, the lighter compound
35. Information on gamma exposures to workers in containing 235Uand 'j4U diffusing more rapidly than
both underground and open pit mines in Canada [A41 the heavier compound containing 238U.Partial separa-
shows annual average effective dose equivalents ranging tion occurs, but in practice many stages of such
from 0.1 to 3.4 mSv for the years 198 1-1983. Some membranes are required in series t o provide a cascade.
underground mines showed average gamma doses as
low as for surface mines, but the major underground 40. The pumping power required t o mo\-e the UF,
mines employing more than 80% of the work-force through the cascade requires a large amount of
had an annual average effective dose equivalent of electric energy. The alternative gas centrifuge process
3 mSv. An estimate of 3 mSv as the annual average consumes only about 5% of the electric energy
effective dose equivalent from inhalation of dust has demanded by the diffusion process. The gas centrifuge
also been made for the Ranger surface mine in process is based on the separation effect on a mixture
Australia [A8]. of UF, isotopes in a strong centrifugal field in a
rotating cylinder, suitably combined with the cascading
36. Taking all the above information into account, effect of counter-current circulation. More separation
the average annual effective dose equivalent to under- is attained in one centrifuge stage than one diffusion
ground uranium miners from both external exposure stage but. as the mass flow is less, a series-parallel
and radon daughter exposure is 10-12 mSv; that for configuration is required.
surface miners is lower, possibly around 5 mSv. Given
the predominance of underground miners. an overall 41. T o fabricate LWR fuel the enriched UF, is
annual average of 10 mSv seems a reasonable estimate converted to the oxide (UO,) powder, which is
for the early 1980s. Taking the productivity to be 3 t a-! granulated, sintered and pressed into pellets. These are
of natural uranium per miner and a natural uranium inserted into tubes (cladding) that are sealed after
requirement of about 200 t (GW a)-'. the normalized being filled with pellets. For LWR fuel cans zirconium
collective effective dose equivalent would be 0.7 man alloy is used, while for AGRs stainless steel cans are
Sv ( G W a)-'. This is comparable t o the estimate in the adopted. After the enrichment process, large quanti-
UNSCEAR 1982 Report of 0.9 man Sv (GW a)-', ties of depleted uranium remain, containing about
which was rounded up to I man Sv (GW a)-'. 0.3% o r more 'I". This uranium would become a
source of public exposure were it to be disposed of,
37. Recent data on doses received by 3.000 workers at but currently it is stored for possible use in breeder
uranium mills in the United States show a n annual reactors and for other purposes. The solid wastes
average effective dose equivalent of 2.7 mSv [E3]. The arising during operation of the uranium fuel fabrica-
external average effective dose equivalent to 131 workers tion facilities will contain the same radionuclides as
a t the Nabarlek mill in Australia during the period those at uranium mines and mills, but will be trivial in
198 1-1982 was 1.5 mSv [M9] and at the Ranger mill quantity by comparison. It does not, therefore, seem
during the period 1985-1986 as low as 0.9 mSv [A8]. worth while to assess their impact separately.
A. EFFLUENTS B. LOCAL A N D REGIONAL COLLECTIVE
DOSE COMMITMENTS
42. Emissions of radionuclides from the conversion,
enrichment and fuel fabrication processes are generally 45. The Committee concluded in the UNSCEAR
small. Most of the uranium compounds are solid and 1982 Report that releases to the atmosphere provided
are easily removed from airborne effluent streams, the major exposure to the population (over 90%) from
while settling tanks are used to reduce liquid effluent fuel conversion, enrichment and fabrication processes.
discharges. Few data published in the United States o r To obtain an order of magnitude assessment of the
Europe give discharge rates of radionuclides from collective dose commitments, the Committee specified
these fuel cycle facilities. The Committee concluded in a model facility with a constant population density of
the UNSCEAR 1982 Report that discharges lipere 25 km-2 out t o 2.000 km. This was chosen to be
small and estimated releases from model facilities representative of North America and Europe, and
producing LU'R fuel. In the United Kingdom, reported collective dose commitments were derived for inhala-
discharges are given in terms of total alpha, total beta tion from the plume, ingestion of foodstuffs conta-
activity and masses of uranium (Table 12). and some minated by activity deposited from the plume and by
isotopic breakdown can be obtained [G2] for centri- external irradiation from the activity deposited on the
fuge enrichment plant effluents. Most of the beta- ground. The same results have been used here. but the
discharges are from the short-lived :'"Pa (half-life: collective effective dose equivalent commitments have
1.17 min) which is separated with "'Th (half-life: been scaled for the normalized releases derived in
24.1 dl. Canadian data-are also available for effluents Table 13; the resultant doses are given in Table 14.
from a conversion plant [A4, LI] with their isotopic The most significant pathway of exposure coniinues to
composition [XII]. There are small releases of "Tc be inhalation of particulate activity, with radon
reported from the British enrichment plant. indicating daughters contributing about 15% of the dose.
some recycling of reprocessed uranium, but these
releases are atypical and no dose assessment has been 46. In summary, the normalized collective effective
made. dose equivalent commitment due to uranium fuel
fabrication is estimated to be 2.8 10-j man Sv ( G W a)-'.
The main contribution arises froni inhalation of the
43. The data presented in Table I? have been used to isotopes of uranium. The figure is similar to that
obtain the effluent releases which are applied to the derived in the UNSCEAR 1982 Report [2.0 10-'man Sv
same model facility sited on a river as tias used in the ( G W a)-']. Individual doses in the vicinity of fuel
UNSCEAR 1982 Report. The normalized releases are fabrication facilities are estimated to be less than
based on an LWR cycle uranium requirement of 150 t 50 mSv per year for members of the public [B I. B2,
(GW a)-' and an HLVR cycle requiren~entof 170 I B3. BX. B 16, 13291.
( G W a)-'. The results are given in Table 13 for
atmospheric and aquatic effluents. The conversion
plant figures are based on data from Canada [MZ]. as C. OCCUPATIONAL EXPOSURES
are those for fabrication. since these relate to fresh-
water discharges in contrast to the British figures. 37. The annual average effective dose equivalents to
which relate to marine discharges. The values quoted workers in fuel fabrication plants were found in the
in Table 13 are typical figures taken from those UNSCEAR 1982 Report to be generally low. ranging
calculated for the five Canadian fabrication plants, from 0.3 to 3 mSv. The annual collective effective dose
based on a fuel cycle requirement of 170 t IGW a)-'. equi\~alcntdistribution ratio (see paragraph 19) \vas
The discharges of L34Thare obtained by assuming that also in general small. often approaching zero. Data on
this radionuclide is in equilibrium with ?"U. the number of workers employed and the correspond-
ing annual average individual and collective effective
dose equivalents are given for some countries in
44. The results in Table 13. which were derived from Table 15. These are not always complete for a c o u n t r -
reported discharges, can be compared H ith the effluents for any particular year and could include workers not
from the model facilities quoted in the UNSCE.AR strictly employed in fuel fabrication. For example. the
1982 Report. which were based mainly on the notional data from the United States [N2] are quoted as
results produced by the Environmental Protection corresponding to fabrication and reprocessing. but i t
Agency [E2]. The results using present data suggest has been assumed that the contribution from repro-
that for conversion, atmospheric releases are generally cessing in the years 1980 and 1981 tvas negligible: the
about twice those quoted prc\ iously for uranium and data for the United Kingdom [H8, RI?] include
thorium isotopes, white aq~laticreleases as reported exposures during enrichment. Annual average doses to
are about 10% of those assumed previously, and in the fuel fabrication workers have remained lour, in the
case of IZbRaare only 13' of that in the Environmental range of 1-2 mSv. The collective effective dose equi-
Protection Agency model facility assumed pre~~iously. valent distribution ratio t i ) r Uni~cd Stales u.orkers.
Atmospheric releases from enrichment are about one \vhich was 0.12 in 1980, decreased to 0.09 in 1981
half of those quoted in the UNSCEAR 1982 Report: [N2]: that for British \vorkers was 0 in 1982 and 0.02
liquid effluents are only a few per cent of the in 1983 [ B 121; that for Japanese workers \\'as 0 in the
Committee's previous estimates. For fuel fabrication. period 198 1 - 1984 [TI 21.
based on a weighted average of natural and enriched
fuels, the atmospheric and aquatic releases are again 48. Some data on the external doses from the
about one half the previously assumed values. fabrication of plutonium fuel at the PNC works in
Japan have been published [A5]. These are shown in components in structural and cladding materials.
Table 16. During the period 1977-1982 the total Radionuclides are formed in the coolant circuit
amount of fuel fabricated was 37.6 t for an advanced because the coolant becomes activated, because of the
H W R and 1.2 t for an FBR. From 1980 to 1982. it diffusion of fission product elements with radioactive
was necessary to process reactor grade plutonium isotopes from the small fraction of the fuel with
recovered from high burn-up fuel, and this led to an defective cladding, and because of the corrosion of
increase in both average and collective doses to the structural and cladding materials anywhere in the
work-force. coolant circuit which leads to particles being carried
through the core and becoming activated. All reactors
49. The estimates of normalized collective effective have treatment systems for the removal of radio-
dose equivalent in the UNSCEAR 1982 Report were nuclides from gaseous and liquid wastes. which arise
considerably reduced from previous estimates; the from leakage out of the core or from clean-up of the
overall figure estimated to be 1 man Sv (G\i: a)-'. coolant.
More recent estimates are shown in Table 15. The
normalized collective effective dose equivalents for 53. The quantities of different radioactive materials
Canada and the United Kingdom were obtained by discharged~fromreactors depend on the reactor type.
directly relating the collective dose in a year to the its design and the specific waste treatment plant
electric energy generated in the year [I3. 14. 15. 161. as installed. Radionuclides discharged to atmosphere
seems appropriate for nuclear power programmes in include fission noble gases (krypton and xenon),
an approximatel> equilibrium situation. For the United activation gases ( I T , IbN, '%, 41Ar).tritium. iodine
Stares the same assumption is made a s in the and particulates. Radionuclides released into the
UNSCEAR 1982 Report; 604; of the fuel Fabricated is aquatic environment in liquid effluents usually include
for United States nuclear power stations. For Japan. tritium, fission products and activated corrosion
figures for 1981-1984 are used [J3], and these have products. The discharge data for the years 1980-1985
been tentatively related to the total electric energy are presented in this section, and the annual normalized
generated in the corresponding years by nuclear releases are evaluated for each reactor type and
power. Giving appropriate weight to more recent averaged over all reactors of each type as TBq
data, a n overall average of 0.5 man Sv ( G W a)-I now ( G W a)-'. Normalized results are not presented for
seems more appropriate. individual sites because releases in any one year may
reflect a need for maintenance or irregular procedures
which are the culmination of a number of vears of
previous operation. The total releases of radionuclides
111. REACTOR OPERATION between 1980 and 1984 have been normalized by
dividing by the total electric energy generated ( G W a )
50. Nearl! all the electric energy generated by over the same period. These normalized releases are
nuclear power is produced in thermal reactors in used to assess collective dose commitments because
which the fast neutrons produced by the fission the 1985 data were incomplete. Generally, the nor-
process are slowed down to thermal energies by use of malized releases for 1985 from the ~ a r t i a data
l lead to
a moderator. The most common materials still used lower values than for the previous five years. although
for moderators are light ivater. heavy water and the 1980-1985 averages are mostly within 10% of the
graphite. The choice of moderator and coolant. light 1980- 1984 averages.
o r heavy water or carbon dioxide gas. greatly affects
the design. size and heat reniotal system of the
reactor. 1. Fission noble gases
51. The uranium fuel is contained in discrete pins, 54. At least nine identified radioactive isotopes of
both t o prevent leakage of the radioactive fission krypton and 1 1 of xenon are formed during fission.
products into the coolant circuit and to improve neutron htosr have half-lives of minutes or seconds and decay
economy by reducing parasitic neutron captures in the before they migrate significantly in the fuel. A fraction
resonance neutron energy region of '-'WU. The heat of the noble gas inventory of the fuel pins diffuses to
generated in the fuel pins by the slowing down of the the fret: space between the fuel and the cladding,
fission fragments is removed by forced con\.ection. the leading to a build-up of gas pressure. The presence of
most usual coolants being light o r heal! \yarer or noble gases in the coolant circuit is generally an
carbon dioxide gas. In the case of fast reactors. the indication of fuel cladding failure.
neutrons are not modcrated and induce fissions \vith
energies close to those at which they are produced. 55. Table 17 lists tlie reported discharges of noble
The usual heat removal system is liquid sodium. which gases irom PWRs. The releases span many orders of
is a good heat transfer medium and does not greatly magnitude partly because of the design of newer
moderate the neutrons. plants and partly because of the need for irregular
operations and maintenance. Thus, the normalized
releases presented are averaged over all PWR electric
.I\. EFFLUENTS energy production from 1980 to 1984. Short-lived
noble gases only appear in PWR effluents because of
52. During the production of power by a nuclear leakages in the primary water pressure circuit. Gaseous
reactor. radioactive fission products are formed within wastes can also arise from the condenser exhaust on
the fuel, and neutron activation produces radioactive the steam circuit and from blow-downs or contain-
ment purges. These wastes are usually held under be replaced. Releases of noble gases from HWRs a n d
pressure in delay tanks to allow decay of short-lived LWGRs are given in Table 21. Normalized release for
isotopes before release. The isotopic composition of +
HWRs has been 212 48 TBq ( G W a)-'. similar to
noble gases released from PWRs in the United States that for PWRs. The highest figures are for LWGRs at
in 1982 is shown in Table 18. Comprehensive data are 5,470 + 1.370 TBq (GW a)-I, about three times the
available for each year from United States reactors; figures for BWRs. The available discharge data
a n d data available from other countries are similar to indicate that FBRs have lower releases of noble gases:
those from the United States. The data for the United measurements at BN-350. an FBR in the USSR.
States for 1982 are therefore assumed to be represen- indicate 65-130 TBq ( G W a)-' [P6].
tative of the isotopic con~positionof releases between
1980 and 1984 and are used for dose estimation.
2. Activation gases
56. Data for 1985 are incomplere and the releases are
not inclgded in the nornlalized set. The normalized 60. Although GCRs d o not generally release fission
releases seem to have remained fairly steady over noble gases, several gases are formed during gas
the five-year period 1980-1984, but the average of cooled reactor operation. These are primarily "Ar.
218 -t 40 TBq (GW a)-' appears to be about half of formed by activation of the stable argon in air. and 'S
the value reported previously by the Committee produced from sulphur and chlorine impurities in the
[430 TBq ( G W a)-']. Xenon-1 33 accounted for 75% of graphite core. The discharge data for "Ar are reported
the discharge and Ij5Xe for 13%. In the UNSCEAR in Table 22. For " S . measurements were made in the
1982 Report the comparable figures were 85% and United Kingdom at Hinkley B, Oldbury and Wyifa
5%. respectively. Some of the reduction in discharges [HI, H2], and discharges have consistently averaged
is thought to be due to better fuel can performance. 0.2 TBq ( G W a)-I with only about 20% variation
which would account for the lower releases t o cooling around the mean.
water. The other feature is the inclusion of' neuer
reactors wilh lower levels of discharge. 61. The quantity of "Ar (half-life: 1.8 h ) released
depends upon the detailed design of the reactor. F o r
57. Reported discharges of noble gases from BUrRs early Magnox reactors having steel pressure vessels,
are shown in Table 19. The releases vary by six orders the principal source of 41Aris the activation of stable
of magnitude, although the average releases continue argon in the air used as cooling air around the outside
to have been reduced from previous years. The of the pressure vessel. For advanced reactors with
normalized releases are shown in Table 19 for all prestressed concrete pressure vessels, the principal
BWRs from 1980 to 1985. The main source of noble source of "Ar is leakage of the coolant CO,, which
gas release from BWRs is gases in the steam circuit contains small amounts of air, to the atmosphere. The
that are continuously removed by the main condenser normalized releases from AGRs are 5-15'2 of the
air-ejector system. The isotopic composition depends values for Magnox reactors. The average normalized
on the hold-up time, which is usually less than for +
release from GCRs is 2,320 220 TBq ( G W a)-I
PWRs, thus allowing more short-lived isotopes to be compared to 3,240 TBq ( G W a)-I in the UNSCEAR
released. Table 20 gives the radionuclide composition 1982 Report. The reduction is due to the proportion
of noble gas releases from. United States BWRs in of power now generated by AGRs and addition of
1982, which is similar to that of reactors in other French data. For BN-350, the Soviet FBR, normalized
countries. These figures again are taken to be repre- 'IAr releases average 470 TBq ( G W a)-! [K4. P6].
sentative of BWR releases in all countries during the
period 1980- 1983 and are used for dose assessment. 62. Nitrogen-16 (half-life: 7 s) causes direct external
radiation at nuclear power plants. The photons pro-
58. F o r BWRs the average discharge rate for noble duced in its decay have energies of 6.1 and 7.1 MeV.
gases during the five-year period 1980-1984 is In BWRs, the I6N generated in the coolant water is
2,150 f 520 TBq (GW a)-! compared with 8.800 TBq transferred in the steam t o the turbine buildings.
( G W a)-' reported in the UNSCEAR 1977 Report for Direct radiation from gas ducts in steel pressure vessel
1975-1979. This reduction seems to have been achieved gas cooled reactors produces the major dose to
because of significant reductions in releases from individuals close to those sites.
those reactors that previously had the highest dis-
charge rates. The normalized release for 1985 is
significantly lower (460 TBq ( G W a)-!), partly because 3. Tritium
of the missing data but mainly because of very large
reductions in discharges from the largest previous 63. In LWRs tritium arises from ternary fission in
sources (Browns Ferry and Brunswick). The isotopic the nuclear fuel and from the neutron activation of
composition shown in Table 20 reveals that most of lithium and boron isotopes dissolved in, or in contact
the activity consists of 68Kr (half-life: 2.8 h), IJ3Xe with. the primary coolant. The Committee assessed in
(half-life: 5.3 d), I3'Xe (half-life: 9.2 h) and 'j6Xe (half- the UNSCEAR 1982 Report the tritium production
life: 17 min) in almost equal quantities. rate from ternary fission as 0.75 PBq ( G W a)-'.
Tritium generation from activation reactions in PWRs
59. In GCRs, noble gas releases are insignificant seems to result mainly from boron, which is used for
compared with activation gases. Magnox reactors, reactivity control, in the coolant, whereas in BWRs it
AGRs, LWGRs and HWRs utilize on-load refuelling results mainly from boron in control rods. In GCRs it
and, in the event of fuel element failure, fuel rods can is the result of lithium impurities in the graphite a n d
the presence of water vapour in the core. For HWRs it [B6, V4]. similar to other PWRs and AGRs. The
is principally the result of the activation of the liquid discharges amount to about 5 TBq ( G W a)-'
deuterium moderator and coolant. The activation and 1 TBq ( G W a)-' for PWRs and LWGRs, respec-
production rate only exceeds that from ternary fission tively [B6, P6. V4]. Measurements indicated that on
in HWRs, where the activation rate was previously average 90% of the atmospheric releases of tritium
estimated by the Committee to be 30 times higher at was in oxide form [B6]. Practical experience a t the
about 25 PBq ( G W a)-'. Novovoronezh APS (PWR) showed that it is possible
to reduce the tritium concentration in the coolant
64. Table 23 presents the tritium releases to the water by 50% [B7].
atmosphere for 1980-1985 for PWRs. BWRs and
HWRs. For PWRs the normalized release over the
five-year period 1980- 1984 is 5.9 f 2.4 TBq (GM' a)-'
a n d no particular trend is apparent over this period.
The corresponding figure was 7.8 TBq ( G W a)-' for 68. Discharges of ''C are of interest because of its
1975- 1979. The BWR releases normalized for the same long half-life (5.730 a) and contribution to collective
+
period average 3.4 1.6 TBq ( G W a)-', compared dose commitments. Estimates of "C production in
with 3.4 TBq (GM' a)-' for 1975-1979. The decrease in fuels depend o n the nitrogen level in the fuel can,
annual BWR normalized releases from 1980 to 1984 although some is produced from reactions o n oxygen
seems primarily attributable t o reductions from the in oxide fuels. The Committee concluded in the
Dresden nuclear plant alone. while the higher figure UNSCEAR 1982 Report that the normalized produc-
for 1985 is due to Hatch 1. These figures indicate that tion rate within fuel for PWRs. BWRs. G C R s a n d
about 1% of the tritium produced in the fuel of LWRs HWRs was close to I TBq ( G W a)-'. Little of this is
finds its way into the coolant and then enters airborne released into the reactor coolant circuits, it appears to
effluent streams. For HWRs the production of tritium be released during reprocessing [BI, B2, B3, 88. B16,
in the moderator is the most probable source of tritium B291. Carbon-14 is produced in the moderators of all
releases, which averaged 670 f 190 TBq ( G W a)-' for reactors, production in H WRs being perhaps 100 times
1980-1984, as compared with 540 TBq ( G W a)-' for greater than in LWRs or GCRs, because of the ''0
1975-1979. For some HWRs. however, the coolant (n, a) 14C reaction in the greater mass of oxygen in the
may be the main source of tritium production. There moderator, and there is a consequential release.
is little release of tritium to the atmosphere from
Magnox gas cooled reactors mainly because humidriers 69. The National Council on Radiation Protection
remove water vapour from the gas circuit. There is and Measurements (NCRP) [NI] has estimated the
some release of tritium to the atmosphere from AGRs, production rate of I4C in PWRs to be between 2 a n d
and the normalized release is 5.4 f 0.9 TBq (GW a)-', 3 TBq ( G W a)-', and for BWRs 3-4 TBq ( G W a)-'.
similar to LWR releases. arising in both cases mainly in stainless steel a n d
zirconium alloy. For the estimation of release rates to
65. From Table 24 it can be seen that releases of the environment, NCRP assumes that the "C formed
tritium to the hydrosphere from PWRs have been in the hardware remains there. but that the fraction
fairly constant over the past five years, and the 1980- formed in dissolved nitrogen in the cooling water is
1984 normalized average is 27 2 1.8 TBq (GW a)-', totally released. The NCRP estimate for PM'Rs is
with the figure for 1985 similar. This compares to the 370 GBq ( G W a)-' and for BWRs 220 GBq ( G W a)-L.
38 TBq (GW a)-' obtained for 1975- 1979. The compar- The NCRP estimate of the release of "C t o the
able figures for BWRs are 2.1 f 0.5 TBq ( G W a)-' for environment for FBRs is essentially zero a t the
1980-1984, which is 50% higher than the 1.4TBq reactor.
( G W a)-' for 1975-1979 and no trend is apparent. For
G C R s the normalized release to surface waters is 70. Environmental discharges of I4C are not routinely
9 6 f 13 TBq ( G W a)-', which contrasts with 25 TBq reported for all reactors. The data summarized in
( G W a)-' for 1975-1979. There appears to have been Table 25 are from a series of measurements made in
a significant increase in tritium releases from GCRs Argentina, the Federal Republic of Germany, Finland,
over the past five years. HWR releases in liquid and USSR. For BWRs it appears that essentially all the
effluent streams averaged 290 2 68 TBq ( G W a)-' for "C appears a s carbon dioxide, and the normalized
1980-1984, compared with 35OTBq ( G W a)-I for release rate for 1980- 1984 is 330 f 1 10 GBq ( G W a)-'.
1975-1979. LWGRs have low liquid releases at 1.7 TBq significantly less than the Committee's estimate in the
(G W a)-'. UNSCEAR 1982 Report of 520 GBq ( G W a)-'. F o r
PWRs in the Federal Republic of Germany [Wl],
66. Thus, about 0.3% of BWR tritium production Finland [B17] a n d the USSR [RI], the data indicate a
appears in liquid effluents, with a similar amount release rate of 345 f 80 GBq (GW a)-', which is signi-
going to the atmosphere. For PWRs about 3% of the ficantly higher than the figure of 220 GBq ( G W a)-'
tritium produced is in liquid effluents. about five times given in the UNSCEAR 1982 Report. For PWRs only
more than that going to the atmosphere. For HWRs about 5 5 0 % of the emission appears as CO,. It now
liquid effluents are about one half those discharged to appears that normalized I4C releases from PWRs a n d
the atmosphere. BWRs are similar.
67. For PWRs and LWGRs in the USSR the 71. In recent measurements at three LWRs in the
atmospheric releases of tritium are reported t o average United States [K2], two PWRs emitted an average of
7.4 TBq ( G W a)-' and 1.9 TBq ( G W a)-I, respectively, 390 GBq ( G W a)-'. The source of I4C was different a t
the two sites: the first had 42% arising from venting of 76. The annual normalized discharges of 13'1 from
gas decay tanks, 35% from auxiliary building ventila- +
PWRs were 1.75 0.33 GBq (GW a)-' for 1980-1984,
tion and 32% from containment venting: the second not significantly changed when compared with 1.9 GBq
had emissions resulting primarily from pressure relief (GW a)-I for 1975-1979. The I3'I releases from BWRs
venting and purging of the containment air, with only for 1980-1984 have averaged 9.3 F 4.9 GBq (GW a)-I
7% from venting of gas decay tanks. For the BWR, compared with l 3 ' I releases of 40 GBq (GW a)-' for
the discharge rate was 460 GBq (GW a)-' with 97% of 1975-1979. This reduction was because the few reac-
the release via the off-gas discharge, which was 95% tors that had large releases are currently releasing far
I4CO,. For the PWR 94% of the discharge was "CH,. less. The results for HWRs indicate releases of
The I4C content of liquid and solid wastes was less 0.23 f 0.08 GBq (GW a)-I. From early GCRs, which
than 5% of the aerial discharge for all reactors. utilize on-load refuelling, releases were negligible, and
releases from AGRs were 1.4 2 1.1 GBq (GW a)-L.
72. Measurements at LWGRs in the USSR gave LWGRs released 8 0 2 40 GBq (GW a)-I [All, and
average releases of 1.3 TBq (GW a)-I [RI]. In the measurements indicated that 60% of the iodine in the
United Kingdom, reported releases were 0.74 TBq reactor off-gases was in organic form, 40% inorganic
(G W a)-' from Magnox reactors and 1.9 TBq (G W a)-' and about 1% particulate [B9, D 1, S6].
from AGRs. Weighted by energy production, the
normalized IJC release for GCRs is 1.1 TBq (GW a)-I 77. The isotopic composition of iodine releases from
[H8]. The main source of IT releases from GCRs is LWRs in the United States in 1982 is shown in Table 27
the leakage of the primary coolant, at a rate typically [T5]. The isotopic conlposition was taken to be
of a few per cent per day, which contains radionuclides representative of reactor operations in all countries
released to the coolant by corrosion of the graphite and was used as the basis for dose calculations. For
moderator. PWRs about 25% of the discharge is accounted for by
" I 1 and 75% by ')'I, compared with the figures
73. For HWRs it has been reported that a significant reported by the Committee in the UNSCEAR 1982
fraction of the inventory formed in the moderator can Report of 30% accounted for by 13'I. For BWRs, 1 3 ' 1
be released to atmosphere. Measurements at Atucha I releases represented about 7% of the discharges. with
[B 18, 031, however, for 1983-1985 have indicated that I3jI and 'jSI contributing 28% and 65%, respectively.
releases are significantly lower than previously calcu- This compares with less than 10% previously reported
lated for 1980-1982. The five-year normalized release for and 30% and 60% for l3jI and 'j51, respectively.
+
is 6.3 3.3 TBq (GW a)-', whereas the Committee For LWGRs, 24% is accounted for by I3'I, 43% by I3'I
had estimated 17 TBq (GW a)-' in the UNSCEAR and 33% by l J S I [B21]. It might be concluded that
1982 Report. The form is again variable, between 40 there was little change in the isotopic composition in
and 80% being reported as CO,. In Argentina, regular the periods 1975-1979 and 1980-1984.
monitoring of discharges of lJC has continued for
several years so that more reliable estimates can be
made. 6. Particulates in airborne effluents
81. The sources of radionuclides other than tritium 85. There is a wide range of activation products and
in liquid effluents are essentially the same as those fission products reported in liquid effluent discharges,
described for particulate releases to the atmosphere. and the isotopic composition varies even between
The reported levels of discharge are equally variable. reactors of the same type. The normalized figures are
the magnitude and isotopic composition depending used. however, to make an estimate of the collective
upon the design and operating practice of the reactor. doses due to liquid effluent discharges.
impurity levels and trace quantities of material in
structural and cladding components. Table 29 sum-
marizes reported liquid effluent discharges from reac- B. LOCAL AND REGIONAL COLLECTIVE
tors around the world. In Table 30 the isotopic DOSE COMMITMENTS
composition of liquid discharges from power reactors
in the United States in 1982 is presented. and in 86. National authorities usually require environmental
Table 31. that for GCRs in the United Kingdom is monitoring programmes in the vicinity of a nuclear
given. also in 1982. power plant to be carried out by the operator, another
competent agency or both. In general, activity concen-
82. The normalized release levels based on the trations of radioactive materials from effluent dis-
reported discharges for each reactor type using reported charges are loo low to be measurable except close to
figures for electric energy generated between 1980 and the immediate point of discharge. Dose estimates for
1984 can be summarized from Table 29 and contrasted the population, therefore. rely on modelling the
with the figures given in the UNSCEAR 1982 Report. environmental transfer and transport of radioactive
PWR: 132?49GBq(GWa)-I. materials.
compared with 180 GBq (GW a)-!
BWR: 115 i- 47 GBq (GW a)-', 87. In the UNSCEAR 1982 Report, rhe Committee
established a model site that was most representative
compared with 290 GBq (GQ' a)-'
+
GCR: 4.520 1.790 GBq (G W a)-'. of areas of northern Europe and north-eastern United
States, since those areas contain a large proportion of
compared with 4.800 GBq (GU' a)-I
the power-producing reactors. Agricultural produc-
HIVR: 25.7 I 8.7 GBq (GW a)-',
tion patterns and population distributions typical of
compared with 470 GBq (GW a)-'
those areas were also established. The cumulati\~e
The normalized releases for PWRs betitreen 1980 and population within 2.000 km of the site is about 2.5 lo8,
1984 are similar to previous years although there has giving an average population density of 20 km-2.
been an increasing trend. while BWR releases are less. Within 50 km of the site, the population density was
Canadian HWRs were previously reported as giving taken to be 400 km-2 in order to to reflect current
discharges of about 50 GBq (GW a)-l. while the siting practice. The objective of the Committee remains
higher figures for the GCRs reflect the fact that unchanged to give a representative value of the
discharges are made, with the exception of Traws- collective dose commitments per unit of electric
fynydd. to the marine environment. I t appears from energy generated by nuclear power stations and to
the above results that aquatic discharges from BWRs reflect the levels of dose received by the most exposed
have been reduced by a factor of 2.5. In the individuals. The results do not apply to any one
UNSCEAR 1982 Report, the Committee found that reactor or any one location, and the collective dose
commitments should not be applied t o a given reactor 92. The normalized release of noble gases from
with known discharge data to obtain estimates of HWRs is 212 TBq ( G W a)" (Table 21), and assuming
health detriment. the same relative isotopic composition as PWRs, the
normalized collective dose commitment is 0.024 m a n Sv
( G W a)-', while for LWGRs a normalized release of
1. Fission noble gases 5.470 TBq ( G W a)-' (Table 21) and the assumption of
an isotopic composition similar to that of BWRs yield
88. Using the normalized releases for PWRs from a normalized collective effective dose equivalent com-
Table 17 for noble gas atmospheric releases and the mitment of 0.72 man Sv (GW a)-'.
radionuclide composition from Table 18, the normal-
ized collective effective dose equivalent commitments 93. In summary, the normalized collective effective
averaged between 1980 and 1984 were calculated for the dose equivalent commitment from noble gas releases
model PWR facility and are shown in Table 32. The is 0.20 man Sv (GM1 a)-', based on the five-year
normalized release term from Table 17 is 218 TBq (1980-1984) weighting of electricity generated by
( G W a)-', and the radionuclides that contribute signi- PWRs, BWRs, HWRs and LWGRs. The Committee
ficantly to the collective effective dose are 'j3Xe and gave a figure of 0.63 man Sv (GW a)-' in the
13'Xe. The in-growth of daughter products. e.g., &%b UNSCEAR 1982 Report, so that an average reduction
from %r, has been included in the dose calculations, of dose from noble gas effluents of about a factor of 3
which are those presented in the UNSCEAR 1982 has been found owing to reductions in reported
Report, but scaled for the different normalized release discharge levels, mainly from BWRs. The annual
and isotopic composition. average effective dose equivalent to the most exposed
individuals in hypothetical critical groups has been
89. The normalized collective effective dose equi- calculated at IOjlSv for the model BWR and more
valent commitment amounts t o 2.6 10-' man Sv than 10 times lower for rhe PWR site, taking a n
( G W a)-' compared with the Committee's assessment average distance of about 1 km from the site. Many
of 3.2 man Sv (GW a)-', which was given in reactors give lower doses, although for some early
Annex F of the UNSCEAR 1982 Report. This reflects BWRs, the doses could be about 10 times higher.
the reduction in discharges with little difference in the
distribution of radionuclide composition. About 64%
2. Activation gases
of the total collective dose is now due to '33Xe(80% in
1982) a n d 28% to IsSXe ( I 1% in 1982). As in the 94. The primary activation product of interest for
UNSCEAR 1982 Report, some 90% of the collective gaseous releases is 4'Ar. Because of its short half-lifc
dose commitment is accumulated within 500 km. (1.83 h), it contributes most of its collective dose
There is little contribution from the inhalation of within a few tens of kilometres of the release point,
radioactive daughter products, and the dose estimates. although the exact result depends on the close-in
as before, include an allowance for the shielding from population density. The normalized release of "Ar
buildings and the fraction of time spent indoors. from GCRs (Table 22) between 1980 and 1984 is
2,320 TBq ( G W a)-', and the associated collective
90. For the quinquennium 1980-1984. Table 19 shows effective dose equivalent commitment is 0.78 man Sv
the normalized releases from B WRs to be 2.150 TBq ( G W a ) - ' , compared with the estimate in the
( G W a)-', compared with the value of 8,800 TBq UNSCEAR 1982 Report of 0.95 man Sv (GW a)-'.
(GW a)-' given in the UNSCEAR 1982 Report. Taking The reduction is due to the fact that new AGRs are
the relative isotopic composition from Table 20. the producing electricity with much lower 4'Ar discharges
normalized collective effective dose equivalent commit- than GCRs. The weighted collective effecrive dose
ment is given in Table 33 as 0.56 man Sv ( G W a)-'. equivalent commitment, allowing for the fraction of
compared with the Committee's estimate in the electricity generated by GCRs, is 0.039 man Sv
UNSCEAR 1982 Report of 1.9 man Sv ( G W a)-'. The (GW a)-', significantly lower than the value given in
main isotope contributing t o the collective dose is "Kr the UNSCEAR 1982 Report of 0.1 man Sv ( G W a)-'.
(half-life: 2.8 h) accounting for about 57%. somewhat Because of reporting procedures, "Ar releases for
more than in 1982. Most of the remainder of the LWRs are included in noble gas data as shown in
collective dose arises from '3SXe (16%), 138Xe(9%) Tables 18 and 20.
a n d 13>Xe(8%), in somewhat smaller proportions than
in the UNSCEAR 1982 Report. 95. The consequences of the release of j5S from
GCRs have been studied in detail. The isotope is
91. The in-growth of "'b (half-life: 15.4 min) from released in the form of carbonyl sulphide (COS),
"Kr and '38Cs (half-life: 32.2 min) from decays which has a low deposition velocity and a slow
are included in the dose estimation, and the collective reaction rate in air. The major route of human
doses include a contribution from the inhalation of exposure is via milk, and the Committee estimated
the a8Rb and '3sCs radioisotopes. The spatial distri- 2.2 lo-' man Sv GBq-' in the UNSCEAR 1982
bution of the normalized collective effective dose Report. so that, using the nornlalized release of
equivalent commitment is biased towards the source, 200 GBq ( G W a)-', the normalized collective effective
with more than 80% of the dose accumulated within dose equivalent commitment is 0.044 man Sv ( G W a)-'
50 km and nearly 50% within 10 km. This behaviour and the contribution weighted for GCR electricity
is caused by the dominance of 88Kr,which decays with production is 2.4 10-3 man Sv (GW a)-', compared
a half-life corresponding to about 40 km distance with 3.8 man Sv (GW a)-' in the UNSCEAR 1982
travelled. Report.
3. Tritium energy generatedare shown in Table 35 and are based on
the normalized releases taken from Table 25.
96. The collective effective dose equivalent commit-
ment to the local and regional population was 100. The normalized collective doses ranged from
evaluated in the UNSCEAR 1982 Report on the basis 0.59 man Sv (GW a)-' for BWRs t o over 11 man Sv
of a specific activity model. For atmospheric releases (GW a)-' for HWRs. The weighted average, allowing
the Committee obtained 1.5 lo-' man Sv TBq-' by for the proporrion of electricity generated by each
inhalation and 9 lo-' man Sv TBq-' by ingestion to reactor type, was 1.6 man Sv (GW a)-' to the local
give a total of 0.0 11 man Sv TBq-' released. and regional population. This is about one half of the
estimate of 2.8 man Sv (GW a ) - ] given in the
97. Normalized tritium atmospheric releases for the UNSCEAR 1982 Report, largely because of lower
quinquennium 1980- 1984 from PWRs are 5.9 TBq reported HWR releases. For the model site the annual
(GW a)-' (paragraph 64). giving 0.065 man Sv (GW a)-'; effective dose equivalents to most exposed individuals
BWR releases of 3.4 TBq (GW a)-' give 0.037 man Sv was 3 pSv for PWRs and BWRs, 10 /IS\' for GCRs,
( G W a)-': HWR releases of 670 TBq ( G W a)-' give about 70 pSv for H WRs and about 13 1tSv for LWGRs.
7.4 man Sv (GW a)-' for atmospheric releases. Releases
from GCRs and LWGRs are comparable with PWRs
a n d give similar dose contributions. In summary, 5. Iodine
weighted by the amount of electricity generated by
reactor type, the normalized collective effective dose 101. Releases of radioactive iodine from nuclear
equivalent commitment for atmospheric releases of power plants are small, and there is little contribution
tritium is 0.53 man Sv (GW a)-', compared with the to the local and regional collective effective dose
Committee's estimate given in the UNSCE.4R 1982 equivalent commitment. Because of its long radio-
Report of 0.46 man Sv (GW a)-'. For the model site active half-life. 1291 enters the global cycle for iodine
used by the Committee, the annual individual effective and has the potential to irradiate the global popula-
dose equivalent for critical groups would be less than tion for tens of millions of years. The release of '"I
1pSv from LWR atmospheric 'H releases, while the contributes only t o the local and regional collective
H W R dose would be 50 pSv per year. doses, but its assessment is complicated by the
chemical form in which the iodine is released, i.e.,
98. For tritium in liquid effluents, the river model elemental, organic o r particulate. Elemental iodine
used by the Committee gave a collective effective dose readily deposits on vegetation and enters terrestrial
equivalent commitment of 8.1 lo-' man Sv TBq-', on food chains. The deposition of organic iodine is
the assumption that the river is used as a source of usually less than 1% of that for elemental iodine per
drinking water. Using the normalized discharges for unit time integrated air concentration. In this Annex.
1980-1984 for PWRs, BWRs, HWRs, GCRs and as in the UNSCEAR 1982 Reporl, the Committee
LWGRs from paragraph 65. the normalized collective assumes that 75% of the iodine released is in organic
effective dose equivalent commitments were calculated form and 25% in elemental form.
and are shown in Table 34. The normalized dose
weighted by the proportion of electricity generated by 102. In the dose evaluation used in the UNSCEAR
each reactor type is 0.033 man Sv (GW a)-', which 1982 Report, the collective effective dose equivalent com-
compares with the estcmate of 0.04 man Sv ( G W a)-' mitment per unit release of '''1 was 4.0 man Sv
given in the LrNSCEAR 1982 Report. The doses from GBq-'. Taking the releases of ''II from Table 26, the
aquatic discharges are therefore about 16 times lower normalized collective doses for "'I per unit of electric
than for atmospheric effluents per unit electric energy energy generated were calculated and are shown in
generated, similar to the difference of a factor of 10 Table 36. Results for the other iodine isotopes are
reported in the UNSCEAR 1982 Report. found by scaling from the results in the UNSCEAR
I982 Report, allowing for the change in isotopic
composition. The PWR figures are about 10% lower
than in the UNSCEAR 1982 Report, while the BWR
results are about 25% of those found previously. For
99. The local and regional collective doses attribut- both BWR and LWGR reactors the short-lived '"I and
able to l4C releases from reactors represent only a 'j51 make significant additions to the dose. The weighted
small proportion of the total dose commitments. The average, taking into account the proportion of elec-
main significance of "C stems from its entry into the tricity generated by each reactor type, is 3.3 man Sv
carbon cycle and the resulting global dispersion. (GW a)-'. Representative effective doses to individuals
leading to long-term irradiation, which is considered about 1 km from the model site are about 0.5 pSv per
in chapter V. The first pass local and regional year for PWR releases and 4 pSv per year for the B WR
collective dose commitment was previously assessed releases. As in the UNSCEAR 1982 Report, 90% of
by the Committee using the specific activity approach the collective dose contribution is estimated to come
which was also used for tritium. The Committee also from the milk pathway.
assumed in the UNSCEAR 1982 Report that the form
of release of 'Twas COz. The normalized local and
regional collective effective dose equivalent commit- 6. Particulates in airborne effluents
ment per unit release previously determined by the
Committee was 1.8 man Sv TBq-I for ingestion and 103. As noted in paragraph 79, the quantities of
0.0003 man Sv TBq-' for inhalation following release to radionuclides in particulate releases to the atmosphere
the atmosphere. The normalized doses per unit electric may vary greatly, even if releases from reactors of the
same type o r those from the same reactor from year to external radiation from sediments. For discharges to
year are compared. Furthermore, there are several marine environments it is usually sufficient to consider
tens of radionuclides identified in the releases. The the ingestion of ocean fish and crustacea. In the
solution previously adopted by the Committee for UNSCEAR 1982 Report pathways such as swimming
estimating doses was to assume that the normalized in contaminated waters o r consumption of unusual
releases are composed of equal amounts of activity food items were considered to contribute little to the
concentration from a range of nuclides most fre- collective dose commitment.
quently reported in atmospheric discharges.
108. The Committee has recognized the difficulty in
104. Dosimetric calculations allowed for transfer assigning values to parameters in assessing the conse-
through foodchains to man as well as external quences of liquid effluents. in particular. water utiliza-
irradiation from deposited radionuclides and inhala- tion and flow rates for rivers. fish production rates
tion from the dispersing plume of activity. Allowance and sedimentation rates. The assessments based on the
was made for uptake by roots of growing vegetation. model used in the UNSCEAR 1982 Report, therefore,
The full environmental modelling and resultant doses must be regarded as merely giving a representative
were described in the UNSCEAR 1982 Report. The value of nuclear power impact and should not be
nuclides considered were "Cr, 54Mn,59Fe, ' T o , "OCo, applied to discharges from a specific site to estimate
h'Zn. a9Sr, 9%r, 95Zr,95Nb, IZ4Sb,l3'Cs, 136"6Cs, collective doses from that site.
]3713?Cs, 140Ba, !"La, :4!Ce and I4'Ce.
109. The normalized releases for PWRs, BWRs.
105. The collective effective dose equivalent commit- GCRs. HWRs and LWGRs for 1980-1984 were
ments per GBq release of the isotopic mixture is taken summarized in paragraph 82, and the isotopic com-
from the UNSCEAR 1982 Report to be 5.4 lo-' man Sv position for these discharges were assumed to be those
(GBq)-I. with nearly two thirds coming from external of United States reactors shown in Table 30 and those
radiation from deposited activity and one third from of United Kingdom reactors in Table 31. Collective
ingestion. The collective doses per unit energy generated effective dose equivalent commitments were evaluated
have been calculated using the normalized releases assuming the discharges took place to freshwater a n d
from Table 28 and arc shown in Table 37, from tvhich to marine environments. The results are shown in
it can be seen that the most important pathway is the Tables 38 and 39.
external dose received from activity deposited on the
ground, followed b) the dose from ingested food- 110. The normalized collective effective dose equi-
stuffs. The normalized doses cover three orders of valent con~nlitment for releases lrom the PWR to
magnitude. with HWRs giving the louest figure of fresh water was 1.6 man Sv (GW a)-', compared
0.00022 man Sv (G\V a)-I and RWRs the highest value with the finding of 1 lo-' man Sv (GW a)-! in the
of 0.23 man Sv (GW a)-I. The doses can be compared UNSCEAR 1982 Report. Drinking water accounted
with the previous figure of 0.012 man Sv (Gki' a)-! for for about 80% of the total and l"I was the major
PN'Rs, about one half of the current estimate. For contributing nuclide (70% of the dose). For BWRs the
BM'Rs the previous figure of 0.29 man Sv (GiV a)-! normalized collec~ive effective dose equivalent is
was slightly higher than the present value. GCR 6.6 lo-' man Sv (GW a)-', compared with the assess-
figures are significantly lower than before (0.007 man Sv ment of 2.8 man Sv ( G W a)-! in the UNSCEAR
(GW a)-' compared with 0.012 man Sv (GU' a)-'). 1982 Report. The reduction is the result of an overall
decrease of discharge, as well as a greater reduction in
106. Some 9 5 5 of the collective effective dose equi- the more significant radiological nuclides. About 75%
valent commitment from ground deposits is delivered of the dose was from drinking water, and 60Co. I3'I,
within 50 years of the deposition and the major 1 i - 1 ~ and
~ I3'Cs contributed almost equally to this
nuclides contributing are '"Cs and 60Co. For ingestion, dose. No results were provided for GCRs since these
'OSr, 'j4Cs and I3'Cs all contribute equally by three path- were coastal-sited. The collective dose from these
ways: grain, vegetables and meat. The normalized col- radionuclides normalized for the amount of electricity
lective effective dose equivalent commitment, weighted generated were 1 . 1 10-3 man Sv (GW a)-! for PWR
for the proportion of electricity produced by each and BWR releases to the model river.
reactor type. is 0.08 man Sv ( G W a)-', essentially the
same as the estimate of 0.1 man Sv (GM' a ) - [ In the 1 1 1 . For PWR releases to salt water the normalized
UNSCEAR 1981 Report. Individual effective dose results are shown in Table 39. The collective effective
equivalents from the normalized releases at the end of dose equivalent commitment was 3.6 lo-' man Sv
a plant's operating lifetime range from about 0.01 jtSv ( G W a)-', about one half the value found in the
a t 1 km from the model BWR to 1.000 times less for UNSCEAR 1982 Report. The fish and mollusc path-
H WRs. \+lays were both equally important, although the most
important nuclide was different for each pathway:
"'Cs for fish and 60Co for m o l l u ~ c ~ .
7. Liquid effluents
112. For RWR releases to the marine environment.
107. Aquatic releases are made into freshu.ater o r the normalized collective effective dose equivalent
marine environments. For releases of radionuclides commitment was 3.8 lo-' man Sv ( G W a)-L.compared
into rivers or lakes. the pathways of exposure were with the figure of 4.2 lo-* man Sv (GW a)-' given in
previously taken by the Committee to be drinking the UNSCEAR 1982 Report. The major contribution.
water, irrigation leading to transfer to foodstuffs. and was, as before, from "Zn, which concentrates in
molluscs, and therefore the marine results differed 116. A comprehensive survey of data on LWRs in
markedly from those for fresh water. For GCR Western Europe has been carried out [B33]. The data
releases the normalized collective effective dose equi- cannot be added to Tables 40 o r 41, as the reactors
valent commitment was 0.19 man Sv ( G W a)-', were not identified specifically by country. The nor-
essentially the same value found in the UNSCEAR malized collective effective dose equivalent for 23 PWRs
1982 Report. The majority of the dose arose from dropped from about 6 man Sv ( G W a)-' in 1980-1981
discharges of I3'Cs. The weighted normalized collective to 4 man Sv ( G W a)-' in 1984. The comparable figures
effective dose equivalent commitment, allowing f o r the for 17 BWRs were more variable but were in the range
respective electricity generation was 0.025 man Sv of 3-6 man Sv ( G W a)-'. A particular study o n PWRs
( G W a)-'. has also been carried out by Lochord and Benedittini
[L5]. A distinct difference is emerging between PWRs
113. Again. it should be emphasized that the figures and BWRs in the annual collective dose per reactor
given in Tables 38 and 39 are representative of the and per unit electric energy generated for reactors of
generation of unit quantity of electric energy and similar electrical capacity. This trend, which is illus-
should not be applied to a specific site where trated in Table 41 for PWRs and BWRs from the
particular releases and specific environmental path- United States and Japan, becomes more apparent as
ways exist that have not been considered here and the reactors enter the second decade of their operating
might lead to significant differences in collective dose life and has been reported in the Federal Republic of
contributions. The normalized collective effective dose Germany [E7]. Japan [19. T121, Sweden [P7] and the
equivalent commitment due to aquatic discharges has United States [N3]. The collective western European
been estimated to be 0.013 man Sv ( G W a)-', assuming data, however, d o not support the conclusion [B33].
that one half the discharges are made to fresh water The collective dose can be higher in BWRs than in
and one half to the marine environment. PWRs by up to a factor of 2, possibly because more
maintenance work has to be performed in radiation
areas on BWRs, especially around the turbines.
C. OCCUPATIONAL EXPOSURES 117. It appears that the significant trend towards
increasing numbers of workers per reactor, which was
114. As was noted in the UNSCEAR 1982 Report. noted in the UNSCEAR 1982 Report, especially in the
more data on occupational exposure to radiation are United States, levelled off in the early 1980s. This
reported for reactor operation than for any other area. aspect has been studied in detail by the Nuclear
There are difficulties in normalizing data on occupa- Regulatory Commission [N3]. who showed that
tional exposure to the electric energy generated, although the number of workers per reactor doubled
particularly for water reactors, as most of the doses from 600 to 1,200 over the period 1975-1980, it
are incurred during maintenance when no energy is remained constant at the higher figure during the
produced. Normalized results are therefore only use- period 1980-1983. The collective effective dose equi-
fully derived over several years for a number of valent distribution ratio (see paragraph 19) was
reactors. Average annual effective dose equivalents to assessed separately for PWRs and BWRs [N3]. For
reactor workers were estimated t o be similar in the both types of reactors the average values of the ratios
UNSCEAR 1977 and 1982 Reports and ranged from 3 for the years 1981-1983 were in the range of 0.4-0.6.
to 8 mSv. During the same period. however. there was Annual average doses have been quoted for the years
a large increase in the number of workers per reactor 1980-1982 at three PWRs in the USSR [V2, V3]. The
in the United States. The trend in the normalized values range from 4-8 mSv and provide detailed
collective effective dose equivalent was downwards, support for the overall average figure of 5.6 mSv given
but oilerall the best estimate for LWRs was taken in by Varobyov [Vl] and used in Table 40. F o r the
the UKSCE.AR 1982 Report t o be 10 man Sv Novovoronezh PWR [V5], however. the normalized
( G W a)-', the same as in the UNSCEAR 1977 Report. collective effective dose equivalent in 1980 of 3.1 man Sv
( G W a)-', based o n an annual collective effective dose
115. .AS can be seen from Table 1, PWRs and BWRs equivalent of 4.0 man Sv and an electric energy
have been installed in many countries, although generated of 1.3 G W a [All was somewhat lower than
installed capacity in 1987 was still dominated by rhe the overall figure of I I man Sv (GW a)-' used in
United States. Recent data on occupational exposure Table 40 [Vl]. Data on doses to personnel at LWGRs
and normalized collective effective dose equivalents in the USSR have been reported at some reactors [P4,
are given in Table 40 for PWRs a n d BWRs. For some B151. For the two reactor units at Kolskaya. the
countries, the data are comprehensive and published collective dose in 1980 of 2.3 man Sv was typical
regularly by the appropriate authorities. For other of earlier years: the normalized collective dose of
countries, data are not available for all years o r all the 1.9 man Sv ( G W a)-' for 1980 was some\vhat lower
units installed. h o n e the less, the data are sufficient to than the average value of 2.5 man Sv ( G W a)-' for
give a reasonably comprehensive indication of the 1977-1980. The annual average dose to personnel was
situation world wide, as substantial numbers of LWRs about 5 mSv over that period. The data for Japan in
enter the middle phase of their predicted operating Tables 40 and 41 were compiled mainly from detailed
lifetimes. In general. the data on electricity generated statistics supplied by Kumatori [K 11 and Terasima
were taken from the summaries produced by the [TI 21.
International Atomic Energy Agency (IAEA) [I3. 14.
15, 161, if not otherwise given in the references for a 118. Recent data for HWRs in Canada are shown in
particular country. Table 42 [A4]. The values include internal doses from
exposure to tritium. The electric energy generated was short-term storage at reactors for initial decay heat
obtained from IAE.4 tabulations [I3, 14, 15, 161. The removal. In addition, waste may include some struc-
results for Canada show considerably higher collective tural components from the core or fuel, such as the
effective dose equivalent per unit energy generated outer fuel element structures from GCR and AGR
than would be obtained by considering only the two fuel elements.
largest power plants that produce the bulk of the
energy. The lifetime collective effective dose equivalent 123. The radionuclides present in the above wastes
generated by the Atucha 1 HWR in Argentina has are fission products, activation products and actinides,
been estimated at 27 man Sv (GW a)-' [P8]. the particular radionuclides, quantities and relative
activities being dependent on the reactor type, the
119. Most of the GCRs in the world are in the state of the fuel cladding, the levels of corrosion. etc.
United Kingdom. Comprehensive data on them [HI, In most cases these wastes will be the bulk of what is
H2, H3. H4. P5, W2] are shown in Table 42. The step normally classified as intermediate-level wastes (ILW),
change in the number of workers after 1980 is because i.e., wastes containing substantial activity concentra-
the figures prior to 1981 did not include workers not tions but not significantly heat generating.
directly employed by the Central Electricity Generating
Board. The collective effective dose equivalent distri- 124. The other main cause of solid wastes during
bution ratio has been low: less than 0.01 in 1984 [P5]. operation is the protective material of various kinds
The GCR in Japan is of a similar design to the early used around the station. Much of this is burnable and
GCRs in the United Kingdom [Kl]; that in the United considerable volume reduction can be achieved by
States is a small high temperature gas cooled reactor incineration and compaction. The radionuclide com-
[B27, N3], so the doses from it are not directly position is even more variable than for the wet wastes
comparable to the others. and the activity concentrations are small to zero.
These wastes are generally classified as low-level
120. Collective doses to personnel at the Dounreay \vastes (LLW).
establishment in the United Kingdom concerned with
operation of the prototype FBR were 0.15 man Sv in 125. In order to characterize the wastes for analysis
1984 and 0.29 man Sv in 1985 [U3]. Most of this of the impact of disposal, it is necessary to determine
collective dose resulted from charge machine refurbish- the volumes and the activity concentrations with
ing and irradiated fuel cell entries. Although many identification of the relative quantities of important
aspects of the design and operation of FBRs were radionuclides, especially long-lived radionuclides and
reviewed at a recent symposium [I 1 I], no data on any actinides.
occupational exposures were reported. The Committee
would welcome more information on this aspect, 126. There were a number of studies in the mid-
especially from prototype and nearly commercial-scale 1970s on the quantities of wastes produced at LWRs
reactors. [B30, M7, M8]. The results, summarized in Table 44,
have been extracted from a review carried out by the
121. Despite the lack of data from some countries Environmental Protection Agency of the United Stares
and for some years. there is enough information from [E5]. More recent reviews have been carried out in the
the countries for which each reactor type is installed in United States by the Nuclear Regulatory Conlmission
large numbers to make a reasonable estimate of the [N8, N9] and by the United States Department of
normalized occupation dose for the quinquennium Energy [D4]. as well as in other countries using LWRs
1980- 1984 for the major reactors. These estimates, or planning to do so [NIO]. On the basis of these
which are based on the data in Tables 40 and 42, are studies, the quantities of conditioned wastes arising
given in Table 43. Bearing in mind the world-wide from LWRs per unit energy generated are assumed to
predominance of LWRs, the overall estimate must be be as shown in Table 45. These are only approximate;
heavily weighted by the estimate for this reactor type, variations of up to an order of magnitude are possible
but a figure of 10 man Sv (GW a)-' does not appear in particular circumstances, depending on the type of
unreasonable. treatment or conditioning used.
122. During operation of a power station, solid 128. The quantities and activity concentrations of
wastes are generated in a number of ways. In LWRs operating wastes of HWRs derived from data given
the main cause is treatment of the circulating water, for Canadian CANDU reactors [B31] are assumed to
giving rise to spent ion exchange resins, filter sludges be as shown in Table 47. The quantities of wastes
and evaporator concentrates. Although these are from operational GCRs have recently been reviewed
originally wet wastes and may be stored in this form [F3], and the results are also summarized in Table 47.
at the site, they are generally solidified before disposal. The main differences in radionuclide composition
A similar type of waste arises from purification of the from the LWR wastes are the higher alpha activity of
water in spent fuel storage ponds at reactors. Even the Magnox reactor sludges and the graphite debris
though fuel elements are eventually removed for long- containing 14C. Although there are significant dif-
term storage or reprocessing, provision is made for ferences between reported inventories for Magnox
reactors and AGRs [PI21 and LWRs, the composition disposed of in engineered shallow disposal facilities. A
in Table 46 is taken for this preliminary study, given typical facility is an excavation about 20 m deep and
the predominance of LWRs. 25 m wide lined with 1 m of concrete. Such facilities
are filled with concreted wastes to about one half their
depth. the interstices being filled with concrete and
2. Solid Haste disposal facilities finished with layers of concrete and clay to form an
impervious cap. The canisters and concrete around the
129. A large proportion of the LLW produced at all wastes will prevent rain or ground-water access for a
facilities during operation can be disposed of by burial considerable time, which is taken to be 100 years.
at a shallow depth. Burial facilities range from simple After this time it is assumed that all radionuclides are
trenches or pits containing untreated wastes and released into percolating water at a constant fractional
capped with soil. to concrete structures containing rate of lo-: a-l.
conditioned wastes and capped with weather-resistant
materials. These will be referred to as trenches and 134. As a result of the greater depth of emplacement.
engineered disposal facilities. it is likely that engineered facilities would be positioned
below the water table. I t is also sensible to locate the
130. Considerable quantities of LLW have been facilities in materials with good sorption properties, so
disposed of in such facilities throughout the past few the reference site is assumed to bc in clay. M a n clay
decades. Many of the earlier disposal sites were not outcrops are associated with harder, more permeable
used for disposal of wastes from the generation of rocks leading to artesian conditions, i.e.. rising ground
nuclear power. except perhaps for some research and water. The trench would interfere with this locally so
development aspects. For example, there are 14 sites that the eventual flow pattern assumed for the
in the United States operated by the United States reference site is that water infiltrating the trench from
Department of Energy for the disposal of wastes above will tend to move downward, then upwards and
generated from certain defence research activities. outwards, eventually entering streams at a distance of
Some major closed and currently operating LLW about 1.000 m on either side of the site [PIO].
burial sites are shown in Table 48 [C8, C9, N9]. These
have accepted wastes from a range of operations 135. An alternative method of disposal for packaged
[H 15, M 101. solid wastes is to dump them into a sea-bed at
considerable depth. Although such disposals were
131. Typical simple trenchs are about 10 m deep and carried out for many years, they ceased in 1982 under
25 m wide and could be from 100 to 200 m in length, a temporary moratorium. The amounts of wastes
depending on the site. They are covered by about 1 m disposed of to this date in the north-east Atlantic have
of compacted soil. The waste is not conditioned except been summarized by NEA [N6] and are given in
to render the material non-combustible where necessary. Table 49. I t is not possible to assign the wastes to a
This is similar to the minimum engineered trench particular power programme. and it is known that
specified by Pinner [Pll] and the base case of the some of the major radionuclides, such as "C. arose as
Nuclear Regulatory Commission of the United States wastes in the form for sea dumping largely from the
[N9]. Some major routes by which radionuclides will preparation of radiopharmaceuticals.
be released from such a trench will be into rainwater
percolating through the trench and into ground water.
There will be considerable differences between the
behaviour of elements that form easily soluble com- 3. Collective dose commitments
pounds, such as iodine, and those that do not, such as
uranium. as well as a marked dependence on the 136. After closure of a burial facility. there will be a
environmental and hydrological conditions of the site. period during which control over the site is maintained.
This does not necessarily preclude the transport of
132. On the basis of knowledge of the chemical radionuclides released from the wastes into percolating
behaviour of the elements of which there are impor- ground water but could reasonably be relied upon to
tant radionuclides, the release behaviour of the wastes prevent major human intrusion into the site, such as
can be classified into three groups [PI I]. It is also for building purposes. Thus, during the controlled
assumed that. since LLW is usually disposed of in period, taken to be 100 years. only release by water
trenches without packaging, radionuclides begin to be contact is considered; other pathways are assessed
released into water as soon as the site is closed. The after this period. The major pathways possibly leading
reference site is assumed to be above the water table in to exposure are shown in Figure 11.
reasonably permeable, weathered material that has an
underlying less permeable rock. In a site with these 137. The actual transport of radionuclides with
characteristics. water filtering through the waste will ground water, after release from the waste, the
tend to move down through the unsaturated zone container and any surrounding engineered structures,
until it reaches the water table and the impermeable will be very dependent on the hydrogeologic charac-
boundary where i t moves downslope. I t is assumed to teristics of the site. Considerable effort is being
reach a stream at a distance of 2,000 m from the site. devoted to the development of calculational techniques
capable of handling detailed knowledge of particular
133. Some categories of ILW containing radionuclides sites. For this study a more general approach is
with longer half-lives or at activity concentrations too appropriate, such as the one adopted in other generic
great for disposal in simple trenches have been appraisals of shallow land burial [PIO, N9. N 101.
External
irradiation
I
Inhalation
i
Crops
Farming Ingestion
Animals
r
Contact
Groundwater
I
Soi 1
by water
I Surface
water
,
I [ ' Seas 1
4 Marine
pathways 1
Figure 11. General release and transport mechanism and pathways from shallow burial facilities.
138. The simplest representation of ground water 140. The output from the radionuclide transport
flow velocity. caused only by the natural hydraulic calculations is the rate of input of activity into either
gradient. is that given by Darcy's law: the nearest stream, as described for the generic site, o r
via ground water into soil that could be used for
farming. b7ater could also be abstracted via a well. In
where V, is the ground water flow velocity, K, is the calculating doses i t is assumed that the water forms a
hydraulic conductiiity. k, is the hydraulic gradient source of drinking water for humans and animals. It is
and i L is the kinetic porosity. This is the basis for also assumed that fish from the stream are caught a n d
several transport codes, such as FEFLON'. which is eaten. The river model is a compartment type. with
used in the Nordic study [N 101, GEOS. which is used each compartment rspresenting a homogeneous fresh-
by the Yational Radiological Protection Hoard of the water body and incorporating adsorption on to and
United Kingdom [H12]. and that used by the Nuclear resuspension of sediment particles [I 151. The flow rate
Regulatory Commission of the United States [N9]. I t of the river is taken to be 6 lo6 m' a-'. The eventual
is adapted to radionuclide transport through a porous transfer from rivers via estuaries to the sea is also
medium by including a retardation factor or distri- included, In assessing doses from drinking water. it is
bution coefficient. assumed that suspended sediments are removed by
filtration. Collective doses from streams and wells are
assessed on the assumption that 0.2% of the flow rate
139. Generic assessments have also been carried out and 1% of the abstraction rate are actually ingested.
using a somewhat more realistic two-dimensional
model, NAMMU [R4]. to calculate the pressure head
distributions and, hence. flowpaths and velocities in 1-11. If the land is used for farming. this will give rise .
saturated porous media. This has been applied to to a large number of exposure pathu.ays. The conta-
migration through undisturbed clay and to movement mination can result from transfer directly upbvards
in the surface soil layer [PIO]. Whatever calculational through the soil from ground water or via streams and
method is used, the general result is that those rivers through irrigation. The calculation of collective
nuclides with small retardation factors o r distribution doses requires an esrimate of the total quantities of
coefficients, such as tritium, I4C, 99Tc and '291, move each foodstuff consumed. shown in Table 50. together
at a velocity close to that of the ground water. with average values for activity concentrations obtained
whereas nuclides with large retardation factors o r from the radionuclide transport models.
distribution coefficients. such as 23sU. '36U and 2'9Pu.
move very slowly. The values for some important 142. The collective dose equivalent rates per unit
radionuclides are intermediate. Values adopted in activity as a function of time after release from an
three major studies [H12, N9. NlO] are reasonably engineered facility via all the pathways are shown for
consistent. a number of important radionuclides in Tables 51, 52
and 53. for three major time periods of interest. In (heavy metal) and that of Cap de la Hague is 900 t a-'
general, farming and water consumption pathways oxide fuel. while the plant at Marcoule processes u p to
both contribute significantly to the collective dose. 400 t a-I of GCR metal fuel. The annual throughput
of irradiated fuel from civilian power programmes in
143. The results of applying the specified models are these three reprocessing plants is currently equivalent
shown in Tables 54 and 55 for the shallow earth to about 8 G W a of electric energy, representing about
trench and the engineered trench. respectively. The 5% of the reported annual nuclear electric energy
results are presented per unit activity in the trench and production (189 G W a. Table 2). Thus, the majority
show the collective effective dose equivalent commit- of irradiated fuel, which arises from LWRs, is not
ment and the maximum collective effective dose reprocessed but is stored pending future policy deci-
equivalent rate. Also shown is the time at which the sions as to whether to dispose or reprocess. A
specified percentage of the maximum collective effec- summary of the attitudes of countries with power
tive dose equivalent rate is reached [S 151. reactors towards reprocessing is given in Table 57.
while in Table 58 national programmes for commercial
144. Using the estimated volume for LLW from reprocessing are given [C3].
Table 45 of 200 m3 (GW a)-I at an activity concentra-
tion of 1 GBq m-' as appropriate for PWRs and assum-
ing the radionuclide composition given in Table 46. it A. EFFLUENTS
can be seen from Table 54 that the normalized
collective effective dose equivalent commitment from 148. The design and operation of reprocessing plants
burial of these relatively short-lived wastes is less than to avoid releases of large amounts of radioactive
10-lo man St' (GW a)-'. Only if long-lived radio- material is complex. The gaseous and volatile fission
nuclides were present could there be a collective dose product elements (iodine. tritium, carbon, krypton.
of any significance; if this proportion were taken to be ruthenium, technetium. xenon and caesium) are largely
one thousandth of the quantity present in ILW, as separated from the fuel when it is dissolved in nitric
shown in Table 46, the normalized collective effective acid. The dissolver off-gas is treated for nitric acid
dose equivalent commitment would be about recovery and iodine removal before being mixed with
man Sv (GU' a)-'. the off-gases from other stages in the process. The
\lessel off-gases are treated by caustic scrubbing,
135. Taking the estimated volume for ILL\' from drying and filtering through high efficiency filtration
Table 35 of 50 m' (GLV a)-' at a n activity concentra- systems before being discharged to the atmosphere.
tion of 100 GBq m-'. again. as appropriate for PWRs, The aqueous wastes containing almost all the fission
and combining this with the data from Table 55 for products and transuranic elements are concentrated
the radionuclides specified to be present in Table 46, by evaporation and stored in double containment
the normalized collective effective dose equivalent stainless steel tanks before they are treated further.
commitment from disposal of I L W in a model
engineered trench is 0.5 man Sv (GI\' a)-'. The main 149. The radionuclides of principal concern in re-
contribution is from the 0.1% by activity of lJC processing effluents are the long-lived nuclides: 'H.
. , IJJCs, "'CS
14C. 8 5 ~ ~1291 and isotopes of trans-
assumed to be present in the waste. The contribution
by radionuclide is shown in Table 56. uranium elements. Table 59 lists the reported dis-
charges to the atmosphere. and Table 60 those in
aquatic releases, from Sellafield, Cap de la Hague and
Marcoule for 1980-1985. The amount of activity in the
I . FUEL REPROCESSING effluents depends upon the specific waste treatment
and processing design of the plant. as well as the type
146. At the fuel reprocessing stage of the nuclear fuel of fuel processed, its irradiation history and storage
cycle, the elements uranium and plutonium in the time prior to reprocessing. Table 61 gives the isotopic
irradiated nuclear fuel are recovered to be used again composition of liquid effluent discharges from the
in fission reactors. Spent fuel elements are stored Sellafield and Cap de la Hague plants in greater detail
under water. which provides both biological shielding for the years 1980-1985. Atmospheric release data and
and cooling. while waiting to be reprocessed. Fuel liquid discharge data for Marcoule are not available
elements are usually left until the short-lived "'I has beyond 1980.
decayed to a low level. normally a minimum of four
o r five months. Since one reprocessing plant can serve 150. The throughput of fuel at both Sellafield and
large numbers of nuclear reactors. the quantities of Cap de la Hague has been calculated on the basis of
nuclides passing through the plant that are significant "Kr reported discharges and on the assessment of the
from the point of view of health will be high in L5Krgeneration in different reactor fuel cycles made in
absolute terms. Careful design limits discharges, how- the UNSCEAR 1982 Report. In that Report, the
ever, so that releases per unit of electricity generated Committee has used production rates of 14 PBq
by the fuel passing through the plant, i.e.. (GW a)-], (GWr a)-I for GCRs and 11.5 PBq (GW a)-' for PWRs.
may be relatively small. These figures make assumptions about fuel bum-up
and reactor thermal efficiency that are not likely t o
147. The only commercial operating reprocessing have changed significantly since the UNSCEAR 1982
plants are at Sellafield (formerly Windscale) in the Report. On this basis. the electric energy production
United Kingdom and Cap de la Hague and Marcoule of the annual throughput of fuel at Sellafield has
in France. The capacity at Sellafield is 2,000 t a-I varied between 1.7 G W a and 3.7 G W a, while for
Cap de la Hague the range has been 2.4 to 6.1 GW a. previously reported. I t seems likely that all the 12q1 in
For Marcoule, there are little data on atmospheric dis- the fuel is released with a few per cent going to the
charges. although the electric energy of annual fuel atmosphere.
throughput for 1980 has been estimated at 1.4 G b ' a.
155. Atmospheric releases of aerosols are summarized
151. For tritium, the Committee used in the in Table 59. The normalized alpha releases from
UNSCEAR 1982 Report a production rate in LWR Sellafield are 0.2 GBq (GW a)-I, of which more than
fuel of 0.75 PBq (GW a)-I and, assuming this applies 75% is due to plutonium isotopes [BI, B2. B3. B8.
to GCR fuel, the inventory passing through Sellafield B16], the remainder being accounted for by 24'.4mand
has varied between 1.3 PBq ( 1985) and 2.8 PBq (1981). 242Cm.This figure is one half that reported in the
In 1981, atmospheric discharges of 3H were 0.46 PBq UNSCEAR 1982 Report. The alpha-aerosol results are
and liquid discharges 2 PBq, giving 2.46 PBq, compared available from France for Cap de la Hague and are
with the estimated throughput of 2.8 PBq. Thus, it some 30 times lower. For atmospheric beta releases.
appears that nearly all the tritium in irradiated fuel is the largest component from Sellafield is I3'Cs, although
released in reprocessing and about 20% is released to since 198 1 the levels have been reduced. The normalized
the atmosphere. This is identical to the percentage release is 63 GBq (GW a)-', compared with 88 GBq
estima~edin the UNSCEAR 1982 Report. The reniain- (GW a)-I for 1975-1979. For Cap de la Hague the
ing tritium may be immobilized in cladding wastes. normalized release is 0.04 GBq (GW a)-' for beta-
For Cap de la Hague the normalized releases of aerosols. and no isotopic breakdown is available. The
tritium have been 0.26 PBq (GW a)-' of which only reduction in aerosol releases in recent years from
about 1% is in reported atmospheric releases and thus Sellafield is the result of improvements in the Magnox
it seems that only about one third of the throughput is cladding silo stores, including the installation of inert
released. gas blankets and filtration systems.
152. The results of routine measurements of I4C 156. The liquid effluents discharged from Sellafield.
atmospheric discharges from the Sellafield reprocessing Cap de la Hague and Marcoule are given in Table 60
plant are given in Table 59. The normalized production for total alpha, total beta, 'H. '"Sr, Io6Ru and I3'Cs.
rate of I'C in GCR fuel was estimated in the There is a yearly isotopic breakdown for the French
UNSCEAR 1982 Report at 3.2 TBq (GWr a)-'. Atmo- plant at Cap de la Hague but not for Marcoule. The
spheric discharges from Sellafield therefore seem to isotopic compositions of Sellafield and Cap de la
account for essentially the whole of the estimated Hague discharges are given in Table 61 for 1980-1985.
throughput of I4C between 1980 and 1985. For the
French reprocessing plants, 14C discharges are not 157. The normalized alpha release from Sellafield to
reported. In the UNSCEAR 1982 Report, the Com-
mittee estimated the I4C content of LWR fuel to be
+
the sea is 8.0 5.2 TBq (GU' a)-', compared with an
average of 25 TBq (GW a)-' between 1975 and 1979.
0.66 TBq (GW a)-'. of which about 75% was assumed For Marcoule and Cap de la Hague the figures are
emitted to the atmosphere, but in view of the 0.063 and 0.16 TBq ( G b l a)-!. while for the previous
Sellafield data. all I4C can be considered released to period they were 0.016 and 0.24 TBq (GU' a)-I. Most
the atmosphere for the dose assessment. of the Sellafield alpha activity was 239"2'0P~, and the
level of alpha discharge has been reduced by a factor
153. The 13'1 content of irradiated nuclear fuel of 6 over the reporting period.
varies, depending upon the cooling time and the final
power level of the fuel discharge. The "'I normalized 158. For liquid discharges of beta activity the
content of LWR fuel cooled for six months is normalized releases from Sellafield, Cap de la Hague
estimated at 2.8 TBq (GW a)-I, falling by a factor of and Marcoule are 0.97, 0.24 and 0.027 PBq (GW a)-!,
2.000 for a cooling period of nine months. Since respectively. compared with 3.7, 0.52 and 0.04 PBq
irradiated fuel is generally cooled for at least a year (GW a)-' for 1975-1979. The isotopic composition of
prior to reprocessing, "'I discharges are very small. the effluents varies between the sites: 55-70% of the
For 1980-1985. Sellafield atmospheric releases of l 3 I l Sellafield discharge is attributable to 13'Cs, whereas
(Table 59) gave normalized values of 19 GBq (GW a)-I; 40% of the Cap de la Hague discharge is attributable
the corresponding figure for 1975- 1979 was 1.7 GBq to Io6Ru.Tile "'Cs levels from Sellafield were reduced
(GW a)-'. the increase being due to a high release by a factor of 9 over the review period. although the
figure in 1981. '06Ru levels remained constant at about 400 TBq
(GW a)-' until 1985. After 'H. Io6Ru is the main
154. The quantity of "'1 in fuel depends upon burn- isotope released from Cap de la Hague; the lWRu
up and is assessed at 37-74 GBq (GW a)-I. Atmo- discharges are comparable to those of the Sellafield
spheric discharges of "'I, as well as liquid effluent plant.
amounts, have been reported for Sellafield and Cap de
la Hague but not for Marcoule. The normalized 9 Monitoring of the marine environment is under-
atmospheric release is 3.7 GBq (GW a)-I for Sellafield taken by regulatory authorities to ensure compliance
and 4.9 GBq (GW a)-' for Cap de la Hague for the with authorized discharges and to ensure that doses to
period 1980-1985, which is about twice the value given exposed populations are at the levels predicted. The
in the UNSCEAR 1982 Report. Liquid effluents results of monitoring around the United Kingdom in
averaged about 30 to 60 GBq (GW a)-! at each plant the vicinity of all operating nuclear plants have been
over the same period, compared with 40 GBq (GW a)-' published by Hunt [H5, H6, H7]. The most significant
results arise from discharges of the Sellafield plant. valent commitment obtained by the Committee in the
Measurements of activity in fish and shellfish in 1983 UNSCEAR 1982 Report was 0.0074 man Sv (PBq)-I.
are shown in Tables 62 and 63 for various locations Thus. the normalized local and regional collective
around the United Kingdom. In order to interpret effective dose equivalent commitment is 0.1 man Sv
these results, consumption data are required to assess (GW a)-'. The normalized discharge from Cap de la
intakes of radionuclides. Hague is 11 PBq (GW a)-'. giving 0.08 man Sv
(GW a)-'. The average annual electric energy generated
160. Aarkrog [A21 has summarized bio-indicator in recent years has been over 160 GW a, and an
studies in Nordic waters to identify levels of radio- annual amount of fuel equivalent to 8 GW a was
active contamination. The marine bio-indicators are reprocessed. Thus, the normalized collective effective
the blue mussel (Mytilus edulis) and bladder wrack dose equivalent commitment from is 0.005 man
(Fucus vesiculosus). which are sensitive to contamina- Sv (GW a)-' electric energy generated.
tion from nuclear fallout and from Sellafield dis-
charges and nuclear power plants in Sweden. Finland
and the rest of coastal northern Europe. Discharges 2. Tritium and carbon-14
from Sellafield have been traced from the lrish Sea.
along the western Norwegian coast, down along
eastern Greenland and then western Greenland. The 164. The Committee used in the UNSCEAR 1982
transit time from the lrish Sea is measured to be four Report specific activity models to estimate collective
years and the activity concentration is diluted by a doses from 'H and 14Cdischarges. The dose resulting
factor of 100. from the release of tritium to the atmosphere was
estimated in that Report at 0.0027 man Sv TBq-I for
161. The measured concentrations of "'Cs in sea the Sellafield site. some four times lower than the
water decrease from the highest levels of 1.000 Bq kg-' value for the reactor site, due to differences in site,
near Sellafield to 8-10 Bq kg-' in the Baltic Sea, population density and meteorological conditions.
1-2 Bq kg-' near Greenland and less than I Bq kg-' near Releases from Sellafield to the atmosphere averaged
Iceland. Levels of 99Tcfrom Sellafield discharges closely I20 TBq (GW a)-' (Table 59), giving a collective
follow those of I3'Cs. Measurements of plutonium show effective dose equivalent commitment of 0.32 man Sv
enhanced levels primarily in British and lrish coastal (GM'a)-', 85% of which was from ingestion. For Cap
waters. although very low levels have recently been de la Hague the normalized release of 3.5 TBq
detected in areas further from the coast. (GW a)-' gives a collective effective dose equivalent
commitment of 0.01 man Sv. Releases to the regional
marine environment were estimated in 1982 to lead to
lower dose commitments. Using the value derived in
B. LOCAL AND REGIONAL COLLECTIVE the UNSCEAR 1982 Report of 1.8 lo-' man Sv PBq-I
DOSE COMMITMENTS released to oceans and the average release to the sea
of 579 TBq (G W a)-' for 1980-1985 from Sellafield
162. The evaluation of the collective dose commit- (Table 60) leads to a collective dose commitment of 1
ments from reprocessing nuclear fuel requires a study lo-' man Sv (Gw a)-'. The total normalized collective
of the local and regional effects and of the global effective dose equivalent commitment weighted by the
consequences of the releases. Estimates of the local relative energy of fuel reprocessed at Sellafield and
and regional collective dose commitments are given in Cap de la Hague is 0.15 man Sv (G W a)-', essentially
this section and the global contribution is provided in the same figure that was given in the UNSCEAR 1982
chapter V. The collective dose commitments are Report. Again, allowing for the fraction of fuel
evaluated for the normalized discharges from Sellafield reprocessed. the weighted normalized collective effec-
and Cap de la Hague by scaling the normalized results tive dose equivalent commitment is 0.007 man Sv
given in the UNSCEAR 1982 Report. As there are (GW a)-'.
only three reprocessing plants operating with signi-
ficant commercial throughput of fuel, the collective 165. For "C releases to the atmosphere, the Com-
effective dose equivalent commitments per unit of mittee estimated the collective effective dose equivalent
electric energy generated are weighted by the fraction commitment at 0.4 man Sv TBq-I, with essentially the
of fuel reprocessed to provide the current contribution same value per TBq released to the aquatic environ-
from all operating reactors. In the UNSCEAR 1982 ment. Averaged atmospheric releases from Sellafield are
Report. the Committee gave typical discharge figures reported to be 3.5 TBq (GW a)-', giving a normalized
for notionzl new designs of reprocessing plant. This collective effective dose equivalent commitment of
has not been repeated in this Report since all fuel may 1.4 man Sv (GW a)-', compared with 0.69 man Sv
not be reprocessed. The weighted average. therefore. (GW a)-' quoted in 1982. The difference is accounted
reflects actual exposures from the nuclear fuel cycle as for by the reported discharges to the atmosphere being
currently operated. double the values reported in 1975-1979. It would
appear that the total throughput of I4C at Sellafield is
now accounted for in atmospheric releases. For Cap
de la Hague. the assumed release of 0.66 TBq (GW a)-'
gives a normalized collective effective dose equivalent
163. The averaged 8'Kr normalized discharge from commitment of 0.3 man Sv (GW a)-'. Weighted for
Sellafield between 1980 and 1985 was 14 PBq (GW a)-' the fraction of fuel reprocessed. the contribution is
(Table 59), and the collective effective dose equi- 0.04 man Sv (GW a)-'.
3. Other atmospheric releases 170. The collective effective dose equivalent com-
mitment weighted for the relative amount of electricity
166. Of the other nuclides released to the atmosphere. produced by the fuel reprocessed at each plant is thus
Iz9I becomes globally dispersed and makes a contri- 25 man Sv ( G W a)-' and, after allowing for the
bution to the collective dose commitment over a proportion of fuel reprocessed commercially. the
prolonged period, while the remainder contribute only normalized contribution is 1.2 man Sv ( G W a)-'.
to the local and regional collective dose commitment. Annual committed effective dose equivalents to the
A summary is given in Table 64. The total, averaging critical group of winkle eaters close to the Sellafield
over Sellafield and Cap de la Hague, amounts to site were reported to be 0.5 mSv in 1985 [B29]. The
1.3 man Sv (GW a)-', compared with the assessment doses are reduced as discharge levels fall.
of 3 man Sv (GW a)-' for atmospheric releases made
in the UNSCEAR 1982 Report. Some 65% of the dose
is now due to ''C discharges, which are reported to be C. OCCUPATIONAL EXPOSURES
twice the previous levels and which counteract reduc-
tions in discharges of other nuclides, particularly 171. I t was noted in the UNSCEAR 1982 Report
actinides. Weighted by the proportion of electric that experience of fuel reprocessing is limited to a few
energy generated, the normalized collective effective countries and that plant design and historical operating
dose equitralent commitment from atmospheric releases conditions may not represent the best current potential
during reprocessing is 0.07 man Sv ( G W a)-'. for new plants. This view is supported by a recent
review of the trends in the annual collective a n d the
maximum individual occupational doses in a number
of reprocessing plants [B22]. The review covered not
1. Liquid effluents only the large operating reprocessing plants at C a p de
la Hague and Sellafield. but also the pilot plants
167. The results are presented in Table 65 for the WAK at Karlsruhe, Federal Republic of Germany. the
normalized collecti\~eeffective dose equivalent commit- Eurochemie plant at Mol. Belgium, the PNC plant at
ments for marine discharges from reprocessing at Tokai Mura in Japan, and the Idaho and Savannah
Sellafield and Cap de la Hague. The environmental River plants in the United States. Although recognizing
dosimetric models are appropriate for the specific the differences in sizes and design age of the various
coastal waters of northern Europe and were fully plants and that some of them reprocess fuel for
described in the UNSCEAR 1982 Report. They military as well as civilian purposes. a downward
assume that consumed fish, molluscs and crustacea trend in average doses was observed starting during
are the important food pathways to man. the period 197 1 - 1973 and ending during the period
1980- 1982. The annual average effective dose equi-
168. For Sellafield, normalized liquid discharges for valent dropped from 4-15 mSv in the early 1970s to
1980-1985 were reduced by a factor of 3 since the 2-4 mSv early in the 1980s. Data since the UNSCEAR
period 1975-1979. The collective effective dose equi- 1982 Report are summarized in Table 66 for Japan
valent commitment per TBq for marine discharges and the United Kingdom [AS. 813. B23. 828. H8].
from Sellafield found by the Committee in the The data for Japan refer only to the PNC plant at
UNSCEAR 1982 Report was 0.068 man Sv for "'Cs. Tokai Mura. An estimate of 0.5 man Sv has been
0.034 man Sv for 'ObRu and 0.025 man Sv for alpha- made of the neutron collective dose equivalent at
emitters. The principal route of exposure is I3'Cs in Sellafield in 1982 [B24]. Data for Cap de la Hague
consumed fish, as before. and for 1980-1985 the and Marcoule from 1973 to 1985 are given in Table 67.
caesium contribution is some 85% of the total taken mainly from the recent comprehensive re\,ie\v by
collective dose. The normalized collective effective Henry [H 131. This also shou's annual average effective
dose equivalent commitment for 1980-1985 from dose equivalents of about 2 mSv in the period 1982- 1985
liquid discharge from Sellafield is 44 man Sv (GM' a)-'. at both establishments.
the estimate made in the UNSCEAR 1983 Report
being 124 man Sv ( G W a)-', If data for 1985 alone are 172. In the UNSCEAR 1982 Report the normalized
taken, the normalized release gives a collective effective collective effective dose equivalents for the plants at
dose equivalent commitment of 25 man Sv (GU' a)-'. \tlindscale (now Sellafield). United Kingdom. and C a p
reflecting the lower discharges after the installation of de la Hague, France. were estimated to be 18 and
a new plant to remove radioactive substances from 6 man Sv ( G W a)-', respectively. Some revised estimates
effluent streams. for the United Kingdom are given in Table 66. based on
' X r discharges related to energy throughput and a fuel
169. In the case of C a p de la Hague, discharges also content of 14 PBq (GU' a)-'. The normalized value for
seem t o have been reduced. The Committee's models Cap de la Hague is reported to have fallen from 6 man
used in the UNSCEAR 1982 Report gave dose Sv ( G W a)-' in 1975 to I man Sv (GW a)-' in 1985
conversion factors per TBq released from Cap de la despite a large increase in reprocessed fuel throughput
Hague of 0. I man Sv for '06Ru. 0.09 man Sv for "'Cs over this period [BZZ]. This is in agreement with the
and 0.4 man Sv for alpha-emitters. The normalized data given in the report of a working group [C6] for a
collective effective dose equivalent commitment shown period leading up to 1981 and supplemented in a
in Table 65 is 1 1 man Sv ( G W a)-', which compares report to the Sizewell B public inquiry in the United
with the figure of 53 man Sv ( G W a)-' given in the Kingdom [ZI] with data for 1982 and 1983. These
UNSCEAR 1982 Report. The majority of the dose estimates are in agreement with the detailed results for
arises from the discharge of lobRu. C a p de la Hague reported by Henry [HI31 and given
in Table 67. The Table shows that the normalized ILW is about 0.005-0.05. These will be very sensitive
collective effective dose equivalent dropped steadily to reprocessing chemical conditions for some nuclides.
from 2.2 to 0.9 man Sv (GW a)-' throughout the especially ?"Np. The generation of ILW from the
period 1980-1985. The difference of nearly an order of proposed oxide fuel reprocessing plant for AGR fuel
magnitude between the normalized values for the two was also estimated by Taylor [TI I] to be 11000 m'
major installations makes it difficult to make a clear from the reprocessing of 600 t uranium metal in the
estimate. It seems, however, that the estimate in the thermal oxide reprocessing plant (THORP). The
UNSCEAR 1977 Report of the global collective activity content is 6 l o i 5Bq alpha and 5 1O1%q beta/
effective dose equivalent per unit electric energy gamma activity, assuming a cooling period of five
generated is, at 10 man Sv (GW a)-I, too high. Based years. The average fuel requirement of the AGR is
on the trends reported for Cap de la Hague, the taken to be 30 t ( G W a)-) to give the quantities in
estimate for Marcoule in 1980. the experience in Table 68. Again. comparing with the alpha and beta/
Japan. and taking into account the predictions for the gamma inventories of the fuel throughput at five
new plant at Sellafield, a better estimate for the whole years, calculated t o be 3,100 and 2.5 10' TBq (GW a)-',
of the 1980s is about 5 man Sv (GW a)-]. When respectively [G5], the fractions of activity throughput
allowance is made for the proportion of fuel repro- lost to the ILW are 0.01 for alpha and 0.1 for
cessed commercially, the normalized contribution beta/gamma activities.
from occupational exposure is 0.25 man Sv ( G W a)-l.
176. The annual rate of waste generation at Marcoule
has been reported [B32] to be about 2,000-3,000 drums
D. SOLID WASTE DISPOSAL containing a total of about 4 TBq alpha and 4,000 TBq
beta/gamma activity. Assuming the annual fuel through-
173. The solid wastes that are generated in the
put of the facility to be 0.4 G W a and the drum
handling, processing and disposal of spent fuels are of
capacity to be 0.2 m3 gives the quantities shown in
two broad categories. Most of the activity in the spent
Table 68.
fuel is separated during reprocessing and, after a
period of storage as a liquid. will be solidified for
eventual disposal as high-level waste (HLW), generating 177. An alternative method of estimating the activity
content of other solid wastes is to assess it directly as a
significant decay heat. During the reprocessing opera-
fraction of the throughput of radionuclides in the fuel.
tion considerable amounts of solid low-level wastes
This approach has been used by the United States
(LLW) and solid intermediate-level wastes (ILW) are
Department of Energy [D4] to give the results in
produced, some streams of the latter being charac-
Table 69. The quantities are comparable with those
terized by an appreciable content of actinides. If the
spent fuel is not reprocessed but stored and prepared estimated by Hill et al. [HI I] but considerably less
for disposal, there will be almost no ILW or LLW. than those estimated for an operating plant, as shown
in Table 68. The difference is about two orders of
But the packaged spent fuel is then treated as HLW: it
magnitude for alpha emitters and nearer to three
conrains the actinides that would have been separated
orders of magnitude for beta/gamma emitters.
for re-use by the reprocessing operation. Since neither
spent fuel nor vitrified HLW have been disposed of.
178. T o give some estimate of the consequences of
they are not considered in this assessment of current
operations. disposal of such wasres. it is assumed thal the alpha
lvastes are entirely 2 ' q P and
~ the b e t d g a m m a wastes
174. Production of other solid wastes in reprocessing entirely I3'Cs, and a typical normalized production
plants has been highly dependent on the operational from Table 68 is taken to be 100 TBq (GWr a)-I for
characteristics of the particular plant. In particular, alpha wastes and 10.000 TBq ( G W a)-I for beta/
much of the waste produced at the Sellafield plant in gamma wastes. Using the model for a typical ILW
the United Kingdom is attributable t o the degradation engineered disposal trench from section 1II.D. and the
of Magnos fuel in underwater storage and should not values for collective effective dose equivalent com-
be taken to be indicative for other plants now o r in mitment per unit activity disposed of from Table 55,
the future. the normalized collective effective dose equivalent
commitment would be 1 man Sv ( G W a)-I. This is
175. Production of ILW from the British Magnox reduced to 0.05 man Sv (GLV a)-' when account is
reprocessing programme has been estimated [TI I] at taken of the proportion of fuel reprocessed commer-
47,000 m' from the reprocessing of 30.000 t uranium cially. Lower losses from throughput to the ILW a n d
metal. The activity content is estimated to be about LLW wasre streams as estimated in paragraph 176
2 10'" Bq alpha and 2 10" Bq beta/gamma a c t ~ \ i t gat would significantly reduce this estimate; greater losses
1990. Taking an average fuel requirement for Magnox of the very long-lived radionuclides I4C and "91 would
reactors of 200 t ( G W a)-I. these correspond to the significantly increase it.
quantities shown in Table 68. Comparing with the
alpha inventory of the fuel throughput, calculated to
be 6.700 TBq ( G W a)-' at six months and 3,800 TBq
( G W a)-; at 20 years [G5], the fraction of alpha V. COLLECTIVE DOSE COM\IITR.IEIVTS
activity throughput lost to the ILW is about 0.02-0.03. FROM GLOBALLY DISPERSED
Similarly, taking the beta/gamma inventory of the RADIONUCLIDES
fuel throughput to be 2.4 106 TBq (GW a)-' at six
months and 1.7 loS TBq (GW a)-' at 20 years [G5]. 179. The nuclides giving rise to a global collecrive
the fraction of beta/gamma throughput lost to the dose commitment are sufficiently long-lived and migrate
through the environment, thus achieving widespread B. TRITIUM
distribution. Those of interest are 'H. ''C. BsKr and
I z 9 I . The environmental transfer of 'H. "C and 8sKr is 183. The models used by the Committee in the
becoming fairly well established. and reliable estimates UNSCEAR 1982 Report gave a collective effective
of collective dose commitments were made by the dose equivalent commitment of 2.8 man Sv
Committee in the UNSCEAR 1982 Report. Other per TBq released. Because of the short half-life of
long-lived nuclides. such as 2 3 q P ~are , far less mobile tritium, this applies to the world population at the
in the environment and therefore become less dis- time of release. For the 1980-1985 world population of
persed after deposition on to soils or sediments, 4.6 lo9, the dose factor is increased to 3.2 man Sv
following release into the local region. per TBq. Releases to the atmosphere and hydrosphere
were not distinguished, since the exchange of water
180. The very long-lived nuclides, such as '291,pose a between the atmosphere and circulating waters of the
special problem because of the uncertainty in predict- globe is rapid. and the models assume immediate
ing population size, dietary habits and environmental mixing and exchange with the hydrogen content of the
pathways over periods of tens of millions of years. circulating water.
Therefore. little use can be made of these collective
dose commitments for decision-making purposes. The 184. The normalized release of tritium to the atmo-
incomplete collective dose commitment, however. is sphere from reactor operations, weighted by electricity
useful to demonstrate the time distribution of the dose production, is 46 TBq (GW a)-', while for liquid
commitment and to estimate the per caput doses discharges the data give 40 TBq (GW a)-'. .4veraged
arising per year from a finite duration of a practice. In over Sellafield and Cap de la Hague. aquatic and
the following paragraphs, complete and incomplete atmospheric releases from reprocessing add up to
dose commitments are given for the globally dispersed about 600 TBq (GW a)-', and since only 5% of the
nuclides up to a maximum of lo6 a. The collective dose fuel is reprocessed, this adds 30 TBq (GW a)-' to the
commitments per unit release were taken from the reactor releases of 86 TBq (GW a)-'. The total collec-
UNSCEAR 1982 Report of the Committee and scaled tive effective dose equivalent commitment amounts to
for the normalized releases derived for 1980-1984 0.004 man Sv (GW a)-'. The incomplete collective
discharges. dose commitments shown in Table 70 indicate that
essentially all of the dose is received in the first few
181. In the UNSCEAR 1982 Report, a model repro- years after discharge. The local and regional contribu-
cessing facility was described and all reactor fuel was tion from tritium releases from reactor operation and
assumed to be reprocessed. In this Report, the the fractional reprocessing contribution amount to
collective doses assessed for reprocessing plant reported about 0.6 man Sv (GW a)-', which is a factor of over
discharges are weighted by the fraction of the energy 100 greater than the global contribution.
value of the total nuclear fuel that is reprocessed,
namely 5% (paragraph 147). The weighted contribu-
tion is added to any contribution from reactor
operation to reflect the current normalized exposures.
185. The Committee used in the UNSCEAR 1982
Report a relatively complex compartment model to
assess the environmental distribution and behaviour
of I4C. This model allows for two hemispheres, each
comprising humus, circulating carbon, surface ocean
182. Since krypton is an inert gas, it disperses and deep ocean. The circulating carbon represents the
throughout the atmosphere and achieves a uniform carbon in the troposphere and those sectors of the
concentration in about two years. The Committee, in terrestrial biosphere subject to rapid growth and
the UNSCEAR 1982 Report. estimated the collective decomposition. Humus represents the carbon content of
effective dose equivalent commitment from B5Krto be the terrestrial biosphere which circulates more slou.ly.
0.17 man Sv PBq-', assuming a world population of Carbon- 14 releases are assumed to be instantaneously
4 lo9. This must be scaled up to 0.2 man Sv PBq-I for mixed in the compartment to which release occurs.
the world population of 4.6 lo9 during the period The results produced by this model are similar to
1980-1985. All the dose commitment is delivered those produced by more complex models; the main
within the first 50 years after release. Paragraph 150 area of uncertainty is the rate of transfer of "C to the
gave normalized production of 8SKr as 11.5 PBq deep ocean, from where it is less available.
(GW a)-' for LWRs and 14 PBq (GW a)-' for GCRs.
leading to 2.3 man Sv (GW a)-' and 2.8 man Sv 186. The resulting collective effective dose equivalent
( G W a)-' collective effective dose equivalent commit- commitment is 67 man Sv TBq-I released, averaged
ment, respectively. Contributions to the collective over both aquatic and atmospheric releases and
effective dose equivalent commitment come almost assuming a future global population of 10l0.Normalized
equally from whole-body gamma-radiation and from releases from reprocessing plants are averaged over
beta-irradiation of the skin. Weighting this collective the reported figures for Sellafield (Table 59) and
dose by the fraction of fuel currently reprocessed calculated throughput for Cap de la Hague (para-
(0.05) leads to 0.12 man Sv (GW a)-'. The incomplete graph 152). Measurements appear to show that all the
collective dose commitments are shown in Table 70. throughput is measured in airborne effluents, and i t is
which indicates that half of the dose from "Kr is assumed that little is discharged to the sea. The
delivered in the first 10 years after discharge. normalized release is 3.5 TBq (GW a)-I from Sellafield
(Table 59): Cap de la Hague is assumed t o give rise to ing incomplete collective effective dose conlmitment to
releases of 0.66 TBq (GW a)-'. The collective effective 10,000 years is 1.5 man Sv (GW a)-'. The incomplete
dose equivalent commitment for Sellafield is thus value to lo4 vears is 0.0093 man Sv (GW a)-' and for
234 man Sv (GW a)-' and 44 man Sv ( G W a)-[ for 100 years 0.0008 man Sv (GW a)-'. as shown in
Cap de la Hague. Since about 5% of the annual Table 70.
energy equivalent of fuel is reprocessed, the weighted
figure averaged over the two sites is 6 man Sv VI. TRANSPORT
(GW a)-', the remaining fuel being stored and not
giving rise to effluent releases of I4C.
191. Materials of various types are transported
187. HWR releases are about 7.3 TBq (GW a)-' of between the installations involved in the entire fuel
''C from reactor operations (Table 25). while those cycle. The amounts and distances depend on the
from LWGRs and GCRs are about 1 . 1 TBq (GW a)-' number of facilities and the degree t o which different
(paragraph 72). LWR releases at about 0.3 TBq facilities are located together. An estimate is given in
( G W a)-' (paragraph 70) are small in comparison. The Table 71 of the transport needs in a complete nuclear
normalized collective effective dose equivalent commit- fuel cycle; this has been adapted from the report of the
ment from HWR operation is therefore 490 man Sk International Fuel Cycle Evaluation (INFCE) [I 151. In
( G W a)-'. This is nearly a factor of 3 lower than the general, mills are located together with mines, and
estimate given in the UNSCEAR 1982 Report, and is tailings are disposed of close by, so that there is no
entirely due t o lower reported discharge figures. significant requirement for transport of \,cry large
About 6% of total nuclear generated electric energy quantities of ore or wastes. The other major transport
arises from HWRs and about 10% from LWGRs and requirements shown in Table 71 can not be eliminated
GCRs, so the electricity production weighted contri- by co-location. as other factors will dominate the
bution to collective dose is 32 man Sv (GW a)-' from siting requirements. IAEA has continued t o work
HWRs and an additional 7.7 man Sv ( G W a)-' from towards a full assessment of the radiological impact of
GCRs and LWGRs. Although LWR releases arc transport and have recently published the preliminary
lower, because of their larger electric production, findings of a technical committee [P13]. The general
LWRs add 17 man Sv (GW a)-'. In summary. the conclusion was that, although the data available were
present practices of reactor operation and reprocessing incomplete, the indications were that exposures result-
lead to a total collective effective dose equivalen~ ing from normal transport operations were low both
commitment of 6 man Sv (reprocessing) plus 57 man for workers and members of the public.
Sv (from HWR, LWR, LWGR and G C R operation),
i.e., 63 man Sv (GW a)-'. This commitment is received 192. The estimates made during the course of the
over some 10000 years, while the temporal distribution IAEA study of occupational collective doses from the
is shown in Table 70 to be 3% in 10 years, 10% in transport of fuel cycle materials were a recognized
100 years and 19% in 1.000 years. cautious estimate of 19 man Sv for the United States
as a projection for 1985 [Nl I] and a more realistic
estimate of 0.14 man Sv for the United Kingdom in
D. IODINE- 129 198 1 [GI]. Estimates of less than 0.01 man Sv were
made for selected operations in France, Italy and
188. When released to the atmosphere. iodine, because Sweden, but these could not be normalized to energy
of its environmental mobility, becomes rapidly incor- production. Using the energy production figures for
porated into foodstuffs ingested by individuals. The the appropriate years gives normalized collective
highest concentrations of iodine occur in sea water effective dose equivalents of 0.5 man Sv ( G W a)-' for
and, as with "C. the greatest uncertainties surround the United States and 0.04 man Sv ( G W a)-! for the
the transfer of Iz9I to deep oceans and any sedimenta- United Kingdom. Noting that the United States
tion that may remove activity from any biological assessment was pessimistic, but that the United
chain. Kingdom assessment did not include the transport
associated with uranium mining and milling. an
189. Assuming again a future global population of overall estimate of 0.2 man Sv (GW a)-' is probably
loL0, the Committee used a collective effective dose reasonable.
equivalent commitment of 1.4 lo4 man Sv TBq-'
released [UI]; of this, some 0.003% is delivered within 193. Doses to members of the public were also
100 years of release. 0.03% in 10,000 years. 5% in estimated as part of the work of the IAEA committee.
lob years. thus leaving 95% of the collective dose to be based again on submissions from the United States
delivered from 1 million years after release, most of i t and the United Kingdom. The estimate for the United
coming between 10 million and 40 million years. For States was 19 man Sv for 1985 [N 1I], the same as that
this report incomplete dose commitments to lo6 years for occupational exposure, whereas that for the
are used so that the value of Iz9I is 700 man Sv TBq-'. United Kingdom was several orders of magnitude
lower, at 0.001 man Sv for 1981 [GI]. No estimates
190. The normalized releases from Sellafield and were available for other countries. Based mainly on
Cap de la Hague from 1980-1985 averaged about the more realistic British assessment, it seems reason-
40 GBq (GW a)-' to the sea and 4 GBq (GW a)-' to able t o conclude that public exposure from transport
the the atmosphere, giving a total of 44 GBq (GW a)-'. is less than occupational exposure and t o adopt a n
which, when weighted for the fraction of fuel that is estimate for the normalized collective effective dose
reprocessed, gives 2.2 GBq ( G W a)-'. The correspond- equivalent of 0.1 man Sv (GW a)-'.
VII. SUMMARY 196. The normalized collective effective dose equi-
valent commitments from the long-term releases from
solid waste disposal are shown in Table 73. T h e
194. In the UNSCEAR 1982 Report the Committee dominant contribution, as was recognized in the
carried out a thorough assessment of the exposures to UNSCEAR 1982 Report, is from mine and mill tailings.
the public from nuclear power production. In this The numerical estimate is roughly proportional to the
Report the same basic assumptions and environmental length of time for which release of radon is assumed
transport models are used to carry out a revised to occur. The estimate of 150 man Sv ( G W a)-'
assessment based on discharge data for the quin- corresponds to 10000 years for a tailings pile with a
quennium 1980- 1984. Some aspects of waste disposal reasonable co\nering. The estimate for disposals of
have been treated here in more detail, especially the LLW and ILW are for the release from the disposal
long-term impact of uranium mill tailings and the sites for all time. but a large proportion of the dose is
disposal of solid low- and intermediate-level wastes by received within about 10"ears from the date of
burial on land. The contribution from reprocessing is disposal. This applies also for the globally dispersed
based more closely on the results being obtained at radionuclides shown in Table 73. as these are domi-
operating plants rather than on the notional plant nated in terms of the normalized contribution by ''C.
used in the previous report. Occupational exposures
from the various stages in the fuel cycle are reviewed 197. The contributions of the various stages of the
in this Annex in association with the other exposures fuel cycle to occupational doses are summarized in
from released radioactive materials. Table 74. The dominant contribution is from reactor
operation, itself based mainly on recent experience
with LWRs in the United States but with considerable
195. .4 summary of the local and regional normalized data from many other countries.
collective effective dose equivalent commitments from
the nuclear fuel cycle is shown in Table 72. The total 198. The per caput doses from existing nuclear
of 4 man Sv (GW a)-' is essentially the same figure as power production are estimated from the contribu-
that derived in the UNSCEAR 1982 Report if the tions to collective dose commitment in the short term.
contribution from uranium mine tailings is excluded, This collective dose commitment is from local a n d
although in this Annex reprocessing is added explicitly, regional collective doses and from occupational ex-
whereas a notional plant was used for the UNSCEAR posure. i.e.. 4 and 12 man Sv ( G W a)-'. respectively
1982 Report. Contributions other than radon arise (Tables 72 and 74). Assuming a global population of
mainly from routine atmospheric releases from reac- 5 lo9, the per caput dose would be 3 nSv ( G W a)-'.
tors and the liquid discharges from reprocessing. The energy production from nuclear power in 1987 is
Effectively, all of these dose commitments are received about 190 G W a (Table 2). so that the annual per
within one to two years of discharge. caput dose is estimated to be 0.6 uSv.
l d b l e 1
Totdl 183.63 (225) 68.02 (85) 13.01 (45) 14.68 (28) 15.98 (27) 2.38 (7) 297.93 0.14
(411)
l a b l e 2
Llectrlc Percentage
Country energy o f total
generated electrlclty
(GW a) generated
-
Unlted States 51 - 9
France 28.7
USSR 21.3
Japan 20.8
Germany. Federal
Repubilc of 14. l
Canada 8.32
Sweden 7.35
Unlted Klngdom 5.58
Belg\um 4.52
Spa 1 n 4.51
Republlc o f Korea 4 .21
Chlna (Taluan Province) 3.58
Sultzerland 2.48
Czechoslovakia 2.36
Flnland 2.11
Bulgaria 1.31
German Democratic Rep. 1.18
Hungary 1.18
South Afrlca 0.71
Argentlna 0.68
1 nd la 0.54
Yugoslavla 0.49
Netherlands 0.39
Brazll 0.10
Paklrtan 0.03
Italy 0.01
Total 189
T a b l e 3
Annual a u a n t l t y of u r a n l u m o x l d e produced ( k t )
Country
T a b l e 4
Annual Normallred
Locatlon nlne type Ore grade radon radon
emlsslon emlsslon
(X) (18~1) (G8q t - l )
T a h l e 5
A l r b o r n e ernlsslans from a m l l l
p r o c e s s l n q 2000 tonnes o f o r e p e r day
lU l I
Annua 1
Radlonucllde ernisslons
(GW)
T a b l e 6
Radon
emanatlon Annua 1
Locat ion Talllngs rate per Area radon
management unlt area emanat Ion
- 2 -1
(Bq m s (ha) (TBq)
Argent lna
Chubut (1984)
Malargue (1984)
Malargue (1985)
Cordoba ( 1985)
Salta a/ (1984)
St. Rafael (1983)
Austral la
Rum Jungle Uncovered 1.3 30 13
3 m capplng < 0.07 30 < 0.7
Canada
llllot Lake Vegetated 1.2-4.0 400 300
Unvegetated 3.5
indla
Jaduguda Uncovered 1.1 12 4
Unlted States
(Temperate) Uncovered 10 40 120
1 m clay 0.3 40 4
(Seml-arld) Uncovered 10 90 300
Impermeable dam 0.1 90 3
Salt Lake City Uncovered 18
Covered 7
Ambrosla Lake 4
T a b l e 7
Predlcted radon
exhalatlon rate
at 1000 years
Optlon relatlve
to base case a/
Inltlal value
a/
- Base case Is the bare talllngs plle.
b/ Crushed rock around exterlor slopes and a gravel cap
over the top surface.
T a b l e 8
-
Collectlve effective dose eaulvalent comnltments
per unlt actlvlty released
In alrhorne releasel from uranluln 111lnesant1 nil 11s
Normallzed collectlve
Radlonucllde effectlvc dose
e q u l v a l ~ n t comnltment
[man Sv (18q)-l]
T a b l e 9
Base case 46
Optlon 1 12
OptIon 2 2.8
Optlon 3 0.6
Optlon 4 12
Optlon 5 1.6
Optlon 6 0.1
g/ Treatment options a r e llsted ln Table 7. The base case ls the bare talllngs
plle. T h e collectlve effectlve dose eaulvalent comnltments from optlons (7)
and ( 8 ) a r e less than 0.01 man Sv.
T a b l e 10
Annual r o l l e r t l v e Annua 1
Number o t workers e t t e c t l v e dose average
monl t o r e d e q u i v a l e n t (man Sv) eftectlve
dose
Country Year equlvalent
t a m Radon E x t e r n a l Radon and I t s a/
exposed exposed radlatlon daughters (mSv)
Annua 1 Annua 1
Number cf to1lect lve average
Country Year workers cttectlve eftectlve
monitored dose dose
equlvalent equlvalent
(man Sv) (msv)
Canada lYBU
1981
1982
1983
1984
1985
Australld
N a b a r l e k 1981/82
Ranger 1985/86
Effluent dlscharqes
from selected fuel converslon. enrtchment and fabrlcatlon plants. 1980-1985
LA^. 01. 82. 83. Be. 616. 829. 11. n71
Unlted Klngdom
Capenhurst (enrlchment)
U-234 0.64
U-235 0.03
U-238 0.64
Th-234 0.65
Tc-99 1I
Sprlngllelds (converslon. fabrlcatlon)
Uranlc alpha 900
Urantc beta 131000
Unlted Klngdom
Capenhurst (enrlchment)
U-234 0.15 0.26 0.20 0.35 0.05 0.003
U-235 0.01 0.01 0.01 0.02 0.002 0.0001
U-238 0.15 0.26 0.20 0.35 0.05 0.003
Th-234 0.15 0.27 0.20 0.36 0.05 0.003
Sprlngflelds (converslon. fabrlcatlon)
Uranlc alpha 10.0 2.0 2.0 1 .O 1.0 1 .O
Uranlc beta 10.0 2.0 2.0 1.0 1.0 1.0
T a b l e I3
Normallzed effluent dlscharqes from model fuel converslon,
enrlchment and fabrlcatlon facllttles
[Mas (~ud)-lI
Atmosphere Aquatlc
Radlo-
nuc l lde
Convcrslon Cnrlchment fabrlcatl~n Converslon Cnrlchment Fabrlcatlon
T a b l e 14
Inhalatlon Deposlted
actlvlty
T a b l e 15
Argentlna 1981
1982
Canada
Japan
United
Klngdom
Annual Annual
collective average
Country Year Number of effectlve effectlve
workers dose dose
monltored equlvalent equlvalent
(man S V ) (m~v)
T a b l e 17
Belglum
Doe1 1.2.3 1974/75
Tlhange 1.2 1975
France
Blayals 1.2.3.4
Bugey 2,3,4.5
Chtnon 81.B2
cnooz
Cruas 1.2.3.4
Damplerre 1.2.3.4
Fessenheim 1.2
Gravellnes 1-6
Paluel 1.2
St. Laurent 81.2
Trlcastln 1.2.3.4
Italy
Trlno
Japan
Genkal 1.2 1975/81
Ikata 1.2 1977/82
Ylhama 1.2.3 1970/72/76
Oh1 1,2 1979
Sendal 1.2 1984
Takahama 1.2 1974/75
Netherlands
Borssele 1973
Sweden
Rlnghals 2 197 5
Rlnghals 3 1980
RInghals 4 1982
- -17.
Table contlnued
USSR
Armenlan 1.2
Kalinln 1
Kola 1.2
Kola 3
Nlkolaev 1
Novovoronezh 1.2
Novovoronezh 3 , 4
Novovoronezh 5
R o v n o 1.2
Zapororhe 1
United S t a t e s
Arkansas One-l
Arkansas One-2
Beaver Valley
Calvert Cliffs 1.2
Crystal RIver
Davls 8 e s s e
Olablo C a n y o n
Donald C. Cook 1 , 2
farley 1
Farley 2
fort C a l h o u n
H.8. R o b i n s o n
H a d d a m Neck
lndlan Point 1,2
Indian Polnt 3
Kewaunee
H a l n e Yankee
M c G u l r e 1.2
H i l l s t o n e Pt. 2
tiur t h A r m
Dcunee
Pa I isades
Yolnt Beach 1.2
Pralrle Island I,?
R.E. Glnnd
Rancho Seco 1
Salem 1
Salem 2
San Unof re 1 '
S a n O n o f r e 2,3
Sequoyah
St. L u c l e 1
St. Lucie 2
Surry 1 , 2
Three l l l e lsland 1
Three 'ile lsland 2
TrI 2/EPICOR
Trojan
Turkey Point
'dlrgll C. Sumner
"olf Greek
Yankee Rode
Z I o n 1.2
Arkansas One-l 0.424 - 0.006 0.168 - 0.001 0.285 0.289 111.333 - 3.978 -
Arkansas One-2 0.435 - 0.815 0.653 - 0.002 1 .I90 0.720 336.404 - 25.226 -
Beaver Valley 1 0.307 - 0.093 - 0.086 0.028 4.621 0.004 0.009 -
Calvert Cllffs 1.2 1.182 0.010 2.039 - 1.001 0.021 2.520 0.859 290.742 - 2.923 -
Crystal Rlver 0.561 5.439 1.180 50.690 0.141 0.451 21.241 1.910 176.585 2.819 12.841 15.133
Oavl5-Besse 1 0.367 - 0.234 - 0.090 0.030 18.901 0.059 0.385 0.158
Oonald Cook 1.2 1.409 0.051 0.231 0.801 0.134 0.096 0.437 0.522 119.120 - 2.205 -
farley 1 0.595 0.433 6.438 0.958 6.882 6.882 0.633 1.432 335.069 0.052 895.403 0.981
Farley 2 0.605 1.084 0.002 0.718 0.201 0.074 0.060 0.238 119.311 - 9.253 -
Fort Calhoun I 0.397 0.237 0.010 0.422 0.004 0.007 0.181 0.071 11.707 0.001 0.164 0.005
H.8. Robinson 0.257 0.296 0.005 0.006 - 0.002 0.014 0.327 5.588 - 0.247 -
Haddam Neck 0.518 0.001 0.042 3.811 0.013 0.031 0.046 0.240 22.388 0.008 1.269 0.011
Indlan Polnt 1.2 0.508 - 0.651 5.476 2.113 0.688 2.287 2.309 289.346 0.158 6.957 0.002
Indlan Point 3 0.164 - 0.275 0.514 0.005 0.015 0.122 0.662 90.661 0,006 2.802 0.002
Keuaunee 0.436 0.262 - 0.154 - 0,001 0.151 - 0.095 -
nalne Yankee 0.516 - 0.254 0.056 3.569 - 0.267 -
&Gut re 0.491 17.464 0.298 0.154 - 0.271 36.1120.012 6.586 -
Millstone 2 0.572 0.080 5.6 2.938 3.474 5.581 0.032 2.017 289.984 3.152 41.904 0.751
Horth Anna 1.2 0.736 0.008 0.032 0.566 0.007 0.015 0.418 0.597 178.164 0.013 6.841 0.006
Oconee 1,2.3 1.221 0.004 0.367 16.293 0.010 - 6.439 6.550 851.126 - 13.211 -
Pal lsades 0.382 9.250 0.011 0.154 0.011 0.016 0.088 0.008 272.321 0.037 0.073 -
Polnt Beach 1.2 0.720 0.273 1.806 2.586 1.465 3.226 0.012 0.3IO 15.811 0.899 7.920 2.409
Pralrle Island 1.2 0.887 0.004 0.085 0.207 0.035 0.049 0.084 0.088 19.580 0.010 0.155 0.005
R.E. Glnna 0.275 0.002 0.001 0.581 0.004 0.004 0.629 0.235 70.300 0.047 0.525 0.005
Rancho Seco 1 0.384 0.028 0.142 0.139 0.040 0.018 0.002 0.336 51.430 - 2.542 -
Salem I 0.467 0.001 0.015 0.021 - 0.009 - 0.001 8.329 0.283 0.047 -
Salem 2 0.906 - 0.011 - 0.043 41.159 - 0.003 -
San Onofre I 0.058 - 0.001 0.500 - 0.005 2.623 - 0.058 -
San Onofre 2.3 0.014 0.025 0.001 - 0.001 - 0.001 0.215 0.002 0.009 -
Sequoyah 1.2 0.560 0.548 0.622 0.055 - 0.44 3.811 195.738 - 10.954 -
St. Lucle 1 0.773 1.228 11.507 2.087 1.289 12.987 ll.410 4.700 147.435 3.959 55.130 4.136
Surry 1.2 1.251 0.149 0.670 2.472 0.012 0.125 - 3.885 751.100 - 20.646 -
Three Hlle Island 1
Three Mlle island 2 - 18.056 -
TMI Z/EPICOR
Trojan
- 15.762 -
0.548 0.011 0.082 0.269 0.061 0.016 0.196 0.205 28.864 0.247 1.758 0.138
Turkey Polnt 3.4 0.868 1.706 0.282 0.622 0.074 0.286 1.913 2.605 128.900 0.172 4.144 0.034
Vlrgll C. Sumner 0.022 - 5.180 -
Ydntee Roue 0.101 0.079 0.068 0.013 0.80 0.126 0.087 0.031 1.985 1.735 1.102 0.154
Zlon 1.2 1.125 2.316 0.944 0.480 48.470 1.188 0.153 13.507 477.514 2.224 10.408 0.095
Hormallzed actlvlty
Iraq ( w a)-ll
T a b l e 19
F lnland
Olklluoto
Italy
Caorso
Japan
fukushlma 1-1.2
3.4.5.6
fukushlma 11-1.2
Hamaoka 1.2
Onagawa
Shlmane
Tokal 1 1 - 1
Tsuruga 1
Netherlands
Oodevaard 1968 0.052 74.4 38.4 38.5 23-68 24.79
Sweden
Barreback 1 1975 0.59 2.1 400.39 662.43 70.1 0.71 0.16
Barreback 2 1976 0.59 2.3 1.702 1.405 7.297 0.90 0.29
Forsmark 1 1980 0.90 0 0.40 11.89 0.22 1.941 71
Forsmark 2 I981 0.90 0 0.147 11.5 23.38 232
Oskarshamn 1 1970 0.46 5247 3696.12 1417.02 870 680 533
Oskarshamn 2.3 1974/85 1.65 309 421.22 110 53.51 45 47.6
Rlnghals 1 1974 0.75 2800 15000 20000 1500 1040 1280
USSR
VK - 50
Unlted States
819 Rock Polnt 1963
Browns Ferry 1973/77
Brunswlck 1975/77
Cooper 1974
Oresden 1 1960
Dresden 2.3 1971/72
Duane Arnold 1 1975
Fltzpatrlck I975
Grand Gulf 1982
Hatch 1 1975
Hatch 2 1979
Humbolt Bay 1963
Lacrosse 1969
Lasalle 1982
Millstone 1 1971
Montlcello 1971
Nlne Mlle Polnt 1969
Oyster Creek 1969
Peach Bottom 1974
Pllgrtm I972
Quad Cltles 1973
Susquehanna 1983
Vermont Yankee 1912
Normallzed actlvlty
[Tap (Gw a ) - 1 )
tlectrlc A c t l v l t y (T8q)
Start-up energy
Reactor year generated
(GW a ) Ar-41 Kr-83m Kr-85m Kr-85 Kr-87 Kr-88 Kr-89 Kr-90
T o t a l annual e l e c t r l c energy
g e n e r a t e d (GW a ) 10.293
Normalized a c t l v l t y
[ T B ~(GW a ) - ) ] 110.505 2.334 234.114 50.268 315.598 548.947 7.511 2.3b3
Electrlc A c t l v l t y (TBq)
Start-up energy
Reactor year generated
(GW a) Xe-13lm Xe-133m Xe-133 Xe-135m Xe-135 Xe-137 Xe-138 Xe-139
B l g Rock P o l n t
Browns F e r r y
Brunsulck
Cooper
Dresden 1
Oresden 2.3
Duane A r n o l d
Fltzpatrlck
Hatch 1
Hatch 2
Humbolt Bay
Lacrosrc
Lasalltr
Mlllstone 1
Montlcello
Nlne U l l e Polnt
O y s t e r Creek
Peach Oottom
Pllgrtm
Ouad C I t l e s
Susquehanna I
Vermont Yankee
T o t a l annual e l e c t r l c energy
g e n e r a t e d (GW a ) 10.293
Normallzed a c t l v l t y
[TRq (GW a ) - ) ]
T a b l e 21
Noble aases dlscharqed In alrborne etfluents from HWRs and LWGRs. 1980-1985
[Al, 819, 836, Ll]
Argent lna
Atucha 1 1974 0.335 250 46 19 47 4.7 5.5
tmba1.i~ 1983 0.0 0.0 0.0 0.0 40.9 156
Cdndaa
Bruce A 1976/79 2.96 830 61 0 510 670 600 800
Bruce B 1984 0.75 29.0 106
Gentllly 1983 0.685 10.1 25.9 121
Plckerlng A 197 1 /73 2.91 240.0 250 270 350 170 190
Pickrrlng 8 1983/80 1.03 137.0 170 270
Point Lepreau 1983 0.630 0.1 3.9 0.0 0.8
USSH
Chernobyl 1.2 1977/78 2.00 10400 14900 8940 7360
Chernobyl 3.4 1981/83 2.00 - 1770 2 190
Iqnallno 1 1983 1.50
Kur5k 1 . Z 1976/79 2.00 4130 9490 64 10 5830 8300 6600
Leningrad 1.2 1973/75 2.00 - 4700 6200 6300 5600 5200
Lentngrad 3.4 1979/81 2.00 - 1400 3000 4100 4000 2600
:molcnrk 1 i982 1 .OO - 2030 2b00 2500
France
Chinon 2.3
Bugey 1
St. Laurent A1.2
Italy
Latina
Japan
Tokal
Unlted Klngdom
Berkeley
Braduell
Chapelcross
Oungeness A
Oungeness 8
Hartlepool
Heysham
Hlnkley Polnt A
HInkley Polnt 8
Hunterston A
Hunterston 8
Oldbury
Sizeuell
Trausfynydd
Wylfa
Normalized actlvlty
[ T ~ Q( G W a)-)]
T a b l e 23
Actlvlty ( T B q )
Country and reactor
Belgium
Ooel 1-3 0.1
f Inland
Lovl lsa 3.5 3.0 11.0
France
Chooz
Blayalr 1.2
Table 23, continued
Actlvlty (TBq)
Country and reactor
Netherlands
Borssele 0.63 0.68 0.40 0.59 0.59
Unlted States
Arkansas 1 4.773
Arkansas 2 0.075
Beaver Valley 0.176
Callauay
Calvert Cllffs 1.2 1.032
Crystal Rlver 0.784
Oavls-Besse 0.220
Dlablo Canyon
Donald C Cook 1.2 0.041
Farley 1 22.681
farley 2
fort Calhoun 0.048
H.B. Robinson 0.225
Haddam Neck 2.313
Indlan Pojnt 1,2 0.407
Indlan Polnt 3 0.182
Kewaunee 0.770
Halne Yankee 0.117
HcGulre
Hlllstone Pt. 2 31.450
North Anna 2.076
Oconee 0.395
Pal l sddes 0.190
Polnt Beach 1,2 24.161
Pralrle Island 3.193
R.C. Glnna 1.465
Rancho Seco 6.549
Salem 1
Salem 2
San Onofre 1 1.365
San Onofre 2.3
Sequoyah 1
St. Lucle 1 13.801
St. Lucle 2
Surry 1.2 0.677
Three rille lsland 1 0.670
Three Hlle lsland 2 14.578
THI ?/EPICOR 21.616
Trojan 0.551
Turkey Polnt 3.4 0.043
V l r g l l C Sumner
Wolf Creek
Yankee Roue 0.054
Zlon 1.2
Normallzed actlvlty
[Teq (Gw a)-l] 7.453 3.310 4.740 9.215 4.702 1.9
kctlvlty ( T 8 q )
Country and reactor
rlnland
Olklluoto
4e?ner lands
Oodeuaard
United S t a t e s
Big Rock Point
Browns F e r r y
arunswlck
Cooper
Dresden 2,3
Duane Arnold
Fltzpatrlck
Grand Gulf
Hatch 1
Hatch 2
Humbolt Bay
Lacrosse
Ldsd l le
Hlllstone 1
Yont lcel lo
kine P i l e Polnt
Oyrter Creek
Peach B o t t o m
Ptlgr lm
Quad C l t l e s
Susquehannd
Vermont Y a n k e e
g'iP-2
Total a n n u a l electrtc e n e r g y
generated ( G W a) 11.76 9.245 12.28 11.91 12.50 15.94
Normallzed a c t i v i t y
[TBq ( G w a)-]] 5.984 3.671 2.881 2.791 I. 6 5 9 6.249
Average norillallzed actlvlty, 1980-1984
[TBq (GW a)-)] 3.4 k 1.6
Table 23. c o n t i n u e d
A c t l v l t y (TBq)
C o u n t r y and r e a c t o r
HWRS
Argentina
Atucha 240 710 300 630 200 250
Embdlse 7.33 29.5
Canacla
Bruce A 1554 3404 151 1 3700 2553 I500
Bruce B 3 99
Gentilly 0.69 14 53.2
Plckering A 660 59 2 666 629 430 390
Plckerlng B 25 46 144
P o l n t Lepreau 25 68 110
T o t a l annual e l e c t r i c e n e r g y
generated(GWa) 4.531 4.810 4.665 5.152 6.408 7.370
riorrnalized a c t l v l t y
[ T e q (GU a ) - ] 1 541.5 874.5 532.3 871.0 518.3 348.9
Average f i o r m a l i z e d a c t l v l t y . 1980-1984
[ l B q (GW a ) - 1 ) 670 t 190
GCR:
Italy
Latina 0.07 0.07 0.90
U n i t e d Klngdorn
Hunterston A 2.2 2.0 1 .6 1.4
Hunterston 0 2.2 4.1 3.4 4.6
Oldbury 0.5 1.6 0.3 1.1
S i zedel l
Tra.:f ynydd 3.7
Wylta
l o t a l annual e 1 e c r r ; c energy
g e n e r a t e d (GW a ) 1.346 1.252 1.41 1.39 1.45 0.379
tiormallzed a c t i v i t y
[TBq (Gw a ) - 1 ) 6.44 6.21 4.40 5.10 4.76 1.135
Average n o r m 1 1 z e G a c t l v l t y . 1980-1984
[ r e p (CM a ) - I ] 5.4 t 0.9
Trltlum dlscharqed In llauld effluents from reactors. 1980-1985
[as. 86. 87. B17.818. 829. 03. F4. HI. HZ. H3. H4, KI, LI, PI. PS, P9.
51. 52. S3. 55. 59. 510. 511. T3. T4. T5. T8. 19. 1101
Actlvlty (TBq)
Country and reactor
Belglum
Doe1 1,2 24.8
T l hange 12.4
f Inland
Lovllsa 1.2 3.7
f rance
Blayals 1.2.3,4
8ugey 2.3.4.5 53
Chlnon 81 .2
Chooz 110
Cruas 1.2.3.4
Damplerre 1.2.3.4 7
fessenhelm 1.2 28
Gravellnes 1.2.3.4 4
Paluel I,2
St. Laurent 01.2 -
Trlcastln 1,2.3.4 10
Italy
Trlno 37.4
Netherlands
Borssele
Sweden
Rlnghals 2 13
Rlnghals 3 0.7
Rlnghals 4
USSR
Armenlan 1.9
Unlted States
Arkansas 1
Arkansas 2
Bedver Valley
Callauay
Calvert Cllffs I
Crystal Rlver
Davls Besse
Olablo Canyon
Donald Cook 1,2
Farley 1
Farley 2
Fort Calhoun
Fort St. Vraln
Grand Gulf
H.8. Roblnson
Haddam Neck
Indlan Polnt 1,2
Indlan Polnt 3
Kewaunee
Ualne Yankee
UcGuire
Millstone Pt. 2
North Anna
Oconee
Table 24. continued
A c t l v l t y (TBq)
Country and r e a c t o r
T o t a l annual e l e c t r l c energy
generated(GWa) 29.69 40.55 44.97 53.09 61.74 57.84
Normalized a c t l v l t y
[T8q (GW a ) - ' ] 29.43 28.40 25.60 23.42 25.95 25.00
Average n o r m a l l z e d a c t l v l t y , 1980-1984
[TBq (Gw a ) - ) ] 27.0 i 1.8
Table 24, continued
Actlvlty (TBq)
Country and reactor
8 W K s
f Inland
Olk l luoto 0.58 0.84 0.17 0.82 1 .O I .2
Germany. Federal Rep. of
Brunrbittel 0.09 0.8 1.9 1 .I 2.6 0.87
Gundremnlngen - 0.41 1.2
Isar 8.8 10.1 14.6 3.1 1.8 0.47
Krumnel 0.043 0.59 0.16
Phrllppsburg I 0.4 0.05 0.8 1.7 2.0 0.90
Wurgassen 2.1 1.9 1 0.43 0.79 0.71
Italy
Caorso 0.2 0.1 9.4
Netherlands
Dodevdard 0.6 0.5 0.3 0.22 0.15
Suedrn
Barseback 1 ,2 0.79 0.75 0.52 0.68 1 .O 0.58
forsmark 1.2 0.14 1.2 1.1 1 .0 1.2 1.4
Oskarshamn 1.2 0.97 0.6 17.56 0.71 0.54 0.63
Ringhdls 1 1.7 1 .8 1.9 1 .0 0.7 0.525
Untted Stater
8jg Rock Point 0.229 O I L 0.110 0.821 0.041 0.047
Brodns Ferry 0.807 0.884 1.18 1.18 I .23
Brunrulck 0.474 0.836 1.806 3.85 1.25 0.25
Cooper 0.324 0.309 0.336 0.281 0.266
Dresden 2,3 0.294 0.224 0.05 0.00005 1.45 0.28
Duane Arnold - 0.00000008 0.00000005 0.0013
Fltzpatrlck 0.104 0.152 0.024 0.101 0.116 0.11
Hatch 1 0.525 0.429 3.811 3.50 2.97 1.45
Hatch 2 0.396 0.343 1.362 1.26 0.788 0.67
Humboldt Bay 0.0036 0.006 0.002 0.002 0.0006 0.04
Lacrosse 2.664 2.864 2.190 4.59 4.63 4.74
Lasalle 0.034 0.157 0.041 0.014
Millstone 1 l .Ol 0.097 0.229 0.310 0.317
!4ontlcello 0.00002 0.0000001 0.000
t d l n ~ nlle Polnt 0.187 0.215 0.292
Oyster Creek 5.698 0.988 0.183 0.324 0.381
Pmch Bottom 1.38 1.362 0.877 0.747 1.32
PI lgr lm 1.48 1.262 0.219 0.577 0.544 0.16
Ound Cltles 0.381 0.44 0.289 0.144 0.201 0.13
5u:quehanna 0.032 0.332 0.414
Vermont Yankee 0.111 0.259
kHP 0.02 0.055
liormallzed actlvtty
[TBq (GW a)-I] 2.227 1 .864 7.811 1 .UOl 1.58 l .Ol
Actlvlty (T8q)
Country and reactor
f rdnre
Mugey 1 1 14 1
Chlnon A2.3 4 4 2
St. Laurent Al .Z 16 1 1
Italy
Latlna 0.03 0.3 0.5
Unlted Kingdom
Berkeley
Bradwell
Chapelcross
Oungenelr A
Oungeness 8
Hartlepool
Heysman
Hlnkley Polnt A
Hinkley Polnt 8
Hunterston A
Hunter:ton 8
Oldbury
Sl leuel 1
Trawsfynydd
b4ylta
Normallzed activity
[T8q (GW a)-1) 81.5 83.3 95.7 103.7 116.4 86.75
USSR
Chernobyl 3.5
Kursk 2.0
Normallzed actlvlty
1r8q ( ~ a)-']
w 1.734
H H R s
Argent lna
Atucha 290 410 310 240 410 370
lmbalse 3.48 16.1
Canada
Bruce A 888 740 962 1600 604 1060
Bruce B 0.6 21.5
Gentllly 0.4 8.0 0.05 0.78 14 30.7
I'lckerlng A 48 1 276 3 70 3 70 330 330
Plckerlng 0 44 330 380
Polnt Lepreau 9.1 68 24
Normallled actlvlty
Ires ( G W a)-11 365.e 796.3 351.4 212.6 234.6 296.1
Average normdllzed actlvlty, 1980-1984
[Teq ( G U a)-]] 290 t 68
T a b l e 25
Carbon-14 d l r c h a r g e d f r o m r e a c t o r s . 1980-1985
[ E l l . 03. R1. W l ]
A c t l v l t y (GBq)
Country and r e a c t o r
PWRs a_/
Flnland
Loviisa 1
Germany, F e d e r a l Rep. o f
Blblls A
Blblls 8
Grafenrhelnfeld
Grohnde
Neckarwesthelm 11 ( 9 6 )
Obrlghelm 22
Phlllppsburg 2
Stade 41 ( 7 8 )
Unterweser 26
USSR
Arrnenlan 400-500 400-500 400-500 400-500 400-500
Kola 3 780 780 780 780
Kola 4 5 10
Novovoronezh 3 140 140 140 140 140
Novovoronezh 4 140-540 140-540 140-540 140-540 140-540
T o t a l annual e l e c t r l c energy
g e n e r a t e d (GW a) 3.654 4.186 7.285 7.020 7.270 7.856
Normallzed a c t l v l t y
[GBq (GW a ) - l ] 329 482 29 7 333 283 39
Flnland
TVO 1
Germany. f e d e r a l Rep. o f
Brunsbiittel 30 240 80 0.9 240 2 60
Gundremnlngen 300 770
lsar 180 4.8 340 310 320
Krumnel 550 190
Phlllppsburg 1 6.3 91 200 220 250
Wirgassen 270 270 88 15 280 360
T o t a l annual e l e c t r l c energy
generated (GW a) 1.195 1.521 1.275 1.880 3.106 4.117
Normalized a c t l v l t y
[GBq(GWa)-l] 251.2 457.7 206.9 295.7 434.6 455.8
Average n o r m a l l z e d a c t l v l t y . 1980-1984
[GBq (GW a ) - ) J 330 i 110
Table 25. continued
Actlvlty (GBq)
Country and reactor
Argentina
Atucha 2300 2700 1800 590 4 50 370
HormdIized activtty
[GBq(Gwa)-l] 9244 8938 8996 2195 2308 8166
USSR
Chernoby 1
Ignallno 1
Kursk 1.2.3
Lenlngrad 1.2.3.4
Smolensk 1
Activity ( G B q )
Country and reactor
F Inland
Lovi isa 0.002
Japan
Genkai
lkata
MI h a m
00I
Senda i
Takahama
Sueden
Ringhals 2 0.01
Rlnghals 3
RInghals 4
USSR
Armenlan 1.2 7.8
Kola 1.2 0.257
Hikolaev 1
~ o v o v o r o n e z h 1 .2 14
Novovoronezh 3.4 0.424
Novovoronezh 5
lcovno 1.2
Unlted States
Arkansas One-l
Arkansas One-2
Beaver Valley
Cal laday
Calvert ClItts 1.2
Crystal CIver
Davls Besse
Dlablo Canyon
Donald Cook 1.2
Farley 1
Farley 2
Fort Calhoun I
H.8. Roblnson
Haddain Neck
Indlan Point 1,2
Indlan Polnt 3
Kewaunee
Maine Yankee
McGulre
Ulllstone Pt. 2
North Anna
Oconee
Pal lsades
Polnt Beach 1.2
Prairie island 1.2
R.E. Glnna
Table 26, c o n t l n u e d
A c t l v l t y (G8q)
Country and r e a c t o r
T o t a l annual e l e c t r l c energy
generated ( G W a) 29.34 32.90 36.79 41.09 44.94 35.65
Hormallzed a c t l v l t y
LGBq ( G W a ) - ] ] I .54 1.91 1.63 1-37 2.31 1.07
Average n o r m a l l r e d a c t l v l t y . 1980-1984
[G8q (GU a ) - 1 ] 1.75 t 0.33
Table 26, continued
A c t l v l t y (GBq)
Country and r e a c t o r
1980 1981
Finland
Olklluoto 0.0042
Germany, F e d e r a l Rep. of
8runsbuttel 0.04
Gundremnlngen
Isar 0.08
Krumnel
Phlllppsburg 1
Wijrgassen 2.2
Italy
Caorso 0.01
Japan
Fukushlma I , 1-6 1.9
Fukushima 11. 1.2 -
Hamaoka 1 . 2 0.010
Shlmane n/d
Tokai 2 0.067
Tsuruga 0.027
Netherlands
Oodewaard 0.09
Sweden
Barseback 1 0.06
Barseback 2 0.02
Forstnark 1 0.02
Forsmark 2
Forsmark 3
Oskarsharnn 1 0.4
Oskarsharnn 2.3 0.3
Rlnghals 1 1.4
Unlted S t a t e s
819 Rock P o l n t 0.0396
Browns F e r r y 2.4346
Brunswlck 9.91 60
Cooper 0.6321
Dresden 1 0.1343
Dresden 2.3 130.6100
Duane Arnold 1.6576
Fltzpatrlck 2.8379
Grand Gulf
Hatch 1 47.3600
Hatch 2 0.5328
Humboldt Bay
Lacrosse 0.1617
Lasalle
Ulllstone 1 7.9180
Hontlcello 0.751 1
NIne U l l e P o l n t 0.4403
Oyster Creek 34.9650
Peach Bottom 1.0878
Pllgrlm 3.2486
Quad C l t l e s 12.2470
Susquehanna
Vermont Yankee 0.4107
WNP-2
Normallzed a c t l v l t y
[GBq(GWa)-l] 15.23 9.690 8.316 9.044 4.230 0.824
Actlvlty (Gap)
Country and reactor
Argent lna
Atucha 1
Emba 1 se
Canada
Bruce A 0.130 0.104 1 .I84 0.359 2.801 0.05
Bruce 8 0.004 0.052
Gentllly
Plckerlng A 0.155 0.063 0.070 0.070 0.13 0.056
Plckerlng 8 - 0.0 0.151 0.040
Polnt Lepreau 0.0096 0.0 0.0042
Normallzed actlvlty
IGBo ( W a)-l I 0.1070 0.1220 0.2776 0.1027 0.5378 0.1461
Average normallzed actlvlty. 1980-1984
[G~Q (GW a)-I] 0.23 i 0.08
USSR
Chernobyl 1.2.3 189 300 118 41.4
Kursk 1,2,3 25.7 28.8 112 45.1 40 47
Smolensk 1 72.1
Lenlngrad 1.2.3.4 - I20 110 74 89 40
Normallzed actlvlty
[GBq (GW a)-]] 67.69 150.0 94.89 53.27 36.86 24.86
A c t l v l t y (GBq)
Country and r e a c t o r
G C R s
France
Bugey 1
Chlnon 2.3
S t . L a u r e n t A1 .2
Italy
Latlna 0.003 0.0001 0.002
Japan
Tokal 1
T o t a l annual e l e c t r l c energy
g e n e r a t e d (GW a ) 0.8215 0.8899 0.8811 1.363 2.372 1.647
Normallzed a c t l v l t y
[GBq (GW a ) - 1 ] 0.64 0.55 0.9 1 3.21 1.86 2.07
Average n o r m a l l z e d a c t i v i t y . 1980-1984
[Gas ( G W a ) - ] ] 1.4 t 1 . 1
T a b l e 27
Actlvlty (G8q)
Reactor
P W R s
Arkansas 1
Arkansas 2
Beaver Valley
Calvert Cllffs 1.2
Crystal Rlver
Oavls-Besse
Donald Cook 1.2
Farley 1
Farley 2
fort Calhoun
H.8. Roblnson
Haddam Neck
Indlan Polnt 1.2
lndlan Polnt 3
Kewaunee
Ualne Yankee
UcGulre
Millstone Pt. 2
North Anna
Oconee
Pall sades
Polnt Beach 1.2
Pralrle Island 1.2
R.E. Glnna
Rancho Seco
Salem I
Salem 2
San Onofre 1
San Onofre 2 , 3
Sequoyah
St. luc le
Surry 1,2
Three nlle lsland 1
lhree Ulle Island 2
Trojan
Turkey Polnt
Vlrgll C. Sumner
Yankee Rove
Zlon 1.2
Normallzed actlvlty
[ c a ~ccw a)-1 j 2.60 0.05 6.50 o.oC067 0.41
Table 2 7 . c o n t l n u r d
A c t l v l t y (GBq)
Reactor
T o t a l annual e l e c t r l c energy
g e n e r a t e d (GW a ) 10.29
Normalized a c t l v l t y
[ G B q (GW a ) - ] ] 13.56 0.46 56.27 0.80 137.03
T a b l e 28
Actlvlty (G8q)
Country and reactor
Finland
Lovll sa
France a_/
Blayals 1,2.3.4
Bugey 2.3.4.5
Chlnon 81.2
Chooz
Cruas 1.2.3.4
Damplerre 1.2.3.4
Fessenhetm 1,2
Gravellnes 1-6
Paluel 1.2
St. Laurent 81.2
Trlcastln 1,2.3.4
Netherlands
Borssele
Suedrn
Rlnghals 2
Rlnghals 3
Rlnghals 4
USSR
Armenlan 1.2
Kallnln 1
Kola 1.2
Kola 3.4
Nlkolaev 1.2
Novovoronezh 1.2
Novovoronezh 3,4
Novovoronezh 5
Rovno 1 .2
Zaporozhe 1
Unlted States
Arkansas 1
Arkansas 2
Beaver Valley
Callauay
Calvert Cllffs 1.2
Crystal Rlver
Davls 8esse
Olablo Canyon
Donald Cook 1.2
farley I
farley 2
fort Calhoun
H.B. Roblnson
Haddam Neck
Indlan Polnt 1
lndlan Polnt 3
Keuaunee
Maine Yankee
McGulre
Ulllstone Pt. 2
North Anna
Oconee
Pal lsades
Polnt Beach 1.2
Table 28. continued
A c t l v l t y (GBq)
Country and r e a c t o r
i o t a 1 a n n u a l e l e c t r l c energy
generated ( G W a) 29.10 39.35 41.77 49.81 56.54 53.82
Normalized a c t t v l t y
[GBq ( G W a ) - I ] 2.514 2.703 1.306 8.40 7.80 l .Ol
A c t l v l t y (GBq)
Country and reactor
Flnland
Olklluoto 0.511
Netherlands
Dodewaard 0.074
Sweden
Barseback 1 0.43
Barseback 2 0.11
Forsmark 1 0.03
Forsmark 2.3 -
Oskarshamn 1 0.031
Oskarshamn 2 0.025
Rlnghals 1 0.26
Unlted States
8lg Rock Polnt
Browns Ferry
Brunswick
Cooper
Dresden 1
Dresden 2.3
Duane Arnold
Fltzpatrlck
Grand Gulf
Hatch 1
Hatch 2
Humboldt Bay
Lacrosse
Lasalle
Ulllstone 1
Uonticello
Nine Hlle Polnt
Oyster Creek
Peach Bottom
Pllgrlm
Ouad Cltles
Susquehanna
Vermont Yankee
WNP 2
Norindlired actlvlty
[G8q(GWa)-I] 28.13 26.72 23.14 76.59 61.99 15.85
Avrrdgr normdliied activity. 1980-1904
[ G B q (GW ,)-I] 43.3 : 24.4
Table 28. c o n t l n u e d
A c t l v l t y (GBq)
Country and r e a c t o r
France
8ugey 1 0.8 0.5 0.4 0.3 0.3 0.2
Chlnon 2.3 0.3 0.1 0.3 0.3 0.2 0.1
S t . l a u r e n t A1.2 7.4 1.7 1 .O 0.0 1.2 1.2
U n l t e d Kingdom
Berkeley 0.111 0.037 0.037 0.037 0.037 0.02
Braduel 1 0.037 0.037 0.031 0.074 0.185 0.09
Oungeness A 0.037 0.037 0.333 0.296 0.259 0.24
Oungeness 0 0.111 0.111 0.12
Hartlepool 0.37 0.037 0.03
Heysham 0.37 0.185 0.04
HlnkleyPolntA 0.333 0.296 0.296 0.333 0.296 0.34
HlnkleyPolntB 0.925 1.132 0.629 0.518 0.518 0.51
Hunterston A 0.074 0.037 0.037 0.031 0.037
Hunterston 8 2.96 2.59 0.74 0.74 0.740
Oldbury 0.140 0.333 0.185 0.148 0.111 0.23
Slzewell 0.37 0.333 0.222 0.444 0.296 0.51
lrausfynydd 0.296 0.407 0.37 0.333 0.370 0.51
Wylfa 0.296 0.259 0.111 0.074 0.074 0.14
T o t a l annual e l e c t r l c energy
generated(GWa) 3.868 4.847 5.382 5.985 6.223 5.738
Normallied a c t l v l t y
[GBq ( G W a ) - ' ] 2.86 1.61 0.87 0.79 0.80 0.74
Average n o r m a l l z e d a c t l v l t y . 1980-1984
[GBq (GW a ) - I ] 1.39 t 0.79
USSR
Chernobyl 1,2 9.3
Kursk 1.2 140 120 140
L e n l n g r a d 1.2.3.4 6.5 8.6 10 6.8 9.4
Smolenks 1 1.61 -
T o t a l annual e l e c t r l c energy
g e n e r a t e d (GW a ) 3.172 3.077 3.583 4.355 3.5 3.5
Normallied a c t l v l t y
[GBq (GW a ) - l ] 2.93 2.11 2.40 34.81 36.22 42.60
Average n o r m a l l z e d a c t t v i t y . 1980-1984
[ G B (GW
~ a)-]] 15.69 t 1b.19
Table 28, continued
A c t l v l t y (GBq)
Country and r e a c t o r
HWRs
Argent l n a
Atucha 1 0.016 0.014 0.0074 0.0086 0.0046 0.022
Canada
Bruce A 0.056 0.093 0.100 0.048 0.060 0.044
Bruce B 0.117 0.210
Gentllly
Pickeriog A 0.118 0.170 0.089 0.020 0.022 0.027
Plckerlng 0 0.012 0.013
P o i n t Lepreau
T o t a l annual e l e c t r i c energy
generated (GW a ) 4.283 4.508 4.386 4.742 4.964 5.956
Normallzed a c t l v l t y
[GBq (Gw a ) - ' ] 0.0406 0.0584 0.0431 0.0143 0.0425 0.0531
Average n o r m a l l z e d a c t l v l t y . 1980-1984
[ G B ~(GW a ) - ) ] 0.040 k 0.016
A c t l v l t y (GBq)
Country and reactor
ilnland
Lovl i:a 17.819 2.757 13.474 22.318 20.463 18.167
Belglum
Doel 1.2,3 98.0 57.0 33.0
T I hange 56.0 294.0 21.5
France
Blayais l,2
Buqey 2.3.4.5 566
Chinon B. 1 ,2
Chuoz 9
Cruds 1-4
Dampierre 1-4 59
Fessenheim 1.2 262
Grave:lnes 1-4 148
Paluel 1.2
it. Laurent 81.2 -
Irlcastln 1-4 17
Italy
Trlno
Japan
Genkal 1.2 n/d n/d n/d n/d n/d n/d
Ikata 1.2 0.01 1 0.0026 0.0004 n/d n/d n/d
riharna 1,2.3 0.17 0.1 0.1 0.096 0.04 0.034
001 1.2 0.06 0.20 0.024 0.071 0.03 6.021
Senda 1 n/d n/d n/d
Takahama I,? 0.052 0.02 0.0078 0.0014 0.009 0.0081
Neth~rlands
Borssele 4.44 7.03 12.58 7.03 22.2
Sweden
Rlnghals 2 I20 78.7 57.7 69.0 153.2 47.72
Rinyhals 3 0.1 22.2 11.4 41. I 106.2 21 .09
RInghals 4 2.1 36.0 47.2 59.02
USSR
Armen l an 0.039
Hovovoronerh 5 0.16
United States
Arkansas 1 126.540
Arkanias 2 152.810
Beaver Valley 3.848
Callaway
Calvert Cllffs I,? 167.610
Crystal River 5.402
Davis Besse 7.659
Dtablo Canyon
Donald Cook 1 .2 50.690
farley 1 2.287
Farlry 2
F o r t Calhoun 1 18.648
H.8. Robinson 13.246
Haddan Neck 10.212
indian Polnt I .2 46.620
-
T-
able 29, c o n t i n u e d
A c t l v l t y (GBq)
C o u n t r y and r e a c t o r -
T o t a l annual e l e c t r l c enprgy
g e n e r a t e d (GW a ) 35.50 40.55 44.97 53.09 61.74 57.02
Normaltzed a c t l v t t y
[ G B Q ( G Wa ) - l ] 92.10 111.5 82.87 214.7 160.9 102.7
Average n o r m a l i z e d a c t l v l t y , 1980-1984
[GBq (GH a ) - ] ] 132.4 t 49.5
Table 29, c o n t l n u e d
A c t l v l t y (GBq)
Country and r e a c t o r
Germany. F e d e r a l Rep. of
Brunsbuttel 9.6
Gundremnlngen
Isar 5.9
Krumnel
Phlllppsburg 1 4.1
Wijrgassen 10
Italy
Caorso 0.44
Japan
Fukushima I
1.2.3,4.5,6 1.9
Fukushlma 11-1 .2 -
Hamaoka 1.2 2.6
Onagawa
Shlmane 0.037
Tokal 11-1 0.31
Tsuruga 0.28
Netherlands
Dodewaard 17.76
Sweden
8arseback 1 .2 57.4
Forsmark 1 , 2 0.25
Oskarshamn l .2 99
Rlnghals 1 99
Unlted S t a t e s
Blg Rock P o l n t
Browns F e r r y
Brunswtck
Cooper
Dresden 1
Dresden 2.3
Fltzpatrlck
Grand Gulf
Hatch 1
Hatch 2
Humboldt Bay
Lacrosse
Lasalle
Llmerlck
Ulllstone 1
Uontlcello
Nlne U l l e P o l n t
Oyster Creek
Peach Bottom
Pllgrlm
Ouad C l t l e s
Susquehanna
Vermont Yankee
WNP 2
Normalized a c t l v l t y
[GBq (GW a ) - l ] 78.23 71.31 175.3 95.86 156.5 40.9
A c t l v t t y (Gap)
Country and r e a c t o r
France
8ugey 1 118 70 40
Chlnon A1,2 38 17 19
S t . Laurent A1.2 407 237 200
ltaly
Lat l n a 59.2 86.2 162.8
Japan
Tokal 1 0.31 0.22 0.23 0.14 0.12 0.1
U n l t e d Klngdom
Berkeley 2190 1321 662 667.1 366.3 290
Bradwell 1443 1735 98 1 962 817.1 1510
Chapelcross 322 1776 4144 307 1 481 2000
Oungeness A 629 714 840 864.2 1750.1 2190
Oungeness 8 7.4 51.8 174
Hartlepool 7.4 118.4 218
Heysham 7.4 59.2 60
H l n k l e y P o l n t A 5106 3367 2660 1306.1 2249.6 3720
Hlnkley Polnt 8 141 100 44.4 812 928.7 840
Hunterston A 13500 8436 8695 281 2 2664
Hunterston 8 1554 2160 301 6 2653 331 9
Oldbury 1406 2290 1994 2620 1713.1 1210
Slzeuell 1924 1143 1036 658 889.1 1010
Travsfynydd 5 18 281 485 350.9 370 430
Wylfa 74 51.8 111 78.3 96.2 48
T o t a l annual e l e c t r l c energy
generated(GWa) 3.868 4.847 5.382 5.885 6.223 5.738
Normallzed a c t l v l t y
[G8q (GW a ) - ) ] 7609 4890 4632 2901 2582 2406
Average n o r m a l l z e d a c t l v l t y . 1980-1984
[G8q (GW a ) - ) ] 4520 t 1790
Argent l n a
Atucha 1 81 51 37 51 51 51
Ernbalse 25.9 1.91
Canada
Bruce A 163 81 78 74 72 -
Bruce 8 7 7
Gentllly 2 2 0.6 4 1 9.7
Plckerlng A 13 8 18 22 27 32
Plckerlng 8 11 27 9
P o l n t Lepreau 18.71 13.10 1.6
T o t a l annual e l e c t r l c energy
generated (GW a ) 4.283 4.508 4.386 5.283 5.729 7.310
Normallzed a c t l v l t y
[GBq (GW a ) - ) ] 41.10 19.74 21.89 23.79 22.21 14.86
Average n o r m a l l z e d a c t l v t t y . 1980-1984
[GBq (GW a ) - 1 ) 25.7 .t 8.7
n/d = Discharge n o t d e t e c t e d .
T a b l e 30
Actlvlty (TBq)
Reactor
1-131 1-13? 1-133 1-134 1-135 Ma-24 Cr-51 Hn-54 Mn-56 Co-57 Co-58
AfkdnSdS I
ArkanSdS 7
Beaver Valley
Calvert Cll!ts I,?
Crystal klver
Oonalc Cook 1.2
Farley 1
Farley 2
fort Calhoun
H.8. Roblnson
tiaddarn Neck
Indldn Polnt 1.2
lndlan Polnt 3
Kedaunee
nalne Yankee
Mctulre
4lllstone Pt. 2
North Anna
Oconee
Palisades
Poict Beach 1.2
Pralrle Island
R.C. Glnna
Rancho Zeco
Salem 1
Salem 2
San Onofre 1
San Onofre 2 , 3
Sequoyah
St. Lucle
5urry 1.2
lhrer nlle 1:ldnd 1
Three 4i le Illand 2
Trojan
Turkey Polnt
Vlrgll C. Sumner
Yankee Rode
Zlon 1
Zion 2
Actlvlty (TBq)
Reactor
fe-59 Co-60 211-65 Sr-89 Sr-90 Zr-95 Zr-97 Nb-95 Nb-97 no-99 Tc-9910
ATkdtlSdS 1
Arkansas 2
Beaver Valley
Calvert Cllfts 1,2
Crystal Rlver
Oonald Cook 1.2
Farley 1
Farley 2
Fort Calhoun
H.B. Roblnron
Haddam Neck
Indlan Polnt 1.2
lndlan Polnt 3
Kewaunee
Walne Yankee
McGulre
Mtllstone Pt. 2
North Anna
Oconee
Pallsades
Polnt Beach 1.2
Pralrte Island
R.E. Glnnd
Rancho Seco
Salem 1
Salem 2
San O n o f r e 1
Oan Onotre 2 , 3
Seauoyah
St. Lucle
Surry 1.2
Three ulle Island 1
Three Wlle Island 2
Trojan
Turkey Polnt
Vlrgll C . S u m e r
Yankee Roue
Zlon 1
Zlon 2
Normallzed actlvlty
[GBq (GW a)-I] 0.50 19.09 0.11 1.26 0.23 1.24 0.04 1.30 0.34 0.47 0.09
Table 30. contlnued
Actlvlty (TBq)
Reactor
Ru-103 Ru-106 Ag-1 lOm Sb-124 Sb-125 Cs-134 Cs-136 Cs-137 Ba/La-I40 Ce-141 Ce-I44
Normallzed actlvlty
[GBq(GUa)-I] 0.26 0.20 1.60 0.62 1.21 10.23 0.27 17.86 1.23 0.06 0.37
Table 30. continued
Actlvlty (Tap)
Rear tor
1-131 1-132 1-133 1-134 1-135 Na-24 Cr-51 Mn-54 Mn-56 Co-57 Co-58
Normallzed actlvlty
I G ~ Q / ( a)]
G~ 3.23 0.03 1.42 0.21 0.42 13.52 4.97 6.90 1.03 0.01 3.31
Actlvlty ( T B q )
Reactor
Fe-59 to-60 Zn-b5 Sr-89 Sr-90 Zr-95 Zr-97 Nb-95 Wb-97 Mo-99 Tc-99m
Normallzed actlvlty 1.67 30.16 10.6 0.9 0.15 0.25 0.00 1.54 0.07 0.34 0.58
[GBu (GW a)-1 ]
Table 30. continued
A c t l v l t y (Tag)
Reactor
Ru-103 Ag-llOm Sb-124 Cs-134 Cs-136 Cs-137 Ba/La-140 Ce-144 Np-239
T o t a l dnnual e l e c t r l c energy
g e n e r a t e d (GW a ) 10.29
Normallzed a c t l v l t y
! G B ~ ( ~ ad) - 1 1 0.15 0.82 0.06 6.61 0.59 13.29 2.88 0.51 0.25
T a b l e 31
--
Actlvlty ( G B q )
Reactor
Berkeley
Brdduell
Chayelcro::
Oungenetr A
Hinkley A
Hinkle 8
liunterston A
Hunterrton 8
Oldbur y
S i z r u ~ ll
Traistynydd
wylta
1 0 1 ~ 1 annual electrlc e n e r g y
gerirrated (Gw a) 4.19
Hormdlized dctlvlty
[GBq (GW a)-]] 821.0 27.41 3.60 29.84 18.13 2.08 292.9
- - - - - - -
Actlvlty ( G B q )
Reactor
Uerk~l~y
Brddwr I 1
Chapel( ro:s
Dungene:: A
Hiniley A
Iilnkley U
Hunterqton A
Hunterston 8
Oldbury
;I~eieil
1rdd:t ynydd
ciylta
N o r m a l l z e d l o c a l and r e q l o n a l
c o l l e c t ~ v ~ ~ f f e c t dose l v e e q u l v a l e n t comnltment
f r o m n o b l e Oases r e l e a s e d from t h e model PWR s l t e
hormallzed c o l l e c t l v e
Radlonucllde e f f e c t l v e dose
e q u l v a l e n t comnltment
[lo-'man Sv (GW a ) - I ]
Ar -4 1
Kr-85m
Kr-85
Kr-81
Kr-88
Xe-13lm
Xe- 133m
Xe-133
xe-135m
Xe-135
Xe-138
Total 251
T a b l e 33
Normal l z e d l o c a l and r e q l o n a l
c o t l e c t l v e e f f e c t l v e dose e q u l v a l e n t comnltment
f r o m n o b l e oases r e l e a s e d f r o m t h e model 0WR s l t e
N o r m a l ~ z e dc o l l e c t l v e
Radlonuc 1 l d e effective dose
e q u l v a l e n t comnltment
[man sv ( G H a ) - ' ]
Ar-41 0.02
Kr-85m 0.014
Kr-85 0.0008
Kr-87 0.024
Kr-88 0.32
Xe-13lm 0.004
xe-133 0.042
Xe-135111 0.004
xe-135 0.090
Xe-138 0.052
-
Total 0.56
T a b l e 34
N o r m a l l z e d l o c a l and r e q i o n a l
c o l l e c t l v e e f f e c t l v e dose e q u l v a l e n t c o m l t m e n t s
trom t r l t l u m released t o the hydrosphere
PWR 27
BUR 2.1
HWR 290
GCR 97
LWGR 1.7
PWU 345
8WR 330
HWR 6336
GCR 1100
LWGR 1300
T a b l e 3b
T a b l e 37
Total
PWR Co-58 33
Co-60 20
Ag-llOm 0.2
CS - 134 10
Cs-137 18
GCR Co-60 20 3 1 10
Sr-90 360 10 3 20
Ru-106 50 5 1 40
Sb-125 40 7 0.2 0.4
Cs-134 500 150 4 30
Cs-131 2500 1300 27 180
Ce-144 150 1.5 7.5 75
F i n l a n d ( 2 PWRs. 2 BURS)
1980 4 2.1 0.48
1981 4 1.4 1.57 0.9
1982 4 3.3 1900 1.80 1.7 1.8
1983 4 2.3 2600 1.90 0.9 1.2
1984 4 3.2 I800 l .8
1985 4 2.2 1500 1.4
France (PWR)
1980
1981
1982
1983
1984
1985
N e t h e r l a n d s ( 1 PWR; 1 BUR)
1980 2 2.7 790 0.45 3.5 5.9
1981 2 6.4 1350 0.39 4.7 16
1982 2 8.9 1560 0.42 5.7 21
1983 2 7.8 1400 0.39 5.6 20
1984 1 (PWR) 5.2 1040 5.0
S w i t z e r l a n d ( 2 PWRs; 2 BURS)
1980 4 8.9 1900 4.6
1981 4 9.1 2050 I. 6 4.4 5.5
USSR (PWR)
1980s
U n i t e d S t a t e s ( R a t i o PURs : BURS
1980 68 538
- 2 to 1)
80300 29 6.7 18
1981 70 54 1 82200 31 6.6 17
1982 74 522 84400 33 6.2 16
1983 75 565 85600 33 6.6 17
1984 78 552 98100 37 5.6 I5
T a b l e 41
Japan
(WR) 1980 25.1 13 4.0 1.9 6.3
1981 28.4 13 4.3 2.2 6.6
1982 29.2 13 5.4 2.2 5.4
1983 32.4 13 5.8 2.5 5.6
1984 34.9 15 5.9 2.3 5.9
1985 36.4 15 6.7 2.4 5.5
T a b l e 42
Argentlna (HWR)
1983 2 5.0 980 0.34 5 13
1984 2 3.6 1000 0.44 4 6
1985 2 6.4 860 0.72 8 9
1986 2 13 18
Canada (HWR)
1980 12 19.1 6780 4.34 2.8 4.4
Japan (GCR)
1980 1 . 1.1
1981 1 0.8
1982 1 0.8
1983 1 0.8
1984 1 1 .O
1985 1 1.4
USSR (LYGR)
1980 2 2.3 - 0.41
Collectlve eftectlve
Reactor dose equlvalent per
type unlt energy generated
[man sv (GW a)-']
LWR
HWR
GCR
HTGR
LWGR
T a b l e 44
3
Annual volume ( m )
BWR 1000 1500 1000 1000-2000
PWR 600 1100 400 200- 5 0 0
a/ Not estimated
T a b l e 45
PWR
BUR
T a b l e 46
Actlvtty
percentage
Radlonucllde
&/ These radionucl ides have daughters that wlll be In equll lbrlum.
Only the percentage of the parent 1s reported.
b/ The radionucllde wlll bulld up as plutonium-241 decays.
-
T a b l e 47
- - - - -
Volume p e r u n l t energy g e n e r a t e d
[m3 ( G Wa ) - ' ]
HWR 50 250
GCR 20 1000
A c t l v l t y concentration
(GBq i 3 )
HWR a/ 100 1
GCR 1000 10
a/ Excludlng t r l t t u m .
T a b l e 48
Approximate
C o u n t r y and s l t e Started Status total
operat ton cacac?ty
Unlted States
B e a t t y , Nevada 1962 open
Maxey F l a t s . Kentucky 1962 closed
West V a l l e y . New York 1963 closed
R l c h l a n d . Washlngton 1965 open
Sheffield. I l l l n o l s 1967 closed
B a r n u e l l . South C a r o l l n a 1971 open
Unt t e d Klngdom
D r l g g . Cumbrla 1971 open
France
C e n t r e de l a Manche 1969 open
T a b l e 49
a/ Recorded s e p a r a t e l y t o r 1975-1982;
I n c l u d e d i n beta/gamna a c t l v l t y f o r
e a r l l e r years.
T a b l e 50
Freshwater f l s h 20
Beef
Cow 1 lv e r
M l lk
Mutton
Sheep 1 l v e r
Green v e g e t a b l e s
Gra I n
Root v e g e t a b l e s
Uarlne f l s h
Crustacea
molluscs
Seaweed
a/ m3.
b/ Inhalatlon rate: 1 d h-1.
T a b l e 51
C o l l e c t l v e dose e g u l v a l e n t r a t e p e r u n l t a c t l v l t y
a t c l o s u r e I n an e n q l n e e r e d f a c l l l t r
as a f u n c t l o n o f t i m e f r o m 100 t o 2.000 y e a r s
C o l l e c t l v e dose
equlvalent r a t e
per u n l t a c t l v l t
Tlme a f t e r [man Sv (TBq a ) - ] I
clorure
l a b l e 52
Collectlve dose equivalent rate per unlt actlvlty
at closure In an engineered taclltty
a s a functlon of tlme from 10.000 to 250.000 years
Collectlve dose
equlvalent rate
Tlme after
closure
per unlt actlvlt
[man Sv (TBq a)- ] r
(years) 2 4 1 ~ u&/ 2 4 1 ~ m&/
T a b l e 53
Collectlve dose
equivalent rate
per unlt actlvlt
Time after [man Sv (T6q a)- ] 1
closure
(years) 2 3 5 ~3/ 2 3 9 ~ u g/
a/ Global clrculatlon.
b/
- Collectlve effectlve dose equlvalent rate less than 10-l2 man Sv a-l,
or collectlve dose comnltment less than 10-lO man Sv.
T a b l e 55
g/ Global clrculatlon.
b/ Collectlve effectlve dose equlvalent rate less than 10-12 man Sv a-l.
or collecttve effective dose equlvalent comnltment less than 10-10 man Sv.
T a b l e 56
T a b l e 51
Attltudes towards reprocesslnq
In countries wlth nuclear power statlons above 3 0 W
Janan A small demonstration reprocesslng plant at Tokai Mura has been reprocesslnq
LWR fuel lntermlttently s l n c e 1 9 7 7 ( a n n u a l capaclty: 2 1 0 t o n n e s of uranium). A
c o m e r c l a l plant For reprocesrlng LWR fuel ( a n n u a l c a p a c l t y : 8 0 0 t o n n e s o f
uranlum) Is scheduled t o begin o p e r a t l o n In 1990. J a p a n has contracted f o r
r e p r o c e s s i n g 1.600 t o n n e s o f u r a n i u m in LWR fuel In f r a n c e and 1 6 0 t o n n e s o f
u r a n l u m ln t h e U n l t e d Klngdom. J a p a n has a l s o renewed a contract f o r
r e p r o c e s s l n g 5 0 0 t o n n e s o f uranlum In g a s - g r a p h l t e fuel tn t h e Unlted Klngdom.
Unlted Klngdom The 8204 plant (annual capacity: 1.000 tonnes of uranlum] reprocessed natural
uranlum gas-graphite fuel ln the 1950s and early 1960s. Ihe 8205 plant (annual
capaclty: 2.000 tonnes o f uranium) has reprocessed thls fuel since 1964 and ls
scheduled t o undergo renovation. The 0204 plant, after modlflcatlon.
reprocessed LWR fuel between 1968 and 1973. A thermal oxlde reprocesrlng plant
(THORP) (annual capactty: 1.200 tonnes of uranlum) 1s under constructton and
expected t o begln reprocesslng LWR fuel by 1990. The Unlted Klngdom has
lnternatlonal contracts for reprocesslng about 3.100 tonnes of uranlum In spent
fuel.
Unlted States The plant at West Valley. New York, (annual capaclty: 300 tonnes of uranlum)
operated Intermittently from 1966 untll 11s closure in 1972. Oue to
maintenance problems, a novel plant at Morris. Illlnols. (annual capaclty: 3 0 0
tonnes of uranlum) never began operatlon. Reprocesslng of comnerctal nuclear
power Fuel was deferred IndefInltely In 1977. Constructlon was halted on a
plant at Barnwell. South Carolina. whlch could requlre an addltlonal 1 8 0 0
mllllon t o complete (annual capactty: 1,500 tonnes of uranlum). Its operatlon
In the 1990s has been suggested.
T a b l e 59
Radlonuclldes dlscharqed ln a l r b o r n e e f f l u e n t s
from fuel reprocesrlnq plants. 1980-1985
[el, 82. 83. 87. aa, 816. 829, F I . F ~ I
Actlvlty ( T a g )
Year Electric
energy P a r t l c u l a t e release
H-3 C-14 Kr-85
Total Total
alpha beta
Normallzed actlvlty.
1980-1985
[ T B q (GW a)-11
C a p d e la Hague. France
Normallzed actlvlty.
1980- 1985
[ T b q ( G w a)-)]
Marcoule. France
Normdllzed actlvlty.
1980
[ T E q (Gw a ) - 1 1
Table 59. continued
Electrlc
Year energy Isotoptc cornpositlon of p a r t l c u l a t e a c t t v l t y (total beta)
S e l l a f l e l d , Unlted K l n g d o m
Normallzed actlvlty.
1980-1985
[ T e a ( G W a)-] ]
C a p d e la Hague. F r a n c e
Normallzed actlvlty.
1980-1985
[TBq (Gw a)-']
T a b l e 60
Radlonuclldes dlscharqed ln ltauld effluents
from fuel reprocesslna plants. 1980-1985
[el. 82. 83. 88. 816. 829. c5. fi. r4. G ~ I
-- -
Actlvlty (TBq)
Year
Total beta
Total (other H-3 Sr-90 Ru-106 Cs-137
alpha than H-3)
Actlvlty (TBq)
Radlonucllde
l o t a l beta/qamna a c t l v l t y I n t l s h f r o m t h e l r l s h Sea
and t h e N o r t h Sea. 1983
[ H7 I
Mean a c t l v l t y
Number o f c o n c e n t r a t l o n ( w e t ) 8q k g - '
Sarnpllng a r e a / Sample sampl l n g
landlng polnts observatlons
Total beta 134-C5 131-Cs
S e l l a f l e l d s h o r e l l n e area Cod
flounder
S e l l a f l e l d offshore area Plalce
Dab
Skate
Whiting
Cod
Ravenglass a/ Cod
Plaice
N o r t h e r n N o r t h Sea Plalce
Cod
Haddock
Sal t h e
M l d - N o r t h Sea Plaice
Cod
Haddock
Herrlng
Whltlng
Southern N o r t h Sea Plaice
Cod
Whiting
Herr l n g
Iceland area Cod
Haddock
Plalce
a/ Landlng p o l n t .
n/d = n o t d e t e c t e d .
T a b l e 63
-a/ Landlng p o l n t .
n/d = Not d e t e c t e d .
228
Normallzed lccal and reulonal
collectlve effectlve dose epulvalent c o m l t n ~ e n t r
from atrnospherlc releases from fuel reprocesslnq
at Sellafleld and Cap d e la Hasue
Normal lzed
Normalized actlvlty collectlve effectlve dose
1980-1985 eaulvalent comnltment
iTBq ( ~ . l ' [man sv (GW~)"]
Pathway
Sellafleld La Hague Sellafleld La Hague
Inhalation
H-3 120 3.5
Pu-239 0.00006 0.000002
Total
Total
-1
Welghted total 1.3 man Sv ( G W a)
T a b l e 65
Norrnallzed collectlve
effectlve dose equlvalent
comnl tment
[man sv ( G M a)-']
Pathway
Sellafleld LaHague
Mollusc and
crustacea
Ru-106 4.7 9.9
Sr -90 1 0.23
Pu-239-240 0.2 0.06
Total 44 11
T a b l e 66
Collectlve
Annua 1 Annual effective
collectlve average dose equlvalent
Country Year Numberof effective effective comnl tment
workers dose dose per unlt energy
monltored equivalent equlvalent generated
( m n Sv) (mSv) lmanSv(GWa)-'1
Cap d e la Hague
Karcoule
a/ No estimate avallable.
T a b l e 68
Solld Intermediate-level waste productlon
at operating reprocesslnq plants
[Tll. 8321
T a b l e 69
Fractlon o f t h e fuel throughput of a reprocesslnq plant
estimated t o arlse as low- or lntermedlate-level vaste
lo41
T a b l e 70
Normallzed collective effective dose eaulvalent comnltrnent,
truncated t o different times for globally dispersed nuclides,
welghted for the fractlon o f fuel reprocessed
Years.
- -
Radlo-
nucllde
10 100 1000 10.000 1.000.000
T a b l e 71
T a b l e 72
Normalized
Operat lon and collectlve effective dose
main radlonucllde equivalent comnltment
[ m a n Sv (GW a)-']
Mining
Radon
Milling
Uranlum, thorlum, radium
Radon
Mine and mlll tailings piles
(releases over Five years)
Radon.
Fuel fabrlcatlon
Uran lum
Reactor operation
Atmospheric
Noble gases
Actlvatlon gases
Tritium
Carbon-1 4
Iodlnes
Particulates (Cs. Ru. Co)
Aquatlc
Trltlum
Others (Cs. Ru. Co)
Reprocesslng
Atmospheric
Trltlum
Krypton-85
Carbon-14
Caeslum-137
Iodlne-129
Alpha-emitters
Marlne
Caeslurn-134.137
Ruthenium-106
Stront lum-90
Alpha-emltters
Transportatlon 0.1
Total ( rounded) 4
T a b l e 73
Norma 1 l zed
collectlve
Source effectlve
dose equlvalent
comnl tment
[man sv (GW a)-']
T a b l e 74
Normal l zed
collectlve
Operatlon effectlve
dose equlvalen:
[man sv (GW a)-']
Total (rounded) 12
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ANNEX C
Exposures from medical uses of radiation
CONTENTS
Poroprophs
I Paragraphs
11. DIAGNOSTIC USE O F RADIO-
PHARMACEUTICALS.. ......... 139-154
1. DIAGNOSTIC hlEDlCAL X-RAY A. Frequency and trends .......... 139- 144
EXAhflNATlONS ............... 14-138 B. Age and sex distribution of patients 145
A. Frequency and trends .......... 14-41 1 C. Impact of new technologies ..... 146
D. Ahsorbed dose ................
B. Age and sex distribution of patients 42-47
E. Occupational exposure from dia-
C'. Impact of specialized types of gnostic nuclear medicine. .......
examinations ................. 48-56
111. THERAPEUTIC USES O F RADIA-
D. Exposure and absorbed dose.. ... 57-90 TION ...........................
E. Causes of dose variation and pos- A. Frequency and trends ..........
sibilities for dose reduction. ..... 91-102
B. Absorbed dose ................
F. hleasures of risk .............. 103-122 C. Occupational exposure from radia-
G. World-wide estimates of doses from tion therapy ..................
diagnostic x-ray examinations ... 123-126
IV. SUMhlARY .....................
H. Occupational exposure from dia-
gnostic radiography. ........... 127- 131
I. Future trends in diagnostic radio- Tables ............................... 269
graphy ...................... 132-138 References ............................ 30 1
3. For diagnostic and interventional uses of radiation, 7. Although it is of interest for the Committee's
there is a possibility of dose reduction, although one purposes to compare the risk from medical radiation
must be careful not to decrease at the same time the with risks from other sources of man-made radiation
associated benefits. Medical radiation differs from other or from n a t ~ ~ r background
al radiation, such compari-
radiation sources in several ways. The first is that. with son has always posed a difficult problem. The effects
the exception of medical occupational radiation ex- of radiation depend upon the energy of the radiation,
posure, those receiving the doses delivered in the course instantaneous dose rate. the time over which the total
of medical procedures are those who are expected to dose is received, and the part of the body exposed. In
benefit directly from such procedures. The second this respect, diagnostic examinations are markedly
difference is that the dose to patients during radio- different from radiotherapy procedures, in which
graphy is usually received over a short time and most substantially higher doses are given to a much smaller
often involves only a limited portion of the body. A third group of patients, in whom non-stochastic effects are
difference from other sources is that the exposed present in the short tern]. The Committee has alivays
population is highly selected, insofar as many of the felt that the potential stochastic risks to patients from
exposed individuals are suffering from some form of diagnostic medical radiation and nuclear medicine
illness and insofar as their age distribution is quite should not be summed or compounded with the risks
different from the age distribution of the population at from radiotherapy. The reasons for this arc that the
large. risk coefficient for a given effect may vary with the
magnitude of the absorbed dose and the dose rate. In
4. One of the limitations of the previous Reports of the addition, the radiation risk coefficient for cancer
Committee, as well as of this Annex. is that good data on patients is unknown and their lifespan and age
frequency of examinations and absorbed dose from distribution are likely to be different from other
medical examinations and occupational sources are populations. Radiation therapy is therefore assessed in
available predominantly from developed countries, this Annex only in terms of average absorbed doses in
which account for less than 25% of the world's organs. It would be of interest to evaluate the absorbed
population. Fragmentary data on examination rates doses to tissues outside the target volume in patients
and numbers of machines and little or no data on who have undergone radiation therapy for estimation
absorbed doses are available for another 25% of the of possible later stochastic effects. L'nfortunately, the
population, and no data are available at all for 50% of Committee has been unable to obtain data on the
the world's population. number and exact treatment regimes that have been
utilized.
5. The present availability of radiodiagnosis is very
uneven throughout the world: one x-ray machine is 8. In 1977, the International Commission on Radio-
shared by fewer than 2.000 people in some countries logical Protection (ICRP) introduced a quantity called
and by 100.000-600,000 people in other countries. the "effective dose equivalent", defined as the sum of
The frequency of procedures is also very uneven all the organ dose equivalents weighted for the relatitle
(15-20 procedures annually per 1.000 population in radiation risk. 'The effective dose rouivalent as defined
some countries and about 1.000 procedures annually for purposes of radiation protection [I?] should nor.
per 1.000 population in others) [RI]. At present, there in principle, be used to estimate the detriment in
are approximately 5 lo9 people in the world and some population groups with sex or age distributions that
authors indicate that more than three quarters of the differ significantly from those of the working popula-
world's population have no chance of receiving any tion, and i t was not the original intention of the ICRP
radiological examination, regardless of what disease that the effective dose equivalent concept should be
they may have. In many developing countries, betlveen extended to patients. However, in the absence of good
30% and 70% of x-ray machines are out of order age distribution data on exposed patients, the Com-
[M32, P2]. The lack of good data from areas that mittee utilized the effec1ii.e dose equivalent concept in
account for approximately three quarters of the the UNSCEAR 1982 Keport [U5] as the best available
world's population has led the Committee to adopt an estimate of medical esposure for the purpose of
extrapolation procedure for estimating world-\vide coni~arisonwith other sources of radiation rxDosure.
medical use of radiation. This .4nnex examines the age distribution of popula-
tions undergoing different radiological examinations
6. In the UNSCEAR 1958 Report [Ul], the Com- and points more specifically to the limitations to the
mittee was predominantly interested in exposures that use or collective effective dose equivalent for estin~at-
might have hereditary effects, so it calculated a ing detriment. A more detailed discussion of this
genetically significant dose (GSD). It became evident problem is presented in section I.F.
during the 1958 analysis that a major portion of dose
was contributed by relatively few types of examina- 9. In addition to examining the population structure
tions. By 1977, and even more by 1982, the Committee itself, the Committee felt that it was important to
became interested in estimating the mean doses to examine trends in the utilization of various procedures
other tissues, particularly those tissues regarded as used for a gi\en diagnostic objective as well as trends
more susceptible to the induction of stochastic effects in types of equipment. Over the past decade there
(e.g., the thyroid, active bone marrow, the lung and the have been many technological adiances that may be
affecting medical exposure: old techniques are being medical practices are computed to evaluate the con-
replaced by new ones; additional examinations are tribution that medical practice makes to man's total
being performed; and procedures are being carried out radiation exposure. Since these data may also be used
with different types of equipment, leading to increases to determine whether special population groups are
or decreases in the mean absorbed doses in organs in being highly exposed, they may be of epidemiological
the course of examinations. This Annex examines trends interest. There remain some difficulties. however, in
where sequential data are available. Although it is clear comparison of absorbed doses. because the techniques
that trends vary markedly from country to country, it presented in the radiologic physics literature some-
appears that, globally, the extent to which medical times measure exposure rather than absorbed doses.
radiation is utilized is increasing. The World Health The determination of interest is the average absorbed
Organization published a report [W19] containing dose in an organ. There is considerable \variability
recommendations intended to alert the medical and from study t o study in modelling, computational
governmental communities t o the fact that, particularly techniques and assumptions utilized. Because organ
in industrialized countries. many clinically unproduc- doses vary markedly from one procedure to another.
tive radiological examinations are being performed. In it is useful to examine this variation within a given
contrast. there is probably substantial under-utiliza- country as well as from country to country, in search
tion in developing countries. of the underlying causes.
10. In a n attempt to estimate the global use of 12. While absorbed dose data exist for many radio-
medical radiation, the Committee has made use of the graphic and nuclear medicine procedures, this Annex
good correlations that exist between population per x- suggests that previous estimates of absorbed dose to
ray machine and population per physician (Figure I). the world's population may be somewhat low. The
A good correlation has been found between the two most important reasons for this suspicion are the
number of x-ray examinations per unit of population widespread use of fluoroscopy in developing countries
a n d the number of physicians per population [M27]. and the large number of malfunctioning machines
Four levels of health care have been defined, based producing high absorbed doses (neither factor was
upon the number of population per physician in a widely appreciated in the past) [B16, Dl]. For
given country in 1982. In countries with the highest example, in the People's Republic of China, most
level of health care (level I), more than one physician radiographic examinations are performed with fluoros-
is available per 1,000 population. In countries of the copy machines that d o not have image intensification
next category (level 11). one physician is available per systems [S32, 241, resulting in higher dose equivalents
1.000-3,000 population. In countries with lower levels of per examination than in some other countries.
health care, one physician serves 3,000-10,000 people
(level 111) and more than 10,000 people (level IV). By 13. Finally, this Annex examines expected changes in
estimating the average number of medical radiation the magnitude of medical exposure through the year
examinations in countries of the various health care 3000. The Committee recognizes that there is expected
levels and reported doses from representative coun- to be (a) a significant increase in total population of
tries, the doses to the world population can be the world; (b) a marked aging of the population in
determined. This approach is used in evaluating the many, mostly developed countries, with increased
doses from x-ray examinations, from diagnostic use of proportions of the population over the ages of 60 a n d
radiopharmaceuticals, as well as therapeutic uses of 80; (c) an increase in the proportion of the world's
radiation. population residing in cities; and, finally, (d) a shift in
the spectrum of diseases [04]. All of these factors are
I I . This Annex also reviews doses to particular expected to play a significant role in the future use,
organs from various types of medical examinations. availability and need for medical radiation.
The individual and collective organ doses from various
19. In Italy in 1983, 744 medical x-ray examinations 76. Gro\+th of diagnostic radiological procedures in
were carried out per 1,000 population [PI]. Indovina the IJnitcd States appears to hatre been fairly rapid.
et al. [I91 indicate that mass screening in Italy resulted There has been a general increase in almost all types
in 4.3 million chest photofluorographies in 1974 and of general radiographic examinations since 1964. The
3.0 million in 1980. rate of hospital-based examinations per 1.000 popula-
tion was 370 in 1964. 400 in 1970 and 570 in 1980,
20. The frequency of diagnostic x-ray examinations \vhicIi is similar to the hospital x-ray examination rate
in Japan is made grea:er by the mass chest x-ray of 650 per 1.000 estimated for Canada. The total
examination campaigns and by an emphasis on frequency of medical x-ray examinations in the United
examinations of the abdomen and the gastro-intestinal States is 790 per 1.000 population [M28]. The increase
in frequency of examinations in Canada and the population per x-ray machine for each level of health
United States is probably due to a number o i factors. care are derived from the data in Table 4 and are
including. among others, a change in the age distribu- shown in Table 5. To the extent that populations.
tion of the population. The number of medical numbers of x-ray machines and examinations have
diagnostic machincs per 1.000 population increased increased in direct proportion to one another since the
from 0.5-7 in 1969 to 0.61 in 1981. surveys took place, it uill be approximately valid to
estimare current levels of practice from present world
27. Zhang et al. [Z4] and Zhang [ZS] conducted 3. population. The number of annual x-ray examinations
survey of radiological services in Shangdong Province. world-wide is thus estimated to be approximately
China. for the years 1976-1980, and this information 1.400 million. and the number of diagnostic medical
has also been included in Table I . The authors x-ray units. approximately 440,000. The number of
reported that during this time the annual frequency of niedical x-ray examinations for the four levels of
examinations in rural areas increased by 77% (from health care are listed in Table 6. As might be expected,
146 to 259 examinations per 1.000 population), while the one quarter of the world's population i n countries
in urban areas the frequency was significantly higher of health care level I receives three quarters of the
but had increased much less as a percentage of the examinations. The average number of examinations
total (from 577 examinations per 1,000 population in performed per year and per x-ray machine ranges
1976 to 7 10 in 1980, corresponding to a 23% increase). from 3.000 to 5,500 for all levels of health care.
Chest fluoroscopy accounted for more than 70% of all
examinations performed. chest radiography for only 32. Table 7 indicates that. of the diagnostic x-ray
2%. skeletal radiography for 6%. and special examina- examinations performed in some Latin American
tions for 4%. The authors also indicated that the countries, chest examinations account for 22-50% and
majority of chest fluoroscopy was for screening examinations of the extremities for 72-36% of the
purposes. Similar urban rates have been reported by total. This is fairly consistent with the data in Table 1.
Sun et al. [S32], who indicated that the total annual ughich showed that in level 1 countries 32% of all
frequency of radiographic procedures in Beijing was examinations were of the chest and 19% examinations
761 per 1,000 population, with chest fluoroscopy of the estremities. The Committee has reviewed
accounting for 65% of all procedures. Approximately a\.ail;rble data over the past decade on the percentage
90% of all x-ray equipment in China in 1980 was of the total of diagnostic s-ray examinations accounted
fluoroscopic (i-e. about 70.000 fluoroscopic units). for by each type of examination. This is shown in
Somewhat lower utilization rates (about 120 per 1.000 Table 8 for three levels of health care. The main
population) have been reported by Zhang [Z7] for the difference appears to be that examinarions of the
Zhoukou region of Hunan Province, although the abdomen and digestive tract represent 16% of the
distribution of types of examinations is similar to that total in level 1 countries but decrease to 13% in level I1
reported by other authors. countries and to 6 5 in level 111 countries. At the same
time. there is an increase in the percentage of chest
28. A discussion of diagnostic radiologic procedures examinations from level I countries to level 111
in the Islamic Republic of Iran in 1980 [S19] indicates countries. I t is of interest that examinations of the
that the estimated overall rate of diagnostic x-ray head and neck and urogenital examinations account
procedures was 180 per 1.000 population. The authors for a fairly uniforni percentage regardless of the level
also suggested that the frequency of x-ray examina- of health care.
tions in urban areas was higher than in rural areas and
small towns. \virh the urban population receiving 33. As might be expected, the urban population
approximately twice the national average. receives more x-ray examinations than the rural
population (Table 9). Similar findings have also been
29. Data regarding the number and frequency o i reported by Cockshott [C7], who terms this the
x-ray examinations available from Turkey for 1977 "capital city syndrome" even though the data are for
[Y I] indicate that the annual frequency was about 80 urban areas in general and not just capital cities. In
examinations per 1.000 population. effect. a segment of the population often receives a
disproportionately high number of examinations. This
30. The number of diagnostic radiological examina- disproportion is also evidenced by the data available
tions performed in various Central and South American from China [S31, 241 and the Islamic Republic of Iran
countries is difficult to ascertain, but some trends can [S 191. Urban populations may receive two to 10 times
be indicated by the growth in the number of machines as many examinations per caput as rural populations.
(Table 3). There has been an increase in the number of
radiodiagnostic machines in Argentina and Chile. 34. Information on the historical trend in the annual
while in Costa Rica, Ecuador and klesico, the number frequency of diagnostic examinations in various coun-
of units per 1.000 population has not increased. tries is summarized in Table 10. With the exception of
China and Turkey, the countries are level of health
31. By applying the estrapolation procedure de- care I. For these level I countries the annual growth
scribed in paragraph 10, the number of diagnostic rate for examinations from 1955 through 1983 ranged
x-ray examinations and machines on a world-wide from 0% to 10%. with an average of 3% over the
basis may be estimated. The basic data used to make decade 1970-1980.
these estimates for various levels of health care are
shown in Table 4. From these values. the average 35. Dental radiography is the most common type of
annual examination rate per 1.000 population and the diagnostic x-ray examination. In the UNSCEAR 1977
and 1982 Reports, the Committee reported data on dental examination rate of 517 per 1,000 population.
the annual frequency of these examinations in several No increase in intra-oral examinations had occurred
countries, but no data were available on trends. At by 1985; however, there was a small increase in
present, data indicating trends are available from pantomographic examinations, to I I million examina-
three countries. tions.
36. The use of dental radiology in the United 39. According to the UNSCEAR 1977 Report [U5],
Kingdom has been reported by Wall and Kendall the number of single dental exposures per 1,000
[W3]. It is apparent from these data that there was a population in Sweden in 1974 was 1,500. Preliminary
marked increase in the use of dental radiology from data from Sweden obtained for 1984-1985 [V2] indicate
1963 t o the end of 1981 (Figure 11). The frequency of that about 1.800 dental films were obtained per 1.000
dental x rays more than doubled between 1970 and population. In the United States. there has also been a
1983. In 1983, there were 9 million dental x-ray substantial increase in the frequency of dental x-ray
examinations (I65 per 1.000 population). In 1981 most examinations per 1.000 population [MIO], although the
were intra-oral (6.7 million). but 150,000 were extra- increase was not as rapid as in the United Kingdom
oral and 910,000 were pantomographic. The average [W3]. The number of dental x-ray examinations in
number of films per examination in 1981 was 1.8. the United States increased from 67 n~illionin 1970 to
105 million in 1982. Exposures increased from 280
million to 380 million during the same period.
Between 1970 and 1982 in the United States the
average annual compounded growth rate for examina-
tions was 4.2%. The number of exposures (films)
increased at an average annual compounded growth
rate of 3.4%. The number of exposures per patient
declined somewhat as pantomographic procedures
gradually replaced full-mouth series. In 1970, approx-
imately 6% of all dental x-ray examinations were
pantonlographic, and this number had risen to 18%
by 1982. In 1982, the annual dental radiographic
examination rate was 456 per 1,000 population. Dental
x-ray machines increased from 98,000 in 1966 to
201,000 in 1981 [MIO].
Figure Ill. Changes as a function of time (1977-1982) i n the number of x-ray examinations of various
organs in a University clinic in the Federal Republic of Germany. (ERCP = encoscopic retrograde cholangio
pancreatographyj.
[HI 41
f7 (;eilbiadd~r
Pancreas
Kidneys
Total
Figure IV. Changes as a functlon o l time (1977-1982) i n the number of sonographic examinations of various organs
In a University clinic in the Federal Republlc of Germany.
[HI41
that, during the same period, pneumo-encephalograms D. EXPOSURE AND ABSORBED DOSE
became extremely rare.
57. The distribution of exposure or absorbed dose in
53. Evens et al. [E3, E4, E5. E6] and Hughes [H31] a patient as a result of a diagnostic x-ray examination
examined trends in the use of computerized tomo- depends upon (a) the amount of incident radiation;
graphy in the United States during 1981-1983. Total (b) the location and direction of the incident beam;
scans increased from 2.337.000 in 1981 to 4.303.000 in and (c) the quality and attenuation of the radiation in
1983. Cranial scans accounted for 75% of such the body. The amount of incident radiation depends
procedures in 1981 but decreased to 63% in 1983. upon exposure at skin entrance and the size of the
During the same period. computerized tomography radiation field. Exposure for an examination is some-
scans of the spine increased from 3% to 1 0 5 and times reported free-in-air (i.e., without the body
other body scans increased from 22% to 27%. However. present) and sometimes as skin surface exposure (i.e..
the rate of increase in the use of computerized with the body there). Alternatively, the absorbed dose
tomography slowed markedly with the percentage in soft t~ssueat the surface may be reported. The ratio
increase over the previous year being 53% from 1981 of the exposure on the body to exposure free-in-air for
to 1982 and 2 1 % from 1982 to 1983. examinations t h a ~contribute significantly to the radia-
tion dose is approximately 1.2 to 1.4. Some authors
54. Imaging procedures of the abdomen are difficult to have reported results in terms of energy deposited in
evaluate since many computerized tomographic exami- the total body or in a given organ rather than in terms
nations of the abdomen and ultrasound examinations of average energy absorbed per unit mass. It would be
are done for retroperitoneal pathology. The increasing worthwhile to unify methods of expression of patient
use of abdominal ultrasound and computerized tomo- exposure and dosimetry.
graphy may have decreased the number of ordinary
x-ray examinations of the abdomen being performed
in the United States between 1980 and 1983 [E6]. 58. While the average absorbed dose in a given
Whether this is a real finding or sinlply due to organ of the body depends on all the factors listed
different reporting of the two surveys is unknown. above, some consolidations are possible when con-
Computerized tomography has decreased the need for sidering relative distribution of absorbed dose in the
some arteriograms [BZ, K7, WIZ], but in general there body. If the physical characteristics of the beam (tube
has been a net increase in examinations utilizing potential, tube current. radiation field size. location
relatively iarge amounts of ionizing radiation. Another and filtration) are the same for a series of esposures,
interesting question is whether computerized tomo- the relative absorbed dose distribution is independent
graphy of the lumbar spine has partially replaced of the amount of incident radiation. Approaimate but
myelography. In the United States the frequency of adequate constancy is also obtained for a small range
myelography examinations has continued to increase in of patient sizes for a particular type of exarnination.
spite of increasing computerized tomographic examina- While the exposure at the body surface of adults for a
tions of the spine. given type of examination may range over a factor of
up to 40 (Figure V) [U9]. the relative absorbed dose is
55. Another particularly important trend is that of usually considered to be adequately constant so that
mammography. Table 16 indicates the significant the effective dose equivalent for a given type and
increase of mammography examinations per 1.000 projection of an examination is proportional to the
female population. At present. the rate in the United exposure or absorbed dose of the incident radiation. I t
States is slightly greater than 10 per 1,000 females should be noted, however, that relative absorbed dose
annually. distributions change so that a different numerical
proportionality is obtained for children and infants
56. In the past decade there has been a rapid than for adults.
expansion of both digital and interventional tech-
nologies. Digital technology in this context refers to 59. In the UNSCEAR 1977 Report [U3], typical skin
the recording of transmitted photons on an image doses in the primary beam for various examinations
intensifier or other such receptor rather than on film. were given. More recently, data on trends and
This process allows computer manipulation of the variability of exposures in the United States have
images. This technology has found widespread use in become available from the Nationwide Evaluation of
vascular radiology, but it can also be used in other X-ray Trends (NEXT) programme [U9]. In this pro-
examinations. Interventional technology refers to a gramme, exposure is measured for five projections using
number of techniques in which radiology is used to specified geometry and measured free-in-air. Histo-
guide the radiologist or other physician in a semi- grams for composite data for the years 1973-1980,
surgical diagnostic or therapeutic procedure. Examples shown in Figure V,indicate a rather wide distribution of
of such procedures are placement of drainage catheters. such exposures. Very similar data for 1975-1985 are
needle biopsy of various lesions, catheter placement available from the NEXT programme in Canada [C2]
for infusion of pharmaceuticals, and balloon catheter Italy [I I]. With the advent of rare-earth screens and
placement for occlusion or dilatation of blood vessels. faster film-screen combinations, one might expect that
Most of these procedures require lengthy periods of the mean exposure at skin entrance would be decreasing.
fluoroscopy and may result in high absorbed doses to However, data from the United States suggest that as of
the patient as well as to the operator. Data on the 1983. in spite of technological advances, there has been
frequency of such procedures are not available at this little reduction in average exposure [U9]. Therefore, one
time. is led to conclude that world wide, skin doses have not
30 - CERVICAL SPIIIE , A/P
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EXPOSURE AT SKIN ENTRANCE (mR) EXPOSURE AT SKIN ENTRANCE (mR) EXPOSURE AT SKIN ENTRANCE (d)
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EXPOSURE AT SKIN EIITRANCE (mR) EXPOSURE AT SKIN ENTRANCE (mR) EXPOSURE AT SKIN ENTRANCE (mR)
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EXPOSURE AT SKIN ENTRANCE (mR) EXFOSURE AT SKIN ENTRAIICE (mR) EXPOSURE AT SKIN ENTRANCE (mRj
Figure V. Exposure at skin entrance (ESE) for various examinations (mR).(Exposure determined as "free-in-air"): (arrow refers to
mean exposure value).
[u91
changed significantly from those identified in the Beijing. China [J4]. These results are not significantly
UNSCEAR 1977 Report. different from results in other countries. Mean skin
doses for five common diagnostic examinations in the
60. F o r purposes of this Annex. in order to be able United Kingdom have been reported by Harrison
to compare results from different studies. exposures [H2]. These data indicate a n approximately tenfold
measured free-in-air have been converted to skin range in dose within one country. with almost all of
exposure using a backscatter correction factor of 1.3. the distributions showing a long tail that extends into
The skin exposures were then converted to skin dose the upper range of doses. Absorbed doses reported for
equivalent utilizing an absorbed dose t o exposure a given examination also differ significantly between
conversion factor of I rad per roentgen o r I centigray countries.
per roentgen. Mean skin doses in the primary beam
for various diagnostic x-ray examinations have been 61. In addition to actual measurements a n d surveys
measured in Canada, Italy, Poland. United Kingdom made of doses received from radiological examina-
a n d the United States (Table 17). Skin doses were tions. simpler methods have been described involving
measured by placing thermoluminescent dosimeters the use of nomograms to estimate exposure o r
(TLDs) on the skin surface of 1,340 patients during absorbed dose from machine parameters. Veitch et al.
22 types of diagnostic radiographic examinations in [V6] investigated the use of nomograms for estimating
the exposure to the skin of a patient from three-phase beam direction. length of examination time. field size
equipment. Substantial work had been done years ago and positioning in the course of examination. During
on single-phase equipment [S22, M241. More recently, standard radiographic procedures, matters such as the
Edmonds [El] described a simple and rapid method incident exposure side of the patient are quite straight-
for calculating patient skin doses based on peak forward, but during fluoroscopic examinations the
voltage, current, source skin distance a n d filtration. In incident and exit sides of the patient are often
fact. the method provides a quick estimate of exposure. changing. The length of time that a fluoroscopic
although it may overestimate the dose for three-phase procedure takes, and thus the resulting absorbed dose.
x-ray equipment by a factor of nearly 4 [S12]. A varies widely depending on the complexity of the
nomogram for estimating skin doses in x-ray diagnostic examination, the co-operation of the patient and the
examinations has also been published [Wl]. skill of the operator of the equipment. Harrison [HZ]
has reported total fluoroscopic screening times used in
62. Absorbed doses in various organs are needed in the United Kingdom for a barium meal examination.
order to calculate the effective dose equivalent. The The average time was 146 seconds, but the range was
organs of interest include the thyroid, bone marrow, 1-620 seconds. Rowley et al. [R9] have also reported
the lungs, the female breast and the gonads. A Monte the median exposure times for various fluoroscopic
Carlo computer technique and a mathematically examinations in local areas of England. They report
describable anthropomorphic phantom have been the following: barium swallow, 180 seconds; barium
developed and can be utilized to calculate tissue-air meal. 180 seconds; and barium enema. 150 seconds.
ratios for selected organs v 4 , R8]. Drexler et al. [DS], Little difference in time was noted in relation to the
Jones [J 101 and Kramer [K 163 calculated organ doses sex of the patient. however, males consistently received
for x-ray diagnosis utilizing Monte Carlo methods for higher absorbed doses due to larger body size. Longer
both male and female phantoms designed according to screening times of 337 seconds for a barium enema
ICRP reference persons. By utilizing these techniques, and 240 seconds for a barium meal are reported by
one can derive mean absorbed doses in a number of Pandovani [PI] in Italy. Maccia et al. [MI. M2] have
organs, normalized to unit exposure measured free-in- reported on the use of fluoroscopy in France: their
air under different conditions of beam quality and mean fluoroscopic times for various examinations are
field size. These provide information for thyroid, bone shown in Table 18. It is of interest that fluoroscopy is
marrow, lung, female breast and gonads. Williams used to position or centre patients in 2550% of
et al. [ W l q constructed three-dimensional phantoms examinations that are usually considered radiographic
using computer tomographic data from patients, examinations.
which allows very accurate calculations of absorbed
dose in organs. 66. In general, fluoroscopic procedures result in
much higher doses t o the individual patient than most
other types of standard radiographic examinations.
63. Monte Carlo calculations of organ doses take For this reason. the achievable dose reductions could
into account only the primary radiation and radiation in principle be larger. Several authors investigated the
scattered within the patient. The scattered radiation effect of variation in equipment design on patient
a n d leakage radiation from the diagnostic source dose. Tole [T4] reported that fluoroscopic machines
assembly, as well as other stray radiation. is usually with the tube placed over the table often give
not included. When theaorgan of interest is within the substantially higher organ doses (particularly t o the
useful beam. stray radiation is not likely to account male gonads) than machines with the tube under the
for more than 1% of the organ dose. However, when table. This occurs because for most fluoroscopic
the organ of interest is at least several centimetres examinations the patient is in the supine position o r
outside the useful beam, neglecting the contribution facing forward and the male gonads are relatively
from the stray radiation may result in underestimating anterior in location and closer t o the x-ray tube a s well
organ dose by as much as 25-5096 [B5]. T o account as being unshielded. Zeck and Young [Z3] pointed out
for this, international [I31 and national [D4] standards the very high radiation levels that can be associated
required for equipment restrict the dose rate outside with C-arm fluoroscopes. In general. the minimum
the beam to 1 per hour and require efficient colli- source-skin distance for a C-arm device is 30 cm.
mation. Spacers are usually used to maintain this distance but
are sometimes removed and not replaced. If the
64. It is much more difficult to calculate organ doses patient is then positioned close to the tube, the
when fluoroscopy is utilized. The reason for this is entrance skin exposure rates will be much higher than
that automatic brightness controls are often used for usually calculated.
fluoroscopic examinations, and the exposure rate and
beam quality change as the beam is moved. Thus. 67. Fluoroscopy times accompanying coronary angi*
even when exposure parameters are known and grams are usually about 10-20 minutes [A3]. Cascade
exposure times recorded, the confidence limits on the et al. [C5] have recently reported exposures and
absorbed doses from fluoroscopy are larger than those fluoroscopy times for the relatively new technique of
from radiography. T o overcome this difficulty (at least percutaneous transluminal coronary angioplasty. In
partially), area exposure product meters can be used this technique. fluoroscopy is utilized to monitor the
1141. progress of a balloon catheter introduced in order to
dilate one or more stenotic coronary arteries. When
65. Fluoroscopic examinations also present other only one stenosis was dilated, the fluoroscopy time
unique problems due t o the continuous changes in was 36 minutes and skin dose was 0.5 Sv. When two
stenoses were dilated, the fluoroscopy time was utilizing photofluorography. Maruyama et al. [h113]
51 minutes and patient skin dose was 1.0 Sv. Similar have indicated that 4.1 million such examinations
data have been reported by Faulkner [F2]. were performed in Japan in 1980: this represents
about one examination per 30 people. The collective
68. While technical parameters affecting absorbed effective dose equivalent from this practice was
dose are relatively well known in some countries, the estimated to be about 16.000 man Sv.
technical factors used for specific examinations are
often unknown. Large portions of the population 72. Knowledge of absorbed doses to the uterus,
receive uncertain but possibly large doses. For example. embrvo and foetus is useful in situations where a
Hussain [H22] surveyed x-ray installations in Bangla- pregnant woman has been exposed to diagnostic
desh and reported that the current and voltage x rays. Glaze [G4] and Drexler [D5] described a
indicators on many machines did not work at all and computer-assisted procedure for estimating both patient
that over 40% of machines either had no collimator or exposure and foetal dose from radiographic examina-
that i t was not functional. Thus the exposure at skin tions. The dose incurred in paediatric x-ray examina-
surface, field size and location of the centre of the tions is also of interest since a large portion of the
field are generally not known. Under these conditions, child's body is often included in the primary beam
calculations of absorbed doses to various organs or [N2]. Morris [M36] calculated doses in .Australia for
determination of effective dose equivalent are virtually patients in the age group 2-4 years and for those under
impossible. the age of two. Similar Monte Carlo calculations are
also ;vailable to assess the doses from paediatric x-ray
69. Similar conditions were described for India by examinations to the total body. bone marrow, thyroid,
Bhargava [B16]. In a survey of diagnostic x-ray lungs, ovaries and testes [G5]. For typical examina-
installations. 20% of the machines produced excessive tions in paediatric x-ray diagnosis. Williams et al.
exposure during fluoroscopy and showed excessive [W16] and Zankl et al. [Z2] used a Monte Carlo code
leakage from the tube housing. In 20% of the to calculate the doses to a baby and child phantom
machines neither cones nor collimators were used to constructed from tomographic data.
control the beam size. Das et al. [Dl], reporting on
exposure to the patient's skin for various examinations 73. Radiation doses to neonates requiring intensive
in India, indicated that a fluoroscopic examination of care were examined in the United Kingdom by
the chest results in a skin dose of approximately Robinson et al. [R5]. These babies are of particular
120 mSv. concern since they may receive larger numbers of
radiographs than adults. and the treatments often
70. In Beijing. China, Sun [S32] has measured skin include barium examinations and computerized tomo-
exposure during 2,395 fluoroscopic chest examinations graphy scans. The marrow dose from all examinations
at 44 hospitals, and he reports mean skin doses of was found to vary approximately inversely with birth
about 10 mSv. Wu et al. [W23] have reported on skin weight. In addition, children with lower birth weight
exposures in 370 patients who had various upper received more examinations (Table 19). Gustafsson et al.
gastro-intestinal examinations in China. For most [G8, G9] have examined the relationship between body
examinations. the skin doses were 50-180 mSv. Weng weight and energy imparted for children of various ages
and Wu [W 1 I] measured skin exposures for 30 patients and body sizes. The energy imparted was less per
in China having cardiac catheterization. The skin dose kilogram for the older and larger children. There was,
in the field was 100 mSv for the fluoroscopy alone and however, substantial variation in energy absorbed for
an additional 260 mSv for the radiographic portion. children of the same weight. This variation was
All these measurements were made on the skin surface ascribed to technical factors, such as beam collimation.
utilizing thermoluminescent dosimeters. Because the Gustafsson also discussed the relationship of beam
use of fluoroscopy is still widespread in developing direction to dose. Performing a chest radiograph in
countries where data are scanty, the absorbed dose to the posterior/anterior projection causes relatively larger
the population may be estimated only very roughly. dose to the bone marrow than when i t is done in the
anterior/posterior projection. The latter projection,
71. Absorbed dose from mass screening esamina- however, delivers a larger dose to the breast and
tions continues to be of interest to the Committee. thyroid. Lcibovic et al. [L4] reported on paediatric
The average skin dose equivalent in the field for a angiocardiography procedures, which provide the
mass chest x-ray examination in Japan in 1980 was highest exposure per examination of any diagnostic
1.5 mSv for adults and about 0.8 mSv for children paediatric procedure. The authors noted that as much
[K22]. In many countries mass chest screening is often as 25% of the exposure from such examinations was
performed with photofluorography. Bengtsson et al. contributed by manual test exposures to adjust the
[B13] have indicated that the average dose to the technique. The average dose rate to the skin in the
breast from such examinations is about 2.0 mSv. posterior/anterior projection for cine filming was
almost as high as the absorbed dose from a mammo- 0.7 mSv per second and in the lateral projection
gram. The effective dose equivalent for chest x-ray 2.1 mSv per second. Fluoroscopy exposure rates were
mass screening in France has been reported to be approximately 5% of this.
0.07 mSv for radiography, 0.32 mSv for photofluoro-
graphy and 0.98mSv for fluoroscopy [LS]. The 74. Of special interest is the dose received by the
collective effective dose equivalent for this practice in breast in mammography. Bates [B3] has reported on
France in 1980 was about 4,500 man Sv. In Japan. skin exposures in 27 screening centres in the United
mass screening of the stomach is often performed States. The results showed that a substantial reduction
in exposures and tissue dose was achieved during the radiography. In most radiography, the dose is highest
course of this project. Rimondi [R3] has reported on the incident side and lowest on the exit point; in
doses from mammography in Italy. He indicated that. most computerized tomography. the dose is lowest at
even with the same type of x-ray apparatus and film- the centre of the body section studied. The effective
screen combination, very different exposure values dose equivalent and absorbed dose from various com-
were obtained, ranging over two orders of magnitude. puterized tomography procedures have been derived
Skin doses in this survey ranged from 2 to 220 mSv. by Stieve [S3 I].
The mid-plane doses were from 0.18 to 1 1.1 mSv.
80. The x-ray beam of a computerized tomography
75. Hammerstein [HI] and Stanton et al. [S26] unit is usually highly collimated. but the eye may be in
reported doses measured in a breast phantom designed o r near the primary beam on scans of the brain o r
to simulate a breast with a uniform mixture of equal face. and the dose to the eye is of particular interest
amounts of adipose and glandular tissue. Similar for radiation protection purposes. Lund et al. [L6]
results have been reported by Panzer [P5] from a and Kronholz [K 181 indicated. for brain computerized
study of 170 facilities in the Federal Republic of tomography, that although slice thickness and patient
Germany. Average glandular doses for non-screen position have some effect on the absorbed dose in the
films ranged from 5 to 35 mSv with a median value of lens of the eye. the greatest doses are those received
16 mSv. and for screen-film systems from 0.8 to when the scan is done with the gantry angled
19 mSv with a median value of 6.6 mSv. Zuur [Z12] downwards in relation to the orbito-meatal (from the
reported similar dose values from 12 institutions in the outer corner of the eye to the external ear canal) line.
Netherlands, ranging from 1.0 to 8.8 mSv. In this circumstance the eye is included in the primary
beam. This positioning factor caused the dose to the
76. Sato [S2] carried out a survey o n the radiographic lens of the eye to increase by a factor of 2-4 compared
technique and frequency of mammography in Japan. Of to standard orbito-meatal scans. Doses to the lens of
the 75 institutions surveyed. 45 utilized intensifying the eye from cranial computerized tomography are in
screens and film for mammography, 30 used a non- the range of the absorbed dose from other neuro-
screen system and 20 did not have any special apparatus radiological procedures. Isherwood et al. [I51 indicated
for mammography. There were approximately 2.9 expo- absorbed doses to the lens as follows: orbital hypo-
sures per examination, or 1.5 exposures per breast. cycloidal tomography, I20 mSv; petrous bone tomo-
graphy, 100 mSv; cerebral angiography. 50-100 mSv:
77. Gannon [GZ] reviewed the equipment perfor- pneumo-encephalography, 20 mSv; and skull exami-
mance at 28 mammography centres in the United nation, 15 mSv. Panzer [P4] collected dose values
States. In this study the actual peak voltage was from 120 facilities in the Federal Republic of Germany.
measured and compared to the dial reading on the Preliminary results show a large variation in the dose
xerox-mammography-type machines. In most cases values (free-in-air) on the axis of rotation. from 10 to
the desired peak voltage was between 36 and 50 kVp. 200 mSv per slice. with a median value of 30 mSv. By
In only one case was the measured peak voltage that calculations using Monte Carlo methods. the dose
which was actually desired; in some instances the peak (free-in-air) can be converted into organ doses [D5].
voltage differed by as much as 7 kV from that set on
the machine. Such differences significantly affect 81. The radiation doses to variorls organs for the
image quality. The two-view (mediolateral and cranio- types of computerized tomography scanners used in
caudal) mid-line (3 cm depth) dose measured in a Japan have been published by Nishizawa et al. [NIO.
phantom ranged from 2.5 to 1 1.6 mSv. N 1 I] and are given in Table 20. While the exact values
depend upon the technique and the type of scanner,
78. The use of grids in mammography has been the values presented are in general consistent with
advocated to improve image quality and to reduce those reported by other authors [BI, C8, E7, E8, G3.
scattered radiation incident on the image receptor. 15, M20, M25, S 10. S 1 1 , S24, S35, W 121. McCrohan et
Kirkpatrick [K I I] measured the effect of such grids on al. [ M 161 surveyed 250 computerized tomography
patient dose. He showed that. although there was a systems in the United States to determine the radiation
gain in image quality, absorbed doses were approxi- dose from a head scan. For the typical adult scan the
m a ~ e l ythree times higher, unless there was a significant absorbed dose was 22-68 mSv; doses varied by a
change in exposure parameters. Whether the improve- factor of two for the same manufacturer and model of
ment in image quality was worth the increased dose was machine. Beck et al. [B4] have devised a Monte Carlo
not indicated, although the use of grids is usually model for absorbed dose calculations in computerized
restricted to circumstances where the thickness of the tomograph y.
compressed breast exceeds 5 cm.
82. There is a trade-off between image noise and
79. Measurement of absorbed dose from the newer radiation dose [TS]. All calculations used by the
technologies has also been a matter of concern. In the computer to construct the image are limited by the
UNSCEAR 1982 Report, the large amount of literature statistical distribution of the detected photons. Several
reviewed indicated that the dose to the skin from a attempts have been made to reduce the dose through
computerized tomography scan could be as high as various technical modifications. Dose reduction can
560 mSv, although in clinical practice the absorbed be achieved by radiating and collecting data only
doses were mostly around 60 mSv. The dose distribu- during a portion of the scan cycle. Oppenheim [ 0 5 ]
tion within the body from computerized tomography found that artifacts caused the method to be of limited
is markedlv different from that from conventional usefulness. More recently, Stanton et al. [S27] devised
a method that collects data over the entire scan but an increase in the dose from pantomographic exami-
exposes the region of interest to a higher dose than nations, from 0.3 mSv in 1973 to 0.8 mSv in 1981.
other anatomical structures within the scan volume.
This is accomplished through the use of a variable 87. Weighted dose equivalents in the United King-
thickness filter: dose peak reductions of up to 80% are dom have been calculated by Wall et al. [W3]. These
claimed for head scans. ,Moseley et al. [M37] discussed values are 20 pSv for intra-oral examinations consisting
various methods of reducing radiation dose in the of two films, 3 0 p S v for extra-oral examinations
management of intracranial lesions that are clinically consisting of two films and 80 pSv for one pantomo-
followed by use of computerized tomography, but graphic film. They estimated the collective weighted
they did not report any quantitative dose reduction dose equivalent to the population of the United
factor. McCullough [.M23] suggested that the per- Kingdom to be 212 man Sv. The mean dose equivalent
formance of each computerized tomography scanner to various organs per dental examination is shown in
be specified and checked in order to ensure a typical Table 2 1.
level of performance and to provide a baseline value
for a programme of quality assurance. Parameters 88. Pellerin et al. [PI01 reported on exposures in
tested usually include slice geometry, patient dosage, both phantoms and patients for various types of
artifactual behaviour and contrast detail performance. dental examinations in France. The intra-oral exposure
was the most commonly used and delivered a maximum
83. Digital medical radiographic systems are now dose to the skin of about 15 mGy. The pantomo-
becoming available in most developed countries. The graphic view gives a picture of the entire dentition but
contrast resolution of such instrumentation is limited delivers a dose of approximately 10 mSv to three intra-
primarily by quantum mottle. Rimkus et al. [R4] cranial "hot spots". Tingey [T2] has re-emphasized the
indicated that the number of meaningful levels of grey need for quality control procedures to reduce the
that are imaged will significantly affect the radiation exposure factors and also to avert repeat examinations.
dose. For example. if 128 meaningful visual shades of
grey o n an image require a dose of 17 mSv to the 89. Dosimetry in panoramic examinations has also
patient, simply raising the level of contrast resolution been studied in the Soviet Union by Trunov et al. [T8]
to 256 shades of grey will increase the dose by a factor and Kirko [KlO] utilizing thermoluminescent dosimetry
of 5-10. However, since such contrast resolution is and anthropomorphic phantoms. The radiation dose
rarely needed for diagnosis. this is an area where was 15-20pSv per film for examinations of the upper
unnecessary dose can be avoided. jaw and 25-30 pSv per film for examinations of the lower
jaw. The thyroid doses were 40-180pSv and gonadal
84. The frequency of dental examinations was dis- doses were 13- 150 pSv.
cussed in section I.A. Data on dental exposures are
available from the Nationwide Evaluation of X-ray 90. Hayami [HI21 recently devised a Monte Carlo
Trends (NEXT) survey in Canada [C2]. For a dental computer programme t o estimate exposure t o the head
bite-wing posterior examination, a dose a t skin entrance and thyroid for panoramic intra-oral x-ray tube
was recorded with a minimum of0.56 mSv, a maximum radiography. With 55 kV (kilovolts) and 0.5 mAs
of 43 mSv and a mean of 4.7 mSv. For periapical (milliampere seconds), the energy imparted for a routine
examinations, the maximum was 2.6 mSv, the mini- examination was 2.1 m J to the head from eachexposure
mum was 0.57 mSv and the mean was 2.2 mSv of the mandible and maxiila, about 8.5 p J to the thyroid
(standard error 1.1 mSv). Results from 200 dental from a mandibular radiograph and 1.7 p J to the thyroid
facilities in the Federal Republic of Germany were from a maxillary radiograph.
reported by Panzer [P6]. Entrance doses for examina-
tions of a molar tooth ranged from 2.5 to 45 mSv with
a median value of 8.5 mSv. Comparison with earlier E. CAUSES O F DOSE VARIATION A N D
results (1970) showed a remarkable decrease in entrance POSSIBILITIES FOR DOSE REDUCTION
doses.
9 1. Some possibilities for dose reduction are found by
85. In Japan [MI I], the annual per caput doses for examining the causes of variation in dose for a given
dental radiography were estimated to be 0.09 Sv examination. Dose reduction cannot be taken as an
(genetically significant dose) and 13 Sv (mean bone ultimate goal in medical radiation since the images
marrow dose). Iwai [I61 compared absorbed doses to generated must have sufficient informational content to
the gonads and to bone marrow for both intra-oral be of diagnostic value. An underexposed radiograph
and panoramic dental examinations and reported the that cannot be interpreted is of no value to the patient
total risk for intra-oral examinations to be lower than even though the absorbed dose is low. Many aspects of
the dose for the less frequent panoramic examinations. image quality and its assurance were discussed at a
seminar organized by the Commission of the European
86. Radiation doses from dental x-ray examinations Communities [C 101. The actual assessment of priorities
were discussed in detail in the UNSCEAR 1982 and analysis of cost versus benefit in this regard is
Report [U5]. The radiation exposure for dental films beyond the scope of this Annex. Such analyses would be
may be decreasing somewhat. The Nationwide Eva- highly dependent on the availability of operating
luation of X-ray Trends (NEXT) programme in the equipment a n d the knowledge of health care practi-
United States [U9] indicated that the mean dose at tioners of a given country. There certainly are, however,
skin entrance from dental bite-wing posterior films some simple and low cost methods that can be used to
was 9.1 mSv in 1973 and 4.3 mSv in 1981. There was substantially reduce absorbed dose. Russell [RlO] has
presented one form of methodology that could be twice as much radiation given as needed (Figure VI).
utilized for such assessments. The shift from circular to rectangular collimation for
chest radiographs in the United States is shown in
92. Wall et al. [W3] have discussed a number of the Figure VII and the resultant reduction in the amount
factors involved in dose reduction. There have been of x rays utilized is shown in Figure VIII. The
many changes in diagnostic radiology techniques over situation is somewhat different with fluoroscopy. In
the past 20 years, many of which might be expected to this case the collimators are usually rectangular while
have had a significant effect on patient doses. The trend the image intensifier is circular. If the operator wishes
towards faster films and the advent of highly sensitive to use the whole of the circular image, there is about
rare-earth screens should have resulted in lower 25% additional and unnecessary radiation.
exposures per radiograph. However, the adoption of
96. Use of lower voltage for a given study will
rare-earth screens has been very slow; for example. only
five out of 21 hospitals surveyed in the United Kingdom require higher entrance surface doses. Contento et al.
[Cl 11 have reported that in France softer x-ray spectra
[W4] used them at all, and then only for obstetric
are used for a given examination than in Great Britain
examination or casualty work. High cost and poor
and Italy. The voltage and radiation output variation
spatial resolution due to quantum mottle are the most
of s-ray machines have been studied by Henshaw
common reasons for their poor acceptance. Use of such
[ H 131 and Pauly [P9]. They observed variations from
rare earth screens appears to be higher in Italy [Cl I].
the desired voltage. ranging from 5% to 20% or more
The use of new materials (such as carbon fibre) for
and averaging approximately 10%. Belletti et al. [B7]
construction of table tops, grids a n d film cassettes has
the potential to reduce patient dose by 30-50% [H191.
Dose reductions in pelvimetry have been marked in the
United Kingdom and the United Stares, as a result of
fewer examinations. feuer projections a n d the increased
use of ultrasound.
Wasted
93. An appropriate combination of radiography and
Needed
fluoroscopy can result in dose reduction, particularly
for examinations of the gastro-intestinal tract [S28].
Fluoroscopic screening times have not decreased [W4],
and therefore the hoped for dose reduction owing to the
increasing use of image intensifiers has not materialized
in the United Kingdom. In some departments automatic
brightness controls are allowing examinations to be
conducted in ambient light rather than in a darkened
room. This increases the absorbed dose to the patient.
Maccia et al. [MI] have reported the percentage of the Circular Rectangular Positive
beam beam beam
collective effective dose equivalent in France that is limitation
contributed by fluoroscopy (Table 22). It appears that
Figure VI. Mean ratio of beam area to film area for chert
about 5.000 man Sv are contributed by the use of
x rays in the Unlted Slates, 1977-1983.
fluoroscopy to position patients prior to routine film 1571
radiography.
o Females
Males
A
1.4 -
> 1.2-
--
W
1.0- (> 60 years)
g 0.8 -
Y,
0.6 -
0.4 -
0.2 -
0 I I I I I I I I
0 5 15 25 35 45 55 65 75
AGE ( y e a r s )
Figure IX. Average annual dose equivalents to the gonads in France.
tBl01
500 - 110. Stochastic risk estimates of various types for
Japan have been published by Hashizume [H3. H41.
Annual per caput bone marrow dose in Switzerland
-
>
2 400 - was reported by Poretti [PI41 as 0.63 mSv in both
W
197 1 and 1978. The average active mean bone marrow
0
'A
dose to the United States population from radiological
0
& 300
u
- procedures in 1980 was about 1.3 mSv if the method
U of Shleien et al. [S9] is used for calculation. This
I=
Z
compares with 0.83 mSv in 1964 and 1.0 mSv in 1970.
I3
;
; ZOO - Estimates of mean per caput marrow doses are very
> dependent upon the modelling parameters utilized.
-
-
<
I
1
While the relative contribution by examination type
U
- does not change appreciably according to the method,
2 100
the numerical quantity obtained is significantly different
z
W
0 [R8, S9].
0 - 111. Beentjes et al. [B6] reported that the annual per
Flgure X. Annual genetically slgnllicant dose in various
caput "somatic effective dose" in 1980 in the Nether-
counlrles. lands from diagnostic radiology was about 0.5 mSv
[a101 and that the average somatic dose per examination
was approximately 0.8 mSv. The somatic effective
four common examinations. Gonadal shielding reduced dose was defined as the uniform whole-body dose that
gonadal doses by a factor of 2-10, depending upon the would cause the same somatic risk as the actual non-
examination and on the distance of the gonads from uniform dose from the x-ray examinations.
the area of interest being radiographed.
112. A somatic dose index has also been proposed
108. According to estimates made by Kudritsky et [L7] that utilizes individual organ doses weighted
al. [K19, K20] for the Russian Soviet Federative according to sex-dependent factors for the relative
Socialist Republic. the trend is towards a gradual radiation risk and not weighted for the gonads. Kaul
increase in the mean per caput gonadal dose. During et al. [K4] compared the ICRP weighting factors and
1970-1980. this increased by nearly 50%. probably the modifications occurring when the genetic risk is
owing to an increase in the number of special neglected: their conclusion is that excluding the
examinations and in examinations of the digestive genetic risk has an effect less than the uncertainty
organs and the osteo-articular system. The value of the involved in the calculation of the absorbed dose to an
genetically significant dose also changed. I t increased by organ.
0.06 mSv during the decade, mainly as a consequence
of examinations involving radiation of the pelvic 113. Calculations of effective dose equivalent from
region (Table 28). diagnostic procedures must include an analysis of the
dose distribution within the body. The dose equivalent
109. The genetically significant dose includes only in an organ. T. for a given radiographic examination
absorbed dose that can be expected to affect the must be obtained by the formula:
progeny; it does not take into account the somatic
effects in the exposed population. Examples of the
limitations of the genetically significant dose concept
in practice have been given by Kaul et al. [K3]. In where k is the type of view involved in the esamina-
cases of a simultaneous increase in both the rate of tion. nk is the number of films for the view k; DT.i is
examinations involving ionizing radiation in a given the average absorbed dose in the organ for view k.
population and the number of alternative procedures and Q is the quality factor. Q is 1.0 for x rays used in
applied in paediatric examinations in the same popu- diagnostic radiology.
lation, the genetically significant dose may lead to a
misinterpretation of population exposure. Kaul et al. 114. The effective dose equivalent, Ht. for an
[K4] have therefore recommended that when sources of examination of type 1 is obtained from the following
radiation exposure are being compared, the genetically equation:
significant dose should be indicated with estimates of HE.I = wTHT.I (7)
somatic radiation exposure. The authors also pointed
out significant limitations in the use of the genetically where w7 is the weighting factor for each organ given
significant dose, particularly in countries where the in ICRP Publication 26 [12]. One rnain difficulty
age distribution changes with time. Under such encountered by most authors has been i n selection of
circumstances the genetically significant dose alone is the "remainder" organs as required by the ICRP
an unreliable indicator of the state and trend of definition, which may change from one examination
medical radiation exposure; comparative evaluations to the next. The selections. however, are not consistent.
of mean radiation exposure in different populations Some potential solutions to this problem have been
will also be of limited value. The latter point will suggested by many groups, e.g.. Stavitsky et al. [S29].
become more important over the next several decades, In many published articles in which effective dose
when the world's population is expected to age equivalents have been reported, the methods for
markedly. choosing remainder organs are not given.
115. Calculations of the effective dose equivalent for 119. The energy imparted during a radiographic
different types of examinations in Poland in 1976 and procedure has been suggested as an approach to
in Japan in 1979 were included in the UNSCEAR estimating radiation risk. This method ignores the
1982 Report [U5]. Since that time, there has been one different sensitivities of individual body organs and
additional publication from Poland [Jl], in which the calculates the energy imparted during a given proce-
effective dose equivalent per adult in 1976 was dure. It is attractive since it avoids the problem of
estimated to be about 1.7 mSv. Vano et al. [V4] calculating mean radiation doses to large organs [P8].
reported an annual per caput dose equivalent of Bengtsson [B 121 and Shrimpton [S 13, S 141 have
0.8 mSv for Spain and a collective effective dose already reported a reasonable correlation between the
equivalent of 32,500 man Sv. mean energy imparted and radiological risk. Over a
range of two orders of magnitude in dose, mean
116. Reported annual effective dose equivalents for energy imparted correlates with the quantity effective
different examinations are shown in Table 29. Values dose equivalent within factors of 2 o r 3 [S14]. There is
generally range from 0.1 to 10 mSv. also a reasonable correlation between the energy
imparted and the somatic effective dose. However,
117. From diagnostic x-ray examinations of the Huda [H 151 has examined this approach with respect
population in France in 1982, the collective effective to computerized tomography scanning and concluded
dose equivalent was 86,000 man Sv. or an annual per that it can lead t o large errors in patient risk
caput effective dose equivalent of 1.6 mSv [BI]. In estimates.
France the examination with the largest percentage
contribution to the collective effective dose equivalent 120. Various other weighting factors can be utilized
is intravenous urography, whereas in other countries, in an attempt to represent the impact of medical
such as Japan and the United States, barium enemas radiology in a more accurate fashion than can be done
a n d upper gastro-intestinal examinations play a larger with the effective dose equivalent. As a first approxi-
role. Even from one highly developed country to mation, one could take the effective dose equivalent
another. the per caput effective dose equivalent may for the mean age of the population having a certain
vary by up ti a factor of 5. Some of these differences examination, multiply this by the specific rate for that
are certainly due to the number of examinations and examination and by absorbed dose. A second approxi-
to technical differences (beam quality, collimation mation would use the total age-specific weighted dose
etc.). In addition, hourever, Benedittini et al. [BIO] equivalent but would not use organ-specific risk
indicate that there have been significant differences in factors. A third approximation could take sex into
the calculations of effective dose equivalents in specific account as well by assuming a standard ratio of males to
organs by various authors. Benedittini et al. [Bll] females having a specific examination. The greatest pre-
reported on the absorbed doses to patients from cision would be obtained by a fourth approximation
dental radiology in France in 1984. The collective which would apply age-specific and sex-specific weight-
effective dose equivalent was estimated as 2,000 man Sv ing factors for each organ. Such weighting factors would
a n d the per caput effective dose equivalent as 0.037 mSv. be multiplied by the known dose to each organ for
Although pantomographic examinations accounted each examination type as well as each examination
for only 6% of the total number of examinations, their rate.
higher absorbed dose caused them to contribute 29%
of the collective effective dose equivalent. Nikitin et al. 121. For a population of both sexes and a certain
[N8. N9] a n d Vorobyev et al. [V7] reported a per age distribution. the ICRP risk coefficient is normally
caput effective dose equivalent of about 1.5 mSv for utilized. T o calculate the expected number of deleterious
the USSR. In 1981 the collective effective dose effects. n, after irradiation, Bengtsson et al. [B14] use
equivalent was estimated at about 400.000 man Sv. the formula
n = RHEN = RS (3)
118. I t should be noted parenthetically that it is
unconlmon for a person to receive the "average" per where R is the risk coefficient, N is the number of
caput effecti~ge dose equivalent calculated for the individuals in the group and S is the collective
country in which he is living. Some authors have effective dose equivalent. If age and sex are to be
reported their findings as collective effective dose taken into consideration, one can have groups i,-,.
equivalents. Once this quantity has been derived for a Additionally for each organ or tissue T. the risk in a
given country, it can be divided by the population to given tissue per unit dose equivalent can be defined.
obtain the per caput effective dose equivalent. Although One can then apply a series of risk factors for each
in highly developed countries the frequency of dia- tissue as a function of that tissue and age and sex of
gnostic medical examinations may approach one the individual. This would be expressed as r , ~ .T h e
examination per person per year, it is unlikely that probability of deleterious health effects in a given
more than 2 5 5 0 % of people will actually have one tissue would be expressed as the product of r i and~ HE
examination in a given year. In less developed in that tissue. Thc probability of a deleterious effect in
countries (health care levels 11-IV), the situation is all tissues of a given individual in an age group would
even more extreme, with perhaps only 1 person in be given by
-
1,000 actually receiving an examination in a given year. nI = r r i T H T i (4)
T
Under such circumstances the person undergoing the
Similarly, the expected number of deleterious effects
examination would receive 1,000 times the average per
for all persons in group i would be given as
caput effective dose equivalent or genetically signi-
ficant dose, while 999 persons would receive no dose.
where r i is~ the risk coefficient in tissue T. HI, is the countries. As was pointed out earlier. Zhang [Z4]
dose equivalent in tissue T and Ni is the number of estimated that in China chest fluoroscopy accounts for
individuals in group i. In a similar fashion. the 70% of all examinations performed and that !he
expected number of deleterious effects produced by associated absorbed dose is at least 15 times higher than
examinations of type J in the total population would that for chest radiography. It must be remembered in
be given by this connection that China accounts for approximately
-
n~ = f P~T~T~J~IJ (6) 20% of the world population.
This could also be written as 125. Faced with these difficulties. the Committee has
n , = S; R decided to calculate upper and lower limits for the
effective dose equivalent and genetically significant
where S; is the collective reference population dose for dose for medical diagnostic radiography ivorid-wide
examination J. rIT/R could also be termed "f factor" (Table 32). Calculations were performed by two
rather than weighting factor. methods, Method 1 is based on the frequency ot'
examinations at various levels of de\~elopmrint.and it
122. This appears to be quite precise in theory assumes that the average doses for a given examina-
although. as was pointed out earlier. there are many tion are comparable in countries of differing levels of
uncertainties in the exposure factors, the absorbed health care. This method leads to a lower limit of
dose t o various organs and, particularly. the rissue- approximately 1.8 10" man Sv for the effective dose
specific risk factors in the presence of disease. The risk equivalent and of 0.5 lob man Sv for the collective
factors used for this model were derived for continuous genetically significant dose equivalent. Method 2
exposure of a working population and not for assumes that although examinations are less frequent
exposures received over a short time. Therefore, the in countries of health care levels 11. 111 and IV, the
risk derived is at best semi-quantitative. In a popula- absorbed doses are 10 to 20 times higher than in level I
tion with a very skewed age distribution, the use of countries primarily because of the extensive use of
collective effective dose equivzlents may lead to an fluoroscopy and poorly calibrated machines. This
overestimation of detriment by a factor of between method yields upper lirnits of 5 lo0 man Sv for the
1.5 and 3 [J8, M291. The applicability of the concepts collective effective dose equivalenr and 1.5 lob man Sv
of effective dose equivalent and risk-weighted dose for the genetically significant collecti\,e dose.
equivalent quantities to medical radiation have been
examined by Drexler [D6], Ivanov [IS] and Kramer 196. Data on the effective dose equivalent and
[K 141. genetically significant dose from dental radiography
are uncvcn and come only from countries of level of
health care I. Since it appears that fltloroscopy is not
G. WORLD-WIDE ESTIMATES O F DOSES widely used for dental purposes, one might assume
FROM DIAGNOSTIC X-RAY EXAMINATIONS that the per caput and collective doses for countries of
health care levels 11, 111 and IV are related pre-
123. In spite of the difficulties mentioned in the dominantly to the frequency of examinations. The
preceding secrion, an attempt is made here to derive genetically significant dose from dental radiography in
per caput and collective effective dose equivalents level I countries appears to be about 1/10.000 of that
from diagnostic x-ray examinations. The reported from medical diagnostic radiography. Estimations of
annual per caput doses for countries having various the per caput and ~vorldwide effective dose equivalent
levels of health care are shown in Table 30. For health and gcnctically sipificant dose for dental radiography
care level I countries. the effecrive dose equivalent and are shown in Table 33. The annual collective eifective
genetically significant dose agree reasonably well. In dose equivalent world-wide from dental radiograph! is
these countries the average per caput efr'ective dose estimatsci to be about 17,000 man Sv with an annual
equivalent is approximately 1 n1Sv and the genetically genetically significant dose of 0.04 jrSv.
significant dose is approximately 0.3 mSv. An analysis
of diagnostic x-ray examination frequencies and con-
tributions to absorbed doses in countries of health
care level I is shown in Table 31. In previous H. OCCUPATIONAL EXPOSURE
FROM DIAGNOSTIC RADIOGRAPHY
UNSCEAR Reports it was been assumed that in less
developed countries the collective effective dose equi-
valent would be lower. perhaps by an order of 127. In the UNSCEAR 1982 Report [U5],occupa-
magnitude, due to the lesser frequency of radiological tional exposure was considered in a separate .4nnex.
examinations. This would appear to be true according For this report. however, occupational exposures are
to literature on genetically significant dose in countries considered along with the associated sources o r
of health care levels I1 and 111. However, most of practices. Evaluation of occupational exposures from
these reports have not included fluoroscopy. medical radiation usage is complicared by the fact that
the radiation usually comes from point sources close
124. If the frequency of examinations is one tenth of 10 the workers. Thus, the exposures are significantly
that reported for countries of health care level I, and if non-uniform over the body because of the inverse
fluoroscopy accounts for 30-70% of the total examina- square law as well as attenuation in the body. The
tions. then the effective dose equivalent and genetically effective dose equivalent cannot be easily inferred
significant dose for countries of health care levels 11, from one personal dosimeter on an individual, and
TI1 and IV may in fact be comparable to those of level I this is especially true if the dosimeter is not in the
primar!, radiation fields striking the body. To make x-ray tube. Gustafsson et al. [GI01 have es:imated
matters more complicated, the dos~metersare not that the effective dose equivalent to the radiologist
always worn in the same position. although generally performing angiography is about 0.03 mSv per
they are \(lorn at the waist or neck. Often the recorded examination.
data do not indicate \itherher the uorkrr wore the
dosimeter inside or outside a protective lead apron. 130. It had been previously assumed by the Com-
For these reasons i t is very difficult to utilize average mittee that lower estimates for occupational exposures
dose as measured by a dosimeter arid to correct i t to would be appropriate for countries that had a lower
effective dose equivalent. Other difficulties are that frequency of exarninations. This may not be the case.
minimum detectable levels vary as a function of however. as is indicated by the recent data published
dosimeter type and that the administrative decisions by Wang [N1lO] and Zhang [Z9] for China, where
on whether to record the minimum detectable dose as average annual occupational doses for diagnostic
zero or some other value are often arbitrary. Such medical workers are reported to be between 2.2 and
decisions can hzve a major impact on estimation of 4.3 mSv. This figure is two to 10 times higher than the
the cullecti\~eocc~ipationaldose. since in occupational comparable figure in some countries of health care
exposure irom medical radiation, a large percentage of level I. There has. however. been remarkable progress
workers recei1.e doses at or near the n~inimum in China (health care level 11) in reducing the
detectable level [D7]. The best that can be said is that occupational doses over the past several decades.
fur rad~stion qualities used for diagnostic \-ray Wrang [Wlo] reports that the average annual dose to
procedures. the dosimeter usuall) measures a value diagnostic x-ray workers was 55.5 mSv before 1957.
that is 2-4 times higher than the effective dose 8.7 mSv from 1957 to 1966 and 2.2 mSv from 1967 to
equivalent [Jl?. %139]. if a protective apron is not 19d0. The reason the doses still remain higher than in
worn and i f the exposure is relatively uniform. I f a countries of health care level I is probably the extreme
protective apron is worn and the personal dosimeter is use of fluoroscopy and the lack of image intensifica-
placed on the outside (3s is practice in the United tion systems. The situation may be significantly worse
States). then reported doses could be as much as 10 to in countries of levels of health care 111 and IV.
20 times higher than the effective dose equii~alent. Hussain [H22] reported on 31 1 x-ray installations in
Bangladesh (level IV) and found that a majority of the
128. A3 was discussed in the UNSCEAR 1982 installations had no shielded control booth. lead
Report [U5]. another ma-ior complicating factor is aprons or gloves. As was mentioned previously,
accurate job classification of workers. While there is almost one half of the machines had no functional
not usuallv a problem in differentiating between collimation. I n this Xnnex it will be conservatively
diagnostic radiologists and radiographers (technicians). assumed that the collective effective dose equivalent
the rota1 number of workers in the field is sometimes per million population is the same in countries of
expanded to include nurses, porters. aides. dark-room various levels of health care.
technicians etc.. which can lead to erroneous caicula-
tions when determining mean annual ~ndividualdose. 131. Information on occupational doses incurred as
hiany of these latter ivorkers are not usually monitored a result of dental radiography is very limited: however.
since they usually receive very l o ~ vdoses. The number of the average annual doses are relatively IOU (Table 34),
unfi~onitoredpersons w h o occasionally perform x-ray ranging from 0.03- mSv to 0.4 mSv annually in coun-
euaminat~onsis unknown but is probably quite large. tries of health care level I. Dental practlce generally
even in developed countries. The exact umber of contributes less than 1 % to the collective effective
monitored workers engaged in performing diagnostic dose equivalent from all occupational sources.
x-rac exam~nations varies ividely from collntry to
country. The range appears to be one monitored
worker per 150-750 examinations annuall) [ U J . U5,
w171. I. FUTURE TRENDS IN DIAGNOSTIC
RADIOGRAPHY
129. Data on occu~ationai doses received from
medical x-ray diagno;is are given in Table 34. In 132. I t is instructive to postulate the future medical
general. the average annual effective dose equivalents uses of radiation and the extent of their application
range from 0.1 to 3 mSv annually above natural and to examine potential areas of concern over the
background for radiologists and technologists. The next 15 years. There is little doubt that, world-wide.
dose distribution among the population o i workers is the frequency and total number of procedures involving
r~larkedly skewed. with a long tail of higher doses medical radiation will increase substantially [04. U6).
received by very few individuals: The highest exposures There are three main reasons for this. First. there is
to radiologists, technologists and nurses occur during the aging of the population, particularly in Europe.
fluoroscopic procedures. Ameil et al. [AZ, A31 and The Federal Republic of Germany. Switzerland, Italy
Tryhus et al. [T7] have reviewed the literature on and Greece are expected to have more than 20% of
absorbed dose to the radiologist during angiographic their populations over the age of 60 by the year 2000.
examinations. Doses were reported as follows: eyes. The USSR and several other countries are expected to
0.01-0.5 mSv; thyroid, 0.03-0.5 mSv; waist (inside lead experience the same phenomenon. but to a lesser
apron). O.UZ mSv; and hands, 0.05-1 mSv. Absorbed degree. As was indicated earlier, the older population
doses can be higher by a factor of 10 or more if the accounts for a disproportionate number of medical
radiologist makes a manual injection (staying in the diagnostic and radionuclide exarninations as well as
room during filming) or if there is an over-the-table radiotherapy procedures.
133. The world's population is experiencing a marked rate of'2.5'70 per year or higher. Latin America's share
contraction in the percentage of population between of the total world population grew from 6.5% to 8.2%
0 and 30 years and a marked expansion in the between 1950 and 1980, and by 2025 its share is
percentage above the age of 30 [U6]. From 1950 to expected to be 10.6%.
1980, changes in the age distributions varied among
the regions of the world. For example, the median age 137. Third, the number and frequency of examina-
of the populations of Europe and the Soviet Union tions will increase as a result of growing urbanization.
increased by about four years between 1950 and 1980 At present. 41% of the population is classed as urban;
and that of Africa decreased by about 1.5 years. The in the year 2025, this percentage is expected to rise to
median age for other regions decreased by about 2 65%. As already discussed, urban populations have a
years until the early 1970s and then began increasing. much higher frequency of x-ray or radionuclide
and i t is now at the same level as it was in 1950. examinations than rural populations, the difference
In contrast with past trends. the future is expected to being an order of magnitude or more. If 50% of the
be characterized by an aging of populations in all ulorld's population were urbanized by the year 2000. if
regions: the median age of the world population is the population aged as predicted and if the total
expected to increase from 22.6 years in 1980 to 26.1 population were 6 billion, the per caput doses and
years in the year 2000 and to 30.8 years in the year collective doses could be 50-100!'i higher than at
2025. The oldest populations in 2025 will be in present.
Europe, East Asia. and Northern America. The
youngest populations will be in Africa and Latin 138. There are some countering factors In these
America. with median ages of 22.8 and 27.4 years, projections. As the population ages, the assumed
respectively. detriment would have less time to be expressed. and
the use of an age-weighted dose equivalent H-ould
134. Second, the total number of examinations will assume more importance. In simpler terms, although
also undoubtedly increase simply as a result of popula- the number and frequency of examinations would
tion increase. The world's population was 2.5 billion increase, an older population would have less time to
in 1950 and 4.4 billion in 1980; it is projected to be be at risk for the induction of stochastic effects.
6.1 billion in 2000 and 8.2 billion in 2025. Even if the Moreover, in addition to depending on age. the
annual per caput effective dose equivalent and gene- genetically significant dose also depends on the
tically significant dose remained the same, the col- reproduction rate. The gross reproduction rate in
lective doses would increase by over 60%. from 1988 to most developed countries is expected to remain fairly
2025. steady in the period 1980-2000, but i t is decreasing in
developing countries. This will be an additional factor
135. The population of the world had an annual to take into account when calculating the genetically
growth rate of 1.7% in 1985. Throughout the nine- significant dose. Overall. i t can be assumed that the
teenth century and the first half of the twentieth genetically significant dose will increase, but not as
century its annual growth rate was 0.5-0.8%. In the rapidly as the per caput or collective effective dose
late 1960s, the world's population was growing at equivalent.
about 2% annually, and projections are that the
growth rate will fall to 1.5% by the year 2000 and to
1% by 2025. It is important to note that while the rate 11. DIAGNOSTIC USE O F
of growth is declining, the annual increment to the
tvorld's population is increasing. The annual incre-
RADIOPHARMACEUTICALS
ment to the world's population in 1950 was 46 million,
and in 1980 i t was about 75 million. The annual A. FREQUENCY A N D TRENDS
increment is expected to peak at approximately
88 million near the end of the century and then decline 139. Since the UNSCEAR 1982 Report. the Com-
somewhat by 2025. .Although the global growth rate mittee has obtained information from various countries
appears to be on the decline. there is marked on the number of in v ~ v odiagnostic nuclear medicine
difference between the more developed and less examinations performed. This information is collected
developed regions of the world. In the det7eloped in Table 35. The frequency of all nuclear medicine
regions population is growing at an annual rate of examinations for countries of health care level I is in
0.6%; in the less developed countries, it is growing at the range of two to 49 examinations per 1,000 popu-
approximately 2%. As a consequence, the proportion lation and for China (level 11) it is 0.6 examinations
of the world's population living in the less developed per 1.000 population. Only in vivo diagnostic nuclear
countries is expected to increase steadily. procedures are being considered in this chapter.
136. Demographic trends also vary substantially 140. Malmstrom [M6, M7, M8, M9] reported statistics
from one part of the world to another. There is a concerning nuclear medicine examinations in Sweden
rapid growth of the population in Africa. which is for the years 1979 through 1982. The total number
currently increasing at 3% per year and is expected to ranged between 125,000 and 130.000 examinations
continue to increase at this rate until the end of the annually (15 per 1,000 population).
century. In 1950, the population of Africa accounted
for about 8.7% of the total. but in 2025 it is expected 141. The number of diagnostic nuclear medicine
to account for 19% of the total. Another rapidly studies in the United Kingdom in 1982 was reported
growing area is Latin America, which has a growth to be about 380,000. 84% of which were imaging
examinations. Bone scans were the most often per- between countries but also within countries. The
formed procedure, although cardiac studies had in- reasons for such variation are not known, but they
creased 150-fold since 1973. Technetium-99m was the may include training of the staff and, possibly.
radionuclide used in 75% of the administrations, while sensitivity of equipment.
iodine-131 was used in only 5%.
144. The extrapolation procedure described in para-
142. The number of diagnostic nuclear medicine graph 10. which has been used to estimate world-wide
procedures performed in the United Stares in different medical diagnostic x-ray activity. can also be used to
years is shown in Table 36. This Table documents the estimate nuclear medicine activity. A broad correlation
progressive increase in the frequency of diagnostic exists between population per physician and annual
nuclear medicine procedures, both in absolute terms nuclear medicine examinations per 1,000 population.
and per uni: population. There was a rather sharp There is also a strong relationship between population
increase between 1970 and 1976, a plateau between per physician and the population per scanner or
1976 and 1980 and another increase until 1982, with a gamma camera (Figure XI). The source terms and
sharp rise in cardiovascular and hepatobiliary imaging trends utilized to obtain averages for various levels of
procedures. The only category in tvhich a decline is health care are shown in Tables 38 and 39. Estimates
evident is radionuclide brain scans. Similar trends of annual examinations per 1,000 population for
have been reported in Denmark by Ennow [E2]. various levels of health care are shown in Table 40.
It is estimated that there are approximately 24,000
143. The percentage of each type of diagnostic gamma cameras or scanners world-wide and that
nuclear medicine procedure may differ substantially approximately 24 million in vivo diagnostic radionuclide
from country to country. Table 37 shows that while examinations are performed annually (Table 4 1). The
thyroid imaging constitutes a large percentage of number and type of nuclear medicine imaging devices
procedures in many Latin American countries, it in the United Kingdom have been reported by Wall
constitutes only 9% of diagnostic radionuclide pro- [WS, W9]. The number of gamma cameras has
cedures in the United States, a variation that was also markedly increased since 1974, while the number of
noticed and commented on in the UNSCEAR 1977 rectilinear scanners has decreased.
Rcport [U4]. A survey of radionuclide thyroid studies
in the United States was reported by Parker et al. [P7],
who identified substantial intra-country variation in B. AGE AND SEX DISTRIBUTION
methodology and radionuclide use. Technetium-99m O F PATIENTS
pertechnetate was used for 54% of all thyroid scans
and iodine- 13 I was used for only 9% of them. The rest 145. For calculations of the genetically significant
of the thyroid scans were done with iodine-123. In dose and related quantities it is necessary to know or
summary, administered activity for a given examina- assume the age and sex distribution of patients
tion varies by as much as a factor of 4 not only undergoing nuclear medicine procedures. Results of
1
I I I I I I
100 500 lOC0 5000 10000 50000 100000
POPULA-IOIi PER PHYSICIAN
Figure XI. Correlatlon between population per physlclan and populatlon per
nuclear rnedlclne mechlne In various countriea.
[M281
surveys performed in Poland in 1981 [S25] and the medicine procedures in the United States in 1983 has
United States in 1980 [UlO] are given in Table 42. been estimated at 32,000 man Sv (0.14 mSv per c a p u t )
About one third of the procedures in the United States [M30]. A more in-depth analysis of the effect of age-
are performed in persons over the age of 64 and and sex-specific weighting factors has been performed
approximately 70% of the procedures are performed by Johansson 158, J9]. who concluded that detriment
in persons over the age of 35. This is true for most was about 40% of that calculated from the effective
procedures, with the exception of thyroid and renal dose equivalent.
imaging procedures. In Poland the population receiving
nuclear medicine examinations of all types is much 149. The annual per caput effective dose equivalent
younger. for most developed countries ranges between 0.03 and
0.14 mSv (Table 44). This is due mainly to the use of
C. IMPACT O F NEW TECHNOLOGIES iodine- 13 1 and technetium-99m. The percentagrs o l
collective effective dose equivalent attributable to
136. The impact of the new techniques has already different radionuclides are shown in Table 45. There
been discussed briefly in section I.C. particularly the are large differences between countries.
impact o f computerized tomography on radionuclide
brain scans and the possible impact of cardiovascular 150. Radiation dose estimates for orally administered
nuclear medicine procedures on invasive contrast radionuclides used in upper gastro-intestinal disease
studies. In view of the relatively high absorbed dose to h a t ~ ebeen calculated by Siegel et al. [Sl8]. Patient
the thyroid delivered in the course of examinations exposure and radiation risk in Bulgarian diagnostic
with iodine-131, many countries have begun to utilize nuclear medicine has been reported by Poppitz [P13].
either iodine-123 or technetium-99m pertechnetate. One of the main sources of exposure in this particular
Unfortunately, iodine-123 is both difficult to obtain case was the iodine- 13 1 used in thyroid studies.
a n d expensive. The number of thyroid imaging pro-
cedures was rather stable in the United States over the 15 1 . As a result of the widespread use of radio-
period 1978-1982. and the number of thyroid ultra- pharmaceuticals labelled with iodine- 13 1 and techne-
sound procedures performed is so far relatively small tium-99m there has been an increasing interest in
a n d does not appear to have significantly reduced the assessing the radiation dose from breast milk follow-
number of thyroid nuclear medicine procedures [M31]. ing administration of such con~pounds to nursing
Another area in which some replacement might be mothers. Many authors have discussed the subject
expected is radionuclide liver scans, which could be [B 13, B 17, C4. 0 1. 0 2 . T6, V 1. iV241. The nature of
replaced by either hepatic ultrasound o r hepatic the radiopharmaceutical significantly affects breast
computerized tomography. No data are availzble on secretion, with technetium pertechnetate having as
the frequency of labelled monoclonal antibodies used much as 109'~of the activity in breast secretions [.All.
predominantly for tumour detection. In almost all instances, the secretion rate in milk
24 hours after injection is insignificant. An important
exception to this arises in the case of iodine-125
D. ABSORBED DOSE fibrinogen. Ahlgren et al. [ A l l recommend that when
nursing mothers have received this radiopharma-
147. The range of administered activities for some ceutical, breast feeding should be stopped for three
types of examinations in different countries is shown weeks.
in Table 43. As with absorbed dose in diagnostic
radiology, the administered activity follows a skewed 152. The method of estimating average practlce in
distribution. There are some differences between countries of various levels of health care can be used
countries in the average activity used for certain to estimate the world-wide annual per caput doses and
examinations. For example. in the United States collective dose from nuclear medicine. Repoited effec-
administered activity for a technetium-99m pertech- tive dose equivalents a n d genetically significant doses
netate thyroid scan is about four times higher than in for countries of health care level I are shoarn in Table 46
other developed countries. Kaul et ai. [K?] and and are used as source terms. Since data are limited o r
Johansson et al. [J5] published data concerning the lacking altogether for countries of health care levels 11.
dosimetry of unsealed incorporated radionuclides and 111 and IV, the values for those levels have been
discussed the mathematical-physical and metabolic estimated according to the frequent) of examinations.
dose models. This ma! result in a slight underestimate, however,
because it may be that longer-lived radionuclides are
148. The effective dose equivalent in the USSR in being uhed in less developed countries. For example.
1980 from diagnostic radinnuclide examinations has technetium-99m has a short physical half-life, making
been reported by Knizhnikoi, et a!. [K13]. He has the dohe of the pharmaceutical lower than that of a
indicated that the per capilt value is 0.04 mSv per s~milar pharmaceutical labelled with iodine-131. At
year. In the following years, in spite of the increasing the same time, the short half-life makes it impractical
number of radionuclide examinations, the average to use technetium-99m in some less developed areas.
dose decreased to a per caput value of 0.03 mSv due The annual per caput doses and collective effective
to expanded use of short-lived radionuclides [V7]. The dose equivalent for health care levels I-IV are shown
collective effective dose equivalent from all radionuclide in Table 47. The annual collective effective dose
examinations was estimated t o be about 8,700 man Sv equivalent is estimated to be 74,000 man Sv; the
for 1981 [V7]. Table 34 shows that the collective genetically significant collective dose is estimated
effective dose equivalent for all diagnostic nuclear world-wide to be approximately 15,000 man Sv.
E. OCCUP.4TIONAL EXPOSURE FROM where 77.000 patients were treated in 1978 with
DIAGNOSTIC NUCLEAR MEDICINE 1.78 lob irradiations (treatlnents). The average number
of irradiations per treatment course was 21. with a n
153. Over the past decade there has been rapid expan- average of 2.4 fields per patient. About 55% of the
sion in the use of nuclear medicine and particularly in treatments were done with cobalt-60 units. 38% with
the use of the many technetium-99m labelled radio- high-energy x rays, 6% with high-energy electrons a n d
pharmaceuticals. Since these are administered pre- 1% ivith conventional x-ray units. More than 50% of
dominantly by injection. there is a potential for the patients were over the age of 45, about 4% were
relatively high doses to rhc hands of the \vorkers. under the age o f 14 years, and less than 1%)of patients
Generally, Icad-shielded syringes are recomn~ended; were treated for [ion-malignant disease. ~Marayuma
ho\vever. they are nor always used. Direcr handling of et al. [M 131 reported that in Japan in 1983 a total of
thin-walled plastic syringes can result in skin doses of 38,900 brachythcrapy procedures were performed.
0.012-0.25 mSv per hour per MBq. Following injec- 36,300 (93%) of which were: in females.
tion, the patient represents another source of exposure
to the technolugist. 157. In United States hospitals [ K 151 the number of
new patients per radiotherapy unit was about 300
154. The limited data concerning occupational doses annually from 1973 through 1979 and the number of
incurred in the practice oi diagnostic nuclear medicine new patients per 1,000 population rose from 1.46 to
a r e presented in Table Jb. ,Mean annual individual 1.73 during the same period. Trends in equipment
doses are 0.3-2.U mSv. Suclear medicine contributes have been discussed in both the UKSCEAR 1977
approximately 2% to the collective dose from all Report [UJ] a n d the UNSCEXR 1987 Report [U5].
occupational sources. The number of monitored wor- Although orthovoltage uniu are still common in some
kers in the field of nuclear medicine varies widely Latin American countries and in parts of Europe, hey
a m o n g countries. On the average, there are 100-300 have been almost completely replaced in the United
examinations carried out annually for each monitored States by cobalt-60 units and high-energy accelerators.
worker in developed countries [U5, lV171. Certainly. Table 51 shows that in the United States from 1975 to
one nuclear medicine technologist can perform as 1980. there has been a n increasing use of high-energy
many as 1.000 in vivo studies annually; however, the accelerators H hile the number of cobalt machines has
monitored workers also include physicians. chemists, remained approximately stable.
physicists. pharmacists and, in some instances. clerks.
158. By estimating average practice in countries at
various levels of health care, i t is possible to obtain a
rough estimate of' radiation therapy acti\.ity world
111. THERAPEUTIC USES OF RADIATION wide. The known radiation therapy esperience by level
of health care is shown in Table 52. For most
countries of health care level I, approximately 2,300
A. FREQUENCY A N D T R E N D S brachytherapy and teletherapy are per-
formed annually per million population. In most
155. Data on the use of radiotherapy are often countries approximately 200 rich patients are treated
confusing because of inlprecise definitions. With annuaily per machine. Using these source terms. it is
teletherapy. a treatment course may extend over possible to estimate radiation therapy activity by level
several weeks and include many irradiations o r treat- of health care (Table 53). The estimated number of
ments. By contrast, brachytherapy and the use of procedures and machines by level of health care is
radiopharmaceuticals for therap) usually entail only s h o w in Table 54. Bv this estimation method it
one o r two applications. For the purposes of this appears that there are approximately 5 million patients
Annex. a teletherapy course o r a brachytherapy treated by radiotherapy allnually and approximately
application will be referred t o as a procedure. Some 18.000 machines in use world-wide. The annual
authors refer only to the number of patients treated; genetically significant dose from radiation therapy in
the use of their data may cause the frequency of radio- countries of health care level I is approximately
therapy t o be underestimated, since some patients are 0.015 mSv (Table 55); estimates for countries of health
re-treated for recurrent tumours. Additional confusion care levels 11. I11 a r ~ dIV are also shown in the Table.
arises in the matter of patient numbers, since some
patients may receive treatment for more than one 159. The future of radiotherapy is somewhat difficult
body area. Since the UNSCEAR 1982 Report [US], to predict. Certainly as the population ages, expands
some data have become available on the number of and becomes more urban, both the need for a n d the
therapeutic radiology treatments in various countries. availability of radiation therapy will increase. In
Table 49 shows there was a slight annual increase addition, the spectrum of diseases will change with
in therapeutic radiology treatments in Canada from time. One of the diseases in which there has already
1978 to 1981. The annual frequency of treatments been such a change (and which often is treated with
is approx~mately 26 per 1,000 of population. The radiation therapy) is lung cancer. Since 1950. the lung
estimated number of different types of cases treated by cancer death rate has doubled, and in some instances
radiotherapy in some western hemisphere countries is tripled, in many European countries [04].
shown in Table 50.
160. At present, the Committee has no information
156. Hashizume et al. [H5, H6, H7] have reported on the age distribution of the population receiving
o n the status of external beam radiotherapy in Japan. radiotherapy in various countries nor does it have
information on the percentage of patients who may be therapy alone (relative risk I I compared to the normal
long-term survivors. There are few new data since the population), was much higher after either adjuvant
UNSCEAR 1982 Report on the uses of radiation chemotherapy (relative risk 117) or chemotherapy
therapy for benign diseases. Probably the most common alone (relative risk 130). Such risks will continue t o
use is administration of sodium iodide-131 for hyper- confound long-term follow-up studies to assess radia-
thyroidism. The effective dose equivalent depends on tion risk in these patients.
the percentage of iodine accumulated by the thyroid,
but in cases of hyperthyroidism the effective dose
equivalent usually exceeds 15 mSv per MBq [J4]. Wall
[W9] has indicated that in the United Kingdom in 1982. B. ABSORBED DOSE
treatments for thyrotoxicosis constituted 2.0% (7.600)
of all nuclear medicine procedures and had a mean 163. The dose delivered outside the useful radiation
administered activity of 367 MBq and a range of 120 to beam is determined mainly by scattered radiation in
1.550 MBq. Similar experience has been reported from the patient and to a lesser extent by radiation
Denmark in 1985 [E2]. Therapy with unsealed radio- scattered in air. For x-ray therapy units and linear
nuclides represented 1.4% of all nuclear medicine accelerators levels of leakage radiat~onthrough the
procedures. Therapy for thyrotoxicosis accounted for housing of the source contribute only 0. I-0.2% of the
88% of therapeutic procedures and thyroid cancer. dose rate inside the useful beam. For neutron genera-
11%. The remaining 1% was for therapy with other tors, however, the value may be 10 times as high [G6].
radionuclides (such as b9Sr for prostatic metastases Results obtained by Kase et al. [KI] suggest that the
a n d I3'I metaiodobenzylguanidine, 32P and for machine collimators contribute 20-40Q of the dose t o
other tumour types). The number of therapeutic patients outside the treatment field and that local
procedures for thyrotoxicosis in Denmark doubled shielding of organs from scattered radiation generated
between 1977 and 1985 [E2]. Whether this is also in the machine collimators could reduce the risk of
happening in other countries is unknown. In Sweden carcinogenesis by as much as a factor of 2. Hudson
between 1979 and 1982 about 3.300 therapeutic nuclear et al. [HI81 have also examined dose levels outside the
medicine procedures were performed annually [M4, beam. with particular emphasis on the provision of
M5, M6, M7]. This accounted for about 2.5% of all radiation therapy to a pregnant patient. They observed
nuclear medicine procedures. Due to the high absorbed that the shielding blocks themselves may contribute to
doses, particularly to the thyroid. where non-stochastic scattered radiation and that this is most likely to occur
effects predominate. therapeutic procedures are not if the block is positioned immediately adjacent to the
usually included in assessment of annual collective main beam. If the shielding block is moved away from
dose from nuclear medicine. Patients with either the main beam, a dose reduction of some 30% is
thyrotoxicosis or thyroid carcinoma are predominantly possible. Williarns et al. [W14] and Petoussi et al.
young and female and have long survivals compared [PI21 have published tables that include Monte Carlo
to other patients undergoing radiotherapy. Some calculations of dose to various organs for different
recent data from Sudan [S36] indicate that 10% of all fields in radiotherapy. These results are extremely
radiotherapy treatments are for benign diseases, with useful since doses to organs and tissues outside the
the majority of these (8.5% of the total) being for irradiated volumes are not often quoted in the
thyroid disease. literature. Vasilev et al. [V4] have reported that when
patients are being treated for benign diseases, appro-
161. Extensive literature exists on endometrial priate selection of x-ray potential can result in
carcinomas occurring 10 o r more years after pelvic improved precision of dose delivered as well as
irradiation for squamous cell carcinoma of the cervix reduction of dose to areas not being treated.
o r carcinoma of the ovary. and after radiation-
induced menopause [CI3, F3, M5, R6. U4. US]. The
164. The annual genetically significant dose from
relative importance of such delayed effects depends
brachytherapy in Japan in 1983 is estimated to have
not only on the availability of radiotherapy in various
been 13 mSv and the per caput mean bone marrow
countries but also on the incidence of these tumours in
dose, 0.31 mSv [M 131. The genetically significant dose
the various countries. Because the incidence rates of
from all radiotherapy in Japan in 1978 was 0.7 pSv and
cancers of various types vary from country to country.
the per caput bone marrow dose was 1.5 mSv. This
the relative percentage of secondary tumour types and
amounted to decreases of 93% and 26%, respectively.
the number of long-term survivors could also vary
compared to 197 1 [H6].
even if radiotherapy were equally available.
162. As the prospects for long-~ermsurvival improve 165. Of course. the fields o r body areas treated by
following therapy and the possibility of secondary radiotherapy vary widely from country to country. so
radiogenic tumours increases, there has been renewed a world-wide assessn~ent of risk from this practice
interest in dose levels outside the useful radiotherapy would require data not only on the number of patients
beam. This was briefly discussed in the UNSCEAR and treatments but also on the tissues o r fields
1982 Report [U5]. In patients treated for Hodgkin's irradiated. As an example, cancer. of the lung and
disease, the relative risk of a second malignancy is breast are very common in the United States, although
5.2 times that of the normal population. The mean overall, cancer is a less significant cause of death than
actuarial 15-year risk reported recently by Tucker [T9] heart disease. In contrast, Olivares [ 0 3 ] pointed out
was 17.6%, of which 13.2% was due to solid tumours. that cancer is the leading cause of death in Lima,
The risk of leukaemia, although elevated after radiation Peru, with stomach cancer being most common in
males a n d cancer of the cervix being most common in C. OCCUPATIONAL EXPOSURE
females. While the Committee recognizes such major FROM RADIATION THERAPY
regional differences. it feels that a complete discussion
of them is beyond the scope of this Annex. For this 169. Occupational exposures during the practice of
reason and others, discussed earlier. the Committee radiotherapy come from several sources. In general.
has not attempted to calculate a n effective dose with the use of external beam radiotherapy the rooms
equivalent from the practice of radiotherapy. are very well shielded and the attendant staff receive
little exposure. An exception to this is doses incurred
166. The optimization of radiotherapy is intimately when using either neutron beams o r electron accelera-
connected with the quality assurance and optimization tors operating above 10 MeV. The neutrons cause the
of cancer control programmes. Zaharia [Zl] has activation of nearby materials, which then constitute a
indicated that in Latin America the most serious source of radioactivity and exposure to the staff even
obstacle t o cancer control is very late diagnosis and after the primary beam has been turned off. LaRiviere
referral for treatment. This is predominantly due to [Ll] and Hoffman [HI61 have examined this problem,
lack of awareness of the early signs and symptoms of and it appears that 75% of the staff dose is due to
cancer. For example. in Peru. 92% of the patients photoactivation products in the treatment head. The
presenting for treatment of cancer were in stages I1 remainder is due to other activation products in the
to IV. This is in contrast to Sweden. where more than room: however, induced activity in the patient is not a
40% of the patients presenting were in stage I and significant source. The exact occupational dose equi-
more than 80% were in stages I o r 11 [W20]. The valent received by a worker in this manner is a
World Health Organization has examined most of the function of the workload. This is measured by
aspects related to optimizing radiotherapy. I t indicates personal dosimeters and appears to be 0.3-2.0 mSv.
that the need for radiotherapy may not be uniform in annually. Tatcher et al. [TI] have examined patients
all countries because the cancer sites in patients treated in a fast neutron therapy facility to determine
referred to radiotherapy institutes may have different how much the (n, 2n) reaction and production of
rates of occurrence. In most industrialized countries, carbon-I l and oxygen- 15 in the patient added to the
approximately one third of all cancer patients need technologists' exposure. They concluded that patients
radiotherapy either alone or combined with surgery. were the source of less than 10% of the occupational
Approximately one half need surgery either alone or exposure of the technologist.
combined with other therapies. About one quarter of
all patients either d o not obtain, or are too advanced 170. A main source of occupational exposure from
for. specific therapy. In less developed countries. the radiotherapy is brachytherapy. This often involves the
distribution of treatment needs will be different if insertion o r surgical implantation of radioactive wires.
the distribution of cancer sites is different. For needles or seeds. Pre-loaded surface applicators are
example, when comparing North America with Latin also sometimes used. There has been a trend towards
America, researchers have found that the death rates utilizing after-loading devices whenever possible t o
from cancers of the breast (highest in North America), reduce occupational exposure. This involves the pre-
cervix. uterus and larynx (higher in Central and South positioning of an applicator or holder on o r in the
America) often differ by a factor of 3 or more [P3]. patient and then inserting the radioactive material a t a
later time. The occupational dose received from
brachytherapy is also very dependent on whether the
167. The World Health Organization has also in- source insertion is manual o r automated in some
dicated that there is a difference in the age distribution manner. Once the sources have been inserted the
of cancer patients from developed countries to devel- radiation exposure of persons around the patient must
oping countries, and the genetically significant dose be considered. Since such exposure may be non-
will vary accordingly. For example, the average age of uniform. a comparison with doses incurred from other
patients diagnosed with cancer was 55.7 years for more uniform sources may be difficult. Annual occupa-
Europeans. 45.9 years for Asians, and 35.9 years for tional absorbed doses from brachytherapy usually range
Africans. Of the age group 10-40 years, Africans from 2 to 5 mSv [U4, U5].
constituted 40%, Asians 31%, and Europeans only
12% [WZO]. 171. Table 56 presents the limited data that are
available concerning occupational doses from the
168. The World Health Organization maintains a entire practice of radiotherapy. Average annual indi-
quality control and dose comparison programme for vidual exposures are 1-3 mSv. but, as pointed out.
clinical dosimetry [W20]. In an IAEA/WHO dose they can be higher in those individuals intimately
intercomparison programme, radiotherapy institutes involved with brachytherapy [H16]. The reported per-
received thermoiuminescent capsules by mail and were sonal dosimeter values for radiation therapy workers
requested to radiate them under varying circumstances. are undoubtedly closer approximations of the effective
Similar co-operative programmes exist in Ellrope and in dose equivalent than for diagnostic radiology workers.
the United States. It is interesting t o note that, even in This is because in radiation therapy the energy of the
highly industrialized countries, 15% of the institutions incident radiation is higher and because protective
made dosimetry errors of more than 10%. Such errors aprons are not worn. The number of monitored
may significantly affect the number of cases cured as workers in radiotherapy is difficult to assess. At
well as the complication rates of the radiation therapy. present, data are available only from the United
Similar dosimetry intercomparison programmes have States, where it appears that there is one monitored
been reported on by Greene et al. [G7]. person for each 25-50 procedures annually.
1 . SUMMARY cost method. In spite of such measures, the collective
effective dose equivalent may increase as x-ray exami-
nations become more available in some countries. but
172. The present state of knowledge regarding the this increase may in fact be medically appropriate.
frequency of use of medical radiation and the associated There have already been positive trends in dose
absorbed dose is good for approximately 25% of the reduction (including decreasing absorbed dose per
world's pop~llation.Data are fragmentary for another examination as well as decreasing absorbed dose per
25% of the population, a r ~ dessentially no data exist patient without jeopardizing the desired clinical objec-
for 50% of the population. For this reason, the tive). particularly in well developed countries.
Committee has de~eloped an estimation procedure
based on the good correlation that exists in most
countries between population per physician and medical 177. Occupational exposure from medical practices
uses of radiation. includes contributions from medical diagnostic radio-
logy, dental radiography, nuclear medicine and radia-
173. The main sources of uncertainty in the effective tion therapy. The sum of these for various countries is
dose equivalent from medical diagnostic radiology are shown in Table 58. The average annual collective dose
(a) the frequency of examinations and absorbed dose equivalent from medical occupational exposure is about
per examination. especially in the case of fluoroscopy; I man Sv per million population. I n both Canada and
and (b) poorly calibrated or malfunctioning equip- the United Kingdom, occupational exposure from
ment. The cffcctive dose equivalent from diagnostic medical practice represents about 10%- of the collec-
medical examinations is far greater than that from tive dose equivalent from all occupational sources
dental or diagnostic nuclear medicine examinations. [U5]. In spite of the fact that the medical trses of
radiation are increasing in most countries, limited
174. The estimated world-wide per caput and collec- trend data indicate that both annual individual doses
tive effecti!re dose equivalent and genetically significznt and collective occupational doses are decreasing by
dose from medical radiation are shown in Table 57. I t 10-20% per decade. In the United States. for example,
would appear that the per caput annual effective dose the number of occupationally exposed medical workers
equivalent is likely to be no lower than 0.4 mSv, but rose as follows: 300,000 in 1960; 400,000 in 1970; and
may be as high as 1.0 mSv. Similarly, the annual 584.000 in 1980. During this time the annual collective
genetically significant dose ma) range from 0.1 to dose equivalent decreased from 580 to 410 man Sv
0.3 mSv. The potential risk from medical radiation, if (Table 58). For developed countries the average
calculated from the effective dose equivalent for occupational exposure is about I pSv per examination.
medical radiation. is probably an overestimate. This is The data also indicate that on average 150-750
particularly true in countries where the older portion examinations are carried out annually for each medical
of the population receives most of the medical radiation worker.
irradiation.
178, The frequency and total usage of medical
175. The world-\vide collective effective dose equi- radiation is expected to increase over the next several
valent from medical radiation is estimated to be decades as a result of (a) a general aging of the world's
between 1.8 10' and 5 lo0 man Sv, and the genetically population; (b) an increase in the total number of
significant collective dose to be between 0.5 106 and peoplc; and (c) a trend toward urbanization in the
1.5 10"an Sv. Between 90% and 95% of both these developing countries. By the year 2000, the collective
vaiues are attributable to medical diagnostic radiology. dose will probably increase by 50% and by the year
Dental radiography and nuclear medicine together 2025 it may more than double.
contribute only 510% of the collective dose. In
developed countries the contribution of diagnostic 179. Consideration of the following points would
medical radiation to the collective effective dose improve future assessments of exposures from the
equivalent is about 0.00 1 man Sv per examination. medical uses of radiation:
(a) collection of better data on the use of, and
176. There are many possibilities for dose reduction. effective dose equivalents from, both mass mini-
In developed countries it may be possible to reduce the ature radiography and fluoroscopy in developing
per caput effective dose equivalent to half its present countries;
value. In less developed countries the use of radio-
graphy rather than fluoroscopy, as well as the (b) continuing analysis of the aging and urbaniza-
calibration and maintenance of equipment, would tion of population groups and its effect upon use
reduce the dose per examination. but the feasibility, of medical radiation;
cost and magnitude of these measures are unknown. (c) continued examination of the data for deter-
One of the simplest and least expensive methods of mining age- and sex-weighted dose equivalent
dose reduction is appropriate collimation of the beam values; and
to conform only to the area of clinical interest. The (dl collection of data on the number of patients
genetically significant dose can be substantially reduced treated with radiotherapy and the proportion of
through the use of gonadal shielding, a practical, low- long-term survivors in various countries.
T a b l e 1
Germany. Italy
Canada Chlna f rance f e d e r a l Rep. a/
Exanlnation 1980 1980 1981-1982 1918 1983
[cl1 [ZS] [ 8 9 . F1. N l ] [u5] [PI]
~p
a/ Northeast I t a l y only.
b/ Includes p e l v l s .
E/ Does n o t I n c l u d e mass s c r e e n l n g .
d/ Great B r l t a i n o n l y .
el Excluding Chlna.
T a b l e 2
D l a q n o s t l c x - r a y e x a m l n a t l o n s I n t h e USSR
IV7l
Number
p e r 1000 p o p u l a t l o n
fxamlnatlon Change
T a b l e 3
1973 [ P l b ] 1980 [ I 7 1
Country
Populatlon Unlts per Population U n l t s per
Unlts 1000 Unlts 1000
(thousands) population (thousands) populatlon
Chjle 166
Chlna 259
Colombla 21 1
Costa Rlca 270
Cuba 139
Oomlnlcan Republ lc 20
Equador 36
Islamlc Rep.of Iran 180
nexlco 70
Nlcaragua 57
Paraguay
Peru
Turkey 80
Uruguay
Venezuela
111 Kenya
Indla
Llberla
. Slngapore
Srl Lanka
Sudan
Thal land
T a b l e 5
T a b l e 7
Ch\lc 5 40 2 18 5 30
Costa Rlca 6 22 1 9 8 36 IH
Domlniran Republlc 10 33 2 19 5 30 I
icuador 3 26 4 8 5 35 1Y
E l Salvddor 10 38 3 6 6 26 II
M~xlco 40 b 12 5 28 9
C
S t . Lucla 50 .
I 1 5 72 II
-
r a b-
i e M
Chlle 15 2
Costa Rlca 5 2
Oomlnlcan Republlc 15 10
El Salvador 9 -
Hexico 20 2
St. Lucla 6 3
T a b l e 10
Annual frequency of dlaqnostlc x-ray examlnatlons
per 1000 populat lon a_/
Canada
Chlna &/
France
Germany, Fed.Rep.
Japan
Netherlands
Norway
Sweden
Turkey
Unlted Klngdom
USSR
USSR e/
Unlted States
T a b l e 11
I Argentlna
France
Italy
Japan
Poland
Sweden
Unlted Klngdom
Unlted States
I1 b/ Chile
Costa Rlca
Ecuador
Hexlco
T a b l e 13
- -
Lumboracra 1 < 15 m a l e
splne female
both
15-29 male
female
both
30-44 male
female
both
45-64 male
female
both
> 64 male
female
both
A l l ages male
female
both
Table 13, contlnued
T a b l e 14
Anglography 200
Coronary and left
ventrlculography 200
Echocardlography 0
Radlonucllde
blood pool 11 25
Radlonucllde
lnfarct scan 2
Radlonucllde scan
perfuslon/lschemla
thalllum 0
T a b l e 15
Head x - r a y and r a d l o n u c l l d e e x a m t n a t l o n s I n t h e U n l t e d S t a t e s
(thousands)
IE61
T a b l e 16
namoaraphy examlnatlons I n t h e U n l t e d S t a t e s
(thousands)
IN11
Per 1000 f e m a l e
populatlon 0.6 2.4 11
T a b l e 17
S k u l l (LAT)
Chest (P/A)
Radlographlc
Photofluorographlc
Abdomen (A/P)
Retrograde
pyelogram (A/P)
C e r v l c a l s p l n e (A/P)
Thorac l c s p l n e (A/P)
Lumbar s p l n e
(Alp)
Cervlcal splne
Thoraclc s p l n e
Lumbar s p l n e
Sacro-lumbar s p l n e
Pelvls, h l p
Abdomen
I V urography
Hysterography
Cholecystography
Skull
Barlum enema
8 a r l u m meal
Thorax
Cerebral anglography
Thoraclc a n g l o g r a p h y
Abdomlnal a n g l o g r a p h y
I n f e r l o r llmbs anglography
Phlebography
O b r t e t r l c a l abdomen
Pyelography
T a b l e 19
R a d l a t l o n doses t o neonates r e c e l v l n q d l a q n o s t l c e x a m t n a t l o n s
I n t h e U n l t e d Klnqdom
( s a m p l e s l r e 85 I n f a n t s )
[ RS I
Organ
Cranlal Upper Lower
abdomlnal abdornlnal
T a b l e 21
Mean dose e q u l v a l e n t
per e x a m l n a t l o n (mSv)
Collective
effectlve Accounted
Examlnatlon dose for by
equlvalent fluoroscopy
(man Sv) (X)
E n t r a n c e dose
Area Procedure reductlon Reference
factor
a/ The r o l e o f p r o p e r t r a l n l n g I n r a d l a t l o n p r o t e c t l o n I s e x t r e m e l y I m p o r t a n t .
Oose r e d u c t l o n f a c t o r s I n t h l s r e g a r d may be l a r g e , however t h e y a r e
d l f f l c u l t t o quantify.
b/ To gonads.
C/ T O eye.
T a b l e 24
Total
T a b l e 25
Cervical spine
Oorsal s p l n e
Oorsolumbar s p l n e
Lumbosacral s p i n e
Pelvls, h l p
Abdomen. w i t h o u t
preparatlon
I V urography
Hysterography
Cholecystography
Skull
Earlurn enema
GI tract
Thorax
Cervlcal splne
Dorsal splne
Oorsolumbar s p l n e
Lumbosacral s p l n e
Pelvls. h l p
Abdomen, w l t h o u t
preparatlon
I V urography
Hysterography
Cholecystography
Skull
Barlum enema
GI t r a c t
Thorax
a/ Per f l l m .
b/ H l p and upper femur.
C/ Pelvjs.
i/ Includes fluoroscopy.
T a b l e 26
Abdomen, w i t h o u t
preparatlon 0.61
1V u r o g r a p h y 2.46
Hysterography
Cholecystography 0.93
Sku1 1 0.02
Barlum enema 3.70
GI t r a c t 0.95
Thorax 0.04
Cervlcal splne
Dorsal splne
Oorsolumbar s p l n e
Lumbosacral s p l n e
Pelvls, h l p
Abdomen. w l t h o u t
preparatlon
I V urography
Hysterography
Cholecystography
Skul 1
Barlum enema
GI t r a c t
Thorax
a/ Per f l l m .
b/ H l p and upper Femur.
C/ Pelvls.
d/ Includes fluoroscopy
T a b l e 27
Annual genetlcally
slgnlflcant dose 0.30 0.09 0.25 0.15 0.05 0.22
(mSv) a/
T a b l e 28
Annua 1
per caput Genetlcally
gonadal slgnlflcant
Year dose dose
(msv) (mSv)
T a b l e 29
Mean e f f e c t l v e dose e p u l v a l e n t
f o r d l f f e r e n t dlagnostlc x-ray examlnatlons
Annual
Level per caput Annual
of Country Year effectlve genetlcally Reference
health dose slgnlf lcant
care equlvalent dose
I Canada
f Inland
f rance
Germany,
fed.Rep.
Italy
Japan
Netherlands
Romanla
Poland
Spaln
Sweden
Swltzerland
Un l ted
K 1 ngdom
Unlted
States
USSR
Average 1 .O 0.3
IV No data
Annua 1 Annual
Annual Effective per caput genetically
Examlnatlon examlnatlons dose equivalent cffcctlve slgnlflcant
per caput per examlnatlon dose equlvalent dose a/
(msv) (mSv) (mSv )
T a b l e 32
Annua 1
Annual collectlve
Level Populatlon per caput Annual effective
of effectlve genetlcally dose
health dose slgntflcant equlvalent
care equivalent dose (thousands
(ml 1 1 tons) (~SV) (mSv) of man Sv)
Total 1760
METHOD 2
b/
I-IV 5000 1 .O 0.3 5000
Annual Annual
per caput collectlve Genetlcally
Level Populatlon effectlve effective slgnlficant
dose dose dose
equ\valent equlvalent
(thousands
(mllllons) (mSv) of man Sv) (uSv)
a/ Data from Poland and United Kingdom [H20. K5. J1. U4. US].
-
T a b l e 34
MEDICAL
Radiologists
Canada
Japan
Norway
Sultzerland
Unlted Klngdom
Unlted States
Technologlsts
Canada
Japan
Unlted Klngdom
Unlted States
Nurses
Canada
Japan
Unlted Klngdom
Alder, porters
Canada
Unlted Kingdom
Physlclsts
Canada
Noway
Unlted Klngdom
All medlcal workers
Japan
Poland a/
Un l ted Kt ngdom
DENTAL (all workers)
Austral la
Canada
f rance
Swltzerland
United Klngdom
Unlted States b/
a/ 1966-1978.
-b/ Earller values: 1.1 (1960); 0.6 (1970) [K23].
T a b l e 35
Frequency o f d l a q n o s t l c n u c l e a r m e d l c l n e e x a m l n a t l o n s
( p e r 1000 p o p u l a t t o n )
Numbers I n p a r e n t h e s e s l n d l c a t e p e r c e n t o f t o t a l
Braln
Blllary
Llver/spleen
Bone
Pulmonary
T h y r o l d a_/
Renal
Tumaur/abcess
Cardlovascular
Other
a/ T h y r o l d scans and u p t a k e s .
b/ A d d l t l o n a l r e p o r t e d v a l u e s o f t o t a l frequency: Canada (1981). 49.0 [Cl];
F l n l a n d (1982). 17.7 [T3]; France (1982). 8.7 [ 8 9 ] .
T a b l e 36
Braln
Hepatoblllary
Llver
Bone
Resplratory
Thyroid (uptake
and scans)
Urlnary
Tumour
Cardlovascular
Other
T a b l e 37
Hepat lc/
Country Thyrold Blllary Braln Bone Lungs Other
Brazll 50 10 15 10 5 10
Colombla 20 25 10 20 10 15
Ecuador 60 15 10 5 10
El Salvador 40 30 20 10
HexIco 30 25 10 15 20
Peru 50 15 25 10
Unlted States 9 22 11 24 16 18
T a b l e 38
- - --
Austral la 4 8 W8. US
Austrla 18 WB
Bulgaria 13 WB
Burma 0.1 0.2 US
Canada 49 C1
China 0.6 Z5
Cuba 0.8 0.8 U5
Denmark 8 14 14 a/ US.WB.E2
Finland 18 73
France 9 89
Japan 5 8 MIS. H9
Poland 2 S25
Sweden 8 12 15 15 US.W8
Unlted Klngdom 7 W8
Unlted States b/ 16 11 29 31 M3 1
USSR 4 V7
a/
- 1985 value.
-
b/ Earller value: 4 (1966).
T a b l e 39
N u c l e a r m e d l c l n e exarnlnatlons b v l e v e l o f h e a l t h c a r e
I A u s t r a l l a (1980) [US] 8 75 a/
Austrla (1971) [ W l ] 18 57 a/
B u l g a r l a (1980) [W7] 13 76 a/
Canada (1981) [C2] 49 20 a/
Denmark (1987) [E?] 14 71 a/
Flnland (1982) [ T 3 ] ) 18
France (1982-87) [B9. P11) 9 160 a/
German Oern-Rep. 8 122 a/
Sweden (1982) [W8.US] IS 50 a/
U n l t e d Klngdom (1982) [W8] 7 160
U n l t e d S t a t e s (1982) [HZ51 32 31 a/
Rounded average 16 160
II 801 l v l a
-
b/ Brazll
Chlna
Colombla
Cuba
Ecuador
Mexlco
Phlllpplnes
Uruguay
111 Burma
-b / Indla
Malaysta
Thalland [KIT]
IV Bangladesh
b/ Indones l a
Nlgerla [ f l ]
. Paklstan
T a b l e 40
E s t l m a t e d average n u c l e a r m e d l c l n e e x a m l n a t l o n s
l e v e l o f health care
T a b l e 42
< 15 male 2.3 0.1 4.0 1.4 5.2 1.1 2.0 0.9
female 2.4 5.6 2.1 3.2 0.9 3.3 0.7
both 4.7 0.1 9.6 3.5 8.4 2.0 5.3 1.6
15-29 male 6.4 3.4 11.2 5.7 11.3 2.9 6.4 3.3
female 6.9 3.1 9.4 5.7 11.6 2.3 15.4 4.9
both 13.3 6.5 20.6 11.4 22.9 5.2 21.8 8.2
30-44 male 9.5 5.4 11.5 10.7 8.7 3.6 7.1 5.2
female 10.5 5.7 12.9 10.0 15.0 6.4 21.7 8.7
both 20.0 11.1 24.4 20.7 23.7 10.0 28.8 13.9
45-64 male 22.4 18.8 17.7 21.5 13.3 14.9 11.7 15.8
female 21.5 21.7 17.4 15.8 22.9 23.9 24.0 21.6
both 43.9 40.5 35.1 37.3 36.2 38.8 35.7 37.4
> 64 male 8.8 19.5 4.3 15.7 4.3 20.5 3.3 11.0
female 9.3 22.3 6.0 11.4 4.5 23.5 5.1 21.9
both 18.1 41.8 10.3 27.1 8.8 44.0 8.4 38.9
All ages male 49.5 47.2 48.5 55.0 42.8 43.0 30.5 42.0
female 50.5 52.8 51.5 45.0 57.2 57.0 69.5 58.0
both 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
T a b l e 43
Organ Radiopharmaceutical
Germany Poland Sweden UnltedKlngdom
Fed. Rep. a/ %I
[K2.K3] [S25] In61 Lug]
-
Thyrold 99m~c-pertechnetate
b/
- 1231-lodlde
1311-lodlde
Liver/ 99mTc-collold
spleen 1 9 8 ~ ~ - c lold
ol
Renal 131 1-Hlppuran
99m~c-OTPA
99~~-glucoheptonate
~ ~ ~ T C - O ~ S A
Bone 99mTc-phosphate
Cardlac 99mTc-erythrocytes
20111-chlorlde
Lung 99mTc-mlcrospheres
Brain 99mTc - 0 7 PA
99mTc-pertechnetate
99mTc-glucoheptonate
T a b l e 44
Brain I3
Hepatobiltary
Llver/spleen 924
Bone 4
Pulmonary
Thyrold 3740
Renal 1
Tumour/abcess
Cardlovascular
Other 12
Annual collect 1 ve
effecttve dose
equlvalent (total)
( m n Sv) 4700 430 2020 540 8700 950 32000
Technetl um-99m 51 2 33 89 b8
Iodlne-131 77 47 96 b2 4 I1
Other 23 2 2 5 7 IS a/
--
T a b l e 46
Annual
Level Per caput genetically
of Country Year effective slgnlflcant Ref
health dose dose
care equlvalent equlvalent
Total 5000 74
T a b l e 48
Average annual lndlvldual occupatlonal doses
for nuclear medlclne technologlsts from dlaqnostlc nuclear medlclne
Nuclear medlclne
technologlsts:
Average annual dose (mSv) 0.4 2.0 0.5 0.6 0.3-1.4
Collectlve dose (man Sv) 0.4 - l .2 0.3
T a b l e 49
Year
Type of
treatment
Columbla
Costa R l c a
Ecuador
E l Salvador
Mexico
Peru
Unlted States
Venezuela
T a b l e 51
Number o f m e q a v o l t a g e radiotherapy u n l t s I n t h e U n l t e d S t a t e s
and a n n u a l number o f new o a t l e n t s p e r u n l t
[KlS, R7]
Llnear New
Year Cobalt accelerators patlents
and b e t a t r o n s per u n l t
T a b l e 52
Annual procedures
per mllllon populatlon
Level Hachlnes
of Country Year Brachy- Unsealed per mlll ton Reference
health therapy radlo- populatlon
care and tele- nuclldes &/
therapy
I Argent lna
Oenma r k
France
Germany.
Fed.Rep. US1
Japan nb, ni31
Sweden us I
Unlted Klngdom 031
Unlted States Kl4. Rb]
T a b l e 53
Annual procedures
per mllllnn populatlon
Level Hachlr~es
of Brachy- Unrealed per mllllon
health therapy radlo- populat lon
care and tele- nuclldes a/
therapy
Annual procedures or
courses of treatment
T a b l e 55
Annua 1
Level Populatlon genetically
of slgnlflcant
health dose
care (rnllllons) (msv)
T a b l e 56
Beam therapy
Rrachytherapy
Radlotheraplsts
Anaesthetlsts
OR nurses
Ward Nurses
Laboratory staff
Mould room staff
Physlclsts
All workers
Annual Annual
collectlve genetlcally
effectlve slgnlflcant
Source dose collectlve
equlvalent dose
T a b l e 58
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ANNEX D
CONTENTS
Paragraphs Paragraphs
INTRODUCTION ....................... 1-7 3. Ratios of integrated concentra-
tions ...................... 11 1-1 13
I . T H E ACCIDENT .................. 8-42 B. Deposition ..................... 114-123
A . The reactor .................... 9-22 1 . Deposition of caesium-137 ... 114-1 16
I . Location .................. 9-12 2 . Deposition of other radio-
2. Design characteristics ....... 13-19 nuclides ................... 117-119
3. Cause of the accident ........ 20-22 3 . Quotient of deposition density
and integrated air concentra-
B . Radionuclide release and dispersion 23-33 tion ....................... 120
1 . Release sequence and compo- 4 . External exposure from
sition ..................... 23-28 deposited materials ......... 121-123
2. Atmospheric transport ...... 29-33 C . Diet .......................... 124-135
C . Emergency measures ............ 34-42 1 . Iodine-131 in foods ......... 127-130
2 . Caesium- 137 in foods ....... 131.135
I1. METHODOLOGY FOR THE DOSE D. The human body ................ 136- 142
ASSESSMENT .................... 43-99
A . Scope and approach ............. 43-61 IV . FIRST-YEAR DOSE ESTIMATES ... 143-170
1. Geographic coverage ........ 49-53 A . Thyroid dose equivalents ......... 145-149
2. Pathways ..................
3. Radionuclides considered ....
54-57
58
B. ........
Effective dose equivalents 150-152
4 . Doses evaluated ............ 59-61 C. Pathway contributions ........... 153-155
B . Calculational methods for first-year D. Radionuclide contributions ....... 156-157
doses ......................... E. Transfer relationships ........... 158-170
1 . External irradiation during 1. Transfer from deposition to
cloud passage .............. dose from external irradiation 159-162
2. Inhalation ................. 2. Transfer from deposition to
3. External irradiation from thyroid dose equivalent of
deposited material .......... iodine-131 ................. 163-164
(a) During the first month . . 3. Transfer from deposition to
(b) After the first month .... dose from ingestion ofcaesiurn-
4 . Ingestion .................. 137 ....................... 165-170
C . Calculational methods for projected (a) Transfer from deposition
................
doses ......................... to diet 165-167
(b) Transfer from diet to body 168
1. External irradiation .........
(c) Transfer from body to
2. Ingestion ..................
effective dose equivalent 169-170
111. EVALUATED INPUT DATA ....... 100-142 1 V . DOSE COMMITMENTS ........... 171-184
A . Air ........................... 105-113 .
A Transfer relationships ........... 173- 179
I . Radionuclide composition ... 105-107 1. Transfer from deposition to
2. Concentrations in air ........ 108-1 10 dose from external irradiation 173
Paragraphs Paragraphs
A. THE REACTOR
1. Location
Y
Heat-up p e r i o d
I
I I
l l
and krypton. which are thought to have been released
completely from the fuel. About 10-20% of the volatile
4
C
-
4-
= I
300 -1 radionuclides iodine, caesium and tellurium and 3-65,
W
"7
5 250 -
Cool-down p e r i o d
r- I
of other more stable radionuclides. such a s barium.
strontium, plutonium, cerium etc., were estimated
2
w
200 - -----I I--4 I
to have been released (Table 1). The estimate of the
F 1 I 1 I
150 -
I
I
--1
- - 1 ----I I--
I
I
--- .
0
3 I3'Cs release is compared in section V1.D with the
amount calculated from estimated deposition in the
100 - I
,-J
I
----- --- m
U
n northern hemisphere. The agreement is reasonable,
50 - -J
--------- 'f
(U
considering the wide uncertainties associated with both
estimates.
0
I
1 Z 3 4 S b 7 8 9 l O M
26. Only two earlier reactor accidents caused signi-
DAYS AFTER INITIATIO1i OF ACCICENT ON 26 APRIL
ficant releases of radionuclides: the one at Windscale
Figure il. Daily release rate to the atmosphere of radioactive (United Kingdom) in October 1957 and the other at
materials, excluding noble gases, during the Chernobyl accident. Three Mile Island (United States) in March 1979 [U I].
The values are decay-corrected to 6 May 1986 and have a While it is very difficult to estimate the fraction of the
range ol uncertainty of + 50%. [ I l l
Windscale radionuclide core inventory that was released
to the atmosphere. it has been estimated that that
accident released twice the amount of noble gases that
24. The release-rate curve may be subdivided into four was released at Chernobyl. but 2,000 times less "'1
stages: and "'Cs [D5]. The Three Mile Island accident
( a ) The initial release on the first day of the accident. released approximately 2% as much noble gases a n d
During thls stage, the niechanical discharge of 0.00002% as much IJ1Ias the Chernobyl accident.
radioactive materials was the result of the
explosion in the reactor; 27. From the c o m ~ o s i t i o n of air s a m ~ l c s taken
(b) A period of five days during which the release during the Chernobyl release and the total release-rate
rate declined to a minimum approximately six data. tentative isotopic release rales for individual
times lower than the initial release rate. In this radionuclides were constructed [ I l l . These generally
stage, the release rate decreased owing to the follow the pattern of the total release rate (I;igure 11).
measures taken to fight the graphite fire. These with decreasing release rates initially and increasing
measures. which consisted of dropping about rates until the end of the release period. .Additional
5,000 tonnes of boron carbide, dolomite, clay and information has been presented [I31 that shows
lead on to the core from helicopters, led to the changing isotopic ratios during the release period
filtration of the radioactive substances released (Table 2): for example, variable '"1 relative to "'Cs in
from the core. At this stage, finely dispersed fuel initial emissions and higher Io3Ru. Io6Ru, I4'Ce and
- escaped from the reactor directly with a flow of "'Ce in later emissions. The changing physical condi-
hot air and with the fumes from the burning of tions and. possibly, the involvement of fuel of varying
the graphite. burn-up may explain these features. The chemical form
(c) A period of four days during which the release of the materials released as aerosols was auite
rate increased again to about 70%) of the initial variable. The particle size of aerosols ranged from less
release rate. Initially, an escape of volatile than 1 micrometre to tens of micrometres.
components, especially iodine. was observed;
subsequently, the composition of the 28. For the region around the Chernobyl site detailed
radionuclides resembled that in spent fuel. These maps of radionuclide deposition could be drawn in
phenomena were attributed to heating of the fuel 1986 and 1987 based on measurements of external
in the core to above 2000°C, owing to residual dose rates and analyses of environmental samples [A9,
heat release. 1121. The pattern of deposition within other regions of
(d) A sudden drop in the release rate nine days after the Soviet Union was also established through gamma
the accident to less than 1% of the initial rate and dose-rate measurements from aircraft and analyses of
a continuing decline in the release rate thereafter. the radionuclide content of soil samples taken at a
This final stage, starting on 6 May, was charac- limited number of locations. These procedures enabled
terized by a rapid decrease in the escape of fission a n estimate to be made of the total amounts of
products and a gradual termination of discharges. radionuclides deposited in the Soviet Union. This
These phenomena were the consequence of the estimate was used in deriving the total amount of
radionuclides released, as mentioned before. The 30. According t o aircraft measurements within the
proportions of the core inventory deposited at various USSR. the plume height exceeded 1.200 m on 27 April,
distances from Chernobyl were estimated to be as \vith the maximum radiation occurring at 600 rn [I4].
follows p 11: On subsequent days, the plume height did not exceed
On-site: 0.3-0.59t 200-400 m. The volatile elements iodine and caesium,
0-20 km: 1.5-296 were detectable at greater altitudes (6-9 km), with
Beyond 20 km: I-1.5% traces also in the lower stratosphere [Jl]. The refrac-
tory elements, such as cerium. zirconium, neptunium
and strontium, were for the most part of significance
only in local deposition within the USSR [13. 141.
2. Atmospheric transport
3 1. Changing meteorological conditions, with winds of
29. At the time of the accident, surface winds at the different directions at various altitudes, and continuing
Chernobyl site were very weak and variable in releases over a 10-day period resulted in a very
direction. However, at 1,500 n~altitude the winds were complex dispersion pattern. The plumes of conta-
8-10 m/s from the south-east. The initial explosions minated air that spread over Europe are described in a
a n d heat from the fire carried some of the radioactive highly simplified manner in Figure 111, along with the
materials to this height, where they were transported reported initial arrival times of radioactive material.
by the stream flow along the western parts of the
USSR toward Finland and Sweden. The arrival of 37. The initial plume, depicted as A in Figure 111.
radioactive materials outside the USSR was first noted arrived on 27 April in Sweden and Finland. A portion
in Sweden on 27 April [Dl]. The transit time of of'this plume at lower altitude was directed southward
36 hours over a distance of some 1.200 km indicates to Poland and the German Democratic Republic.
transfer at an average wind speed of 10 m/s. Other eastern and central European countries became
Flgure Ill. Descrlpllve plume behavlour and reported lnltlal arrlval llmer of detectable actlvlv in alr.
Plumes A, 8. and C correspond to air mass movements orlglnating from Chernobyi on 26 Aprll.
27-28 Aprll, and 29-30 Aprll, rerpecllvely. The numbers 1 lo 8 lndlcate lnltlal anlval tlmes: 1 (26 Aprll).
2 (27 April), 3 (28 April), 4 (29 April), 5 (30 Aprll), 6 (1 May), 7 (2 May), 8 (3 May).
affected on 29 and 30 April (plume B). Activity in air radiological monitoring. Provisions were made for
entered north-east Italy during 30 April (also plume B). decontaminating people's skin and, in some cases, for
Central and southern Italy first had evidence of the changing their clothing.
plume's arrival during the following day. Switzerland
reported its first arrival on 30 April. The generally 37. In view of the duration of the release of radio-
northward flow air across western Europe brought active gases and aerosols from the damaged reactor, it
detectable activity to eastern France, Belgium and the was decided that the accident zone should be further
Netherlands on 1 May and to the United Kingdom on evacuated. As a result of this decision, over 88.000
2 May. Contaminated air (plume C) arrived in Greece people, including 21,000 children, were evacuated
on 2 May in the north and on 3 May in the south from the Kiev region and a further 25,000 people.
[GZ]. Airborne activity was also reported in Israel. including 6,000 children, were evacuated from the
Kuwait and Turkey in early May [K 1. S6. TI]. Gomel region of Byelorussia. After the radiation
situation had been verified, about 1.000 people were
33. Long-range atmospheric transport spread the evacuated from the Zhitomir.region in the Ukraine
released activity throughout the northern hemisphere. and a similar number from the Bryansk region in the
Reported initial arrival times were 2 May in Japan. RSFSR. The total number of evacuees rose to 1 15.000.
4 May in China, 5 May in India, and 5-6 May in All of these people were medically examined and
Canada and the United States [B 1, C7, L2, L6. N4]. resettled in neighbouring districts [A9, 1121.
The simultaneous arrival at both western and eastern
sites in Canada and the United States suggests a large- 38. To prevent the iodine radioisotopes (mostly "'I)
scale vertical and horizontal mixing over wide areas present in the plume from accumulating in the
[L2. R8]. No airborne activity from Chernobyl has thyroid. potassium iodide preparations weredistributed
been reported in the southern hemisphere. to the population in the surrounding zone starting on
the morning of 26 April. During the following days.
iodine prophylactics were given to 5.4 million people
C. EMERGENCY MEASURES in the USSR. including 1.7 million children [I 12. 1161.
34. After the accident, the first emergency measures 39. Some tens of thousands of cattle also had to be
taken at the nuclear station were fire-fighting and removed from the contaminated area. Measures were
short-term operations to stabilize the reactor. During taken to prevent or reduce the contamination of water
the night of 25-26 April 1986, 176 reactor operational bodies and ground-water supplies. The extensive
staff and workers from different departments and environmental radiological monitoring that took place
maintenance services were on duty at stages one and from the very beginning revealed many foodstuffs had
two (Units 1-4) of the nuclear power station. In been contaminated. On the basis of derived interven-
addition. 268 builders and assemblers were at work on tion levels for the most important items in the diet. the
the night shift at the construction site of the third consumption of locally produced milk and other
stage. foodstuffs was banned over a considerable area [I 121.
35. Of the on-site personnel and fire-fighters, about 40. According to measured levels of contamination,
300 had to be hospitalized for burns and the diagnosis the area within a 30-km radius of the reactor was
of possible radiation injuries. These individuals were divided into three zones: (a) a zone of some 4-5 km
observed and given care and, if necessary, specialized around the plant, where no re-entry of the general
treatment. The short-term effects and treatment of population is foreseeable in the near future and where
radiation injuries caused by the accident arc discussed no operations other than those required at the
in the Appendix to Annex G . "Early effects in man of installation will be permitted: (b) a 5-10 km zone.
high doses of radiation". where partial re-entry and special operations may be
allowed after some time; and (c) a 10-30 km zone.
36. A system of meteorological and radiological where the population may eventually be allowed to re-
monitoring was organized to survey the contamination enter and agricultural activities may be resumed.
levels in the surrounding area. Aerial radiological subject to strict radiological surveillance. Personnel
monitoring was carried out by aircraft and helicopters and vehicles are being controlled at the zone boundaries
equipped with air samplers and radiation-detection to reduce the spread of contamination.
instruments. On the morning of 26 April, people in
the town of Pripyat were instructed to remain indoors 41. Great effort has been devoted to decontaminating
and to keep their windows and doors shut. Schools off-site areas. In a 7,000 km2 area surrounding the
and kindergartens were closed. Late at night on reactor, houses and, particularly. public buildings
26 April, radiation levels in Pripyat started rising, (schools, nurseries, etc.) were repeatedly treated.
reaching about 10 mSv/h on 27 April. I t soon became Houses that could not be brought to acceptable levels
apparent that both the lower intervention level for and contaminated, old buildings of low value were dis-
evacuation (250 mSv whole-body dose) and eventually mantled and buried. Roads and other contaminated
even the upper intervention level (750 mSv whole- surfaces were covered with asphalt, gravel, broken
body dose) could be exceeded if the population stone, sand or clean soil, which brought about 10- to
remained in their homes and no other countermeasures 100-fold decreases in gamma dose rates. In contami-
were taken. The evacuation of Pripyat started on the nated agricultural areas, deeper ploughing was carried
morning of 27 April. after safe evacuation routes had out and more mineral fertilizers were added. Grass-
been established on the basis of the first results of lands and pastures were also ploughed and reseeded.
All of these measures substantially reduced radio- (local fallout) was largely ignored; its distribution was
nuclide transfers and radiation levels. very uneven and its contributions to the total collec-
tive dose commitments were small, and (b) following
42. In many countries the countermeasures taken releases from nuclear installations, environmental
immediately after the accident were effective in reducing concentrations and body burdens are often below the
individual and collective doses. Thyroid dose equi- detection limits of the measuring instruments. Doses
valents were reduced by 80-9092 in the most contami- are calculated using generic source terms characteristic
nated region of the USSR. Estimates of theeffectiveness of the particular type of nuclear installation under
of the I3'Cs countermeasures in that country varied considcrntion and using environmental transfer models.
between 20'% and 90%. depending on the level of the parameter values of which are largely independent
contamination. In Austria, the Federal Republic of of the location of the installation.
Germany and Norway, doses were reduced between
30% and 50% by countermeasures, and in other 46. In the case of the accident at Chernobyl. a
European countries they were reduced somewhat less different set of conditions prevailed: ( a ) the release
[N5]. These countermeasures were taken into account was into the troposphere and took place from a single
in the Committee's assessment, as far as possible, by location at a specific time of year; ( b ) even so. the
considering the reduction in intakes of contaminated duration of the release over several days, the large size
foods. of the affected region and changing weather through-
out the region resulted in a locally varying deposition
pattern; (c) the accident occurred a t different stages in
11. METHODOLOCJ' FOR THE DOSE the agricultural growing season: in the north of
ASSESSMENT Europe, the season had not yet begun. in the south it
was already under way; (d) protective measures varied
from country to country; (e) a large number of
A. SCOPE A N D APPROACH environn~ental measurements were made available,
providing input data for comprehensive dose assess-
43. Since the accident, a sufTicient number of measure- ments.
ments have been made t o show the basic features to
consider in a dosimetric evaluation. The main pathways 47. In these circumstances. UNSCEAR was able to
a n d radionuclides contributing to doses are external perform its dose assessment for the Chernobyl accident
irradiation from deposited radioactive materials (prim- in some detail, accounting for regional variabilities but
arily 13'Cs in the longer term) and the dietary applying uniform calculational methods to achieve
ingestion of radionuclides ("'1 in milk and leafy comparability of results between countries. The Com-
vegetables during the first month and, after that. lJ4Cs mittee relied as much as possible on measured results
and I3'Cs in foods). and used a general model to project the dose
commitment.
34. The inhomogeneous deposition of dispersed
materials makes i t necessary to take a regional 48. This report includes estimates of average doses to
approach to dose calculation. Enough information is populations of countries. Occupational exposures arc
available to calculate doses in the most affected not included. because dose information for workers
region. which includes most of the European countries participating in the restoration work in the USSR is not
(some of these countries were further subdivided). The yet available.
input values for the calculations make full use of
measurement results through the first year following
the accident. Thereafter. projections are required to 1. Geographic coverage
estimate future environmental behawour. primarily of
"7Cs. and the continued contribution to dose for a 49. There are practical reasons for considering coun-
few decades, These projections were made on the basis tries as the basic geographic units: most measurements
of long-term observations of global fallout from have been co-ordinated and averaged country by
nuclear weapons testing. country and much of the secondary data, such as
population, food production and consumption. is
45. It may be instructive to consider the differences available only o n a similar basis. This approach also
between this dose assessment and the previous allows the Committee to compare its calculations of
UNSCEAR dose assessments carried out in connec- first-year dose equivalents with the calculations of the
tion with nuclear fallout or routine. low-level releases individual countries. Dose commitments are then
from nuclear fuel-cycle installations; namely. that calculated o n a regional basis.
(a) much of the radioactive debris from nuclear
weapons tests in the atmosphere was injected into the 50. Although it was the countries of Europe that
stratosphere, from which altitude there was rather were most affected by the Chernobyl accident. the
more uniform hemispheric deposition over the course of radioactive materials became dispersed throughout the
several years. Doses could be assessed o n the basis of a northern hemisphere, and so the dose assessment
latitudinal deposition distribution derived from a considers the entire hemisphere. It is well established
relatively small number of measurements and on the that, for an atmospheric release into the lower
basis of transfer factors inferred from measurements in troposphere. there is very little transfer of particles
only a few countries. Representative rather than com- from one hemisphere to another. Although there may
prehensive results were required. Short-term deposition be some transfer of dose to southern hemisphere
residents through imported foods, this increment in 53. In Asia and North America. only IOU, levels of
the collective dose equivalent can be accounted for by radioactivity could be detected. The approximate dose
considering total production as well as consumption estimates for some countries in these regions have
of foods in the affected regions. been extrapolated to obtain estimates for larger
geographic areas. Although they were not significantly
51. Because they were closest to the release point. affected by the airborne transport of radioactive
the countries of northern. eastern and western Europe materials from the accident. other developing coun-
and the western part of the USSR require the most tries have been concerned about the possible contarni-
detailed consideration. It was in these places that nation of imported foods. Further. the accident has
deposition u a s greatest and most non-uniform. In prompted several countries to engage in activities to
countries further removed from the release point. the evaluate and assess immediate and late effecrs of this
more widely dispersed material was deposited with and other possible accidents. I t is clear that inter-
more regional uniformity and was, at any rate. less national agencies must become involved in the training
significant from a dosimetric standpoint. of scientists and technicians: the procurement of
equipment; the development of simplified techniques
52. For almost all the countries of eastern and for measurement and assessment; and procedures on
western Europe, enough radiation-monitoring data which to base setting of restrictions on imports of
and other information were available to allow detailed contaminated foods.
dose calculations for the first year. In so far as was
possible, each country was considered as a single
geographic unit. However, to avoid averaging wide-
ranging dosimetric data, several countries were sub-
divided. These geographical breakdowns within the 54. There are two primary pathways t o be considered
various countries of Europe are indicated in Figure IV. in thts dose assessment: (a) external irradiation from
For the calculation of dose equivalent commitments. radioactive materials deposited on the ground and
countries were combined into broad geographical (b) ingestion of contaminated foodstuffs. T w o
regions. secondary pathways have been considered as well,
Figure IV. Divislon of Europe by country, or by subregions within counlrles, for purpose of the dose assessment.
since the concentrations of radionuclides in air, on ingestion of radioactive materials. First-year dose
which they depend, have been generally available: equivalents to the thyroid of adults and one-year-old
(a) external irradiation from radioactive materials infants are also estimated.
present in the cloud. referred to as "cloud gamma".
a n d (b) inhalation of radionuclides during passage of 60. The evaluations of dose for the first year reflect
the cloud. The inhalation pathway can. in fact. be as nearly as possible the prevailing conditions, taking
important right after an accident and if people are sub- into account not only measured values but also
sequently evacuated and received no further exposure. it shielding and occupancy factors and protective meas-
can turn out to have been the most important ures. The recently observed and reported reduction in
pathway. exposure levels in urban areas as a result of runoff has
been incorporated into the dose models. Other factors
55. Some data available from different countries are introduced and described along with the calcula-
show a small amount of resuspension of the deposited tional methods.
material that led to measurable concentrations in air
some weeks or months after the accident. The 61. The second component of the dobe assessment is
contribution of resuspension to further inhalation the collective effective dose equivalent commitment.
doses is considered to be s n ~ a l lin comparison to that which requires projection of doses to be received in
of the other exposure pathways. the future from deposited materials. For this purpose
the models developed by the Committee for estimating
56. The path\va!.s of cloud-gamma exposure and dose commitments from fallout have been used.
inhalation of radionuclides are effective only for the Because the parameters for these niodels were obtained
short period before the airborne material has been by averaging results from widely separated regions.
deposited. Transfers along the two primary pathways wider groupings of countries have been selected to
continue for a length of time that depends on the half- reflect regional deposition patterns. The dose com-
lives of the radionuclides, some tens of days for "'1. mitments have been evaluated for each large region
for example, and some tens of years for "'Cs. and used for calculating the collective dose commit-
ment. The estimates are based on both consumption
57. For the ingestion pathivay, only the basic food and production of foods.
items have been considered: milk products, grain
products, leafy vegetables, other vegetables and fruit,
a n d meat. Those five categories are sufficient to
B. CALCULATIONAL hiETHODS
account for the food ingeslion of most individuals.
FOR FIRST-YEAR DOSES
Radionuclide uptakes in other foods, such as mush-
rooms and lake fish, have been noted. Although these
other foods may be irnportant for some consumers, 61. For the most part, the calculations simply
they, like other possible, but minor, pathways, have involve multiplying integrated concentrations by dose
little effect on collective dose estimates. factors, with reduction factors taken into account. The
integrated concenlrations in food are derived, where
possible, from measurements through the first year
3. Radionuclides considered follo\ving the accident. T o supply missing data, use is
made of ratios to other measurements or to "default"
values, tvhich are values derived from measurements
58. Only "'I. '"Cs and "-Cs. the most important
at other sites o r averaged from representative results
contributors to the total dose. have been considered
from neighbouring locations. The methods for each
systen~aticallyby the tarious countries. Other radio-
pathway are described below.
nuclides ("Zr, I0'Ru. ;"bRu. ."re. '"OBa and .'Ice)
were reported in air or deposition. Several of the latter
were important short-term contributors to cvternal
1. Exterrlal irradiation during cloud passage
irradiation from deposited material; when not measured
directly, they may be accounted for by scaling to 13-Cs
63. During a very brief period, usually only hours
o r "I1 deposition. The long-lived radionuclidss 'H,
but sometimes a few days. the passing cloud of
"C. 85Kr and "'1 are discussed later. They. too. are
contaminated air exposes people to external irradia-
but minor contributors to the total dose.
tion. This exposure is referred to as cloud-gamma
irradiation. .Although this exposure rate could in
theory be measured direaly. -in practice it is not
4. Doses evaluated possible to distinguish this component from radiation
caused by deposited activity on the ground. The doses
59. The assessment of doses has two components: from cloud-gamma exposure can be easily calculated
(a) the committed dose equivalents resulting from from measured air concentrations. Thc equation for
exposures and intakes during the first year following radionuclide i is
the accident and (b) the collecti\,e effective dose
FIE.Ji) = C 3 i ) Oc(i) ( I - Fo)+ C:(i) aC(i) Fo Fs
equivalent commitment due to the accident. In assessed
countries and subregions, estimates are made of the where FIE.c ( i ) is the cloud-gamma effective dose
first-year effective dose equivalent, i.e. the dose equivalent (Sv): C:(i) is the integrated concentration
received in the first year from external irradiation and in outdoor air (Bq d/m3); a, (i) is the effective dose
the dose committed from first-year inhalation and equivalent factor per unit integrated air concentration
(Sv per Bq d/m3); F, is the indoor occupancy factor 68. The first term is the outdoor component and the
(the fractional time spent indoors); and F, is the second term is the indoor component. The breathing
building shielding factor (the ratio of indoor to rates are taken to be 22 m3/d for adults and 3.8 m3/d
outdoor dose rates). for infants [I6]. Indoor occupancy is the same as in the
previous calculation. Air concentrations are assumed
64. The first term in the equation is the outdoor to be lower indoors due to filtration effects. For all
component of effective dose equivalent and the second countries, the value of the indoor air concentration
term is the indoor component. An additional small reduction factor is taken to be 0.3. Experiments in
component of dose from contaminated air indoors has Finland and Norway showed a range of values. from
been neglected in this calculation. The effective dose 0.22 to 0.47, for this factor [C23]: in Denmark they
equivalent factors have been derived for uniform semi- ranged from 0.1 to 0.5 [R9]. Calculations have been
infinite cloud geometry. A list of effective dose made both for the thyroid and for the effective dose
equivalent factors is given in Table 3. The same values equivalents. This calculation also depends upon data
are assumed to apply to both infants and adults. of integrated concentration in air with "'I being of
particular importance. Such data were inferred where
65. F o r the calculations here. an indoor occupant). needed as discussed under the section above. Dose
factor of 0.8 and a building shielding factor of 0.2 equivalent factors are listed in Table 4.
have been used for all countries. The values of these
factors had been previously used by the Committee
[UI. U2]. I t is to be noted, however. that measure- 3. External irradiation from deposited material
ments a s well as calculations of the shielding factor
afforded by buildings show a large range of variation
69. External irradiation from radioactive materials
depending on the kind of building: from 0.01 to 0.1
deposited on the ground makes a significant contribu-
for multi-storey buildings and from 0.1 to 0.7 for
tion to the total dose equivalent. During the first
single-family houses in Sweden [C25], while in Nor-
month after deposition. a number of short-lived
way the mean shielding factor of houses \itas reported
emitters. including "ZTe. ":I. !''I, "OBa. I4OLa and
a s 0.5 during the first month and 0.29 during the sixth
'3bCs. were important components of the total external
month following the accident [S14]. For typical
gamma exposure rate. For several months, ""Ru a n d
European houses, calculations for "'Cs deposition
IohRu made contributions, but since then only "'Cs
yield values of 0.44. 0.084, and 0.0063 for the ground
and ]"Cs have been of significance. External gamma
floors of prefabricated. semi-detached. and multi-
esposure rates will remain elevated for some years due
storey houses, respectively [M8].
to '"Cs and for some tens of years due to "'Cs.
66. T o calculate cloud-gamma (and also inhalation)
70. Calculation of the effective dose equivalent from
doses, it is necessary to knot\ the integrated concentra- external irradiation from deposited material proceeds
tions in air of many short-lived radionuclides. In some in two steps: the exposure in the first month is
countries, complete data were available. In others,
considered separately from exposure in subsequent
only one or a few radionuclides were reported. so months.
concentrations of other radionuclides were inferred
from ratios measured in nearby countries. In a few (u) During rhcfirsr month
cases, n o measured air concentrations were available.
s o the integrated air concentration of I3'Cs was 71. The outdoor exposure XI (C/kg) during the first
inferred from its ground-deposition density and a month was assessed by four different methods. with
nominal quotient of ground deposition to integrated the choice dependent upon the data available. If
air concentration of 1,000 m/d: the integrated concen- continuous or daily data were provided, the exposure
trations of other radionuclides were then inferred rates were integrated. If incomplete data were pro-
from ratios to "'Cs measured at nearby locations. vided. a n attempt was made to fit a power function of
the forn; a t h to the data. where t is time (days) and a
and b are constants to be determined. X , is then the
2. Inhalation in~egralof this function from arrival day I to day 30.
67. Contaminated air is inhaled during the short 7 2 . If measurements of external gamma-exposure
time that the radioactive materials remain airborne. rate were nor available, two approaches were used. If
This is a straightforward calculation from measured data on the ground deposition of the radionuclides
integrated concentrations in air. The equation for were provided, the exposure rate from each was
radionuclide i is: computed using the factors published by Beck [BlO]
for a relaxation depth of 0.1 cm. The term relaxation
depth follows from the assumption that the activity
where H,,,(i) is the inhalation effective dose equivalent mass concentration S(z) of a radionuclide decreases
(Sv); C:(i) is the integrated concentration in outdoor air exponentially with depth z in soil:
(Bq d/m3); B is the breathing rate (m3/d); @,(i) is the
dose per unit intake from inhalation (Sv/Bq): F, is the
indoor occupancy factor; and F, is the indoor air and the relaxation depth is defined by u-I. In this case,
concentration reduction factor (the ratio of indoor to X , was evaluated as the sum of the integrated
outdoor air concentrations). exposure rate from each radionuclide.
73. In several cases, only data on the deposition of reduction for urban areas is 0.75 with the assumed
'"Cs were available. and XI was evaluated on the parameters. The proportion of populations living in
basis of the relationship of the exposure to "'Cs urban and rural areas is given in national statistical
deposition density as measured at a specific location, reports. The urban proportion is around 80% in most
e.g.. Neuherberg. Federal Republic of Germany [GI]. European countries, according to the various defini-
tions of urban areas. However, as urban populations
74. The effective dose equivalent during the first also include people living in suburban locations, the
month was calculated from X I by: urban fraction (F,). for purposes of this calculation,
was assunled not to exceed 0.5. Effective dose equi-
HL,c,= AXl(! - F,) + AXIF,,F, valent conversion factors are listed in Table 5.
where H,cel is the effective dose equivalent from
external exposure during the first month (Sv), A is the 79. Data were available from almost all countries in
conversion factor (23.6 Sv per C/kg, i.e.. 33.7 Gy per Europe and elsewhere on the deposition of "'Cs. If
C/kg X 0.7 Sv/Gy), F,, is the indoor occupancy factor data \icere not reported for "'Cs. a measured ratio in
and F, is the building-shielding factor. The values of air was used, or a nominal ratio of 0.5. Data were also
the latter two factors are 0.8 and 0.2. the same as used typically available for "'I, but if not. deposition was
for the calculation of effective dose equivalent from inferred based on ratios measured on airborne particles
cloud-gamma irradiation. or ratios of deposition in nearby countries. Data on
'O'Ru and IUbRuwere available from about half of the
(b) A.fier l h e j i r s l nronrll countries; if they were not, the calculations were made
on the basis of the ratio to I3'Cs measured in air or
75. The calculation of external gamma dose beyond deposition in nearby countries.
one month is based on the measured total deposition
of "'Cs and I"Cs and, although less important, "'Ru,
'06Ru and "'I. The conversion factors for long-term 4. Ingestion
deposition to dose rate depend on the penetration of
these radionuclides in soil. Change with time is 80. The ingestion of radionuclides in foods is a
accounted for by using factors appropriate for a second primary pathway for radiation doses. As
relaxation depth of 1 cm during the first year and determined by an initial sensitivity analysis, only the
3 cm thereafter. The latter value had been previously radionuclides "'1, "4Cs and I3'Cs make significant
used by the Committee for its assessment of doses contributions and need be considered. The dose
from nuclear weapons fallout [U 1, U2]. estimation is based on measured or inferred concen-
trations during the first year, but projections are
76. Follouing the deposition of radioactive material required to take account of caesium transfer in future
from the Chernobyl accident, several groups observed years.
that the measured external gamma exposure rate
decreased more rapidly over urban surfaces than over 8 1. The food categories considered include milk and
grass surfaces [J2, K6. S18]. Although varied. these milk products, grain products. leafy vegetables. other
results are consistent with the loss of half of the vegetables and fruit. and meat. The occurrence of ')'I
material with a half time of 7 days and the other half in foods was of significance only for milk and milk
being firmly fixed on urban surfaces. This urban products and leafy vegetables, with the exception of
runoff effect has been reflected in this assessment by high relative values reported for the radish in Japan
applying these factors to that portion of a country's [N4]. Root vegetables and fruits were. in general. less
population considered to be urban. affected, and they have been considered together. An
integrated food concentration (Bq a/kg) has been
77. The equation for the calculation of external
calculated or inferred for each food category; it is
gamma effective dose equivalent for the time period
based on all types of individual foods to the extent
between one month and one year for radionuclide i is
data were available. weighted by consumption amounts.
H,,,(i) = [F(i)/i(i)J [Qe2(i)(e' 'f"13'12 - e-"" l" )I For esa~nple,the concentration for meal wascalculated
[ I - F,(I - F,)][1 - Fp(l - F,)] on the weighted average concentration in beef, pork.
lamb, poultry, game and fish. Similarly. the concen-
where H,,,(i) is the external gamma effective dose tration in rnilk products was calculated as a weighted
equivalent for the time from one month to one year average of the concentration in milk (of cows, sheep
(Sv); F(i) is the deposition density (Bq/mz): @,:(i) is and goats), cheese, butter etc.
the deposition density to effective dose equivalent
conversion factor during the period between one 82. Food consumption by adults has been taken
month and one year (relaxation depth of I cm) ( S V per from national estimates or from data tabulated by the
Bq/m2); i.(i) is the radioactive decay constant (a I); F, United Nations Food and Agriculture Organization
is the urban fraction of a country's population; F, is [FIO]. There are substantial variations in these values
the fraction of the deposition that remains fixed on from country to country. National consumprion esti-
urban surfaces (assumed in this Annex to be equal to mates for infants were more variable than would be
0.5) and F,, and F, are as previously defined. reasonable, probably because different age groups
were considered. Accordingly, consumption estimates
78. The equation applies to the period between for infants up to one year old were standardized and
30 days and I year. The overall reduction for used uniformly in calculations for all countries: milk
occupancy and shielding of buildings is 0.36 and the products, 200 kg/a; grain products, 20 kg/a; leafy
vegetables, 5 kg/a; vegetables/fruit, 15 kg/a; and meat, 87. The dose assessment for the first year after the
5 kg/a. Chernobyl accident depends on the use of measured
concentrations of radionuclides in foodstuffs. Such
83. Doses from ingestion of contaminated foods are concentrations are assumed to represent consumption-
calculated simply as the product of integrated concen- weighted averages for the area concerned. Reliable
trations in foods during the first year (from the estimates of such averages depend on systematic
beginning of May 1986 to the end of April 1987). sampling plans specially designed for this purpose.
consumption amounts and dose equivalent factors. For some types of foodstuffs. the prime example being
The integrated concentrations are summations of dairy milk, it is relatively easy to achieve reasonably
measured values averaged over the regions considered. reliable estimates, because a measurement on a single
In some cases, extrapolations were required to com- sample can be assumed to typify both a large produc-
plete the full year of data. tion area and a large consumer group. For other
dietary components, reliable estimates necessitate both
84. If countermeasures were known to have been large numbers of samples and well-designed sampling
taken in different countries, the effects were included plans. This is especially the case when there has been
in the integrated concentrations in foods. For example, both small-scale and large-scale variability of the
Austria banned leafy vegetables, so the concentration deposition density, as was the case after the Chernobyl
of ')lI in leafy vegetables is given as 0.0 [M3]. In other accident.
countries. foods with radionuclide concentrations above
certain limits were withheld from markets; any reported 88. After the Chernobyl accident. the affecred coun-
concentrations in foods above that limit were there- tries started sampling and measurement programmes.
fore. disregarded. These programmes were in many cases control pro-
grammes. designed to assure that foodstuffs contami-
85. Nearly all countries reported measurements of
nated above a particular level did not reach consumers.
"'I in milk and leafy vegetables. Levels of I3Ts
Such programmes are often characterized by a planned
and I3'Cs were usually reported for milk and leafy
or unplanned bias, such that sampling is concentrated
vegetables. The reporting of concentrations in grain,
in areas where high contamination levels are sus-
meat and other vegetables and fruits was more
pected. The average calculated from such programmes
limited. Methods of inferring concentration varied
therefore tends to overestimate consumption-weighted
depending upon what other data had been reported
averages. and there is little possibility of correcting
and the general relationships among food categories
afterwards for a bias of this kind.
deduced previously [UI]. The concentration of "'Cs
or 'j7Cs, if necessary. was typically inferred using a
89. For the long-lived caesium isotopes, there will be
first-year transfer factor. Specific values varied from
a time-averaging that results in less variability for
region to region. As an example. "'Cs in meat was
contamination levels in such foodstuffs as milk. green
estimated from 'j7Cs deposition using a first-year
vegetables and meat. Since the short half-life of "'I
transfer factor of 3-4 Bq a/kg per kBq/m2, in some
precluded such averaging, the estimated average levels
west European countries; in others, it was inferred
must in many cases be regarded as tentative.
from a ratio of integrated concentrations of meat to
milk of 2-3. The concentration in other vegetables and
fruits was similarly deduced using a transfer factor of
C. CALCULATIONAL METHODS
0.8-1.6 Bq a/kg per kBq/m2 or by using a ratio of 0.3 FOR PROJECTED DOSES
for integrated concentration relative to milk. Grain
presented a special difficulty because measurements
were lacking and because some data showed a very 1. External irradiation
strong effect of time of contamination before harvest.
as noted earlier by Aarkrog [A4]. A more complete 90. External exposure from radioactive materials
discussion of how concentrations in grain were cal- deposited on the ground was evaluated by the
culated is provided in the next section. following equation:
86. The equation for this part of the ingestion HF.c3(i) ~ ]- F,(1 - F,)]
= [F(i)/i(i)J [@,,(i) e - ; ( ~ )[I
pathway calculation for food category g and radio- [I - Fp(l - Fu)1
nuclide i is The symbols were defined in paragraph 77. The
HE.$,(^) = Cp+(i)1,9g(i)
deposition density to effective dose equivalent factor,
where HE,gl(i)is the effective dose equivalent from @,,(i), to be used beyond one year after deposition,
first-year ingestion of food group g (Sv); C;(i) is the uses a relaxation depth of 3 cm, as has been assumed
weighted integrated concentration in food group g (Bq previously in UNSCEAR assessments. Values of this
a/kg); I, is the consumption rate for food group g factor are listed in Table 5.
(kg/a); @,(i) is the effective dose equivalent per unit
intake from ingestion (Sv/Bq). Summation is required
over the relevant food categories for the total dose 2. Ingestion
equivalent from each radionuclide. Values of the dose
factors are listed in Table 6. Specific values of 91. Projections are required to estimate ingestion
consumption rates are taken as reported by the doses beyond the periods for which measurements are
individual countries or as derived from F A 0 data available. Over many years, a deposition-diet transfer
[FIO]. model has been developed and used by the Committee
t o describe the behaviour of fallout radionuclides. *Sr 95. Grain is usually harvested in the summer months
a n d "'Cs, in the environment and t o estimate dose and later processed into flour and bran or used a s
equivalent commitments [U I]. The basic transfer animal feed. The transfer factors from grain to bread
relationship for radionuclide i and for food category g o r other products for human consumption and the
of the weighted diet total is: composition of grains in the consumed products have
been reported for Denmark [A5].
C: (i) = Pz3(g,i) F(i)
Transfer from Percenrage
where C:(i) is the integrated concentration in food grain to bread of grain consumption
over all time (Bq a/kg); P2,(g.i) is the transfer factor
from deposition density (compartment 2) to food o r Rye 1 36
Wheat 0.5 55
total diet (compartment 3) (Bq a/kg per Bq/mz); and
Oats 0.5 9
F(i) is the total deposition density (Bq/m2).
Applying these factors to the measured "'Cs activity
92. The values of deposition density and concentra- mass concentrations in grains harvested in 1986 results
tions in food have been determined on an annual basis in P2, transfer factors of 0.5 Bq a/kg per kBq/m2 in
a n d the parameters in the transfer function evaluated Finland; 0.25 in Norway, 3.3 in Denmark. 4 in
by regression fitting. The model for the transfer France, 4.5 in Czechoslovakia and 16 in Japan. The
function is average P2, for grain products delivered after the
P2! = b, + b2 + b3e-"
atmospheric testing of nuclear weapons was 15 Bq a/kg
where b , is the component of first-year transfer; b 2 is per kBq/m2 (Table 7). The latitudinal dependence of
the second-year transfer; and b,e-" is the subsequent the Chernobyl contamination reflects the different
transfer (the latter accounts for both environmental stages of grain maturity at the time of the accident.
loss and radioactive decay). Tliis model was developed \+'here grain contamination is not reported for a
for the rather more uniform a n d continuing deposition particular country, values of P,, for grain products
pattern of radioactive fallout from atmospheric nuclear have been assumed to be 0.5 Bq a/kg per kBq/m2 for
weapons testing. Thus it is not specifically intended to latitudes above 55" N, 5 for temperate latitudes
predict time-integrated concentrations in foods in (40-55' N), and 20 for latitudes below 40° N. Higher
specific countries for a release such as that which values are not likely because the grain at latitudes
occurred from the Chernobyl reactor. However, in below 30" N was about to be harvested when the
so far as seasonal and local conditions are largely contamination occurred.
accounted for by direct measurements of the first year,
the model may be applied t o obtain projected behaviour
96. Assunling that the grain products derived from a
for the second year and beyond over large areas, such
given summer harvest are available from November of
as groups of countries. The part of the transfer
that year to November of the follotving year, the grain
function that accounts for the time-integrated concen-
contaminated by the deposition in \lay 1986 can be
trations beyond the first year, the second and third
considered t o have been distributed for six months
terms, is referred to as P21.2+:
(November to April) during the first year after the
P2>.?_= b 2 + b?e-" accident and for six months during the second year. so
that b , = PI3/2 and P?,.?+ = P13/2.
93. Detailed evaluation of the P, factor for ''-Cs for
all food categories is available from fallout measure- 97. Estimates of projected doses from the ingestion
ments in Denmark and .4rgentina, reported in [ U I]. A pathway are obtained by multiplying the factor P_13.2+
similar analysis has been made for Chicago in the by the deposition in the region, the consumption rate
Lnited States [E7]. The values of these parameters are and the dose per unit intake from ingestion:
listed in Table 7. The three locations are far apart. and
the results show some of the variability that can be
expected as a result of different soil types, agricultural
where HE,g2(i)is the effective dose equivalent from
practices and other local conditions. These results
have been combined and the averaged values of ingestion of radionuclide i in food group g beyond the
first year (Sv); P,,,,+(g.i) is the deposition density to
used in the dose calculations for all food categories
diet transfer factor; F(i) is the total deposition density
except grain products.
(Rq/m2): I, is the consumption rate (kg/a): and @,(i)
94. A separate assessment is required for grain is the effective dosc equivalent per unit intake (Srp/Bq).
products, whose contamination has been shown to be
very dependent on the maturity of the plant [A4, 98. Collective dose estimates are made for each
C131. Contamination by root uptake is negligible in pathway by multiplying doses by the relevant popula-
comparison to contamination by direct deposition. as tion of each region. For the ingestion pathway two
is generally the case for any vegetable product. Under estimates are made: namely, (a) a consumption-based
controlled conditions, the transfer of caesium to grain estimate, whereby the intake per individual is multi-
has been studied in relation to time of harvest [A4]. plied by the number of individuals and (b) a production-
Uniform deposition to a test area of a barley field based estimate which is derived from the country's total
three months before harvest resulted in a 100-fold production. The estimates are usually in fairly close
lower concentration in grain than applications two agreement, certainly within the uncertainty of the two
months before harvest. There was little difference in methods. The production-based estimates account for
transfer for applications at other times within two any additional collective dose outside the country if
months of harvest. large amounts of food are exported.
99. Countries were grouped together. and population- F4, F5. F6. H5, K2. K3, K 6 . 1 3 , S I . S 8 , S 9 , S131;
weighted values of deposition density and transfer Central Europe: Austria [Al. B7, D2, F7, K7, M3,
factors were used in evaluating the collective effective 0 1. S 18. S19, S201; Czechoslovakia [B 12. I1 I. M7.
dose equivalent commitments. M9); German Democratic Republic [LI]; Federal
Republic of Germany [B13. D4. D6. GI. 110. J5. K1.
S2. S16. W2, W4]; Hungary [A2, B9. HI. H4. S7];
111. EVALUATED lKPUT DATA Poland [CI, CZ]; Romania [R6]: Switzerland [B2. B3.
C14. HZ. PZ, S12. V2. W?]; West Europe: Belgium
[CIO. G4,S4. S5]; France [C5, C21, C22. D3. 15, S3,
100. Following the Chernobyl accident, extensive S17. S211; Ireland [C9]; Luxembourg [CIO. S3, S5]:
national monitoring programmes were undertaken to Netherlands [C8. C261; United Kingdom [C3. C11.
determine the extent and degree of contamination F2. F?. F12, 512, WI]; South Europc: Bulgaria [C1.
from the radionuclides released and to evaluate the P41: Greece [G2, G3]; Italy [C15. C16. C17. C18. CIO.
need for countermeasures. Continued measurements C20. E2, M3, M5. M6. R4. R53: Portugal [L1]: S p a ~ n
in many countries of the environmental levels and of [C6. G5, G6]; l'ugoslavia [F8. F9. 17. 18. 531; USSR:
concentrations in the diet and in the human body [A9, 11. 12, 13. 14, 112. 113. 116. P6. US. U6]: \Vest
provide a basis for evaluating the radiation exposures. .Asia: Cyprus [C12]; Israel [S6]: Syrian Arab Republic
[Sl I]; Turkey [TI, T2]; East Asia: China [B8. C21,
101. The material in this chapter is not intended to L6]; India [Bl]; Japan [A7. NZ. N4. SIO]; North
document the many results obtained; rather. it com- America: Canada [C7, R8]: United Stales [DS, E3. Uj].
prises, in summary form, the representative input data
required for the dose calculations. In most cases, these
data are the first-year integrated concentrations for A. AIR
each country or subregion. Relationships between
integrated quantities have been used to check the 1. Radionuclide composition
consistency of the results and to form the basis for
estimates where data are incomplete or missing. as 105. Radionuclides in air. identified by filter sampling.
indicated in the previous chapter. The input data used \wre predominantly volatile clements (iodine, caesiun~,
in the dose assessment are presented in tabular form, tellurium) rather than non-volatile ones. The radio-
and measured and inferred data are carefully distin- nuclldes detected by gamma spectrometry included
guished. J*Xlo. 9YmTc. ; O J R ~ , !::St,. 12%.
. . . .
13:Te 1311 1321 1331.
13JCs. 1 1 6 ~ ~lj. :cs '"Ba, and "OLa. Some additional
102. Various types of input data are required to radionuclides ('5Nb, lohRu."""Ag. I2'Sb. IzqmTe."lCc.
complete the dose calculations. These include non- IJ4Cc) could be dctected only after the decay of
radiological data, such as population, area. food interfering gamma lines.
production and consumption, and radiation data.
-
such as integrated concentrations in air and foods and 106. Other radionuclides in air were determined by
deposition densities. The values of the non-radiolog~cal beta or alpha spectrometry. Strontium radionuclides
parameters for each country or subregion are listed in were present in low concentrations, the "'CS/~"S~
Table 8. Food-production estimates, when not reported ratlcl being approximately 110 to I as measured at
directly by countries. were obtained from reports of Xlunich-Ncuherberg and the "Sr/'*Sr ratio about 10
the Food and Agriculture Organization of the United to I (on I May). Transuranic elements were estimated
Nations [FlO. FI I], adjusted to reflect food-use to be present on I May at concentrations of 1 30pBq/m3
amounts by accounting for feed and non-food pro- (?''Pu). 200 pBq/m3 (:39.240Pu) and 1.500 pBq/m3
cessed amounts. Other sources for non-radiological (242Cm)[W4]. Other radionuclides assumed to have
data included publications of the United Nations and been present but which were below the detection limits
European and other regional publications [E4. E5. E6, were 12"1 and ''C [W4]. The noble gases h5Krand l"Xe
P5:LT3]. were detectable in air. as was 'H in rain water.
103. It has not been possible to substantiate fully all 107. The composition of iodine activity in air at the
of the reported radiation measurement results. In hiunich s ~ t eon initial arrival was found to be 40%
selecting representative values for specific regions, aerosol form. 35% elemental gaseous form and 25%
considerable care and judgement are required. Although organically bound; however. these fractions changed
scientists in each country were asked to review the somewhat in subsequent days as rainfall depleted the
input data. some inconsistencies and questionable aerosol and elemental forms more than the organic
values remain. However. these should not affect the form (Figure V) [W4]. The particulate iodine fraction
more general results of the assessment. measured at Nurmijarvi in Finland on 28 April was
15% [S7] in a sample collected between 29 April and
104. The sources of radiological data have been 2 May and 3-24% in samples collected through June
numerous; some of the data was obtained directly [Sl]. Other determinations were 33% in Belgium on
from scientists in the relevant countries and some of it 2 May [S4], 29-3196 at two sites in Hungary on 2 and
came from published reports. The references for the 4 Ma); [HI], 50% on 29 April and about 33% on
countries are as follows: North Europe: Denmark [A3, following days in Austria [All, 20% on 4 May and
RI. R2]; Finland [A8. F1. 114, 115, N6, PI, R3, R7, decreasing to 10% thereafter in Switzerland [H2]. 25%
RIO, R11, R12, R13, S22. S23, S24. S25, S26. S27]; in the United Kingdom during 7-12 May [C3], about
Norway [B4, B5, S14, S15, W3]; Sweden [A6. El. E8. 33% in China on 4-5 May [L6] and 30% on 5-6 May
particles
----- gaseous
..... o r g a n i c bound
Apri 1 Kay
in Japan [A7]. Over the monitoring period shown in 400 Bq/rn3 at the Berezinsky National Park 120 km
Figure V. the integrated concentration of I3'I was 23% north-east of Minsk, 300 Bq/m3 at Varyshevka 140 km
aerosol. 27% gaseous and 50% organically bound. sourh-east of Chernobyl [I3], 210 Bq/m3 at Helsinki.
Approximately similar results were obtained for l3'l. 170 Bq/m3 at Vienna, 52 Bq/m3 at Munich-Neuherberg.
Ninety-eight per cent of "*Te was associated with 3 I Bq/m3 at Brussels. 2.5 Bq/m3 at Fukui and 0.3 Bq/m3
particles. as was 65% of its daughter '>:I. Of the at Beijing. For I3'Cs, the peak values were 12 Bq/m3 at
remaining 132J,30% was gaseous and 5% organically Helsinki and Berlin, 9.6 Bq/m3 at Vienna, 9 Bq/m3 at
bound. Munich-Neuherberg, 6 Bq/mJ at Brussels, 0.04 Bq/rn3
in Japan, and 0.02 Bq/m3 at Beijing.
Figure VI. Average caeslum-137 deposition density in countries or larger subregions in Europe.
325
Country-wide deposition densities of >5 kBq/m2 for 4. External exposure from deposited materials
entire country averages are indicated for Austria.
German Democratic Republic and Poland. Table I I 121. External irradiation from deposited radioactive
lists these average deposiiion densities. materials is. in the long term, due primarily to '"Cs
and 1J7Cs.In the first month after initial deposition,
1 16. The deposition of "'Cs and other radionuclides however, a number of short-lived emitters, including
outside Etirope and the USSR was, accordingly, much I3'Te, IJ2I, I j 1 I . I4OBa, 140La,Io3Ru and 1 0 6 R ~were
,
less. Representative 4 u e s of l"Cs deposition densities more significant contributors to the external exposure
were 16-300 Bq/m2 i n Japan, 20-90 Bq/m2 in the rate.
United States and 20-40 Bq/m2 in Canada. 122. The exposure rate in air from natural back-
ground is about 0.7 pC/(kg s). Off-site external exposure
rates i n air folloiving the accident were, at maximum.
2. Deposition of other radionuclides 40-60 pC/(kg s) at Kiev, USSR, 27 in south-west Fin-
land; 12 at Sofia, Bulgaria; 12 at Salzburg, Austria;
117. Radionuclides of importance to the external 7.9 at Munich-Neuherberg and 1.5 at Karlsruhe.
gamma-irradiation dose from deposited materials Federal Republic of Germany; and 1.4 at Athens.
beyond the first month include "'Cs. 13JCs.'06Ru and Greece. The component of the external exposure rate
'nlRu. The deposition of )"I, I3'Cs and "-Cs is of attributable to the Chernobyl release was typically
importance in determining doses from the ingestion lower than the initial value by a factor of 5 by the end
pathway. The deposition densities of these radio- of the first month.
nuclides in different countries and the ratios to "-Cs
are given in Table I I. The ratio of l J I I to "'Cs is 123. The exposure rates in air oirer the first month
higher i n Norivay and Sweden than in other countries. have been summed in order to evaluate the specific
The ratios of other radionuclides to I3'Cs are relati~ely contribution of short-term emitters to effective dose
uniform. The median ratios of radionuclide deposition equivalent. These results have been norn~alized to
to that of "'Cs for all countries are "'Ru, 1.6; '"Ru. "'Cs deposition density in Table 13. While the outdoor
0.5; '"I. 6.2; and '"Cs. 0.5. effective dose equivalent in the first month is not due
primarily to I3'Cs, the normalized values can be use-
118. On an individual measurement basis, there are ful for estimating effective dose equivalents where
differences of more than an order of magnitude in the measurements were incomplete or absent. Anomalies
ratios of radionuclide depositions, particularly in the in results can point to errors in data. With a few
iodine/caesium ratio. Therc appear to be two reasons exceptions, the results range from 5 to 40jtSv per
for this: the first is the difference in isotopic release at kBq/m2. The median value is 15pSv per kBq/m2.
different times during the course of the accident itself; These results are illustrated in Figure VII.
the second is the effect of differcnt rates of precipita-
tion during the passage of the radioactive plume.
Leafy
0.01 !
20 30
I
40 50
I
60
I Y I'
70
0.01 !
20
I
30 40
I 1
50
-
1
I
60
i
70
LATITUDE (ON) LATITUDE (ON )
Flgure VIII. Integrated concentretlons of iodine-131 In milk and leafy vegetables per unlt lodlne-131 deposltlon density.
iOO1 Elilk
0 Leafy vegetables
PERCENTAGE
Figure IX. Probability distribution of integrated concentrations of iodine131
In milk and leafy vegetables per unit iodine-131 deposltion denslty.
130. The ratios of integrated concentrations of "'I in growth. Increases later in the year were due to the use
leafy vegetables to those in milk are given in Table 14. of animal feeds produced earlier in the year. These
This comparison removes uncertainties in l3!I deposi- changes can be adequately modelled by an appropriate
tion, but there is still great variability among regions. choice of parameters [J5]. Similar variations have
suggesting differences in definition of the individual been noted elsewhere. Also shown in Figure XI1 is the
results, the use of milk of different sources, differences country-wide average concentration of "'Cs in milk in
in local agricultural practice and the effect of various Finland [R3]. The initial peak was relatively small and
countermeasures. The majority of values of this ratio occurred a few weeks after the accident because the
lie in the range 1-5 with a median of 2. cows had initially been off pasture; also, the variability
with time was less marked, presumably because the
data came from wider-ranging samples.
2. Caesiuni-137 i n foods
134. Country-wide monitoring results for I3'Cs in
131. The assessed first-year integrated concentrations. meat in Finland are shown in Figure XIII. For
norn~alizedto unit deposition density. of 13'Cs in the reference, the concentrations in milk are also shown.
basic food categories are listed in Table 15. These The curve labelled "average meat" is weighted to
concentrations are based on measurements, as reported reflecr average consumption of three parts pork for
and averaged over the countries or subregions. every tivo parts beef. A beef/milk ratio of about 4 is
Generally the transfer for all food categories is higher seen to prevail and an average meat/milk ratio of
in southern Europe. The latitudinal dependence of about 2. as referred to in paragraph 132. Owing to
integrated concentrations of "'Cs in foods is illustrated differences in feed sources. the concentrations of I3'Cs
in Figure X. The probability distributions of all were generally lowest in pork and poultry, higher in
measured values are shown in Figure XI. beef and lamb and highest in game.
132. The ra~iosfor leafy vegetables/milk and for 135. Some foodstuffs that are consumed in small
meat/milk are compared in Table 15. Relative to its amounts by most people or in large amounts by
concentrations in milk, the integrated concentrations relatively few people had. on average. much higher
of "'Cs in leafy vegetables are lower by a factor of activity mass concentrations of "'Cs than the foods
about 2 and in meat are higher by a factor of about 2, presented in Table 15. Foods that should be mentioned
with some deviations. in this regard are reindeer meat, mushrooms and lake
fish: (a) the feeding habits of reindeer (consuming
133. The longer-term monitoring of I3'Cs in milk lichens) lead to exceptionally high levels of I3'Cs, as
from a dairy farm in the south-eastern part of the was observed in the 1960s following atmospheric
Federal Republic of Germany [J5] gave the results nuclear testing. After the accident. a large fraction of
shown in Figure XII. Concentrations of "'Cs in milk the reindeer in Sweden had "'Cs levels of more than
decreased through the summer of 1986, primarily 10,000 Bq/kg [SI]: (b) enhanced levels of "'Cs have
because the "'Cs was diluted in pasture grass of fresh been found in mushrooms, although there was wnsider-
loO1
Milk Grain
\
0-
m
0.1 t
20
I
30
I
40
I
50
I
60
I
70
0.1 !
20
I
30
I
40
- I
50
I
60
- 1
70
LA1ITUOE ('11) LATITUDE (ON)
1'1
Leafy vegetables
m
A
0.1 I
ao
20 io 50 io
, 40 50 60 70
-.a
I
50 6'0
I
70
LATITUDE (ON) LATITUDE (ON)
100 7
- Meat Total d i e t
.
"E
c
CD
A
L
a
0
.-
u 7
2
+a
10
-
rn
c
z
0
r
U
<
1-
L:
L
W
e
3
C
0.1 20 I 30 40 50
LATITUDE ('11)
60 70 0.1 20 30 40 50
LATITUDE (ON)
60 70
Figure X. Integrated concentrations of c&eslum-137 in food8 and total dlet in the flnt year atler the accident
per unit caeslum~l37deposition density.
O.OD1
1- Vegetableslfrui t (100)
0.ooOl ] I I 1 I I 1 I I 7
2 5 10 15 io 30 4b 5b 60 70 BO 85 90 95 98
PERCEIITAGE
c:
1 I I I I I I I I 1 I I I I I I
10 25 30 35 40 35 501 j :n 15 20 25 30 35 40
UEEK I H 1986 HEEK 1;: 1907
Figure XII. Weekly monltorlng results of caerlum-137 concentrations i n mllk from the Federal Republlc of
Germany (dalry farm In south-eart Bavaria) and Finland (country-wlde mean).
155. R31
WEEK I N 1986 WEEK I N 1987
Figure XIII. Country-wide mean concentrations of caeslum-137 in meat and milk In Finland
[R3. R7]. (Meat average obtained by weighting according to consumption).
able variability depending on type and location. The the Federal Republic of Germany that were intended
highest levels were measured in mushrooms of the to evaluate estimates of "I1 intakes through inhalation
family Boletaceae that live in symbiosis with trees and ingestion showed that those intakes were over-
(mycorrhiza), e.g.. in Xerocomus badius (Maronen- estimated by a factor of about 5 [S16].
rohrling). In this species, the 13'Cs levels were around
250 Bq/kg, but peak values of around 20.000 Bq/kg 137. The amount of "'Cs in the body is generally
were measured at the beginning of September 1986 in measured by whole body counting, which can be
the Federal Republic ofGermany [W2], and 800 Bq/kg performed in a reliable, comparable way. These
average and 7.800 Bq/kg maximum were measured in measurements enable a direct assessment of internal
the German Democratic Republic. also in September doses from I3'Cs. Although ingestion was responsible
1986 [Ll]. In other Boletaceae. e.g., the popular for most of the dose, the contribution from inhalation
Bolerus edulis (Steinpilz or ctpe). the levels were lower. could also be measured during the first few weeks
usually below 100 Bq/kg. In non-mycorrhizal mush- following the accident [O I].
rooms. e.g.. mushrooms of the genus Agaricus. such as
the common mushroom, "'Cs levels were very low; 138. Examples of I3'Cs body measurements in the
a n d (c) concentration of "'Cs in freshwater fish were Federal Republic of Germany. France and the United
in some places, e.g., Sweden, found to be many Kingdom are presented in Figure XIV. Generally the
thousands of Bq/kg, though there were large differences amounts increased until late spring or early summer
between types of fish and even between nearby lakes 1987. Regional differences are accounted for by the
[Sl]. Values of about 300 Bq/kg in plankton-eating varying levels of "'Cs in the diet. Lower body burdens
lake fish were measured in the Federal Republic of are accumulated in children and adult females than in
Germany [W2]. Marine fish accumulate only very low adult males as a result of shorter retention half-times
concentrations of "'Cs. in the body [NI].
Aug ' Sept ' Oct I Nov ' Oec Jan ' Feb ' M a r ' Apr I 3ay I June ' July ' Aug I Sept I O c t I Nov I Dec I
1 9 8 6 1 9 0 7
Figure XIV. Caesium-137 in the human body al Munich, Federal Republic 01 Germany (A: males; El: females; C: children) [S16];
in Oxfordshire, Unlted Klngdom (D: adults) [F2]; and In France (E: Grenoble, adults; F: Saclay, adulls) (J4, LS].
and include retention beyond one year of the acquired amounts consumed. This was certainly a factor in the
body burden. The integrated "'Cs body measurements places where people refrained from eating foodstuffs
range from 100-200 Bq a in areas of the United expected to present higher-than-average "'Cs concen-
Kingdom and France to 2,000-3.000 Bq a in Austria. trations. Ingestion of less typical foods explain why
Bulgaria. Finland, Italy and Norway: in Japan, they the measured body burdens of some people, e.g.,
were 34 Bq a. The retention function for the adult was Lapps (see the Norwegian data in Table 16), are
taken to be 10% of the burden retained with a half-life greater than those predicted from the average diet.
of 2 days and 90% of that retained with a half-life of
110 days [I9]. This retention function was used to 142. The "7Cs concentrations in foodstuffs may he
estimate the time-integrated body burdens during the overestimates. These overestimates could have come
first year, when the measured information was limited from a sampling bias towards high deposition areas or
to one or two points in time. and also to calcula~ethe they could have been due to the fact that losses during
fraction of the time-integrated body burden attribut- food processing or preparation are usually not taken
able to retention beyond one year. Continuous intake into account: also commercial distribution could cause
of 'I7Cs at a rate of 1 Bq/d gives an integrated large scale movements of food and a smoothing of the
concentration in the body of 87 Bq a at the end of one concentrations over entire countries. This may explain
year and a further integrated concentration of 56 Bq a why the measured body burdens in Oslo. Vienna, and
from continued retention with no further intake. regions I of Finland and France (low-deposition
Thus. 1 Bq/d for one year gives 143 Bq a in the body areas) were higher than predicted and why the reverse
or 2.0 Bq a/kg, which results in an effective dose was true in the high-deposition regions of Finland and
equivalent of 5.0 ySv to reference man. France.
%
s w
?
-
TIIYROID DOSE EQUIVALCIiT (IIISV)
THYROID DOSE EQUIVALENT (rnSv) 5.
Q
4
z
0, ' - C C C C N N r U N
I 2 O N O m w 4, O N P O ~ w O N P m 4
-
g o
5 1 1 1 1 1 1 1 1 1 CI(LECE
1 1 1UUL 1 1-." %
YUGOSLAVIA ;d
'CE
2
,
m
x u
-
<
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147. The calculated results for thyroid dose equi- the country-reported results reflect differences in the
valents. and also for effective dose equivalents. take various assumptions regarding intake. the age groupings
into account. where possible, the application of for infants and the ways of accounting for counter-
countermeasures. This was usually done by adjusting measures. The dose estimates are both higher and
the integrated concentrations in foods so that the lower than those reported by the countries, but the
values represented what was actually consumed. How- differences are generally not greater than a factor of 4
ever, the Committee has not taken into consideration for infants and a factor of 3 for adults.
the use of thyroid blocking agents or stable iodine
preparations. By reducing uptake, these would have
afforded some additional protection against inhaled
and ingested radioiodine. B. EFFECTIVE DOSE EQUIVALENTS
148. The country averages of infant and adult
thyroid dose equivalents are listed in Table 18 and 150. The effective dose equivalents recei~redby indi-
shown in Figures XV and XVI. Infant thyroid dose viduals (adults) during the first year following the
equivalents in Europe generally ranged from 1 to accident are presented in Table 17, which also shows
20 mSv. but there were higher doses in some parts of rural-urban differences. Contributions to dose from
Romania, Greece, Switzerland, Bulgaria and the the ingestion pathway also include committed doses
USSR. Adult thyroid doses were usually smaller than from caesiurn in the body following the first-year
infant doses in the same country by a factor of about intake of caesium in diet.
5 in central and western Europe, but the differences
were smaller in northern Europe, where milk was less
151. The highest average first-year committed effec-
contaminated because the cows had not been on
tive dose equivalent in subregions was 2 mSv in the
pasture, and in regions of southern Europe and Asia,
Byelorussian Soviet Socialist Republic. Subregions
where the contamination of leafy vegetables increased
adult thyroid doses. where effective dose equivalents were 1-2 mSv were
located in Romania and Switzerland and 0.5-1 mSv in
Austria. Bulgaria, Federal Republic of Germany.
149. The thyroid dose estimates are compared with Greece and Yugoslavia. The effective dose equivalent in
the estimates reported by individual countries in Table the Byelorussian Soviet Socialist Republic approached
18. The country-reported results are those collected by the yearly effective dose equivalent due to natural
the Nuclear Energy Agency of the OECD [N5]. radiation sources. The mean values for each country
Differences from unity in the ratios of the estimates to arc listed in Table 18 and plotted in Figure XVII.
Figure XVII. Country-wide average first-year committed effective dose equivalents from the
Chernobyl accldent.
152. These estimates of first-year committed effective C. PATHWAY CONTRIBUTIONS
dose equivalent are in reasonable agreement with the
results reported by individual countries [N5],as is also 153. The pathway contributions t o the first-year
shown in Table 18. While there are some greater committed effective dose equivalents varied substan-
discrepancies between these estimates and other. tially by location for all pathways except cloud
provisional dose estimates [Ml. DS], the latter were gamma, which was everywhere less than 1%. The
based o n measurements made in the first months after contribution from inhalation averaged 5%. with a
the accident. Differences in estimates from country- range from 0.1% in Ireland to 22% in Turkey.
reported results can be attributed t o the averaging of
results over larger subregions, the inclusion of addi- 154. The first-year committed effective dose equi-
tional food groups and the use of different assump- valents resulted primarily from the ingestion pathway.
tions for occupancy. shielding and food consumption. which in most countries accounted for over 60% of
Most results from individual countries did not account the total dose and in southern countries for over 80%.
for urban run-off. On average, however, the compar- The differences in pathway contributions are illustrated
ability of the Committee's estimates and those of in Figure XVIII for three groupings of countries:
individual countries is good. the average ratio being southern countries (<40° N latitude), temperate coun-
1.06 with a standard error of 0.6. tries (41°-55' N latitude) and northern (Scandinavian)
PATMWAY C O t ~ T R I G U TI O N S
100 -
90 -
-$ - 00
70-
u
-h 60-
n
5 so-
+-
40-
a
-
+
30-
20 -
to-
0*
latitude latitude latitude larirude latitude latitude
Southern Temperate Nortlrcrn Soutl~ern Tectpcratc Northern
countries countries countries countries countries countries
FIRST-YEAR COfITRIDUTIDN TOTAL COXTCICUTI@N
too - Othcr
YO -
- CO -
Iodine-131
d
& 70- Caes iIIIII- 1311
U
-2 60-
50-
h
3
0 40-
-=5 3 0 -
io -
10 -
First month
All 15 0.36
Second to
twelfth month
CS-137 8.04 0.36
CS-134 18.6 0.36
Ru- 103 0.69 1 0.36
Ru- 106 2.09 0.36
I- 131 0.0 15 0.36
Total (first year)
2. Transfer from deposition to thyroid dose equivalent dependencies in the transfer factor from deposition to
of iodine-131 thyroid dose equivalent from "'I for infants and
adults are shown in Figures XIX and XX.
163. The derivation of the transfer factor from
deposition to thyroid dose equivalent in the first year
is presented in Table 19. Since the thyroid dose 3. Transfer from deposition to dose from ingestion of
calculation includes inhalation and ingestion contribu- caesiurn-137
tions, some differences may result from relating the Transfer from deposirion to dier
total dose only to IJ1I deposition. (a)
165. The quotients of the first-year integrated con-
164. The results vary by orders of magnitude. The centrations of "'Cs in foods and the "'Cs deposition
very 10~9values for Scandinavian countries reflect the density, which were presented in chapter 111 (Table 15)
early stage of the growing season there and the for the individual food categories, define the first-year
consequently low transfer to milk and leafy vegetables. deposition to diet transfer factors for lJ7Cs, the b,
The relatively high values are due to several factors. In values. These values have been combined and weighted
southern countries, animals were already on pasture by consumption amounts to obtain the average
and in addition. in some areas contributions from deposition to first-year total diet transfer factors for
extensive use of sheep's milk was included, in which each country or subregion listed in Table 20. Also
the concentrations were about 10 times higher than in listed are the average integrated concentrations of
cow's milk. Protective actions that were taken further "'Cs in diet and the total first-year intakes of "'Cs.
increased the variability of these results. The latitudinal
166. The results of first-year transfers of lJ7Cs to
total diet under the conditions that prevailed at the
time of the accident are included in Figure X. The
least-squares fit through the measured values shows a
trend toward increasing transfer per unit deposition at
southern latitudes, as seen also in the individual
components of diet from first-year measurements (also
in Figure X). Most countries and subregions in
temperate latitudes are in the range 1-4 Bq a/kg
per kBq/m2. There are, however, greater deviations in
some countries that reported higher levels in foods
than would have been expected from estimated deposi-
tion. In some cases, there is uncertain transfer to some
food items as well as higher transfer to diet due to the
inclusion of certain foods, such as milk and meat from
goats and sheep. I t would be of interest to study in
more detail the local conditions that cause deviations
from the more widely applicable transfer factors
derived here.
- io jo 40 5'0 io 7b
LATITUDE (ON)
167. The log-normal distribution of b, transfer factors
for "'Cs in total diet is shown in Figure XXI. A single
Figure XIX. Transfer factor for infant thyroid dose equivalent population-weighted value is plotted for each country:
from ingestion and inhalatlon relative to iodine-131 deposition for some countries. the values were largely inferred.
density.
but these have also been included. The values range
from 1 to 9 Bq a/kg per kBq/m2, with a geometric
mean of 2.6 Bq a/kg per kBq/m2. This mean may be
compared with the average value of 4.1 Bq a/kg per
kBq/m2 (range 1.9 to 6.3) for the first-year transfer of
fallout "'Cs. derived from long-term measurements
(Table 7).
(b) Transfer from dier to body
168. The transfer factor from diet to body burden,
P,,, is derived in Table 20. The integrated concentra-
tion of '"Cs in the body is obtained by multiplying
the dietary intake of IJ7Cs in the first year by a
1,
20
I
30
I
40 50
I I
60
. 70
standard factor, 143 d/70 kg (the mean residence time
of "'Cs in the body divided by the body mass). The
integrated concentration includes retention in the
body beyond the first year. The transfer factor from
total diet to body burden is the ratio of integrated
LATITUDE (O::) concentrations in the body and in diet. Variability in
Flgure XX. Transfer factor for adult lhyrold dose equlvaient this factor reflects only differences in food consump
from ingestion and inhaiatlon relative lo iodine-131 deporltlon tion. The median value for this transfer factor is
density. 2.9 Bq a/kg per Bq a/kg.
Figure XXI. Probability distribution of caesium-137 in first year total
diet relative to caesium-137 deposition denslty.
(c) Transferfrom bodv to effecrive dose equivalenr ground and ingestion of foodstuffs. and the only
radionuclides that contribute significantly to the dose
169. The transfer factor from IJ7Csin the body to the equivalents are 134Csand 137Cs.For these radio-
effective dose equivalent, P,,, is based on the dose factor nuclides, the effective dose equivalent and the thyroid
given in Table 6. For adults. this factor is 0.014 pSv per dose equivalent have the same value for a given
Bq intake. The retention function for caesium in the exposure.
body was discussed in paragraph 139. Since the mean
retention time is 143 days, an intakeof I Bq corresponds 172. The methods for obtaining projected dose
to 1 Bq X 143 d + 70 kg = 5.6 Bq a/kg in the body. estimates were discussed in section 1I.C. After specific
The transfer factor from integrated concentration values for the transfer factors have been derived, they
in the body to the effective dose equivalent is are applied to the average I3,Cs and "7Cs deposition.
0.014 + 5.6 lo-', or 2.5 uSv per Bq a/kg. Since the IJ4Cs to I3?Cs deposition ratio was uniform
in all countries, the contributions to the dose from
170. The overall transfer factor from deposition to both radionuclides may be related to the L37Cs
the first year effective dose equivalent. P2J.I,is obtained deposition value.
by sequential multiplication of the transfer factors P,,
(which is referred to as bl for the first-year transfer). P,,
and Pas. These values for the ingestion of "?Cs in A. TRANSFER RELATIONSHIPS
countries or subregions are listed in the last column of
Table 20. 1. Transfer from deposition to dose
from external irradiation
V. DOSE COMMITMENTS 173. Values of the effective dose equivalent per unit
deposition density of radionuclides for the period after
171. Dose equivalenr commitments have been cal- one year are given in Table 5. These apply to a soil
culated using transfer factors developed and used by relaxation depth of 3 cm. Assuming an initial runoff
the Committee for its assessments of the dose com- loss of one half of deposition in urban areas, equal
mitments resulting from atmospheric nuclear weapons proportions of urban and rural residents, a shielding
tests [UI, U2]. Since those transfer factors were factor of 0.2 indoors and an indoor occupancy factor
developed for the rather more uniform and continuous of 0.8, the transfer factors for the dose per unit
deposition patterns of fallout, they are here applied deposition from external irradiation beyond one year
only to regional groups of countries. Because first-year are 7 1 pSv per kBq/m2 for I3'Cs and 9.8 pSv per
doses were for the most part calculated from measured kBq/m2 for I3'Cs. An additional small contribution of
data. only the components of the fallout models 0 . 4 , ~ per
~ s ~kBq/m2 comes from lo6Ru. Using a value
corresponding to transfers beyond the first year of 0.5 for the deposition ratio 1J4Cs/'37Csas well as
following deposition were taken into consideration. for 106R~/1"Cs,the total dose may be estimated
For that time, i.e.. more than one year after the directly from "'Cs deposition: 76 pSv per kBq/m2. The
accident, the only pathways to be considered are derivation of this transfer factor may be summarized
external irradiation due to activity deposited on the as follows:
Ourdoor effecrive Shielding/ Llrhan Rarro Transfer facror
dose equivalenr ocrupancy popular~on/ 10 cornponenrs
Radionuclide (pSv per kBq/rn2) facror runo//jocror coes~um-137 (PSI' per kEq/ml)
2. Transfer from deposition to dose from ingestion 178. The overall transfer factor for 'j7Cs from
deposition to total diet to body to effective dose
(a) Transfer front dcposirion 10 dier equivalent in the time period beyond the first year,
174. The model for the transfer from deposition to P,.,-. is given in Table 21. The values average 20pSv
diet is: per kBq/m2 in the northern and temperate countries
PZj= bl + b: + b3e-" and about 25 pSv per kBq/m: in southern countries.
where b2 is the second-year transfer and b3e->' is the 179. The transfer of '"Cs from deposition to effective
subsequent transfer. in which the elimination of radio- dose equivalent may be related to I3'Cs deposition,
caesium by environmental and physical processes is taking into account the lower deposition (1'4Cs/137Cs=
taken into account. The transfer from deposition to 0.5) and the higher dose per unit intake ("4Cs/'37Cs =
diet beyond the first year is thus represented by: 1.4). This gives effective dose equivalents from " T s
70% of those from lJ7Cs in the first year. Subsequent
transfer is less because of the shorter half-life of "'Cs.
Values of P,,,, and PzSderived from long-term fallout but most significant transfer to most foods occurs
measurements of IJ7Cs are given in Table 7. For all within the first feu? years of deposition. Average
foodstuffs except grain products, the average values of results for all countries show the "'Cs ingestion dose
Pz3,?-given in Table 7 were used for "7Cs in all of the to be 65% of that from l"Cs. corresponding to 70% of
large regions considered in the assessment: 2.1. 1.4. 2.0 the first-year '"Cs dose and 60°/0 of the subsequent
and 8.0 Bq a/kg per kBq/m2 for milk products, leafy "'CS dose.
vegetables, vegetables/fruit and meat. respectively. In
the case of grain products, the value of P23.2+for "'Cs
in a large region was assumed to equal the population- B. AVERAGE DOSE EQUIVALENT
weighted mean of the b l values estimated for that COMMITMENTS I N LARGE REGIONS
region (see paragraph 96).
180. The effective dose equivalent commitments from
175. The deposition to total diet transfer factor is all radionuclides released in the accident are evaluated
obtained by weighting the values for the food groups in Table 22. These are the average results for the large
by consumption amounts. Population-weighted food regions. The first-year dose is the population-weighted
consumption estimates for the large regions considered result of the effective dose equivalents given in Table 18.
in the commitment assessment are listed in Table 21. The component of dose from exposure or intake after
The regional value for the transfer factor for grain the first year is determined by multiplying the popula-
products is given along with the weighted total diet tion-weighted I'*Cs deposition density in the region by
transfer factor. the total Pz,,. transfer factor. comprising external
gamma exposure (invariant across regions and derived
Transfer from diet lo body in paragraph 173) and doses from "'Cs and lJ4Cs in
(b)
foods (derived in paragraphs 178 and 179).
176. The transfer factor from total diet to body
burden, P,,, is the quotient of normalized body 181. The results range from 1,ZOOpSv in south-
burden and normalized dietary concentration. These eastern Europe (Bulgaria. Greece, Italy, Yugoslavia),
values vary only because of consumption differences. 970 j~Sv in Scandinavia, 940pSv in central Europe,
The value can be derived by multiplying total food SZOpSv in the USSR and 510/1Sv i n eastern Medi-
consumption (kg/a) by 143 Bq d per Bq (residence terranean countries to 20 1rSv or less in other regions.
time in body) and dividing by 365 d/a and 70 kg These results are illustrated in Figure XXII. Further
(body mass). The results are listed in Table 21. The evaluations of regional effective dose equivalent com-
median value for these large regions is 2.8 Bq a/kg per mitments are presented in the following section, V1.C.
Bq a/kg.
...........Cariobean
Country reasurenwnt
0 Regional average
. ' . . . .Central Anerica
'.... North P a c i f i c Ocean
0 Xegional estimate
0.001 I
100 1000 10000 100000
D?STAtlCE FTO!! CHECNOBYL (km)
Figure XXIII. Deposition density of caesium-137 with distance from the Chernobyl reactor.
190. The first component of this transfer factor from Table 19 and from Figure XX. Based on the fit to
external irradiation was derived in paragraphs 159-161 calculated values for individual countries or their sub-
and 173. The summary values are entered in Table 23, regions. approximate average values are 5, 50 and
which compiles the general transfer factors for southern 100pSv per kBq/m2 for countries at northern, tem-
(<40°), temperate (4!-55') and northern (>55O) lati- perate and southern latitudes, respectively. These are
tudinal regions. For external irradiation, the same the thyroid dose equivalents relative to I 3 ' I deposition
assumptions are used for all regions, so the compo- density. The contribution to the effective dose equi-
nents of the transfer factor per unit '"Cs deposition valent is obtained by multiplying them by the weighting
are the same. factor for the thyroid (0.03). The transfer factor may
be based on Ij7Cs deposition by multiplying further by
191. Because of differences in agricultural conditions the average ratio of "'I to 'I7Cs deposition. 6.2
in countries at the time of the accident, some (Table I I ) . The resulting transfer factor components
latitudinal dependence must be introduced into the for "'I. for the first year only, are 1, 10 and 20pSv
components of the transfer factor from the ingestion per kBq/m2.
pathway. The transfer factors to effective dose equi-
valent for '37Csfrom first-year ingestion were derived in 194. The components of the transfer factor based on
Table 20. The population-weighted values for northern, I3'Cs deposition to effective dose equivalent commit-
temperate and southern latitudes are approximately 15, ment from the two major pathways and from the
20 and 25 pSv per kBq/mZ. The values for I3'Cs. based dominant radionuclides are summarized in Table 23.
on '"Cs deposition amounts, are 70% of the cor- I t must be understood that these factors apply to the
responding values for 'j7Cs. These estimates are conditions at the time following the accident and to
entered in Table 23. the average composition of radionuclides in the
dispersed material as observed. The latitudinal dif-
192. After the first year, the transfer factor com- ferences apply only to the ingestion pathway.
ponents for lJ7Csingestion are 20 pSv per kBq/m2 at
northern and temperate latitudes and 25pSv per
kBq/m2 at southern latitudes (Table 21 and paragraph C. ESTIMATES O F COLLECTIVE EFFECTIVE
178). The corresponding estimates for "'Cs are 60%, DOSE EQUIVALENT COMMITMENT
of the 13'Cs estimates (paragraph 179).
195. Estimates of collective dose equivalent com-
193. Regional (i.e., northern, temperate or southern) mitments for all regions of the northern hemisphere
values of "'I transfer factors may be selected from are compiled in Table 24. To allow an estimate to be
made of the total release of '"Cs. this listing includes are compared with the actual measurements (Table 16).
also the ocean areas north of the equator. The country i t can be seen that the estimate of effective dose
populations given in [U3] have been adjusted, based equivalent commitment from ingestion may be high
on individual country growth rates, to values appro- by perhaps 50%. As discussed above, a possible
priate for 1986. The population of the northern explanation for this discrepancy is the difficulty of
heniisphere (4.3 10') makes up 88'3 of the total world knowing the radionuclide content of what is acrually
population. being consumed, given the limitations of food-sampling
techniques. The Committee believes, accordingly, that
196. The effective dose equivalent commitments in its estimate is unlikely to be an underestimate of the
the large regions (Table 22) were estimated on the effective dose equivalent commitment that will actually
basis of measurements in the first year and projections occur but that it might be an overestimate by a few
for subsequent times. The estimates for European tens of per cent.
regions are carricd forward to Table 24. with a few
additional countries having been included in some
regions. The product of pop~ilationand effective dose D. COLLECTIVE DOSE COMMITMENT
cquivalsnt comnlltnient is the estimated collective PER UNIT RELEASE
effective dose equivalent commitment.
20 1. From estimates of the average 'I-Cs deposition
197. Countriesoutside Europe but still in the northern density in the regions included In Table 21. an
hemisphere (i.e.. the countries of .4sia, North America estlmate can be made of the total amount of "'Cs
a n d parts of Africa and South America) have been rclcased in the accident, independent of estimates that
grouped in several regions. 'The population-weighted could be made near the reactor site at the time of the
distances to individual countries are used as the accident. The sum of the products of average deposi-
distances to the regions for the purpose of estimating tion density and area for all land and ocean regions
average !I-Cs deposition (1-igure X X I I I ) . For these gives an estimated total Il7Cs deposit of 70 PBq. Of
regions. all of ~ h i c hlie at southern latitudes (<40°). this total, some 42% was deposited within the USSR.
the transfer factor 190 pSv per kBq/m2 (Table 23) is 37% in Europe. 6% in the oceans and the remainder in
used. The estimated effective dose equivalent com- the other regions of the northern hemisphere.
mitments for all geographical regions are illustrated in
Figure XXII. hlultiplication by the populations of the 202. This estimated "'Cs total deposit in the northern
regions gives the collective effective dose equivalent heniisphere may be conipared with the original "'Cs
commitments. +
release estimate of 38 PBq 50% (Table 1). These
estirnates arc in reasonable agreement, given the
198. The total collective cffecti1.e dose equivalent magnitude of the uncertainties associated with each
commitment from the accident is estimated to be estimate. The estimated release of 70 PBq would
600.000 man Sv. From Table 24. it is seen that 53% is correspond to about 25%, of the "'Cs calculated to
experienced in turopean countries. 36':i in the USSR. have been in the reactor core.
8% in Asia. 2% in Africa and 0.3% in North, Central
a n d South America. 203. The reported release of "'Cs from the damaged
reactor was about 10% of the core inventory (Table 1).
199. Alternative estimates of collective effective dose Based on the higher estimate of "'Cs release and on
equivalent commitnient have been made for the the activity relationship. the "'Cs release could have
34 countries for which more detailed radiological data been 35 P B q . corresponding to a percentage release of
were available. These estimates are based on the total Itif;. If the release of ' " I . originally estirnated t o have
production for human consumption of foods in all the been 2 0 5 of the total "'1 in the core, was, instead.
countries. There is no need t o consider where the 25%. the estimated release would be 330 PBq.
foods are consumed. The collective effective dose
equivalent commitment estimates based on production 204. From the calculations or estirnates of the
are generally in close agreement with the estimates collective el?ective dose equivalent commitments listed
based on individual consunlption rates in countries in I'able 24, i t may be determined that 430,000 man Sv
and populations. The production-based est~rnated is due to Ii7Cs. 120.000 man Sv to "4Cs, a n d
total for all 34 countries is just 10% greater than the 37.000 man Sv (collective effective dose) to "'1. The
consumption-based estimate. remaining 20.000 man Sv was contributed by shorter-
lived radionuclides deposited immediately after the
200. I t is difficult to assess the uncertainty in the accident.
Committee's estimates. Much of the dose commitment
has not ye1 been experienced. a n d can only be 205. From these values, the collective effective dose
calculated on the basis of projection models. The equivalent commitments per unit release of the major
general methodology for projections used by the radionuclides may be estimated as follows:
Committee, has been detteloped after some years of "'Cs: 430,000 man Sv/ 70 PBq = 6 IO-"man Sv per Bq
studying the transfer factors for "'Cs. the radio- "'Cs: 120,000 man Sv/ 35 PBq = 3 10-"man Sv per Bq
nuclide of primary concern. The comparison of the 1311: 37,000 man Sv/330 PBq = 1 10-"man Sv per Bq
calculations b) the Cornniittee for the first year and
the calculations by individual countries (Table 18) For the thyroid dose equivalent from 13'I. the estimate
showed reasonable agreement. When the first-year would be the above value divided by the thyroid
integrated body burdens calculated by the Committee weighting factor of 0.03.
206. These estimates pertain to the particular condi- VII. SUMhlARY
tions that prevailed at the time of the accident, but
they may be a useful point of reference for this type of
radiation source. For comparison. the collective effec- 210. The accident at the Chernobyl nuclear power
tive dose equivalent commitments per unit release station was a serious occurrence. indeed a tragic event
from another source. atmospheric nuclear testing. are for the people most closely affected in the USSR. The
as follows [UI]: material costs of control. resettlement and decontami-
nation have been enormous. Some of the people who
I3'Cs: 2,200.000 man Sv/960 PRq=2 10-"man Sv per Bq dealt with the emergency lost their lives. Although
1311: 110,000man Sv/700EBq=2 10-lbman Sv per Bq populations were exposed in the countries of Europe
These resulted from releases largely into the strato- and, to a lesser extent. in countries throughout the
sphere and apply to world populations of 3.2 lo9 northern hemisphere. the radiation exposures were. in
persons (for "'1) at the time of the main releases and perspective. not of great magnitude.
4 lo9 persons (for I3'Cs) during the main exposure
period. Because the fallout frorn weapons tests was 211. The detectability of radiation in very small
injected into the stratosphere, a longer time elapsed concentrations has allowed extensive measurement of
for decay of "'I before deposition. the released radioactive materials in the environment,
and i t has been possible to make a complete inventory
207. Estimates of collective effective doses per unit of "'Cs, the main component of the release. The
release have also been made for modelled dispersion amount 70 PBq of "'Cs corresponds to 22 kg of
from nuclear installations (Annex B). Based on a caesium, which was. however, dispersed across an
population density of 25 persons per km:. these entire hemisphere of the earth. Radionuclides are
estimates are [W'5]: a unique class of substance whose environmental
13'Cs:5 lo-'? man Sv per Bq behaviour can be studied in detail at such trace levels.
"'1: 4 10 I' man Sv per Bq
Core l n v e n t o r v and e s t l m a t e of t o t a l r e l e a s e o f r a d l o n u c l l d e ?
1111
a/
- Reference: [ I S ]
b/ Decay c o r r e c t e d t o 6 Ray 1986.
C/ S t a t e d a c c u r a c y : f SOX, e x c e p t f o r n o b l e gases.
T a b l e 2
A c t l v l t v r a t l o s o f r a d l o n u c l l d e s released I n t h e Chernobyl a c c l d e n t
r e l a t l v e t o caeslum-137
[I31
T a b l e 4
T a b l e b
Parameters of caeslum-137 d e D o s l t l o n t o d l e t t r a n s f e r f u n c t i o n
d e r i v e d from l o w - t e r m f a l l o u t measurements
[Ul.E71
( 8 9 a/kg p e r k8q/mL)
-
Transfer
F l r s t year beyond Total
Country transfer f l r s t year transfer
bl P23,2+ P23
M \ l k products
Argentlna
Denmark
Unlted States
Average
Graln products
Argentlna
Den~rk
Unlted States
Average
Vegetables
Argentina
Denmark
United States
Average
Frult
Argentlna
Denmark
Unlted States
Average
Meat
Argentlna
Denmark
Unlted States
Average
TOTAL D I E T
Argentina 6.3 1.8 8.1
Denmark 4.0 8.0 12
Unlted States 1.9 3.5 5.4
Average 4.1 4.4 8.5
T a b l e 8
Infants Total Ullk Graln Leafy Veg./ neat Mllk Graln Leafy Veg./ Heat
prod. prod, veg. frult prod. prod. veg. frult
NORTH EUROPE
Denmark
Flnland
Norway
Sweden
Reglon 1
Reglon 2
Reglon 3
CENTRAL EUROPE
Austrla
Czechoslovakia
Reglon 1
Reglon 2
Region 3
German Oem. Rep.
Reglon 1
Reglon 2
Reglon 3
Germany,
Fed. Rep. of
Reglon 1
Reglon 2
Reglon 3
Hungary
Reglon 1
Regton 2
Poland
Romanla
Reglon 1
Reglon 2
Regton 3
Switzerland
Reglon 1
Reglon 2
Reglon 3
Reglon 4
W E S T EUROPE
Belglum
France
Reglon 1
Reglon 2
Region 3
Ireland
Luxembourg
Netherlands
Untted Kingdom
Reglon 1
Reglon 2
Regton 3
SOUTH EUROPE
Bulgarta
Reglon 1
Region 2
Greece
Reglon 1
Reglon 2
Italy
Regton 1
Reglon 2
Portugal
Spaln
Reglon 1
Region 2
Yugoslavia
Region 1
Reglon 2
Reglon 3
Table 8, continued
Infants Total Milk Graln Leafy Veg./ Meat Mllk Graln Leafy Veg./ Heat
prod. prod. veg. frult prod. prod. veg. frutt
USSR
Region 1 207.6 0.17 10.01 6360 1300 217 754 1040 332 133 37 118 63
Region 2 269.4 0.35 21.94 10800 3050 785 2270 1800 332 133 31 118 63
Reglon 3 485.1 0.51 29.80 8270 1780 474 1510 1300 332 133 37 118 63
Reglon 4 4532.6 2.47 139.70 49300 20900 4630 14800 9400 332 133 37 118 63
Reglon 5 16696.3 2.12 77.37 17900 10000 1180 5670 3600 332 133 37 118 63
WEST ASIA
Cyprus 9.3 0.01 0.64 50 20 100 100 50 83 94 87 315 83
Israel 20.7 0.08 3.87 470 200 660 950 220 120 130 140 190 60
Syrla 185.2 0.18 8.98 1100 1900 300 1500 200 10 190 30 340 22
Turkey 774.8 1 .OO 52.00 5000 20000 5000 20000 2000 125 200 100 150 40
EAST ASIA
Chlna 9571.3 18.63 1046.39 5380 216000 28400 170000 30000 5 229 29 173 30
India 3287.3 25.38 750.90 26300 120000 18900 61000 3060 39 183 28 89 5
Japan 358.8 1.43 121.01 4660 13500 5600 16800 16900 50 193 30 180 120
NORTH AMERICA
Canada 9215.4 0.38 25-36 4550 10600 281 5080 3980 181 93 21 301 130
United States 9372.6 3.75 238.74 39400 71800 5970 61600 31700 114 91 25 260 146
T a b l e 9
Country Sr-90 Zr-95 no-99 Ru-103 Ru-106 1-13] Te-132 Cs-134 Cr-136 Cs-137 8a-I40 Ce-141 Ce-144 ND-239
SORlH EUROPE
Denmark 0.012
f Inland
Norway
Sweden
Reglon 1
Reqlon i
Reglon 3
CENTRAL EUROPE
Austrla (0.58)
C~echoslovakla
Reglon 1
Regton 2
Reglon 3
German Oem. Rep.
Reglon 1
Reqlon 2
Reglon 3
Germdny. Fed.Rev.of
Reqlon 1
Reglon 2
Reglon 3
Hungary
Reglon 1
Reglon 2
Poland
Romdnla
Reglon 1 (1.2)
Reglon 2 (1.9)
Region 3 (1.5)
kltzerland
Rcqlon 1
Reglon 2
Reglon 3
Reqlon 4
YES1 EUROPE
Belgium 0.05
f rance
Reg lon I
Reglon 2
Reglon 3
Ireland
Luxembourg 0.05
Netherlands
Unlted Klngdorn
Reglon 1.2
Reglon 3
SOUTH EUROPE
Bulgarla
Reglon 1.2
Greece
Reqlon 1 1 .O
Reqlon 2 1 .O
Italy
Reglon 1
Reylon 2
Portugal
Sva l n
Reqlon 1
Reglon 2
Yuqoslavla
Reglon 1
Reqlon 2
Reqlon 3
USSR
Reglon 1 3.7
Reqton 2 2.4
Reqlon 3 0.7
Reqlon 4 (0.5)
Reqlon 5 (0.02)
*EST ASIA
Cyprus
Israel
Syrlan Arab Rev.
lurtey
EAST ASIA
Chlna
Indla
Japan
NORTH AMERICA
Canada
Unlted States
NORTH EUROPE
Denmark 2.2
Flnland 0.28
Norway (2.0)
Sweden
Reqlon 1 1.3
Reqlon 2 1.4
Reqlon 3 1.9
CENTRAL EUROPE
Austrla (2.0)
Czechoslovakia
Reqlon 1 1.3
Reqlon 2 1 .6
Reqlon 3 2.4
German Dem. Rep.
Reqlon 1 0.61
Reqlon 2.3 0.72
Germany.
fed.Rep.of
Reqlon 1 1.3
Reglon 2 1.3
Reqlon 3 1.3
Hungary
Reqlon 1 4.0
Reqlon 2 3.5
Poland 2.5
Romanla
Reqlon 1 1.3
Reqlon 2 5.0
Reqlon 3 (3.6)
Swltzerland
Reqlon 1 (1.9)
Reqlon 2 (1.9)
Reqlon 3 (1.9)
Reqlon 4 (1.9)
NEST EUROPE
Belqlum 1.3
f rance
Reqlon 1,2,3 1.5
Ireland 1.5
Luxembourg 1.3
Netherlands 1.3
Unlted Klnqdom
Reqlon 1,2 1.9
Regton 3 1.9
SOUTH EUROPE
Bulqarla
Reqlon 1.2 3.1
Greece
Reqton 1 4.0
Reglon 2 4.0
Italy
Reqlon 1 1.8
Regton 2 1 .8
Portugal (2.0)
Spa 1n
Reqlonl (1.5)
Reqlon 2 (1.5)
Yuqoslavla
Reqlon 1 1.8
Reqlon 2 1.5
Reqlon 3 1 .8
USSR
Reqlon 1 1.1
Region 2 1.2
Reqlon 3 1.4
Reqlon 4 1.4
ReqlonS (1.3)
Table 10, continued
WEST ASIA
Cyprus (2.9) (0.50)
Israel 2.2 3.1 2.2 0.52 2.3
Syrian Arab Rep. (5.3) (0.50)
Turkey 3.3 2.4 5.4 0.51 0.78 4.8 0.69
EAST ASIA
Chlna (1.4) (0.30) (6.7) (3.9) (0.51) (0.15) (0.59)
Indla (2.1) (0.30) 5.0 (0.47) 0.29 0.10 0.29
Japan (2.5) (0.50) 12 (3.9) 0.50 (0.12) (0.07)
NORTH AMERICA
Canada (1.3) 0.52 2.5 (4.0) (0.50) (0.20) (0.50)
Unlted States (2.4) (0.30) (10) (1.7) (0.50)
T a b l e 11
De~osltlonof radlonuclldes
Country Ru-103 Ru-106 1-131 Cs-134 Cs-137 Ru-103 Ru-106 1-131 CS-134
NORlH EUROPE
Denmark
Flnland
Noruay
Sueden
Reglon 1
Reglon 2
Reglon 3
CENTRAL EUROPE
Austrla
Czechoslovakla
Reglon 1
Reglon 2
Reglon 3
German Oem. Rep.
Reglon 1
Reglon 2
Reglon 3
Germany.
Fed. Rep. of
Reglon 1
Reglon 2
Reglon 3
Hungary
Reglon 1
Reglon 2
Poland
Romanla
Reglon 1
Reglon 2
Reglon 3
Sultzerland
Reglon 1
Reglon 2
Reglon 3
Reglon 4
Table 11, cont\nued
Oeposltlon denslty R a t l o s of d e p o s l t l o n d e n s l t l e s
(kBq/mZ) t o caestum-137
Counrry Ru-103 Ru-106 1-131 Cs-134 Cs-137 Ru-103 Ru-106 1-131 Cs-134
W E S T EUROPE
0elglum
France
Reglon 1
Regton 2
Reglon 3
Ireland
LuxemDourg
Netherlands
Unlted K l n g d o m
Reglon 1
Reglon 2
Reglon 3
S O U T H EUROPE
Bulgaria
Region 1
Reglon 2
Greece
Region 1
Reglon 2
Italy
Reglon 1
Reglon 2
Portugal
Spain
Reglon 1
Reglon 2
Yugoslavla
Reglon 1
Reglon 2
Reglon 3
USSR
Realon 1
Reglon 2
Reglon 3
Reglon 4
Reglon 5
NEST ASIA
Cyprus
Israel
S y r l a n A r a b Rep.
Turkey
E A S T ASlA
Chlna
Indla
Japan
hORTH AMERICA
Canada
United S t a t e s
- p~
N u m b e r s I n Darentheses a r e I n f e r r e d v a l u e s .
T a b l e 12
Q u o t l e n t s o f d e D 0 5 l t l o n d e n s l t y and t l m e - l n t e q r a t e d c o n c e n t r a t l o n I n a l r
f o r caeslum-137
Integrated
Country Oeposltlon concentratlon Ouotlent
d e n s l t y a/ I n a i r a/
( k8u/rn2) (Bq d/m3) (cm/s)
NORTH EUROPE
Denmark 1.3
FInland 11
Norway 1.1
Sweden 9.5
CENTRAL EUROPE
Austrla 23
Czechoslovak!a 4.2
German Oem. Rep. 7.2
Germany. Fed. Rep. o f 5.1
Hungary 2.7
Poland 5.2
Romanla (9.4)
Svltzerland 3.4
WEST EUROPE
Belglum 0.84
France 1.1
Ireland 3.3
Luxembourg 2.1
Netherlands 1.8
U n i t e d Klngdom 0.9
SOUTH EUROPE
Bulgarla 8.5
Greece 4.8
Italy 4.8
Portugal 0.02
Spa ln 0.03
Yugoslavla 14
USSR 1.4
WfST ASIA
Cyprus (0.6)
Israel (0.4)
S y r i a n Arab Rep. (0.13)
Turkey 4.0
EAST ASIA
Chlna (0.15)
Indla 0.035
Japan 0.18
NORTH AMERICA
Canada 0.030
Unlted States 0.026
a/ A r e a - u e l g h t e d average values.
T a b l e 13
Outdoor effective dose equlvalent ln the flrst m o n t h
from external lrradlatlon per unit caeslum-137 deposltlon
NORTH EUROPE
Denmark
f inland
Norway
Sweden
Reglon 1
Reglon 2
Reglon 3
CENTRAL EUROPE
Austrla
Czechoslovakia
Reglon 1
Reglon 2
Reglon 3
German Oem. Rep.
Reglon 1
Reglon 2
Reglon 3
Germany.
Fed. Rep. of
Reglon 1
Reglon 2
Region 3
Hungary
Reglon 1
Reglon 2
Poland
Romanla
Reglon 1
Reglon 2
Reglon 3
Switzerland
Reglon 1
Reglon 2
Reglon 3
Reglon 4
WEST EUROPC
Belglum
France
Reglon 1
Reglon 2
Reglon 3
lreland
Luxembourg
Netherlands
United K l n g d o m
Reglon 1
Reglon 2
Reglon 3
S O U T H EUROPE
Bulgarla
Reglon 1
Reglon 2
Greece
Reglon 1
Reglon 2
Italy
Reglon 1
Reglon 2
Portugal
Spa 1 n
Reglon 1
Region 2
Yugoslavla
Reglon 1
Reglon 2
Reglon 3
Table 13, contlnued
USSR
Reglon 1 1200 39 31
RegIon 2 860 15 59
Region 3 190 10 19
Reglon 4 86 2.8 31
Regton 5 (1.3) 0.09 (14)
WEST ASIA
Cyprus (5.6) (0.6) (9)
Israel (5.6) (0.4) (1 4 )
SyrIan Arab Rep. (3.9) (0.1) (39)
Turkey 5.6 4.0 1
EAST ASIA
Chlnd
IndIa
Japan
NORTH AMERICA
Canada (0.13) 0.03 (4)
Unlted States (0.13) 0.026 (5)
T a b l e 14
lodlne-131 In foods
Normallzed Ratlo of
Integrated concentration Integrated concentration lntegrated
(Bq a/kg) ( B q a/kg per k8q/m2) concentrations
Country Latl tude
(degrees Mllk Leafy MI lk Leafy Leafy vegetables
north) products vegetables products vegetables /mllkproducts
HORTH EUROPE
Denmark
f Inland
Noruay
Sweden
RegIon 1
Reglon 2
Reglon 3
CENTRAL EUROPE
Austrla
Czechoslovakla
Reglon 1
RegIon 2
Reglon 3
German Dem. Rep.
Reglon 1
Reglon 2
Reglon 3
Germany.
Fed. Rep. of
Reglon 1
Reglon 2
Reglon 3
Hungary
RegIon 1
Reglon 2
Poland
T a b l e 14. continued
Normallzed Ratlo of
Integrated concentration Integrated concentratlon lnteqrated
(Bq alkg) ( B q a/kq per k8q/m2) concentratlons
Country Latitude
Romanla
Reqlon 1
Reglon 2
Reglon 3
Sultzerland
Reglon 1
Reglon 2
Reglon 3
Regton 4
KEST tUROPL
Belqlum
France
Reqlon 1
Reglon 2
Reglon 3
Ireland
Luxembourg
Netherlands
Unlted Klngdom
Reglon 1
Reglon 2
Reqlon 3
S O U T H EUROPE
Bulqarla
Region 1
Reglon 2
Greece
Reqlon 1
Reqlon 2
Italy
Reglon 1
Regton 2
Portugal
Spa l n
Reqlon 1
Reglon 2
Yuqoslav\a
Reglon 1
Reglon 2
Reglon 3
USSR
Reqlon 1
Reqlon 2
Reglon 3
Reglon 4
Reglon 5
Y E S T ASIA
Cyprus
Israel
Syrlan Arab Rep
Turkey
EAST ASIA
Chlna
Indla
Japan
NORTH AMERICA
Canada
Unlted States
nllk Graln Leafy Veg./ neat nllk Graln Leafy Veg./ neat Leafy veg. neat/
prod. prod. veg. frult prod. prod. veg. frult / mllk mllk
NORTH EUROPE
Denmark
ilnland
NOrva y
Sweden
Reglon 1
Reglon 2
Reglon 3
CENTRAL EUROPE
Austrta
Czechoslovakia
Reglon 1
Reglon 2
Regton 3
German Oem. Rep.
Reglon 1
Reglon 2
Reglon 3
Germany.
Fed. Rep. of
Reglon 1
Reglon 2
Reglon 3
Hungary
Reglon 1
Reglon 2
Poland
Romanla
Reglon 1
Reglon 2
Reglon 3
Sultzerland
Reglon 1
Reglon 2
Reglon 3
Reglon 4
HEST EUROPE
Belglum
France
Reglon 1
Reglon 2
Reglon 3
Ireland
Luxembourg
Netherlands
Unlted Klngdom
Reglon 1
Regton 2
Region 3
SOUTH EUROPE
Bulgarla
Reglon 1
Reglon 2
Greece
Reglon 1
Reglon 2
Italy
Reglon 1
Reglon 2
Portugal
Spaln
Reglon 1
Reglon 2
Yugoslavla
Reglon 1
Reglon 2
Region 3
USSR
Reglon 1 90 23 25 33 200 2.3 0.6 0.6 0.9 5.2 0.3 2.2
Reglon 2 26 6.0 17 8.0 55 1.8 0.4 l .2 0.6 3.8 0.7 2.1
Reglon 3 21 6.0 10 10 50 2.1 0.6 1.0 1.0 5.0 0.5 2.4
Reglon 4 4.2 (1.7) (2.1) (2.6) 14 1.5 (0.6) (0.8) (0.9) 5.1 (0.5) 3.3
Reglon 5 (0.16) (0.05) (0.04) (0.06) (0.50) (1.7) (0.5) (0.4) (0.6) (5.3) (0.3) (3.1)
Table 15, contlnued
nllk Graln Leafy Veg./ neat nllk Graln Leafy Veg./ neat Leafy veg. neat/
prod. prod. veg. fruit prod. prod. veg. frult / mllk mllk
WEST ASIA
Cyprus (3.0) (2.0) (3.0) (0.6) (2.0) (5.0) (3.3) (5.0) (1.0) (3.3) (1.0) (0.7)
Israel (0.8) 4 (5.0) (2.0) (10) (2.0) (lo) (13) (5.0) (25) (6.3) (13)
Syrlan Arab Rep. (1.0) (0.3) (0.05) (0.02) (0.3) (1.7) (2.3) (0.4) (0.2) (2.3) (0.05) (0.3)
Turkey 21 2.0 6.5 3.5 17 5.3 0.5 1.6 0.9 4.3 0.3 0.8
EAST ASIA
Chlna (0.18) (0.47) ( 1 . 1 (0.19) (0.78) (1.2) (3.2) (7.4) (1.3) (5.4) (6.2) (4.5)
lndla (0.16) (0.39) 0 . 1 (0.046) (0.18) (4.7) (11.2) 3.2 (1.3) (5.1) (0.7) (1.1)
Japan 0.22 0.056 0.29 (0.28) 0.29 1.2 0.3 1.6 (1.6) 1.6 1.3 1.4
NORTH AMERICA
Canada (0.05) (0.08) (0.03) (0.02) (0.09) (1.5) (2.5) (1.0) (0.8) (3.0) (0.7) (2.0)
Unlted States (0.04) (0.13) (0.03) (0.02) (0.08) (1.5) (5) (1.0) (0.8) (3.0) (0.7) (2.0)
Time-Integrated Body
Number Caeslum-137 body burdens (Bq a ) burden
Country of deposltlon ratlo Ref.
persons denslty
Measured Expected (measured/
(k~s/m2) I n man from d l e t expected)
Aus t r l a
Vlenna 1200
Country average 7000
Bulgarla
Country average 9200
Czechoslovakia
Country average 3000
Finland
Aeglon 1 61 0
Reglon 2 1BOO
Reglon 3 4600
Reglon 4 10000
Aeglon 5 1 6000
Country average 4500
France
Reglon 1 40
Reglon 2 430
Reglon 3 1700
German Dem. Rep.
Country average 1700
Germany,
Fed. Rep. o f
Reglon 1 670
Reglons 2.3 2600
Hungary
Country average 39 3.1 770 2300 0.3 [H41
Italy
Reglon 1 43 6 3500 4200 0.8 [HbI
Reglon 2 67 4 2600 31 00 0.8 [M61
Japan
Country average 19 0.18 34 43 0.8 [N41
Netherlands
Country average 20 1.8 250 4 80 0.5 LC261
Norway
0s l o 38 1 .O 1400 5 50 2.5 [El 1I
Oppland
N. Tr.
151
78 b/
27.8
18.7
31 00
21000
15000
10000
0.2
2.1
r~lli
'
[ell]
f lnmark 45 c/ 0.4 5600 21 0 27 [Ell1
Poland
Country average 535 5.2 1700 31 00 0.6 [C21
Sweden
Reglon 1 50 31 1900 3300 0.6 [FbI
Country average 218 6.8 820 1200 0.7 [F61
Switzerland
Mltteland 2.0 7 50 1500 0.5 [PZI
Turkey
Country average 30 4 1700 1900 0.9 [ 12 I
U n l t e d Klngdom
Reglon 1 30 0.1 190 120 1 .6 IF121
Reglon 3 300 3 710 2500 0.3 [f121
Thyrold Effective
dose equlvalent dose equivalent
Country
Infants Adults Rural Urban
NORTH EUROPE
Denmark
Flnland
Norway
Sweden
Reglon 1
Reglon 2
Reglon 3
CENTRAL EUROPE
Austrla
Czechoslovakla
Reglon 1
Reglon 2
Reglon 3
German Oem. Rep.
Reglon 1
Reglon 2
Reglon 3
Germany. Fed. Rep.
Reglon 1
Reglon 2
Reglon 3
Hungary
Reglon 1
Reglon 2
Poland
Romanla
Reglon 1
Reglon 2
Reglon 3
Swltzerland
Reglon 1
Reglon 2
Reglon 3
Reglon 4
WEST EUROPE
Belglum
France
Regton 1
Reglon 2
Reglon 3
Ireland
Luxembourg
Netherlands
Unlted Klngdom
Reglon 1
Reglon 2
Reglon 3
SOUTH EUROPE
Bulgarla
Reglon 1
Region 2
Greece
Reglon 1
Reglon 2
ltaly
Reglon 1
Reglon 2
Portugal
Spa ln
Reglon 1
Reglon 2
Yugoslavia
Reglon 1
Reglon 2
Reglon 3
Thyrold Effectlve
dose e q u l v a l e n t dose e q u l v a l e n t
Country
USSR
Reqlon 1 21000 6900 2000 1900
Reglon 2 24000 6300 930 880
Reglon 3 3800 1400 4 60 420
Regton 4 3600 910 140 130
Reglon 5 82 25 4.3 3.9
WEST ASIA
Cyprus 4700 1200 67 66
Israel 1500 1100 94 92
S y r l a n Arab Rep. 1400 74 7.7 7.3
Turkey 2300 4 80 200 180
EAST ASIA
Chlna
lndla
Japan
NORTH AMERICA
Canada 75 11 1.4 1.3
Untted States 110 I5 1.5 1.4
T a b l e 18
C o u n t r y a v e r a a e o f f l r s t - y e a r dose e a u l v a l e n t s
T h y r o l d dose Rat10 t o r e s u l t r e p o r t e d
equivalent from country [NS]
Effectlve
dose
Country Infant Adult equlvalent T h y r o l d dose
Effectlve
dose
(usv) (usv) Infant Adult
EUROPE
Bulgarla
Austrla
Greece
Romanla
Finland
Yugoslavla
Czechoslovakla
Italy
Poland
Swl t z e r l a n d
Hungary
Norway
German Oem. Rep.
Sweden
Germany. Fed. Rep
Ireland
Luxembourg
France
Netherlands
Belglum
Denmark
U n l t e d Klndom
Spa 1n
Portugal
USSR
ASIA
Turkey
Israel
Cyprus
S y r l a n Arab Rep.
Chlna
Japan
Indla
NORTH AMERICA
Canada
Unlted States
T a b l e 19
T r a n s f e r factor f r o m d e p o s l t l o n t o t h v r o l d d o s e f o r iodine-131
NORTH E U R O P E
Denmark 6.1 130 33 21 5.4
Flnland 100 1500 690 15 6.7
Norway 85 930 350 11 4.1
Sueden
Region 1 160 1500 280 9.4 1.8
Region 2 13 17 13 1.3 1 .O
Reglon 3 41 820 190 20 4.6
CENTRAL E U R O P E
Austrla
Czechoslovakia
Reglon 1
Reglon 2
Reglon 3
G e r m a n Dem.Rep.
Heglon 1
Region 2
Reglon 3
Germany.
fed. Rep. o f
Region 1
Reglon 2
Reglon 3
Hungary
Reglon 1
Reglon 2
Poland
Romanla
Reglon 1
Reglon 2
Reglon 3
Sultzerland
Reglon 1
Reglon 2
Reglon 3
Reglon 4
WEST EUROPE
aelglum
f rance
Reglon 1
Reglon 2
Reglon 3
Ireland
Luxembourg
Netherlands
United K i n g d o m
Reglon 1
Reglon 2
Reglon 3
SOUTH EUROPE
Bulgaria
Reglon 1
Reglon 2
Greece
Reglon 1
Reglon 2
Italy
Reglon 1
Reglon 2
Portugal
Spaln
Reglon 1
Reglon 2
Yugoslavla
Reglon 1
Reglon 2
Reglon 3
Table 19, continued
USSR
Reglon 1 590 20000 5100 34 8.6
Reglon 2 480 23000 5500 48 11
Reglon 3 160 3500 980 22 6.0
Reglon 4 20 3600 790 180 40
Reglon 5 0.4 80 22 200 55
WEST ASIA
Cyprus 2.0 4700 1200 2400 600
Israel 0.7 1500 1000 2100 1400
Syrian Arab Rep. 1400 69
Turkey 2200 320
EAST ASIA
Chlna
Indta
Japan
NORTH AMERICA
Canada 0.1 75 9.4 750 94
Unl ted States 0.15 110 14 740 94
T a b l e 20
NORTH
Denmark 1.3 1.35 660 3.7 9.2 1.0 2.7 7.2
Flnland 14.7 20.8 12100 68 170 1.4 3.3 12
Norway 5.3 14.1 7030 39 98 2.7 2.8 19
Sweden
Reglon 1 31 17.3 8860 50 120 0.6 2.9 4.0
Reglon 2 0.81 (6.3) (32101 (18) (45) (7.7) 2.9 (55)
Reglon 3 2.3 6.3 3210 18 45 2.7 2.9 20
TEMPERATE
Austrla 23
Belglum 0.84
Bulgar la
Reglon 1 3.9
Reglon 2 12
Canada 0.03
Czechoslovakld
Reglon 1 2.3
Reglon 2 5.3
Reglon 3 2.8
France
Reglon 1 0.18
Reglon 2 0.66
Region 3 3.2
G e r ~ n0em.Rep.
Reglon 1,3 6.1
Reglon 2 11
Table 20. contlnued
Germany,
Fed. Rep. of
Region 1 2 4.5 1690 9.4 24 2.2 2.1 12
Reglon 2 4 8.2 31 00 17 43 2.0 2.1 11
Reglon 3 16 31 .9 12000 67 170 2.0 2.1 11
Hungary
Reglon 1 4.8 13.0 7300 41 100 2.7 3.1 21
Reglon 2 1 .5 8.9 5000 28 70 6.0 3.1 41
Ireland 3.4 8.4 3280 18 46 2.5 2.2 14
Italy
Reglon 1 6 23.2 10700 60 150 3.9 2.6 25
Reglon 2 4 16.9 7770 43 110 4.2 2.6 27
Luxembourg 2.7 4.6 221 0 12 31 1.7 2.7 11
Netherlands 1.8 2.4 1 1 70 6.6 16 1.4 2.7 9.1
Poland 5.2 14.6 81 60 46 110 2.8 3.1 22
Romanla
Reglon 1 4.5 (10.3) (7250) (41) (100) (2.3) 4.0 (23)
Reglon 2 18 (41 .O) (29000) (160) (410) (2.3) 4.0 (23)
Reglon 3 9 20.5 14500 81 200 2.3 4.0 23
Sul tzerland
Region 1 14.8 59.1 37900 210 530 4.0 3.6 36
Reglon 2 3.5 10.0 6430 36 90 2.9 3.6 26
Reglon 3 2.0 6.1 3890 22 54 3.0 3.6 27
Region 4 1.3 3.7 2390 13 33 2.9 3.6 26
Unlted Klngdom
Reglon 1 0.1 0.69 300 1.7 4.3 6.9 2.5 43
Reglon 2 1.7 7.9 3500 20 49 4.7 2.5 29
Region 3 3.0 14.2 6300 35 88 4.7 2.5 29
USSR
Reglon 1 38.8 73.7 50400 280 700 1.9 3.8 18
Reglon 2 14.5 21.2 14500 81 200 1.5 3.8 14
Reglon 3 10.0 18.3 12500 70 170 1.8 3.8 18
Region 4 2.8 4.2 2890 1b 40 1.5 3.8 15
Regton 5 0.094 (0.15) (100) (0.6) (1.4) (1.6) 3.8 (15)
Yugoslavla
Reglon 1 23 23.5 12400 70 170 1.0 3.0 7.6
Region 2 10 9.8 5200 29 73 1.0 3.0 7.3
Reglon 3 4 3.4 1780 10 25 0.8 3.0 6.2
SOUTH
Chlna
Cyprus
Greece
Reglon 1
Reglon 2
Indla
Israel
Japan
Portugal
Spaln
Reglon 1
Fteglon 2
Syrlan Arab Rep.
Turkey
Unlted Stater
Reglon a/ P 2 3 , 2 + b/
Ullk Graln Leafy Veg. / Heat Total -------------
prod. prod. veg. fruit Total
Graln dlet
North Europe
Central E u r o p e
West Europe
Southeast Europe
Southwest Europe
USSR
W e s t Asla
E a s t Asia
North Amerlca
a/ N o r t h Europe: D e n m a r k , F i n l a n d , Norway. S w e d e n .
C e n t r a l Europe: A u s t r l a , C z e c h o s l o v a k l a , G e r m a n D e m o c r a t l c Republlc. Federal R e p u b l l c o f
Germany. Hungary, Poland. Romania. Swl t z e r l a n d ,
W e s t Europe: e e l g l u m , France, Ireland. Luxembourg, N e t h e r l a n d s , U n l t e d Klngdom.
S o u t h e a s t Europe: B u l g a r i a , G r e e c e , I t a l y , Yugoslavia.
S o u t h w e s t Europe: Portugal. Spain.
W e s t Asla: Cyprus. Israel. S y r i a n Arab Rep.. Turkey.
E a s t Asla: Chlna, Indla. Japan.
N o r t h Amerlca: Canada. U n l t e d States.
b/ D e p o s l t l o n to total d l e t a f t e r f l r s t year; unlts: Bq a/kg p e r k8q/m2.
c/ D l e t t o body; unlts: Bq a/kg p e r Bp a/kg.
d/ D e p o s l t l o n t o e f f e c t l v e d o s e e q u i v a l e n t c o m n l t n e n t a f t e r f l r s t y e a r ; unlts: u S v p e r k ~ q / m 2 .
T a b l e 22
North Europe
Central E u r o p e
West E u r o p e
S o u t h e a s t Europe
S o u t h w e s t Europe
USSR
W e s t Asla
E a s t Asia
N o r t h Arnerlca
T o t a l t r a n s f e r f a c t o r f o r effective dose e a u l v a l e n t
based on caeslurn-137 d e o o s l t l o n
[ uSv per k8a/m2)
Pathway/
radlonucl lde After After After
flrst flrst Total first flrst Total Flrst flrst Total
year year year year year year
External gama
CS-137 2.2 71 73 2.2 71 73 2.2 71 73
Cs-134 2.5 4.9 7 2.5 4.9 7 2.5 4.9 7
Other 5.6 0.2 b 5.6 0.2 6 5.6 0.2 b
Subtotal 10 76 86 10 76 86 10 76 86
Ingestion
Cs-137 15 20 35 20 20 40 25 25 50
Cs-134 11 12 23 14 12 26 18 15 33
1-131 1 1 10 - 10 20 - 20
Subtotal 27 32 59 44 32 16 63 40 103
(103km2) (106) (km) Area Populatlon (Pea) First year Total flrst year Total
EUROPE
North a/ 1249 22.8 1300 8.2 7 .O 10.2 210 970 4100 22000
Central b/ 1253 178.0 1200 7 .O 6.0 8.8 280 930 49000 1 66000
uest c/ 936 137.7 2000 1.3 1 .0 1.2 48 150 6600 21000
Southeast i/ 829 101 .b 1500 8.2 7.2 6.8 380 1200 39000 121 000
Southwest e/ 596 47.2 2900 0.03 0.03 0.02 4 7 180 340
USSR 22190 279.1 1.4 5.0 30.9 260 810 72000 226000
ASIA
Southwest f / 4611 114.9 2200 1.0 1 .O 4.6 70 190 8000 22000
South 91 6786 1082 5400 0.08 0.08 0.5 6 IS 6100 16000
Southeast h 2575 240.6 7800 0.03 0.03 0.08 2 6 510 1400
East 11720 1268 6600 0.04 0.04 0.5 3 8 3600 9600
AMERICA
horth 11 20560 347.0 9000 0.02 0.02 0.4 1 4 490 1300
Carlbbean k/ 21 6 30.1 9200 0.018 0.018 0.004 1 3 40 100
Central 1/ 51 7 26.9 10700 0.012 0.012 0.006 0.7 2 20 60
South !/ 2520 49.7 10100 0.013 0.013 G.03 1 2 50 120
AFRICA
North -n/ 8438 128.4 3000 0.4 0.4 3.4 28 76 3600 9800
west -
o/ 6118 172.3 5600 0.08 0.08 0.5 6 15 970 2600
Central e/ 2415 16.3 5300 0.08 0.08 0.2 5 15 100 280
East 91 2117 59.5 51 00 0.09 0.09 0.2 6 17 380 1000
Northern hemisphere
Total (rounded) 252800 4304 5700 0.3 0.9 70 45 140 200000 600000
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ANNEX E
Genetic hazards
CONTENTS
Poragrophs Paragraphs
INTRODUCTION ....................... 1-2 11. RELEVANT NEW HUMAN DATA
PUBLISHED AFTER THE
.4. Germ cell stages and radiation UNSCEAR 1986 REPORT ........ 77-78
conditions relevant to genetic risk
evaluation .................... 3-4
111. RISK COEFFICIENTS FOR GEN-
B. General assumptions ........... 5 ETIC EFFECTS ................. 79-80
V.
ESTIMATES OF DETRIMENT
70. In addition to risk estimares for low-dose, low- 74. The most recent estimates of risk, those of the
dose-rate. low-LET irradiation conditions. the NUREG UNSCEAR 1986 Report, are given in Table 11. The
Report also provided estimates of genetic risk for the changes with respect to the estimates of 1982 are
irradiation conditions that would prevail in nuclear the following. First, on the basis of litter-size reduc-
accidents. As would be expected, the risks are higher tions observed in niouse studies involving acute, high-
under the latter conditions, but this case will not be dose-rate x-irradiation, chronic gamma-irradiation or
further considered here. chronic fission neutron irradiation (in all, spernia-
togonial irradiation; these data are discussed in the
71. The NUREG Report also sought to determine 1986 Report), the Committee estimated that, following
whether its risk estimates were consistent with the lack irradiation of male mice, between 5 and 10 per lo-' Gy
of detectable genetic effects of radiation in the genetic per million live born (in the first generation) would die
studies of Hiroshima and Nagasaki. In its analysis of between birth and weaning as a consequence of
the Japanese data, i t used ( a ) the paper of Schull et al. induction of dominant sub-lethal effects. In vie\!, of
as a basis [S13: specifically, Table 7. in which the uncertainty as to whether and to what extent litter-
mortality up to age 17 for 16.173 children of exposed size reduction in mice can be extrapolated to mortality
parents is correlated with the distribution of parental in humans between birth and early childhood, the
doses]; ( b ) the linear-quadratic model as the one above estimate has been appended to Table 11 as
applicable for the induction of gene mutations and footnote b.
chromosomal aberrations at high doses and high dose
rates (developed independently of the Japanese data. on 75. The second change (see footnote e in Table 11)
the basis of the experimental results discussed in the pertains to the risk of induction of autosomal recessive
preceding paragraph); and (c) average doses for each genetic disease as a result of radiation esposures. In
exposure group (parents), i.e.. 0.05 Gy (0.01-0.09 Gy); the past, the Committee's view has been that although
0.295 Gy (0.10-0.49 Gy): 0.745 Gy (0.50-0.99 Gy); and recessive niutations are expected to be induced, no
2 Gy (>I Gy). These values were introduced into the cases of individuals affected with recessive disease will
equations to project the number of cases of each occur in the first generation; it therefore made no
genetic event relative to the child sample size in each attempt to present a quantitative estimate of risk in
of the 32 sectors of exposure in the matrix of Schull et the subsequent generations following one-time or
al. [SI?]. generation-after-generation radiation exposure. Searle
and Edwards [S9] have now provided a numerical
72. The important conclusion that emerged from this estimate of risk for autosomal recessive disorders.
analysis \\,as that "the central estimate of prediction of Basing their calculations on a combination of data
cases should lead to a statistically insignificant. i.e., from observations in human populations and in mice,
undetectable increase in genetic disorders among the these authors have estimated that (a) a genetically
16,713 progeny of irradiated parents. For example. significant dose of lo-' Gy of x- or gamma-irradiation
there were 1,040 deaths in this group of 16.7 13 progeny received by each parent once in a stable population
up to the age of 17 (6.22%); in the unexposed groups, with I million live born would induce up to 1,200
there were 2.191 deaths among 33,976 progeny pro- additional recessive mutations; (b) from partnership
duced (6.45%) and the two frequencies are not effects (i.e., partnership with another recessive mutation
either induced or already present in the population), 78. In cytogenetic studies [All, among 8.322 children
about one extra case of recessive disease would be born to exposed survivors. 19 (0.23%) had sex-
expected in the following 10 generations; (c) homo- chromosomal anonlalies (3 XYY. 7 XXY. 5 X X X ,
zygosity resulting from identity by descent would not 3 mosaics and 1 miscellaneous). and 23 (0.28%) had
normally occur until the fourth generation after structural rearrangements (I0 Robertsonian transloca-
exposure, but on certain assumptions. about 10 extra tions, 7 balanced reciprocal translocations. 1 inversion,
cases would be expected from this cause by the tenth 2 unbalanced supernumeraries and 3 miscellaneous
generation; and (d) in the same period. about 250 unbalanced aberrations). Of 7,976 control children,
recessive alleles would be eliminated as heterozygotes. 24 (0.309TrI had sex-chromosomal anomalies (5 XYY.
on the assumption of a 2.5% heterozygous dis- 9 XXY. 4 X X X . 3 mosaics and 3 miscellaneous) and 27
advantage. Such elimination through heterozygotes (0.34%) had structural rearrangements (6 Robertsonian
may occur through, for example. an increase in translocations. 13 reciprocal translocations, 6 inver-
disease susceptibilities, malignancy or a decrease in sions and 2 miscellaneous unbalanced aberrations). Of
intellect. the I I balanced structural rearrangements for which
family studies were made. one reciprocal translocation
76. The third change pertains to risks associated in each group was a new mutant. the rest were
with the induction of balanced reciprocal transloca- familial.
t i o n ~ .In its 1982 Report, the Committee used the
cytogenetic data collccted in studies with the rhesus
monkey and the marmoset Saguinus fuscicollis, as 111. RISK COEFFICIENTS FOR
well as some limited human data. as a basis for its GENETIC EFFECTS
risk estimates. The rates of unbalanced products of
reciprocal translocations expected to be generated
(estimated from the corresponding rates for balanced 79. All the numerical estimates of genetic risks
reciprocal translocations) were used in conjunction discussed thus far have been obtained on the basis of
with the assumption that 6% of unbalanced zygotes genetically significant doses, i.e., on the assunlption
might result in congenitally malformed children, that the doses are received by individuals before or
giving the range 0.3- 10 per lo-=Gy per 10h live births during the reproductive period. It is obvious that in
(the lower limit was based on the rhesus monkey data the case of population exposures, the genetically
and the upper one on the combined marmoset and significant doses are markedly less than the total doses
human data). New data at low doses and low dose received over a lifetime: damage sustained by germ
rates have since then become available from experi- cells of individuals who are beyond the reproductive
ments involving the rhesus monkev and the crab- period or who are not procreating for any other
eating monkey: further, the estimate of conceptions reason. poses no genetic risks. If it is assumed that the
uith unbalanced products that may survive birth has mean age at reproduction is 30 years and the average
been revised upwards, from 6% to 9% (discussed in life expectancy at birth is 70-75 years, the dose
the UNSCEAR 1986 Report). As a result, the esti- received by 30 years is about 40% of the total dose.
mated risk is now 1-15 cases of congenitally mal-
formed children per lob live births per lo-? Gy of 80. To derive risk coefficients for genetic risks to a
paternal irradiation and 0-5 cases per lo6 live births population, therefore. one needs to multiply the
per Gy of maternal irradiation. Further details genetic risk estimates discussed earlier by 0.40. The
are given in footnotes f and g to Table 11. following calculations make use of the most recent
risk estimates presented in Table 7: (a) risk coefficient
on the basis o f gonadal dose in the reproductive
segment of the population (from Table 7); for quanti-
11. RELEVANT NEW HUMAN DATA fiable damage only, over all generations, per Gy:
PUBLISHED AFTER THE UNSCEAR 1986 -12.000 per lob or 1.2% ; ( b ) risk coefficient to the
REPORT population: for quantifiable damage only. over all
generations. per Sv ( 1.2 X 0.4 = 0.5): 0.5%.; (c) risk
77. The most recent results from the Hiroshima and coefficient for the first two generations under condi-
Nagasaki genetic and cytogenetic studies again show tions otherwise similar to (a) above (from Table 7):
no significant effects of radiation. The mutation tvork 3.100 per lo6 or 0.3%; (d) risk coefficient to the
[S 121 involved examining 13.052 children of' proximally population for the first two generations. per Sv
exposed parents and 10.609 children of control parents (0.3 x 0.41: 0.1%,. it is useful to reiterate here that
for rare electrophoretic variants of 30 blood proteins; these risk coefficients are for conditions of continuous
three mutations were detected in each group in exposure at a finite rate every generation and that they
725.587 and 539.170 equivalent locus tests. respectively. also reflect the total genetic risk from a once-only
The mutation rates can therefore be estimated as exposure of the parents.
0.4 lo-' per locus (exposed group) and 0.6 lo-' per
locus (control group). In a subset of 4.983 children of
exposed parents (= 55.689 equivalent locus tests) and IV. ESTIMATES O F DETRIMENT
5,026 control children (= 59,269 equivalent locus tests)
who were studied for deficiency variants of nine
erythrocyte enzymes, one mutant was encountered in 8 1. The estimates of risk discussed in the preceding
the first group (rate: 1.80 per locus) and none in sections refer to the expected number of cases of
the second. serious genetic disease due to radiation-induced muta-
[ions and chromosomal aberrations in the progeny of Report. However, this statement is not meant to imply
irradiated parents. The Committee had always realized that there have been no advances in our knowledge in
(although it had not explicitly stated so in Reports the areas relevant to genetic risk evaluation in recenr
prior to 1982) that presenting numerical estimates is years: rather, it reflects the fact that the impact of
just one aspect of risk estimation. Without some these advances has still not been fully assessed, as
objective and quantifiable indicators of severity, it is illustrated below..
difficult to perceive the impact of these on the
individual and on the society at large and to make
comparisons with the risks of induction of other A. PREVALENCE OF MENDELIAN.
biological effects, such as cancer. Therefore, starting CHROMOSOMAL AND OTHER DISEASES
with the UNSCEAR 1982 Report. the Committee
began a systematic review of data bearing on this 1. Mendelian diseases
problem, focusing on spontaneously arising Mendelian,
chromosomal and other diseases in order to gain some 85. There is no need to belabour the point that a
perspective of the detriment associated with these sound knowledge of the contribution of gene mutations
diseases and hoping to be able to use this knowledge and of chromosomal aberrations to genetic diseases is
to assess the impact of radiation-induced diseases at of paramount importance. not only because i t affords
some later stage. a perspective on those diseases to which man is
litera!ly heir. but also because it provides a frame of
82. Particularly important in this context are the reference within which to appraise the increases
rough estimates of the disability caused and the length expected as a result of radiation (or other mutagenic
of life lost by the more common genetically determined esposures). Our current estimates of prevalences of
(i.e.. Mendelian and chromosomal) diseases provided Mendelian diseases are based on a total of about
by Carter [C4] and discussed in the 1982 Report. 50 entities, the individual birth frequencies of which
Carter's analysis revealed that for monogenic diseases range from about 1 lo-' to about 1 lo-", with some
(autosomal dominants. X-linked recessives and auto- upward adjustment in the total frequency for those
somal recessives) and for an estimated total birth diseases yet to be discovered. For obvious reasons.
prevalence of 12,500 per lo6. about 190,000 years of these estimates pertain to a very small proportion of
life are lost, 300.000 years of life are potentially those listed in the recent update of the McKusick
impaired and about 150,000 years of life are actually cornpendiurn [M4](i.e.. a total of 1.906 conditions that
impaired per lo6 live births. For chromosomal diseases, are well documented as being inherited in a Mendelian
Carter's figures are about 89.000 years (lost life). manner and a further 3,001 for which such evidence is
180.000 years (potentially impaired life) and about incomplete). The disparity is even greater when one
90,000 years (actually impaired life) per 106live births. considers that the total amount of nuclear DNA in the
The average life expectancy at birth assumed in these hurnan haploid genome is about 3 lo6 kb, which in
calculations was 70 years. principle can accommodate between 100.000 and
150,000 genes (on the assumption that an "average"
83. Czeizel and Sankaranaraanan [C5] extended this gene is 20-30 kb long). However, this estimate is
analysis to spontaneously arising congenital anomalies probably roo high, since it neglects introns, pseudo-
in man (these results are discussed in the UNSCEAR genes, highly repetitive sequences such as satellite
1986 Report [U7]). The data on birth prevalences DNA and other interspersed and non-transcribed
for the various conditions considered were derived DNA sequences [B7, D2, E5. E6, JI]. Judging from
from several epidenliological surveys carried out in the phenomenal progress in the understanding of the
Hungary and from the Hungarian Congenital hlal- human genome that has been made possible in recent
formation Registry. Most of the information on years by applying the methods of recombinant DNA
mortality profiles was obtained from the records of technology (reviewed in the UNSCEAR 1986 Report
the Hungarian Central Statistical Office in Budapest. [U7]1. one can confidently look forward to (a) a better
Their analysis showed that with an estimated prevalence understanding of the relationship between genes and
of about 60.000 per lo6 live births in Hungary, the mutations and their effects on health and disease and
congenital anomalies may cause about 480,000 years (b) the application of the knowledge so derived to the
of lost life, about 3,700,000 years of potentially evaluation of genetic risk.
impaired life (including congenital dislocation of the
hip. whose birth prevalence is 25,770 per lo6; and
which. if excluded, would reduce the potentially 2. Chromosomal diseases
impaired life figure to about 1.800,000 years) and
about 4.500 years of actually impaired life. In these 86. At the chromosomal level, the application of
calculations. it has been assumed that the average life banding techniques to the study of human chromo-
expectancy at live birth is 70 years. somes has led to the identification of a variety of
chromosomal defects. particularly deletions and dupli-
cations involving every chromosome of the human
V. UNCERTAINTIES AND PERSPECTIVES complement (reviewed in the UNSCEAR 1977 Report
[U7]). However, since most of the currently available
information on these a~iomaliesis in the form of case
84. The foregoing discussion amply documents the reports, their prevalences and their contribution to
fact that there have been only a few changes in the disease states cannot be readily determined. Of parti-
numerical estimates of risk since the UNSCEAR 1977 cular interest are microdeletions observed in mal-
formed children. especially those predisposed to a anisms by which genetic predisposition acts or of the
number of cancers. The): provide new ways to localize environmental factors involved.
and characterize important genes involved in pathol-
ogy, both at the chromosomal and molecular levels. 90. The same is true of the "other multifactorial
They also suggest that a pathological character may diseases" tvhose population prevalence has been esti-
result from the presence of a pre-existing abnormal mated to be about 600,000 per lo6. The question of
allele and a somatic mutation. whether and to what extent the prevalence of all these
multifactorial diseases will increase as a result of
87. One exciting development in human cytogenetics radiation exposures remains a matter of conjecture.
in recent years has been the discovery of fragile sites Our ability to make reliable estimates for these
on chromosomes. which can be made visible by diseases depends largely on establishing the role of
appropriate culturing techniques (re\iewed in the genetic factors in their aetiology. While no quantum
UNSCEAR 1982 and 1986 Reports [U6. U71). As was leaps are expected in this area. there are persuasive. if
already mentioned, the fragile site on the X-chromo- not yet compelling. reasons to believe that it may soon
some (at position Xq27) has elicited considerable be possible to estimate the mutation component in some
attention because it is associated with one form of of the seemingly multifactoriaily inherited diseases. The
X-linked mental retardation. The prevalence of fragile- use of restriction fragment analysis and the develop-
X-associated mental retardation has been estimated to ment of more rapid methods for sequencing DNA
be about 4 lo-' both in males and females [S6]: this will. in time allow a search for mutational variation
would make the fragile-X the second most common at specific loci known to be involved which contribute
(after Down's syndrome) chromosomal abnormality to the occurrence of these diseases. The following
associated with mental retardation. It is currently examples are illustrative.
not known whether this abnormality can be induced
by radiation, so no genetic risk assessments can be 91. In a large Icelandic family (over 200 members in
made. four living generations) showing Mendelian inheritance
of X-linked secondary cleft palate and ankyloglossia
("tongue-tied"), Moore et al. [M 101 localized the gene
3. Congenital anomalies and other diseases to Xq13-Xq21; the eventual cloning of the cleft palate
of complex aetiology gene could become a starting point for the analysis of
the genetic basis of this developmental abnormality. A
similar analysis using restriction fragment length
88. Previous estimates of the prevalence of diseases polymorphism in an Old Order Amish pedigree made
of complex aetiology (i.e., congenital anomalies (43,000 it possible to localize a dominant gene conferring a
per lob) and other multifactorial diseases (47.000 per strong predisposition to manic depressive illness (a
lob) are based on the results of the British Columbia form of affective psychosis) to the tip of the short arm
survey [TI], in which the follow-up period was from of chromosome 1 1 [E9]; however. in three Icelandic
birth to age 21. Recent studies of Czeizel and kindreds [H3] and three North American pedigrees
Sankaranarayanan ([Cl] and Czeizel et al. [C7]; [D3] there was no linkage with any of the chromo-
discussed in the UNSCEAR 1986 Report [U7]) lend some I I probes used. The inference is that mutations
credence to the view that the above prevalence figures at different loci are responsible for the manic depres-
(in particular those of the "other multifactorial sive phenotype in the Amish and in the other two
diseases") are underestimates. Their data show that in population groups studied. Two other areas with
Hungary (a) congenital anomalies have a prevalence particular promise involve lipid metabolism, where it
of about 60.000 per lo6 live births and (b) the "other is already possible to specify the contribution of
multifactorial" diseases may have a prevalence of specific loci concerned with the apolipoproteins to the
about 600,000 per lo6 population when all individuals variation in cholesterol levels seen among individuals
up to age 70 are included. I t should be made clear that (see [B9] for a recent review) and the transport of
the latter figure refers to the number of diseases per sodium and potassium which looms large in the
lo6 and not to affected individuals; thus, some occurrence of essential hypertension (reviewed in [H4]
individuals have more than one disease. and: [WZ]).
l a b l e 7
a_/ Includes dlsorders and tralts that cause serlous handlcap at some tlme
during llfetlme.
b/ Estlmated dlrectly from measured phenotyplc damage or from observed
cytogenetlc effects.
c/
- Estlmated by t h e relatlve mutatlon rlsk method.
d/ No flrst-generatlon estimate avallable for X-llnked disorders; t h e
expectation ls that It would be relatively small.
N.B.: A typographlcal error In the 8EIR Report Is corrected here.
g/ Some estimates have been rounded off t o dlspel an lmpression of
conslderable preclslon.
f/ Includes only aberratlons expressed as congenltal malformatlons. resulting
from unbalanced segregatlon products of translocatlons and from numerical
aberratlon.
q/ Hajorlty of t h e Sub-Comnlttee feels that It Is considerably closer to zero,
but one member Feels that It could be as much a s 20.
T a b l e 4
Follows that glven ln the 1972 BEJR Report [BI]. except that chromosomal
dlseases are dlvlded lnto those wlth a structural and those wlth a
numerlcal basts.
Based o n the results of the Brltlsh Columbla survey and other studles.
The flrst generatlon lncrement 1s assumed t o be about 15% of the
equlllbrlum lncldence for autosomal domlnant and X-llnked dlseases. about
three flfths of the equlllbrlum lncldence For structural anomalles and
about 10% of the equlllbrlum lncldence for dlseases of complex lnherltance.
Includes dlseases ulth both early and late onset.
Also includes dlseases malntalned by heterozygous advantage.
Based on the pooled values from cytogenetic surveys of new-borns but
excludlng euplold structural rearrangements, Robertsonian translocatlons
and 'othersm (malnly mosalcs).
Ext ludlng mosalcs.
Includes an unknown proportlon of numerlcal (other than Down's syndrome)
and structural chromosomal anomalles.
Based on the assumption of a 5% mutdtlonal component.
T a b l e 6
Risk o f 0.01 Gy b/
Normal
Type of d l s o r d e r lncldence
Flrst All
generatton genrratlons
a/ c_/
Slngle g e n e
Autosomal domlnant
X-llnked
Irregularly lnherlted
Chromosome a b e r r a t l o n s f /
Aneuploldy
Unbalanced t r a n s l o c a t l o n s
Based o n the results of the Brltlsh Columbla Study and other studles: for
detalls see [US].
The first-generatlon lncrement Is assumed t o be 15% of that at equlllbrlum
tor autosomal domlnant and X-llnked dlseases and t h r e e ttfths of that at
ec;ulllbrlum for chromosomal dlseases d u e t o structural anomdlles.
Not given In the UNSCEAR 1986 Report and estlmated here; for autosomal
domlnants and X-linked dlseases, It Is calculated as 15% of (equlllbrlum
Increase mlnus the lncrease In the flrst generatlon); a slmllar procedure
appller t o chromosomal dlseases due t o structural anomalles.
These values apply If 0.01 Gy Is glven In each generatlon, but they also
express the total genettc d a m a g e Dver all generatlons If t h e d o s e of 0.01
Gy 1s glven ln o n e generatlon.
Frequency of recessives m l n t a l n e d by mutatlon assumed t o be 1100 per
lo6 llveblrths.
F r o m partnershlp between lnduced mutatlons and t h o s e already present In
the populatlon, assumtng 2.5% heterozygous dlsadvantage and a mean number
of harmful recesslves per gamete of 1 [S9].
T h e lncldence of t h e s e ln human populations Is unknown because they act
too early t o be recognlred a s transmlsslble domlnants; they Include
domlnant sub-lethals, t h e rate for uhlch has been estlmated t o be 5-10 per
0.01 Gy of paternal lrradlatlon of mice (see Table 2 3 of t h e UNSCEAR 1986
Report [Ul]).
Studies by Lyon and Nomura and colleagues show that, ln t h e mouse, they
a r e induced by lrradlatlon of male and female g e r m cells, but the
associated risks appear t o be low.
The prevalence Is much higher than that glven In prevlous UNSCEAR Reports.
because dlseases manifest up t o age 70, lnstead o f mainly t o a g e 21, have
n o w been included, together utth some less serlous condltlons.
furthermore, the flgure denotes the number of dlseases per lo6
lndlvlduals and not t h e number of affected lndlvlduals. There Is
conslderable uncertainty over whether a douhllng d o s e of 1 Gy and a
mutattonal component of 5% ( a s used prevlously) can be Justlfled. The
UNSCEAR 1982 Report arrived at estimates of 4.5 extra cases per 1 mllllon
In t h e flrst generatlon and 45 per mllllon at equlllbrlum after a parental
dose o f 0.01 G y , o n t h e basts of the prevlous e s t l m a t e of populatlon
prevalence of 90.000 per mllllon.
Nomura has reported t h e lnductlon o f pulmonary and other tumours In the
F 1 generatlon of mtce after lrradlatlon ( s e e [U7] for detalls). but
t h e s e have very l o w expresslvlty; thelr llkely effects o n health a r e thus
unclear.
It Is stlll not clear whether germtnal lrradlatlon leads t o slgnlflcantly
lncreased frequencies of non-dlsJunctlon, but any resultant genetlc rlsk
f r o m the production of trlsomlc condltlons Is thought t o be low.
T a b l e 8
Sumnary o f q e n e t l c r l s k s e s t l m a t e d
I n t h e UNSCEAR 1977 Report u s l n g t h e d l r e c t method
1. Autosomal m u t a t l o n s a_/ 60
2 . Dominant v l s l b l e s b/ Very lor
3 . S k e l e t a l m u t a t l o n s c/ c
4 . Balanced r e c l p r o c a l
translocatlons g/ 17- 87 Lou
5 . Unbalanced p r o d u c t s o f
e n d - p o l n t 4 above 34.174
6. X-chromosome l o s s h/ Very low Lou
7 . Other chromosome a n o & l l e s -
Males Females
Induced mutations
havlng domlnant eftects a/ -10 t o -20 b/ 0 to -9 c_/
Unbalanced products o f
lnduced reclprocal translocattons -0.3 t o -10 g/ 0 to -3 g/
induced mutatlons
havlng dominant effects a/ b/ - 1 0 to - 20 c/ 0 t o -9 d_/
Note: These estimates are the same as those made In the UNSCEAR 1982 Report
except for changes lndlcated ln footnotes b/ and g/.
a_/ Includes rlsk from the lnductlon of domlnant mutatlons. as well as of
deletions and balanced reclprocal translocatlons wlth domlnant effects.
b/ Does not Include the rlsk of mortality (between blrth and early llfe)
estlmated on the basls of data on lltter slze reductlon In mlce (about 5-10
cases per mlllion conceptlons); see text for detalls.
L/ The lower llmlt ls derived from the data on cataract mutatlons and the
upper llmlt from those on skeletal mutatlons (both In mlce); the latter Is
the same as that arrlved at In the UNSCEAR 1977 report [US]. A
multlpllcatton factor o f 2 has been used In the skeletal estlmate. but not
ln the cataract one. Thls factor Is a n attempt to allow for t h e llkellhood
that many domlnant mutatlons (espectally those affecting bodlly systems
other than the skeleton) remaln t o be detected. A correctlon factor of
0.5, whlch allows for skeletal mutatlons that a r e not cllnlcally
slgnlflcant. ts not requlred for the cataract estlmate. See UNSCfAR 1982
Report [ U b ] for detalls.
d/ The louer llmlt of zero Is based on the assumptlon that the mutational
sensltlvlty of human \ m a t u r e oocytes ls slmllar to that of mouse lmnature
oocytes; the upper llmlt of -9 Is based on the assumptlon that the
sensltlvlty of the human oocytes Is slmllar to that of mature and maturlng
mouse oocytes and that the latter 1s 0.44 tlmes that of spermatogonla. See
UNSCEAR 1982 Report for detalls.
g/ Although the rlsk (of recesslve dlsease from the lnductlon of recesslve
mutatlons) Is zero In the flrst generatlon, about 1 extra case per mllllon
llve blrths would be expected In the folloulng 10 generatlons (from
partnershlp effects) and on certaln assumptlons. about 1 0 extra cases per
1 mllllon would be expected by the tenth generatlon (from effects due to
ldentlty by descent). See text for further detalls.
f / The louer llmlt Is based on comblned cytogenetlc data from chronic low-LET
lrradlatlon experlments lnvolvlng the rhesus monkey and the crab-eatlng
monkey. and the upper llmlt. on the comblned human and marmoset (Sagulnus
lusclcollls) cytogenetlc data (see UNSCEAR 1986 Report for detalls). It
has been assumed that 9% o f unbalanced products of reclprocal
translocatlons wlll rerult In blrth of congenltally abnormal chlldren.
q/ The lower llmlt of zero Is based on the assumptlon that the sensltlvlty of
the human lmnature oocyte to the lnductlon of herltable reclprocal
translocatlons wlll be slmllar to that of mouse lmnature oocytes wlth
respect to the lnductlon of chromosome aberratlon phenomena; the upper
llmlt Is based on the assumptlons that ( a ) the sensltlvlty of the human
lrnnature oocytes to the lnductlon o f reclprocal translocatlons wlll be one
half that of t h e human and marmaset spermatogonla (based on results wlth
mlce on herltable translocatlons); (b) the frequency of unbalanced products
dl11 be slx tlmes that of recoverable balanced reclprocal translocatlons;
and (c) about 9% of unbalanced products ulll result In congenltally
malformed chlldren. See UNSCEAR 1982 Report for detalls.
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ANNEX F
CONTENTS
Paragraphs Paragraphs
14VTRODUCTIOh' . . .. ..... ....... ... .... 1-5 11. ASSESSMENT O F DOSE-RESPONSE
AND RISK PROJECTION.. ..... . . . 59-1 19
I. GENERAL CONSIDERATIONS ... . 65% A. Problems associated with assess-
ment ......................... 59-66
A. Terms. approaches and concepts . .. 6-29 I . Form of the regression of
1. Terms and units of radiation response on dose . .. .. . . . . . . 59-62
exposure .................. 6-8 2. Contingency tables and pro-
2. Concepts of risk .. . . . .. . ... . 9-19 portional hazard models.. . . . 63-64
(a) Dose-response pattern . . 10-1 1 3. Mortality versus morbidity
(b) Risk measures and projec- data ...................... 65-66
tion .................. 12-19 B. Dose-response patterns . .. .. . . . . . 67-76
3. Assignment of causation . . ... 20-22 1. Assessment of the effects of low
4. The analytic approach to radia- dose ...................... 68-72
tion carcinogenesis.. . . . . ... . 23-29 2. Assessment of the effects of
B. Sources of data.. .. . .. . ...... .. . high dose.. ....... .... .. . . . 73-76
30-37
I. Special exposed cohorts . . .. . 31 C. .
Risk projection ... . . . . . . . . . . . . . 77-1 19
2. Patients treated with thera- Latency time and the platcau
.
peutic radiation . .. ...... . . 32 period ....................
3. Individuals receiving diagnostic Excess and baseline risk as a
examinations ............... 33 function of time since exposure
4. Occupational groups . . . . . . . . 34 Age and sex structure of the
5. Populations receiving chronic population and baseline mor-
exposures .................. 35 . .
tality rates . . ... . . . .. . . .. .
6. Accident victims.. . . . .. . . . . . 36-37 .
Age at exposure . . . . .. . . . . .
The dose-response function . .
C. .
Types of studies . .. . . . . . . . . . . . . 38-58 Other exposure factors . . . . . .
..
1. Cohort studies . . . . . . . . . . . 39-57
Previous approximations of
lifetime risk projection . . . . . .
(a) Ongoing investigations 3944
(b) Ascertainment of exposed Risk coefficients for high-LET
and comparison indivi- .
radiation . . . . . . . . . . . . . . . ..
duals ................. 35-47 Selection of preferred projec-
(c) Suitability of comparison tion model.. . .. . . . . . . ... ...
group ................ 48
(d) Accurate determination of 111. BIOLOGICAL ISSUES IN THE
expected risks.. ... . . . . . 49-50 ASSESSMENT O F RADIATION
(e) Meaning of relative risk
in a changing exposure
..
CARCINOGENESIS . . . . . . . . . . . . . 120-432
environment . . . . . . . . . . . 5 1-52 A. Biological models of radiation car-
( f ) Identification of new ex- cinogenesis .. . . ..... . . . .. . . . . . . 12 1- 15 1
posed cohorts.. . . . . . . . . 53-57 1. Multi-stage models and the role
2. Case-control studies. . .. . . ... 58 of radiation in carcinogenesis 12 1-1 35
Paragraphs Paragraphs
2. Consideration of results of E. Hormonal effects ... . . .. .. . .....
oncogene studies in statistical
models . . . . . . . . . . . . . . . . . . . .
F. Other diseases.. . . ... . .. . . . . . .. .
3. Does radiation induce unique
cancer characteristics at the V. E N V I R O N M E N T A L F A C T O R S
cellular level? . . . . . . .. . . . . . . THAT MODIFY RISK .. . ....... . . .
4. Causal mechanisms: gene acti-
vation or inactivation?. . . . . .. .4. Smoking . . ............... .... .
B. Tissue susceptibility in children. . . . B. Diet. .........................
1. Exposures in utero.. . . . .. . . . C. Interaction between therapeutic
2. Exposures in childhood.. . . . . modalities . . . . . . . . . . . . . . . .. . . . .
la) Children exposed to radia-
D. Statistical reflection of high popula-
tion for treatment of
primary cancers.. . . . ... ..
tion risks.. . . . . . . . . . . . . . . . . . .
(b) Children exposed to radia- E. General considerations about inter-
tion for treatment of actions. . . . . . . . . . . . . .. . . . . . . .. .
benign conditions . . . .. .
(c) Children exposed to
atomlc bombings and fall- VI. SUMMARIES O F RlSK ESTlhfATES
out................... IN iMAJOR COHORTS.. . . . . . . . . . . .
(d) Exposure of the female
A. Studies providing summary risk
breast in childhood and at
perimenarch~alages . . .. estimates . . .. . . . . . . . . . . . . . . . . . .
3. Tissues apparently not sus- B. Projection of relatire risk in the
ceptible to radiation-induced major studies . . . . . . . . . . . .. . . . . .
carcinogenesis . . . . . . . . . . . . . . I . Results from exposure to treat
4. Summary ofexposure effects in cervical cancer .. . . . . . .. .. . .
.
children . . . . . . . . . . . . . . ... . 2. Results from exposure to treat
ankylosing spondylitis . . . . . . .
C. 'rissue susceptibility in adults .. .. . 3. Joint analysis of Japanese
I. Adultsexposed to radiation for (T65D) and ankylosing spon-
treatment of primary cancers dylitis data . . . . . . . . . . . . . . . .
(a) Treatment for Hodgkin's 4. Recent results from studies of
. . .. .
disease. . . . . . . . . . . the Japanese exposed to the
(b) Treatment for cervical .
atomic bombings . . . . . . . . . .
. .
cancer . . . . . . . . . . . . . .
C. Uncertainties associated with risk
( c ) Treatment for ovarian
cancer . . . . . . . . . . . . . . . . estimates. . .. . . . ..
. ... . . . . . .. . .
( d ) Treatment for breast D. Uncertainties associated with risk
cancer . . . . . . . . . . . . . . . . projections . . . .. . . . . . . . . . . . . .. .
2. Adultsexposed to radiation for
Immune suppression . . . . . . . .
3. Leukaemogenesis in cancer VII. RISK PROJECTIONS.. . . ..... .. .
radiotherapy generally. . . . . . .
A. General considerations.. .. . ..... .
4. Adults exposed to radiation for
treatment of benign conditions 1. Whole-body risk coefficients
(a) Haematopoietic tissue. . . 2. Site-specific risk coefficients
(b) Son-dividing tissue.. . . . B. Summary of risk projection methods
(c) Dividing non-epithelial and risk estimates.. . . . . . . . . . ... .
~ISSU~ . . . . . . .. . .. . . . . . . The basic projection model
(d) Epithelial tissue .. . . . . . . Analytical expression of the
5. Occupationaily exposed adults model ....................
6. Exposurcs to elevated cosmic Calculation of the loss of life
and terrestrial radiation . .. . . expectancy ................
7. Summary ofexposure effects in Demographic and background
adults ..................... epidemiological data required
The computational process
~ e f e r e n c e ~ o ~ u l a t i.o.n. .. . .
1V. HOST F.ACTORS T H A T MODIFY
RISK ............................. 433-457
Risk coefficients . . . . . . .. ...
Indexes of harm . . . . .. . . .. .
4. Sex ....... .... .. . .. ........... 434-435 Treatment of uncertainty . . .
Fractionated and low-dose-
B. Age of onset of tumour~i n exposed rate exposure . . . . . . . . . . . . .
adults: single and chronic exposures 438-441
1. Exposure to the atomic bomb- C. Results of projections.. . . . . . . . .. .
ings in Japan. . . . .. . . . . . . . . . 436-439 I . The adult population.. . . . . . .
2. Exposures to nuclear tests and (a) Excess lifetime mortality:
. .
fallout . .. . . . . . . . . . . . . . .. 44044 1 .
leukaemia .... . . . ... . .
..
C. Genetic constitution.. . .. . . . . . . 442-450
(b) Excess lifetime mortality:
all cancers other than
D. Ethnic characteristics .. . . . . .. . . . 351 leukaemia ...
..........
Poragraphs
Paragraphs I
(c) Loss of life expectancy: E. Lifetime risk estimates for special
leukaemia ............. 571 tissues ........................
(d) Loss of life expectancy: all I. Lung .....................
cancers orher than leukae- 2. Bone.. ....................
mia .................. 572-574 3. Thyroid ...................
2. The population of children as a
part of the population ....... 575-586 F. Risk assessment by cancer type. ...
3. Extrapolation to other popula- C. Summary and conclusions ........
tions. ..................... 587-590
4. Comparisons with previous
studies .................... 59 1-599 Tables .................................
D. Risks at low doses and low -dose rates 600-607
3. It is particularly propitious that risk assessments 6 . A variety of units are or have been used for the
be made now, in light of the revised dosimetric quantities needed in assessments of exposures to
evaluations of the Japanese survivors of the atomic ionizing radiation. However, it having been decided to
bombings. the most important study population. This adopt the modern metric system, the Systkme Inter-
re-evaluation, completed in 1986 and known as the national (SI); throughout this Annex, SI units will be
dosimetry system 1986 (DS861, replaces the previous used wherever practicable. A detailed account of the
estimates of 1965 (T65). Not all of the revisions could correspondence between the older units and the SI
be taken into account in analysing cancer incidence units is found in [N3]. For the reader unfamiliar with
frequencies, but the latest values are used in the these units, it is sufficient to note that 1 rad, the old
Committee's analytical evaluation of risk coefficients unit for absorbed dose, equals 0.01 gray (Gy); 1 rem.
for mortality. the old unit for dose equivalent. equals 0.01 sievert
(Sv); and, finally, the curie (Ci). the old unit for
4. Of all of the factors that affect the carcinogenesis activity, equals 3.7 10'O becquerel (Bq).
process, age at exposure is particularly significant.
Susceptibility of tissues to radiation effects is related 7. The subjective expressions "low", "intermediate",
to proliferative activity of cells, a n d periods of active "high" and "very o r ultra-high" as applied LO absorbed
growth and development can be expected to be doses of sparsely ionizing radiation are arbitrarily
periods of greater sensitivity. There are difficulties. defined here. following the convention established in
hon.ever. in accounting for age differences. Many the UNSCEAR 1986 Report [UI], as 0-0.2. 0.2-2.0.
study populations involve individuals of particular 2.0-10.0, and above 10 Gy, respectively. For other
types of radiation the corresponding dose equivalent to high doses may be prevented from dividing by the
ranges are the same, but with units of sievert. This sterilizing (or cell-killing or inactivation) effects of
correspondence does not necessarily reflect RBE, but irradiation. These matters have been thoroughly dis-
rather assigned quality factor values. Following the cussed in Annex B of the UNSCEAR 1986 Report.
same convention, "low" dose rates for all radiations
are those below 0.05 mSv/min; "high" dose rates are 11. The age, sex and other characteristics of the
those above 0.05 Sv/min; and "intermediate" dose exposed individual may o r may not be specified in
rates fall between the two figures quoted. assessing the dose-response pattern. Similarly, the age,
the time since exposure and the end-point used t o
8. Exposure of the lung to alpha particles from assess the response may vary from one application t o
radon daughter products is customarily expressed in another. In practice, all data from the time of
terms of working level (WL) or working level months exposure to the time of analysis are often pooled, and
(WLM). The WL is any combination of radon and its the cumulative excess risk in the exposed population,
daughter products in a litre of air that will result in commonly expressed as excess deaths or incident
the emission of 1.3 loS ,MeV of potential alpha energy; cases, is related to the dose received. However, in
the WLM is the exposure resulting from the inhalation principle, there may be significant differences in the
of air with a concentration of 1 WL of radon dose-response relationships between different groups
daughters for 170 (working) hours. of people. e.g., between exposed children and adults.
These might be reflected as host-factor effects on the
shape of the dose-response function.
2. Concepts of risk
(b) Risk measures and projecrion
9. Conventionally, the risk associated with exposure
to radiation. either sparsely or densely ionizing, has 12. A second objective of assessing risk is to follow
been expressed in absolute o r relative terms. Absolute individuals after exposure has begun. or after it is
risk is usually taken t o mean the absolute increase in complete, a n d to quantify the excess cancers during
the frequency of cancer, mutation. or the like. and the the lifetime of groups of such individuals. Since the
absolute risk coefficient is the increase per unit individuals may vary in other respects than simply
exposure per unit time of risk after adjustment for their ages. different assessments may be made for each
confounding variables. Commonly, it is defined as the sex, age at exposure, exposure to other risk factors
excess deaths o r incident cases per gray (or rad) per and s o on. It may also be important to be able t o
ten thousand (or million) person-years and is estimated predict future risk in exposed cohorts, even t o ages
by regressing the difference between the observed beyond those for which current estimates exist.
number of events and the expected number, based on
a suitable comparison group o r population, as a 13. In this Annex. the assessment of events after
function of dose (see, e.g., [K7] or [W5]). Relative risk exposure and beyond the period of observation will be
is the ratio of the number of cases observed in an referred to as the projection of risk. When the risk in
exposed population to the number of cases expected in the exposed individuals exceeds the spontaneous (non-
a non-exposed, but otherwise comparable. population. exposed) risk level by the same amount at all ages, the
effect of exposure will be termed additive (often the
(a) Dose-response parrern term absolute has been used in this context, since at
all ages the excess risk is constant). When the risk t o
10. One objective of risk assessment is to estimate the exposed is some constant fraction greater than the
the relationship between the dose administered and spontaneous risk, this will be termed a multiplicative
the response elicited, specific to exposed individuals of effect (often the term relative has been used, in the
differing ages, sex, or other biological characteristics. sense that at all ages after exposure the relative risk,
This relationship is called the dose-response relation- o r risk ratio, is constant). Actual effects map fit
ship, and is an expression of the form neither of these simplified models, or they may fit
r = f(D) some combination of them.
where r is a defined measure of response, e.g., a risk 14. When the risk experiences of several age (or
quantity, usually an excess absolute o r excess relative other) strata are combined into a single summary
risk, and f(D) is a function of absorbed dose. The measure, one must be aware of the nature of the
function f(D) commonly takes one of the following exposure experiences over which the single value is
forms: (a) linear, i.e., a + b D ; (b) linear, non-threshold, computed. If no method is specified in the naming of
better called proportional, i.e., bD; (c) quadratic, i.e., such a measure, then n o assumptions can be made
a -+ b D + cD2; (d) pure quadratic, i.e., cD2; (e) proper about the way in which aggregate data were used t o
order polynomials. In addition, any of these forms compute the expected risk. When the measures are
may be modified by multiplying by a n exponential single values derived from the cumulative experience
term with the exponent containing negative terms in D of a n exposed cohort, this will be referred to as the
and D2. A quadratic term in the dose-response total relative o r absolute risk.
function is usually included wh'en the effects at low
doses are less than would be predicted by a strictly 15. The excess risk is usually computed from the risk
linear response to dose at intermediate doses. For in a comparable group, either the population a t large
dose-response relationships going through a maximum o r a control group. When using an unexposed control
a t intermediate doses, it is assumed that cells exposed group matched by age and sex, the number of cases in
that control group is considered to be the baseline years of observation or by pooling individuals with
number. Often. however, the control group is the different ages at exposure o r pooling both sexes. Such
entire population of which the exposed are a part. The measures are dependent on these pooling o r aggregat-
risk schedule in that population. say r(s), is the annual ing procedures and may not be comparable between
incidence (or mortality) per person at age .r per year; studies. Computation of an absolute risk in this way
this can also be made specific to sex and historical does not imply that the projection effect (on post-
time period. In a cohort of exposed persons. over the exposure age-specific risks) is additive, nor does
course of the investigation, a certain number of computing relative risk mean that the projection effect
person-years of experience at age x will arise: this is the is itself multiplicative.
sum of all years spent by exposed cohort members at age
x. Let this number be c(x). Then the expected number of 19. For these reasons, it is necessary to distinguish
cancers in the cohort, E, can be approximated by between the projection effect (additive or multiplica-
E = ~c(x)r(.v) tive) and the measure of risk based on observational
data (absolute risk. that is, excess deaths o r cases.
and the excess number of cases is the observed relative risk. attributable risk [see paragraph 221). This
number, 0 , minus the expected number, 0 - E . The distinction is not always clear in the literature. where
number of person-year-grays (PYGy) of exposure to the same terms are often used in both circumstances.
which this excess applies is the sum over all exposed T o make i t quite clear, when projection effects are
individuals of the product of the dose to the i-th referred to in this Annex. the terms multiplicative o r
individual, di, times the number of years that indivi- additive will be used; when measures in data are
dual was followed in the study (up to the point of referred to, the terms absolute or relative risk will be
manifesting the cancer of interest) yi. That is. summing used.
over the n individuals in the cohort,
N = Ed,yi 3. Assignment of causation
I
The desired summary measure is then (0-E)/N excess 20. An increasingly frequent question addressed to
cases per 10' PYGy. Note that this measure aggregates radiation biologists is whether a specific cancer could
the experience of different ages and that i t is possible have been radiation-induced. This question may arise
to obtain the same value for N by including exposed in litigation. in the adjudication of occupational
cohorts of different age distributions, followed for compensation o r in the legislative process o r it may
differing lengths of time, to a different distribution of arise through simple curiosity. Rarely, if ever, is it
doses. Life-table methods can make the computation possible to state categorically that a specific cancer
of expected numbers of cases somewhat more precise was o r was not due to radiation exposure. At present.
by accounting for the fraction of the exposed cohort there is typically no radiation-specific tumour patho-
expected to die from causes of mortality other than biology. a n d radiation-related tumours appear similar
the cancer of interest. to spontaneous tumours at the same site. Inasmuch a s
16. The relative risk is usually computed simply as some tumours that are extremely rare in the general
O/E, again aggregating the experience of individuals population are much more common after radiation. it
at different doses and of different ages. When the may be that radiation alone is able to produce a
irradiated population is actually a subset of the tumour. In general, however. radiation exposure
comparison population under scrutiny. this ratio is only increases the frequency of an already prevalent
not strictly the relative risk of exposure compared to tumour.
non-exposure. and in this case 100 times (O/E),
should be referred to as the standardized mortality 21. Despite these conceptual problems, it is possible
(or morbidity) ratio (SMR); however, because of its to consider causation in a probabilistic manner [B17].
nearly universal use in radiation epidemiology, the Briefly, if an outcome. A, can occur only when one of
term relative risk (RR) will be used, in general, for the a series of exhaustive and mutually exclusive events
ratio of the observed to the comparison group. occurs, and if the a priori probabilities of these latter
events are known, then it is possible t o compute the
17. In addition to depending o n the details of the age conditional probability that A is due to a specific one
pattern of cases since exposure. relative t o age at of the series of events. This latter, conditional prob-
exposure and dose, both of these measures also depend ability is sometimes described as the a posteriori
o n the background, or baseline, risk in the population probability of the event. In the present context, the
[r(x)]. SO that it may be difficult to apply excess deaths probability of causation, P, or. more formally (given
(cases) o r relative risk estimates to populations epide- the occurrence of a cancer in an exposed individual),
miologically different from the exposed population. the probability that it is due to radiation (one of a
series of presumably mutually exclusive causes of
18. In the latest reports on the survivors of Hiroshima cancer) is simply the ratio of the additional risk
and Nagasaki [P15, S48. S491, excess relative risk, at imposed by the radiation dose D to the total risk; the
1 Gy of exposure, has been computed. This is the latter is, of course, the sum of the baseline risk a n d the
excess relative risk value (i.e.. RR-I) over all age, sex radiation risk. It can be written as
a n d other strata in the data. This measure combines P = [ D X R ] f l B + ( D X R)]
aspects of the other measures, but is still a single,
cumulative measure of effect. Relative o r absolute where R is the absolute annual site-specific risk per
risks can always be calculated in this manner. For gray and B is the baseline cancer rate, specific for site.
example, they can be computed after any number of age, sex and other pertinent concomitants.
22. A related, commonly employed epidemiological can be controlled in an informed way, Another goal
notion is that of attributable risk. The latter is the has been to use the limited epidemiological data to
proportion of a health disorder that can be attributed infer the risks that attend other conditions of exposure.
t o a causal factor. Epidemiologists use a variety of
mathematical definitions of attributable risk. One is 26. A continuing objective has been to determine,
derived by subtracting the incidence of the disorder for given exposures and tissue sites, ivhether there is a
among persons not exposed to the factor, e.g., linear or non-linear (specifically. quadratic) dose-
ionizing radiation. from the incidence among persons response relationship at low doses. This issue has been
who were exposed. Thus, in the present context. it is studied, without resolution, in animals and in man,
merely for decades. There is still no unambiguous answer, but
in many cases newer data have contributed to the
observed - expected cases
Attributable risk = ability to infer the existence o r non-existence of risk
person/years at risk thresholds or the likely forms of the dose-response
relationships, a subject treated at length in Annex B of
4. The analytic approach to radiation carcinogenesis the UNSCEAR 1986 Report [UI].
23. There are a number of factors that influence the 27. A different approach to the dose-response relation-
risk of cancer in individuals exposed to radiation. ship has also been taken [F6]. Species-specific para-
These include the nature of the individual receiving meters for a theoretical model of cancer have been
the dose. often known as the host (genetic back- fitted to experimental data and used to estimate lou-
ground. general health, specific health problems, sex dose response rates. While the theory seems to work
etc.); the nature of the dose received (high or low, for cellular effects in vitro. it is not obvious that it
acute o r chronic, radiation quality); other factors that applies in vivo, where species-, individual- and tissue-
may interact with radiation o r affect the susceptibility specificities, as well as differences in the nature of
of the host (e.g., smoking, diet, weight. exposures to the radiation action, are not controllable and often
chemicals. other diseases and medical treatments); and cannot be measured accurately. Ho~vever,a theoretical
the nature of the carcinogenic process itself. Because approach is necessary when actual observational data
of the existence of these factors, there is no single way d o not exist.
in which effects should be assessed. Actually, several
approaches have been taken. 28. Finally, ?.here have been direct regression
approaches to risk assessments. Recently, multiple
24. The first is to examine the relationship between regression theory has been extended to the evaluation
biological n~odelsof carcinogenesis and the effect of of risk factors in a complex disease (exposure)
different exposures or host conditions. There have phenomenon. This has been very useful in chronic
been many different attempts to model radiation disease epidemiology and, given the nature of the
carcinogenesis. Generally. the parameters of the pro- data, seems appropriate to assessing the risk of
cess are estimated using epidemiological data on radiation carcinogenesis. Several applications of these
exposed individuals to infer the action of radiation methods, generally those called proportional hazards
and to estimate the relative importance of different models (see, e.g., [K12]), have been made in this
components of the process. T h ~ s components
e usually context and will be reviewed.
include mutation, mutation-repair, growth stimulation
and cell sterilization. Specifically, various multi-stage 29. Since the carcinogenic effects of very low doses
processes have been applied to the age-onset distribu- cannot be shown directly with existing data (see, for
tion of cancers following irradiation in an attempt to examplc, [U5]) nor reliably extrapolated from high-
determine the consistency of such processes with the dose data (for a discussion of some of the problems
action of ionizing radiation and to infer which part of associated with extrapolation, see [D25]), the shape of
the process is affected by exposure. These investiga- dose-response relationships at low doses of ionizing
tions d o not provide risk estimates for a given dose, radiation remains conjectural. An understanding of
but they d o suggest aspects of risk, such as vulnerable these relationships will involve a kno~vledgeof carcino-
ages, and whether the effects of exposure can be genesis as a biological process and the relation of
expected to be long lasting o r not. radiation to this process (e.g., [FS. F6]).
6. Accident victims
1. Cohort studies
36. There will continue to be isolated cases of high
exposures due to accidents of various sorts. Hereto- (a) Ongoing invesrigarions
fore, these cases have provided little insight into the
long-term consequences of exposure to ionizing radia- 39. Most of the investigations in progress in 1977.
tion, but with the establishment of a world-wide when UNSCEAR last reported on human radiation
Registry of Radiation Accidents at Oak Ridge in the carcinogenesis, have continued, and additional results
United States, they may become more informative have since been reported. Moreover. the investigations
[D7. F4]. At present the Registry lists more than concluded prior to the last Report have received fresh
230 accidents; by far the largest number were the result scrutiny and much of the older data has been
of either a mishandling of industrial, sealed radio- subjected to further analysis and interpretation. In
isotope sources or an inadvertent exposure to x rays several instances. the early findings have been improved
used for quality control [S25]. Often the accidents and joint estimates of dose-response patterns made
involved unsuspecting individuals, not a few of them more precise by combining data from several investiga-
children, who picked up a metal object and carried it tions (see, e.g., [Dl I] or [T16]). In other instances.
home, where they and other household members previous results have been called into question because.
became exposed, unknowingly, to the radiation emitted for example, doubts had been cast upon the dose
by what was a metal-encapsulated source. No fewer estimates or ascertainment biases or because better,
than 1,100 individuals are enumerated. 38 of whom later studies had yielded conflicting observations.
died, presumably as a direct consequence of their
exposure; about half of those who died received 40. There are further data on women who received
significant exposures of 0.25 Sv or more to the whole chest fluoroscopy (to monitor pneumothorax), irradia-
body or of 6 Sv locally to the skin, or of 0.75 Sv or tion for mastitis. or other exposures to the breast in
more to a critical organ. The accident at Ciudad connection with breast cancer [H6].These results
Juarez in Mexico is typical of the accidents that show (a) a higher susceptibility of the young; (b) dose
involved general populations. There, a cobalt-60 fractionation does not reduce the risk of breast cancer
source. improperly disposed of, resulted in the exposure in all studies; and (c) there is uncertainty as to the
of 300-500 individuals, some of whom received doses level of risk a[ low dose rates. Similarly, much has
of 0.5-1.0 Gy. A similar but more recent accident at been added to the literature on the effects of exposing
Goiania, Brazil, involved some 244 individuals. 54 of the thyroid to various kinds of irradiation in child-
whom were subsequently hospitalized and 4 of whom hood [RI. S131. Quantitative estimates of dose-effects
have died; exposure in that instance was to "'Cs. have been improved; however, the pattern of radiation-
Accidents have also occurred when fuel rods were induced thyroid cancer has been extensively reviewed,
being inserted or removed from reactors [see. e.g., leading to the suggestion that, while radiation does
W7, R78,W9]. In ihese latter instances. the subsequent have an effect at moderate doses, the clinical signi-
health experience of the exposed individuals is generally ficance of this in terms of active thyroid cancer, rather
being carefully scrutinized by the employing labora- than subclinical thyroid changes, is not patent [C6,
tories or utility companies. P4].
37. In the review of radiation carcinogenesis that 41. Studies of cancer following pelvic irradiation for
follows, data from all these sources will be considered. malignancies of the cervix have not discovered the
Of necessity, this review will overlap in some parti- excess of leukaemia that had been expected [BIZ, B13.
culars with material contained in other UNSCEAR W6], although cancers have appeared at other exposed
documents. specifically in Annexes A and B of the sites and more information should arise as follow-up
UNSCEAR 1986 Report [UI]. The reader should cont'inues. New studies of cancer resulting from the
consult these for further details and for aspects of use of injected radioisotopes, including radium and
radiobiology that do not apply directly to human Thorotrast, have been reported, and substantial re-
radiation carcinogenesis. Thus, for example. no effort analysis of the older data has occurred. The dose-
will be made here to review the data on radiation- response patterns of bone and liver cancer in relation
induced cancers in experimental animals. to sources of alpha-particle radiation have been
improved, but some concern has been voiced about
the meaning of estimates of effective dose to susceptible
C. TYPES OF STUDIES cells, in the presence of local cell necrosis. Related
issues have been advanced in regard to lung, thyroid
38. Of the ways in which radiation carcinogenesis and cenlical cancers. There are additional data on
may be studied,.two have predominated: (a) cohort leukaemia subsequent to diagnostic radiation. showing
studies, in which individuals exposed in some special very low frequencies of occurrence. and there is
way and individuals not exposed are compared. The further information on individuals exposed to localized
follow-up can be retrospective or prospective, or both; high doses of therapeutic radiation for the treatment
and (b) case-control studies, in which cancer cases of childhood cancers. Data on radium dial painters
have been re-analysed [RIO], and there are more one study of radiation effects in childhood leukaemo-
estimates of exposure risks in underground miners genesis, it has been suggested that children exposed in
[M19. M42. R5, R7, S20, S51]. utero during diagnostic radiation examinations may
already have been at risk of leukaemia. because no
42. Several studies, interpretations, and reinterpreta- similar risks had been observed in Japan [K6].
tions have appeared since 1977, particularly in connec- Exposed individuals at the Portsmouth Naval Shipyard
tion with occupational exposures (Hanford [e.g., GI?, seem more likely to have been discovered if they later
K201; Portsmouth Naval Shipyard workers [N6, R17, developed cancer, and a potential ascertainment bias
R21, S331; and plutonium handlers [C21, V2, V3. exists in situations where extraordinary efforts were
W 181). The earlier results have often been shown, on made to detect cancer in individuals or their exposure
closer examination, to have been spurious, and the to irradiation [B6]. This bias may well exist in studies
effects of different ascertainment or reporting biases of military servicemen exposed to the testing of
have been revealed. nuclear weapons [C16. C17, KZI] or of children
exposed in Utah to fallout. A "healthy worker" effect.
43. The Life Span Study in Hiroshima and Nagasaki, in which employees in a given industry are healthier
continues and three further reports on mortality data. than the general population, may have led to spurious
as well as additional incidence data have become interpretations in many epidemiological studies and
available. The consequences have been to improve must be accounted for wherever possible. In several
estimates of dose effects for some tumours, to include studies, the unexposed group disclosed excess cancers
others in the list of radiation-induced sites (e.g.. colon. at sites that had been associated with elevated risk
ovary and, possibly, multiple myeloma), to confirm from radiation exposure; clearly the status of such
the absence of excess cases at some sites (e.g.. individuals in regard to other risk factors must be
pancreas, uterus and chronic lymphocytic leukaemia) evaluated. Such an evaluation can be especially
and to confirm the existence of only marginal risk for difficult if the later effects are small (as in low excess
some sites (urinary tract and oesophagus) [K7, P15, S48, risks of late-onset tumours), if the dose estimates are
S491. The Hanford study, the study in the Marshall uncertain or if the investigators are so thorough as to
Islands and studies in British patients irradiated for perhaps over-define cancer, as may have occurred in
ankylosing spondylitis, pneumothorax, mastitis or regard to thyroid tumours.
thymus-related conditions continue. While details of
the dose-response curve at low exposure levels remain 46. In population studies such as those in Japan and
unclear, much has been added to the high-level data the Marshall Islands, the exposed individuals are
and to the nature of the relative risks. In some series, known and the task is to continue reporting the results
the time distribution of leukaemia seen in Japan and as the diseases appear. I t is clear that even 40 years of
elsewhere has been further corroborated. Absolute surveillance is not sufficient to exhaust all of the
and relative risks continue to increase in Japan for effects, so these large studies must be continued
many sites. and further follow-up could reveal elevated throughout the lifetimes of the exposed. Similarly, in
risk at other sites, clarify some relationships and add smaller special-cohort studies, such as those of uranium
new ones. mine workers and therapeutically exposed patients,
the long-term effects must be continually monitored as
44. The large series of 14.000 British ankylosing the cohorts diminish through attrition.
spondylitis patients has continued to accumulate
person-years of observation, and some of the patients 47. The more challenging ascertainment problems
have been followed for more than 30 years [D21. S3 I]. are to determine the actual exposure levels of the
The doses received by the patients have been re- individuals and the correct expected cancer risks for
evaluated, although not on an individual basis, and them. The exposure levels are reasonably well known
several new patterns have been observed. Most notably, in some of the cohorts, but not well known in others.
unlike the findings in Japan and elsewhere, adult solid Even when exposure is well known, the amount of
tumour risk appears to diminish more than 30 years radiation delivered to specific tissues or cell types may
after exposure. not be. This has become an important consideration
in regard to liver. bone. and lymphatic cancers in
(b) Ascerrainment of exposed and comparison patients exposed to internal radium sources and
individuals Thorotrast, for example. Furthermore, it is vital to
determine the comparability of exposures to other
45. A few new problems have been identified in the carcinogens to which the individuals in these cohorts
ascertainment of cases and matched controls, or may have been subject.
comparison individuals since the UNSCEAR 1977
Report. Mostly, however, there has been continued (c) Sui~abili~y
of comparison group
concern over the nature and level of exposure to
individuals. For example, as a result of variation in 48. For a number of potentially relevant studies,
the calibration of equipment and therapeutic tech- there is a continuing debate and re-analysis of data to
nique, it is uncertain how much radiation was actually determine whether the control individuals have been
delivered to the thyroid in children irradiated for tinea appropriate. For example, it is not obvious whether
capitis or to different tissues in spondylitic patients. individuals suffering from disorders such as thymus
There is also the problem of resolving whether, in enlargement or tinea capitis, many of whom were
some instances, the cases were similar to the general economically underprivileged, were normal in all the
population in regard to other cancer risk factors. In other health respects that might relate to cancer.
Similarly. second tumours may arise because of other may not be a serious problem at high doses if those
effects of the treatment for cancer. independently of effects appear as very unusual tumours, or as tumours
irradiation: the treatment may debilitate o r it may in locally irradiated tissues. However, this dependence
alter hormonal or other physiological states. It is is more likely to be important in regard to low-dose
difficult to know the extent to which this may occur, effects or to late-onset, long-latency tumours that
since in the absence of therapy most cancer is fatal, occur naturally with substantial frequency.
a n d not much data exist on the subject. If an
inappropriate comparison is made, the relative risk Idenrificarion of new e.rposed cohorrs
applies only to that comparison, not to a more general
population. It is essential that the control data, o r the 53. Since the UNSCEAR 1977 Report [LT2]. several
population-based expected risks used, d o not con- additional groups of exposed individuals have come
found different exposures with other risk factors. under scrutiny, and others are potentially available.
The groups being studied include nuclear workers
(d) Accurate dererminorion of especred risks [B22, C21, D24, RZI] and military senpicemen from
Great Britain [D26] and the United States [C16, C17,
49. One of the most serious problems that has arisen R16] exposed to fallout from nuclear weapons testing.
in connection with estimating risks in exposed cohorts The results are equivocal and may remain s o even if
is the problem of defining the appropriate expecta- the cohorts continue to be followed. T o date. most
tions for the cohort. The first question is whether the claims have been for leukaemias. and the occurrence
exposed are comparable to the contemporary popula- of new radiogenic cases, if any, should have ceased.
tion from which the expected rates are derived. based on what is known about radiogenic leukaemias
Specifically, it is critical to determine whether they are in other exposed cohorts. Another group is composed
similar to the general population in regard to the of children exposed in southern Utah to fallout from
cancer-related aspects of general health, to socio- nuclear weapons testing [L4]; this study is contro-
economic status as it bears on exposure t o other versial. and its estimates of risk are not accepted by
agents, and to other factors that may have affected most critical investigators (see. e.g.. [L5]).
ascertainment or that may be affected by the subject's
awareness of his continued surveillance. In the Life 54. A more consequential group of individuals now
Span Study in Japan this matter of comparability is being studied is one that comprises children exposed
less likely to be a problem, although it could be to therapeutic radiation for childhood cancers. The
serious in the smaller studies in which specific cancers continuing investigation of these individuals suggests
(such as thyroid cancer, following childhood exposure, that second primary turnours occur more frequently
or leukaemia, following fallout exposure) may have than in non-irradiated children. Many of these are
been screened much more carefully, or defined more leukaemias or sarcomas in the irradiated areas, but
loosely, than in the general population. In Japan, carcinomas also occur, including those of the thyroid.
internal controls have often been applied, whereby These subjects may afford risk estimates for second
those exposed to high doses are compared t o those turnours, especially for sarcomas for which little data
receiving essentially no exposure. exist (excepr for bone): the doses in these cases were
large, and they are reasonably accurately known.
50. In a large series of cervical cancer patients. there
is evidence that other risk factors, presumably involving 55. Another important new group is a series of over
environmental exposures, make the results less repre- 180,000 women, in a number of countries, who have
sentative for more general populations. In a similar been followed after treatment for cervical cancer.
way, the results of the ankylosing spondylitis series These women received high pelvic doses and moderate
indicate various causes of death at different rates from to low doses to more distant organs. Since the
the general British population. UNSCEAR 1977 Report was issued, many reports
have appeared on this set of patients. The number of
(e) itleaning of relative risk in a changing
person-years of observation has become substantial
esposure environmenr
and excess cancers are appearing [B 12, B73, D9].
51, Many significant changes in esposure to non-
radiation risks are taking place in regard to diet. the 56. Many disparate groups of individuals have in
use of tobacco, exogenous hormones and other drugs, common the fact that in the course of their lifetimes
toxic agents in the work-place, pollutants, and the they have been or will be exposed to atypical amounts
like. When these interact non-additively with radia- of external, low-LET radiation. .4mong these groups
tion, they may materially alter the lifetime radiogenic are radiologists and radiographers, nuclear shipyard
risk of cancer. Such changing regimes of esposure to and atomic energy workers, as well as segments of
other risk factors may seriously affect the meaning of the general population exposed to high-LET radon
relative risk and the dose-response patterns for radia- daughter products in their homes or to higher-than-
tion exposure unless these other factors are taken into usual backgrounds as a result of where their homes
account. This is clearly important in risk assessment. are sited. Most receive small to modest amounts of
because for many organ sites the relative risk for a radiation above the average, but some (early radio-
given radiation dose is a function of the general risk logists, for example) may have accumulated lifetime
for the tumour. exposures of 2-20 Gy. More and more data are
becoming available on the cancer risks in these groups
52. The dependence of the cancer risk due to [see, e.g., M 18, M301. Data are also accumulating on
radiation o n the general level of risk for that cancer nuclear laboratory employees who have been exposed
in the course of their occupational lifetimes (e.g., [W7, where R is the response. or increased risk of cancer
W8. U'9. W201). For example, causes of death have (such as absolute o r excess relative risk), D is the
been examined for employees of the Chalk River absorbed dose, and a, b, c. f. and g are coefficients to
Nuclear Laboratories in Canada who received lifetime be estimated from the epidemiological data. These
occupational doses of 0.2 Sv or more. Through 1982, coefficients are usually determined by either the
413 long-term, traceable employees had accumulated method of least squares or the method of maximum
exposures of this magnitude (their average lifetime likelihood. In many circumstances it is more accurate
occupational dose was 0.42 Sv). There have been no to express the value of R as a function of variables in
excess cancer deaths among the 64 members of this addition to dose; for example, age, sex and history of
cohort who succumbed; indeed, only 12 cancer deaths exposure t o other carcinogens.
were obsened where 17.6 had been expected [W9].
60. The attractiveness of this model resides in its
57. Information should be available shortly from the simultaneous provision for the estimation of linear
study of employees of the United States Atomic and quadratic effects ascribable to radiation and those
Energy Commission (and its administrative succes- competing effects of radiation, such as cell steriliza-
sors) who have received occupational esposures of tion or killing, that could obscure the carcinogenic
0.05 Sv or more. effect itself. Commonly, when the absorbed doses are
not large, the exponential term is ignored. A still
simpler, frequently used model is of the form:
2. Case-control studies
+
R = (a bDh) exp (-fD - gD2)
58. Case-control studies have been. for several reasons. Its merit rests largely in its incorporation of either a pure
less valuable than cohort investigations in the present linear effect (when h = I ) o r a quadratic effect (when
context. The shortcomings of case-control studies are h = 2). with o r without competing effects (f and g) and
several. First. in most situations the frequency of prior in the fact that it approximates a linearquadratic
radiation exposure among cancer cases will be low. form when h has a value between 1 and 2. Thus, it can
requiring very large case numbers in order to estimate reflect a convexity in the dose-response curve. How-
relative risks accurately. Second, the absolute dose- ever. h can also be less than l, which poses problems,
response relationship cannot be estimated statistically for then the slope becomes infinite at zero dose.
from retrospective designs alone, since the affected
and non-affected fractions are specified through the 61. Each of these approximations t o the true, bio-
sampling strategy rather than being the observed logical dose-response relationship has its limitations
outcome proportions among exposed and unexposed or potential pitfalls. Common to all the approxima-
individuals [B19]. Third, it is often difficult, retro- tions is that inferences based on the shape of the dose-
sprcti\,ely, to select a truly comparable control group response curve are .more susceptible t o error than
whose risk-factor characteristics closely match those inferences based on the overall slope. In addition.
of the cases; this is not a problem in some prospective
there are errors that stem from (a) an inappropriate
designs. Finally. there are several sources of potential
choice of the reference value; (b) systematic o r random
bias in terms of case ascertainment tvhen exposure
mismeasurement of exposure; and (c) inadequate
history must be ascertained long after the fact (such as allowance for latency or too short a period of follow-up.
a more intensive search for a history of exposure
Errors in the measurement of exposure are particularly
among the exposed group than among the ostensibly troublesome, for even the inevitable random mis-
non-exposed group).
measurements can introduce a spurious curvilinearity
and cause the slope to be underestimated [G13, ~ l i ]
and the intercept to be overestimated. unless the latter
11. ASSESSMENT OF DOSE-RESPONSE A N D is constrained to its true value, which is, however,
RISK PROJECTION rarely, if ever. known.
79. Knowledge of these factors can only be derived 1. Latency time and the plateau period
from the experience of a small number of cohorts (the
survivors of Hiroshima and Nagasaki, the ankylosing 83. Epidemiological data cannot distinguish between
spondylitis patients, and the large international series the first occurrence of a radiogenic tumour and its
of cervical cancer patients). The details of these clinical appearance, so that in this Annex the time
studies and their site-specific risk coefficients will be until the tumour is clinically detectable is referred t o
presented later in this Annex. Most of the other as the "latency time" for a cancer. As will be shown
studies serve primarily t o confirm these three studies. belou, different human cancers have clear and charac-
(These comments pertain mainly to low-LET, high teristic latency times following radiation exposure
dose rate exposure.) There are a s yet no definitive ~91.
studies from which to estimate lifetime effects of
exposure to high-LET radiation (e.g.. occupational 84. For adult exposures, leukaemias and bone cancers
exposure in mines, radon in homes) o r very low-dose have a minimum latency time of 2-5 years, whereas
a n d low-dose-rate exposures of either high- o r lou1- solid tumours have a minimum latency time of
LET radiation. approximately 10 years [UI]. For solid tumours,
excess tumours commonly occur a[ ages comparable
80. There have been several recent attempts to to those at which spontaneous tumours of the same
project the long-term post-radiation effects of whole- site occur. The evidence is not clear or consistent as to
population exposure, Notable are ( a ) the BEIR 1980 whether other risk factors, such as smoking in the case
Report [CJ]; (b) a study by the United States Nuclear of lung cancer, interact with exposure to hasten the
Regulatory Commission regarding risks in a popula- onset of radiogenic tumours.
tion from exposures due to a nuclear accident [GI I];
and (c) an attempt by the National Institutes of 85. The pattern following childhood exposure is
Health of the United States to estimate the probability somewhat variable. Tunlours that typically arise in
that a specific cancer was radiation induced at times childhood, such as osteosarcomas. occur in the exposed
subsequent to exposure [U4]. These studies have had at ages similar to those at which they occur naturally.
specific objectives, and all have been applied to the Bone cancers and leukaemias have a 2-5 year latency.
population of the United States. For carcinomas of typically adult onset, the latency
time is 10 years or more. and current evidence
81. The purpose of the BEIR computations was to suggests that they also arise at their normal ages. late
estimate as accurately as possible the lifetime risk in a in adult life.
86. The appearance of radiogenic leukaemias and function of age. sex, time since exposure and perhaps
bone cancer commonly follows approximately a log- other risk factors. If the additive projection model is
normal distribution [C4]; as earlier noted. the excess correct, then at any post-latency time the difference
risk appears after about 2 years and reaches a peak by between observed and expected cancers, divided by
10 years. Data on other tumours are less clear, and it the total PYGy observed, will be constant. Sometimes
is usual to assume that after the latency time full a variable excess risk model is used, in which the value
excess risk is, approximately, attained [C4]. One of A is estimated from the data by regression
report [U4] has fitted a cubic function in order to methods, specific to sex. age at exposure. time since
produce a smooth transition from zero risk to exposure, and/or other variables.
maximum risk over the period from 5 to 10 years after
exposure. 90. The second basic projection model is knon-n a s
the multiplicative projection model. According to it.
87. The plateau periods, or periods of expression of the ratio of incidence or mortality rate in the exposed
excess risk. observed for specific tumours are generally to that in the unexposed is constant once the latency
consistent over a variety of studies, although there are time has elapsed. That is,
exceptions. For leukaemias and bone cancers. excess
risk typically declines with time. but still exceeds that
in the controls as much as 40 years later in the case where R R is constant for all t > latency time. The
of the atomic bomb survivors and the ankylosing value R R has been estimated in two ways. First. the
spondylitics. though it has ended after 25-30 years in number of observed cancers at some time t after the
other studies. latency time is divided by the number of expected
cases. Sometimes, the excess relative risk per G y is
88. The plateau period for adult carcinomas among computed. If the multiplicative projection model is
individuals exposed as adults appears to be open- descriptively correct, there should be an approximately
ended; that is. in almost every instance, once risk has constant relative risk at any post-latency time in an
become elevated it remains elevated for the rest of the exposed cohort. In some instances, a variable rnulti-
life of the exposed individual. Most major exposed plicative risk model is used. in which the value of RR
cohorts are still under investigation. and this finding is estimated from the data by regression methods.
could change: in one major study, that of the specific to sex. age at exposure. time since exposure
ankylosing spondylitics [DZI], the excess risk of adult and/or other variables.
carcinomas seems to disappear 25 years after exposure.
Since this finding tvith respect to the spondylitics has
not generally been seen with respect to adult atomic 3. Age and sex structure of the population and
bomb survivors or the subjects of other studies, it may baseline mortality rates
be unique to that study. However. i t should be noted
that in Hiroshima and Nagasaki among the two 9 1. T o predict future cancers in an exposed cohort. it
youngest cohorts, i.e.. 0-9 and 10-19 years of age at is important to know the age (and sex) distribution of
the time of the bombing (ATB), the risk has been the cohort. This is so because with either the
declining significantly in the 0-9 year group, also in multiplicative o r the additive risk models, since
the 10-19 age group. but not significantly so. baseline cancer risks change with age and sex. the
number of cancers expected depends on how many
person-years of experience at different age (and sex)
2. Escess and baseline risks as a function of time categories occur in the data. In an exposed population
since exposure of mixed ages the number of expected cases per
exposed person of age t is E(t) and a fraction f(t) of
89. As was stated in paragraph 13. there are two the exposed cohort is in that age category, the total
basic models for the pattern of expression of risk after number of expected cancers will be
exposure (once the latency time has passed). These are
often known as projection models. The first is the
constant additive projection model. according to
which there is a constant number of excess cancers in A similar weighted expectation can be computed for
any given year per unit number of persons exposed each sex. The observed number of cancers can then be
per unit dose. That is, the number of excess cancers is compared to this aggregate expectation.
fixed. regardless of the baseline risks:
92. The number of expected cancers depends o n the
number of person-years at risk experienced at each
where A is the absolute excess risk for all t > latency age (after the latency period) and the baseline risk.
time. The value A is usually estimated in one of two The number of person-years to be lived between ages y
related ways. In the first, the total number of cancers and y + n, per person now in age group x to x + n, is a
expected in the cohort had they not been exposed (i.e., standard life-table function which depends solely on
the baseline risk) is computed. and subtracted from the baseline age-specific mortality rates, m(t). for ages
the number obsenred in the cohort. and divided by the +
x < t < x n. The number of person-years declines
total number of person-year-Gy (PYGy) of observa- each year as mortality occurs (i.e., as survivorship
tion. In the second, a regression model may be fitted declines). The cause-specific mortality rate for a
to the time of onset of every cancer: such models specified tumour site is a component of the m(t)
express the excess risk and the baseline risk as a schedule, and the expected deaths at any given age can
be computed approximately by multiplying the cause- non-linear dose-response is desired, the number of
specific rate by the number of person-years. This excess deaths (cases) or the relative risk per unit dose
approach is followed in risk computations for this is multiplied by the appropriate function of the dose
Annex i n chapter VII, and is essentially the method (e.g.. a + bD + cD2).
used by the BEIR 111, the National Institutes of
Health, and the United States Nuclear Regulatory
Commission computations referred to earlier [C4, 6. Other exposure factors
G11. U4].
97. Where adequate information is available, the
93. On the assumption that current mortality rates projection of risk may take into account such factors
do not change, life-tables may be constructed for an as exposure to smoking or other environmental
actual or hypothetical exposed cohort to compute the hazards. other radiation exposures. or the different
person-years and expected cancers. The excess cancers biological effectiveness of high-LET radiation. As
are determined by multiplying the person-years by a long as one can supply an appropriate dose-response
series of coefficients appropriate to a given projection function, a projection model, and an estimate of
model. For example, with the additive projection additive or multiplicative projection coefficients, the
model. the number of excess cancers per person-year same principles should apply.
is the coefficient. With the multiplicative projection
model, the baseline rate [m(t, cause)] is multiplied by
the relative risk coefficient. RR. This is multiplied by 7. Previous approximations of lifetime risk projection
the person-years to determine the number of cancers
in the exposed group. Excess cancers are this number 98. I t is useful to summarize thc most important
minus the number expected in the population in the recent attempts to estimate lifetime risks, or related
absence of exposure. Given the assumption of un- measures, from population exposures. As was noted
changing risk coefficients and baseline mortality rates, earlier. while these studies attempted to synthesize risk
it is possible to compute the additional risk to any coefficients from the world literature, they relied most
exposed group of persons in the population for which heavily on the Japanese and ankylosing spondylitis
the baseline risks are applicable. data; however, the latter studies have since been
updated, in terms of both new dose estimates and
longer follow-up times, so the specific risk estimates
4. Age at exposure they once provided must now be reconsidered.
94. The age at exposure can affect the coefficients of 99. The BEIR 1980 Reporr [C4]. The BEIR Committee
subsequent absolute or relative risk (i.e.. the values of attempted to synthesize the data on radiogenic cancer
A or RR can be specific to age at exposure). Few risk as of approximately 1979. It used a life-table
statistically sound generalizations can be made about projection approach, employing the 1969-1971 life-
this, except (as will be shown later) that for some tables from the United States. and baseline cancer
tumours, notably those of the female breast, exposure mortality rates for five-year age groups. A table was
in childhood can lead to much greater risks, and devised to convert mortality data to incidence data.
exposure after age 50 to lesser risks, than exposure at based on cancer survival rates, so that estimates could
intermediate ages. Childhood exposures leading to be made for both the commonly fatal and the rarely
childhood cancers are generally treated separately; fatal radiogenic cancers. This is given here as Table 3.
other than for leukaemia and bone cancer. there is A table of risk coefficients, excess cancer incidence per
relatively little data on the details of the projection 10' PYGy was derived, and estimates of the lifetime
effects for such exposures because the Japanese risks associated with single exposures and continuous
exposed to the atomic bombs in childhood (the main exposures were computed, based on linear and linear-
source of data) are still too young for the late-age quadratic dose-response functions, for both risk pro-
effects to have been expressed. jection models. Estimates were made separately for
leukaemia and bone cancer and for all other cancers
5. The dose-response function combined. Representative summary tables from the
BEIR 111 Report are repeated here as Tables 4 , 5. 6
95. The dose-response function is discussed fully in and 7 for comparison with the projections presented
the UNSCEAR 1986 Report [U I]. For projecting risk. in chapter VII.
the dose received by each exposed individual must be
taken into account. Where a linear dose-response 100. The Unired Stares Nuclear Regularory Cornrni3-
pattern is assumed. the dose is used directly. Where a sion study. As part of a study sponsored by the United
more complex pattern is assumed. the dose is trans- States Nuclear Regulatory Commission, Gilbert [Gl I]
lated into some selected function of dose via the developed estimates of lifetime risks that would
equation relating risk to dose for that pattern. The pertain to the population of the United States were it
risk is then linear relative to this function of dose. The exposed to a nuclear accident. These estimates are for
equations used in human studies have essentially all low-LET. single-exposures and are specific to the
been variants of those described in paragraphs 59 and population of the United States (e.g.. baseline cancer
60. rates from the United States were used).
96. Usually, in projection, a model of excess deaths 101, Gilbert used (a) the age and sex distribution in
(cases) or relative risk per unit dose is determined. If a the United States: (b) the age, sex, and cause-specific
mortality rates in the United States; (c) a model of the life-table approach. The study computed a value. R.
dose-response pattern, latency period, and projection defined from PC a s follows:
effects: and (d) estimates from past studies of the PC = [Prob(cancer w exp.) - Prob(cancer w/o exp.)]/
absolute or relative risk per unit exposure. largely Prob(cancer w exp.) = R/( 1 + R)
from the BEIR 1980 Report updated by subsequent
papers from Japan and the spondylitics. She provided where R is the excess relative risk. defined as the
methods for computing the total number of years of increase due to dose D as a proportion of the
life expected to be lost as a result of the esposure probability of cancer in the absence of the exposure.
incident. The input characteristics used in her study These probabilities are specific to a given dose, sex,
are given in Table 8, which is an adaptation of and age at and since exposure.
material from the Nuclear Regulatory Commission
study.
107. The National Institutes of Health report defined
102. Gilbert's projection of lifetime effects is based R in terms of its components as follows:
o n a linear-quadratic dose-response model, with non- R=FXTXKXW
linear effects at intermediate dose rates (C0.05 Gy/day)
of low-LET radiation, as might obtain in a nuclear where F is a function of dose. T gives the dependence
power plant accident. Upper and lower bounds and of R on time since exposure, K is the dependence of R
central estimates for the effects of exposure were on age at exposure and W is the effect of an additive
computed. These d o not have statistical meaning as. interaction between radiation and other (known) risk
for example, mean and confidence limits do; in fact. factors. The study described each of these parameters
there is currently no way to provide probability for each tumour site.
statements on the likelihood that the true effects will
take any particular value. Gilbert merely provided 108. Qualitatively, the results of this study can be
what appeared to be reasonable limits for the plausible summarized as follows. For leukaemias a n d bone
range of effects. cancers. the probability of causation rises rapidly with
time after the minimum latency time, reaches a peak
103. Gilbert used a linear-quadratic dose-response (whose height depends on dose and which is maintained
equation to account for the incomplete human data for 10-20 years) and then falls to zero at the end of the
for low-LET radiation [C4], consonant with animal risk period. For other cancers, the probability of
experimental data [N I]. The extent of effect-reduction causation is roughly constant at all ages after the
at low doses a n d low dose rates is not yet known, but minimum latency time has passed, but is a function of
the National Council on Radiation Protection and age at exposure. I t is typically highest for young ages
Measurements of the United States (NCRP) has at exposure, declines t o a minimum (which varies by
suggested that the correction coefficient is in the range site) for ages 40-50 a t exposure and then may rise
2- 10 [N I]. which is the range used by Gilbert [G 111. slightly o r stay roughly constant.
116. Muirhead and Darby tested this approach with 120. The data available for the assessment of radia-
mortality data on all cancers except leukaemia in tion carcinogcnesis in man come from several sources,
Hiroshima up to 1978 between the 0-0.09 Gy and the most important of which have already been cited.
above I Gy dose groups. Table I I shows the results of A number of different approaches have been used to
some of their fitting efforts, and Table 12 the evaluate the patterns of cancer that occur in irradiated
implications of the different models for lifetime risk individuals. While some studies have combined several
projection. While this work was not based on the most approaches, and the approaches are not incongruent.
recent dose estimates, the qualitative nature of their most have employed only one, o r a few.
A. BIOLOGICAL MODELS O F RADIATION of the expected effects on both the absolute and
CARCINOGENESIS relative risks of constant exposures, single exposures
and short-term exposures [WZ]. If the first of the
1. \lulti-stage models and the role of radiation necessary transforming events is affected by the
in carcinogenesis exposure. the number of individuals already partially
transformed should increase, and even after the
171. At the cellularlevel,cancer isa clonal. molecular- specific exposure terminates, they will remain at excess
genetic disease. One way to understand the response of risk, having to await only a smaller number of events
a n individual to radiation is to model the process of in subsequent years. If the last stage is affected. then
carcinogenesis itself in terms of the events thought to those cells that have already experienced some events
occur at the cellular level during the transformation of will be quickly transformed. but once the exposure
cells from normal to malignant. Generally, such ceases there will be no further excess risk in the
models consider cancer to be a multi-stage process; it exposed cohort relative to the unexposed cohort. If an
is presumed that for a cell to be affected. a series of k intermediate event is affected by the exposure, the
events must occur in its lineage: the time. or age, to a fraction of the cohort in a more highly prepared state
tuniour is a functiuri of the rate at which these events (and. hence, the rate of occurrence of disease) should
take place. The k events must occur in a single cell increase, as with an early stage event. However, after
lineage, the last event rendering some single cell some time has passed, the remainder of the cohort will
cancerous a n d causing it to become the progenitor of also gradually accumulate these stages. and the excess
the entire subsequent tumour and its metastases. This risk in the exposed cohort will diminish.
has been established biologically for such a wide
variety of tumours that i t can be accepted as a fact. 125. These predictions have been applied to age-
onset data in exposed cohorts of individuals to infer
122. Numerous multi-stage models have been pro- what event may be affected by radiation in the
posed (see [WI] for a review). One of the motivating generation of cancer in various organs; the results are
factors behind the development of these models has sunimarized in Table 13. The bases for these inferences
been the obser~.ationthat many tumours in man and are the relationship between age at exposure. the
animals exhibit a linear increase in the logarithm of relative risk, and time since exposure. A major point is
the incidence (or hazard) function. h(t). plotted that if a late stage is affected, then individuals who
against the logarithm of age. t; that is, have already experienced all prior stages will quickly
manifest a cancer; because a higher fraction of older
individuals are presumably in such a condition, late
where A is a constant of proportionality. usually a age of exposure should, according to this model,
function of the transformation rates of the k events. manifest more. and quicker, excess cancers than in
among other things. Empirically. the slope of such a younger individuals. On the other hand, if an early
plot on a log-log scale is 4-6 for a wide array of event is affected by radiation, there will be a long time
human [Cl] and animal [PI] cancers. It should be until those affected will manifest their excess tumours.
noted that many non-mutational chronic diseases Further. the effect of radiation would be less at later
show similar patterns. ages. since more of the older population would
already have experienced these early stage events. The
123. Many other variations of multi-stage models logic of the interpretation is given in [C?2]. and
have been proposed. but there are probletns associated several applications can be found in [W2].
with any purely formal approach to radiation-induced
carcinogenesis. Stochastic models of carcinogenesis 126. As Table 13 shows. these ideas may have merit.
model the process at the cellular level, yet data on but they have not yet led t o easily understood
human radiation carcinogenesis used to test those conclusions. In leukaemia and other tumours, there
models come from observations on populations of are no simple o r clear patterns of relationship of latent
individuals. It may be unrealistic to infer from such period with age at exposure. or latency itself. There-
data much about the nature of the process itself or of fore, epideniiological evidence alone cannot be used to
the role of radiation. Additional errors may arise from make reliable inferences about the nature of the
the heterogeneity of the exposed population, which is carcinogenic process either in terms of the number of
not considered by statistical models. stages invol\ied. or which of those stages is affected by
radiation.
124. Based on the way the multi-stage statistical
models were developed. some investigators have inter- 127. T o account for smaller numbers of events. o r
preted the slope of a log-log plot of cancer incidence for the differential growth of tumours relative to
data (4-6) as directly reflecting the number of stages normal tissue. several models have been proposed
involved. For a variety of reasons. it is unlikely that [WI]. One is a three-stage model that includes dose-
this interpretation, based on population data used to dependen1 cell killing (or sterilizing) effects. originally
infer cellular processes, is useful for this purpose proposed by Neyman and Scott [N2]. It is consistent
[W3]. However, it is possible, without specifying the with data on radiogenic osteosarcomas in dogs and
nature or even the number of stages, to express the humans caused by 226Ra (half-life: 1,600 years) in
effect of exposures of varying intensi~yto carcinogenic showing that a response is proportional to the square
agents that affect only one of the required stages. This of the dose at low doses: that incidence is not
has been done by Whittemore [Ur2], by Day [D2] and dependent on time and dose at high doses; and that
by Day and Brown [Dl]; Whittemore derived a table radiogenic tumours may appear at a much later time
after exposure than simply the tumour growth period 131. The chain of events culminating in a clinicall?
[M3, W 1, W4]. The first two events are assumed to be manifest tumour starts with the initiation process in a
affected by the radiation directly, perhaps as muta- normal target cell. I t is clear that in at least some
tions with effect proportional to dose, while the third tumours the event causing initiation is a mutation in
is a bone growth phenomenon related to bone the DNA. This can be a point mutation or a
remodelling and the eventual stimulus for transformed chromosomal rearrangement; many examples of both
cells to grow. are known. Filyushkin and Petoyan [F9], Petoyan and
Filyushkin [P13], and Sandberg IS421 have suggested
128. This result is somewhat different from the result a hypothesis relating carcinogenesis to symmetrical
observed in individuals, both children and adults, who chronloson~etranslocations (reciprocal translocations
had been given lZJRa,which has a shorter half-life and without loss of chromoson~e material). Initiation
a very different skeletal dosimetry. In those individuals. seems to occur frequently [G16. G171, but most
excess cancers occur a few years after exposure but no initiated cells never result in a lumour. Several
longer occur about 25 years after exposure. The mechanisms ensure that most potentially carcinogenic
Marshall-Groer model calls for a cell-division effect, cells do not cause a cancer.
which should lead to different results in children,
whose bones are more actively growing, and adults; 132. One of the principal mechanisms preventing the
however. this has not been observed [M22]. development of a tumour, even though mutation has
129. In an attempt to generalize the carcinogenic occurred, is the repair of the damaged DNA within a
process, taking into account the promoter and muta- few hours or days of initiation. The time. between a
tional effects, and still generating age-incidence curves mutation and the next mitosis is critical for the final
which are proportional to the 4 6 t h power of age, result: stimulation of proliferation after exposure
Moolgavkar and his colleagues [M 1, M2] have devel- results in a higher number of transformed cells [B39.
oped a two-stage model, with differential growth of K24]. This may be due to the diminished time
normal or partially transformed cells (or both). This is available for repair before fixation of the lesion during
an improved version of earlier work of Armitage and mitosis [B34. M331. Proliferation seems also to be
Doll [A2]. The Moolgavkar paradigm makes predic- essential with regard to the persistence of the potentially
tions similar to those of modified Armitage-Doll carcinogenic character of the initiated cell. Studies of
models [Al, W2] in regard to the effects of age at three different cell lines in vitro revealed that between
exposure and the incidence pattern as a function of four and six mitoses must occur after irradiation to
time since exposure. I t has been fitted to data on lead to a fixed transformation; the first mitosis has to
breast cancer [M5]. where hormonal (and possibly take place within the first 24 hours [B33, K25. L141. If
dietary) effects are influential, and to data on smoking it does not, the potentially carcinogenic character of
and lung cancer. The results are consistent with the initiated cell is lost.
radiation being a mutagen for both of the mutational
stages required in the model. if the known facts of 133. In radiation-induced mouse myeloid leukaemias
breast tissue growth are taken into account. First, a partial deletion of the long arm of chromosome 2 is
nulliparous women have fewer cells susceptible to necessary but not sufficient for the disease [H29,
transformation which will later undergo extensive H301. The cells with the deletion proliferate without
mitosis [BI]. Second, the risk of post-pubertal radia- manifesting malignant phenotypes in the mouse unless
tion carcinogenesis decreases with increasing age at a second transforming step occurs [H30]. This stage
exposure, again agreeing with the circum-pubertal may be explained as the loss of a suppressor gene or
tissue growth. Finally. pre-pubertal irradiation should by a second somatic mutation at the gene located on
have less of an effect. since few breast cells are the intact homologous chromosome, as occurs in
dividing at that time. Until recently, no pre-pubertal retinoblastoma and other human cancers.
effect had been seen in atomic bomb survivors [TI];
however, this no longer is the case [T6, T7]. From the 134. Another important. though seemingly trivial,
most recent data, i t now appears that in fact the risk fact should not be overlooked. An initiated cell may
may be highest in ages under 10 years and greater be the cause of a tumour only if the radiation-induced
than in ages 10-19 years. The longer the interval lesions are compatible with cell survival. In the high-
between irradiation and menopause, the longer will be dose range, there will be competition between cell
the period during which partially transformed cells transformation and cell death.
can proliferate and hence be vulnerable to a final
transforming event: this age effect has been observed 135. A fixed transformation still does not mean that
a tumour will inevitably develop. The affected cells
[B21.
can apparently remain quiescent for a long rime,
130. A number of experimental observations support during which they may be recognized and eliminated,
a model based primarily on the biological nature of perhaps by the immune system. This process surely
tumour formation rather than on formal concepts. takes place, even though i t is poorly understood. If all
Within the framework of this model, two biologically of the mechanisms mentioned above fail, there is still
different stages of carcinogenesis are singled out: the need for the transformed quiescent cells to start
initiation and promotion. To develop a specific model dividing. This activity is thought to be induced by a
of radiation carcinogenesis based on a two-stage promoter. Hormones are of particular interest in this
theory i t is necessary to discover the mechanisms connection, as has been shown by different expen-
underlying these processes (for a comprehensive review mental approaches [N7. S43, Y5, Y6]. Generally,
see [F9, FIO, P13, P141). substances that stimulate cell proliferation enhance
carcinogenic processes [S43]. It is not clear to what N-ras and H-ras oncogenes, and in one case [ZI] the
extent radiation can act as a promoter [ F l , UJ]. transformed gene is due to a guanine-to-adenine
Finally, the developing tumour must be vascularized (G-A) nucleotide substitution (a point mutation). In a
when it has reached about 0.2 millimetres in diameter, different study. the c-K-ras oncogene was activated by
in order to maintain an oxygen supply to the cells. gamma radiation, which also caused a G-A substitu-
Only after all of these processes have taken place and tion [G6]. These findings suggest that. at the oncogene
additional growth has occurred will a tumour be level. the carcinogenic effects of radiation are at least
clinically manifest [S44]. similar to, if not identical with, the effects of
other carcinogens. The studies cited involved different
tumour sites, s o that more direct comparisons are
2. Consideration of results of oncogene studies difficult.
in statistical models
136. Recently, a rather elaborate picture of the 3. Does radiation induce unique cancer characteristics
nature of some of the genetic events involved in at the cellular level?
carcinogenesis has emerged. A limited series of genes,
commonly called oncogenes, has been implicated in 140. Several investigations have shown that the
the transformation of cells to the n e o ~ l a s t i cstate. normal somatic cells of cancer patients differ from
Some of these oncogenes seem to be incorporated into their tumour cells in respect to oncogene activation o r
the cellular genome by viruses that transfect cells. but other chromosomal changes. This finding documents
the genes themselves, or structurally very similar ones, the clonal nature of the tumour and, more importantly,
are known to exist in nornlal cells. It has been shown the specific events involved in the tumour's origin.
in some cases that simple mutations in members of Similar studies should be undertaken in radiation-
these gene families have transforming activity. Muta- exposed individuals where it would be valuable to
tion in an oncogene can lead to a modified structure determine whether the tumour cells alone manifest the
in the coded protein. or. by changing the mechanisms chromosomal or oncogene-related changes attribut-
that regulate the coding and expression of such genes, able to irradiation or whether the normal cells. too,
i t may cause the ectopic production of a normal gene manifest these changes. In particular, it may be
product. o r its production in improper amounts. The important to examine affected and normal cells in
biochemical activity of several of these agents has individuals exposed in utero, in order t o relate the
been characterized; they appear to affect a variety of effects of radiation to prenatal age at exposure,
pathways in the control of cell division a n d prolifera- especially for those individuals exposed early in
tion. Other work has suggested that cell transformation prenatal development.
may occur after a small number of events, possibly
two o r three. although in some instances (for example, 141. For many reasons it is desirable to know
retinoblastoma) recessivity at a single locus (i.e.. two whether the cancer cells produced by ionizing radia-
events) may suffice. In the case of recessivity at a tion differ cytologically or biochemically from the
single locus. genes of protective effect, now often cancer cells produced by other carcinogens at the
called "anti-oncogenic". are turned off. This subject is same organ site. A clinically detectable difference
reviewed in Annexes A and B of the UNSCEAR 1986 could have uses in screening and in testing. It could
Report [U I]. also be valuable in determining which cases of cancer
are due to radiation exposure and which are not; this
137. In the case of these "anti-oncogenes" there is would be useful for epidemiology as well as for
evidence that after a first mutation at one of these occupational safety. liability and the like. DNA
loci, a somatic recombination event occurs which sequences at certain loci affected by different mutagens
replaces the normal gene on the unmutated chromo- in some experimental systems show characteristic
some with the mutated gene, leading to cell transfor- patterns (e.g.. base changes, deletions), suggesting that
mation. One recent report from an in vitro study of different mutagens have preferential effects at the
yeast cells has shown that radiation may induce DNA level. It has been possible, for some cancers, to
somatic recombination. thus being able to affect both determine whether or not radiation induces similar
the initial and the second of these stages. changes at the genetic level to those caused by other
carcinogens. Experimental studies of chemical mutagens
138. Evidence has accumulated that various carcino- on cell lines and the finding of the "Philadelphia
gens. including radiation. tend to break human chromosome" in the Japanese atomic bomb survivors
chromosomes at specific locations. While these "fragile with chronic granulocytic leukaemia (as is observed in
sites" are not yet well understood, some correspond spontaneous cases) suggest no radiation-specific muta-
closely to known cancer-related chromosomal break tional pattern [F3].
sites, for example, known rearrangement points or
oncogene locations [YI]. However, it is not clear 142. The available information generally suggests
whether radiation causes cancer in ways different from that radiation induces the same cellular anomalies a s
other carcinogens. - other carcinogens. Data from Hiroshima and Nagasaki
on breast cancer suggest no differences in histologic
139. Several studies have shown that mouse cells type nor tumour size by age at exposure o r radiation
may be transformed by the application of chem- dose [T9, 1141. nor were atypical changes o r residual
ical carcinogens such as N-methylnitrosourea and proliferative lesions seen in women exposed t o radia-
benzo(a)pyrene [G7, M2 1. Z I]. This activates the tion but free of cancer. These observations led
Tokuoka and his colleagues to conclude that "radio- 147. Biopsies of thyroid cancers from 31 patients
genic breast cancer does not differ histologically from who had been given external x-irradiation have been
spontaneously occurring (breast) cancer in Japanese compared with biopsies of thyroid cancers from 389
women" [T9]. Similarly, Matsuura and his colleagues non-irradiated patients. The irradiated patients were
[M15], in an analysis of the histological types of significantly more likely t o have the papillary type of
stomach cancer seen among the survivors, found no tumour, with a higher incidence of metastatic lymph
compelling evidence of a radiation-specific histological nodes [T13]. While these results suggest that the tissue
type, although there was evidence that the degree of types are not unique to radiogenic thyroid cancers.
differentiation of adenocarcinomas is poorer in high- they may depend on the external source of the
dose than low-dose groups. On the other hand, a irradiation and may not be comparable to the
comparison between exposed and unexposed stomach histopathology after exposure to internal nuclides.
cancer patients from Japan showed a higher frequency
of better-differentiated tumours in the exposed, who 148. A recent study [M34] has found that the
were also several years older than the unesposed distribution of cell types In radiogenic acute leukaemias
[S35]. Twenty years ago, gastric carcinoma in the in adult atomic bomb survivors and cervical cancer
exposed occurred at the same age as in the unexposed. patients did not differ from that in spontaneous
leukaemias. In spondylitis patients secondary acute
143. While in all risk groups the lower third of the leukaemias were of all cell types other than chronic
stomach was the site of most cancers. there seemed to lymphocytic leukaemia.
be an increase in the degree of intestinal metaplasia of
the gastric mucosa with increasing dose [M15. Y2]. 149. A general conclusion from the available data is
The Japanese population in general has been prone to that there is no diagnostic difference between the cells
develop gastric carcinoma in the lower third of the of radiogenic tumours and the cells of the spontaneous
stomach, in areas affected by intestinal rnetaplasia. tumours of the same site. This conclusion is consistent
This is also characteristic of stomach cancer in high- with the fact that cancer is a mutational disease that
risk areas of .4ndean Latin America and may be can be caused by any mutagen.
related to dietary constituents. However. it is conceiv-
able that the stomach as a whole was predisposed to
carcinogenesis by irradiation and that in rhe lower 4. Causal mechanisms: gene activation or inactivation?
third of the stomach the normal risk processes were
accelerated. If this is true, it represents an interacrion 150. As mentioned above, some tumours (especially
with environmental lactors and will change, as the retinoblastomas) are apparently caused by gene dele-
frequency of stomach cancer in Japan is changing. tion, which presumably inactivates necessary genes o r
gene repressor regions of chromosome 13. The result.
if both homologous chromosomes are affected, is
144. An examination of the cytopathology of lung cancer. In other tumours, cancer appears to be caused
cancers in uranium miners in New Mexico. United by the incorrect activation of a normal gene. o r the
States, suggests that the same array of cell types is activation of a mutant version of a normal gene; in
observed in roughly the same proportion as would be these cases, the tumour occurs in heterozygous cells
expected [S20]; others have found some differences in and the effect is "dominant" at the cell level.
p r o ~ o r t i o n ,but most of the usual cell types are seen Oncogene amplification, one of the means by which
[C4]. Some malignancies have not yet been shown to oncogenes are activated. occurs in a variety of human
arise after exposure to radiation; chronic Iymphocytic tumours including neuroblastomas (where amplifica-
leukaemia and polycythemia Vera, Hodgkin's disease tion of the N-myc occurs), retinoblastomas [L13],
and cervical cancer are esamples. glioblastomas [L 121, leu kaemias and carcinomas.
Radiation may work in different tissues by inducing
145. In one autopsy series [K17], about 25% of the chromosomal translocations, by deleting repressor
liver cancers caused by Thorotrast exposure were sequences, by deleting or inactivating necessary genes
angiosarcomas, a tumour type also caused by chemical o r by causing point mutations in normal genes.
agents but which is otherwise quite rare. In this series Further studies \rfill be required to identify the
of 29 autopsies of Thorotrast-induced angiosarcomas, molecular nature of the lesions caused by radiation.
the authors found that the cell types and histo-
pathology were similar to those of angiosarcomas 151. As noted earlier in the section describing dose-
from other causes. Thus, while a radiogenic tumour response models, there is a variety of evidence
may be of a relatively rare tissue type, it is not itself suggesting that high doses of radiation can damage
different from a non-radiogenic tumour of the same cells to such an extent that DNA-repair mechanisms
type. The presence of the Thorotrast as an internal, are ineffective: apparently, such cells are often so
long-term resident in the liver may induce histological damaged that they are either non-viable or cannot
changes by means other than simply the radiation replicate. At least, they d o not seem capable of further
effect. transformation to malignant states. This form of cell
inactivation has been found in several studies. Mole
146. In a series of 180 autopsies of Japanese Thoro- has argued that high doses of radiation to foetuses
trast patients who had malignant hepatic tumours, in utero seemingly show this effect [M7], though this
Mori et al. [M31] reported a preponderance of has not been proven directly. Among adults, a relative
cholangiocarcinomas and especially of haemangio- deficit has been seen in osteosarcomas in radium dial
endotheliomas. workers subject to very high doses [R12]; in breast
tissue irradiated in the course of mastitis therapy [L6], and promoters, the embryo or foetus should be highly
in thyroid cancer after irradiation including "'I susceptible t o radiation-induced cancer. The available
ingestion for hyperthyroidism [DIO. H121; and in the data are equivocal at best: indeed. animal experiments
pelvic organs of women who were heavily irradiated have failed t o find a particular sensitivity [B5. UI].
to treat benign gynaecologic disease [W6] and cervical There are basically only two ways to collect data on
cancer [B12]. Leukaemia in ankylosing spondylitis this topic. One is to examine the children of women
patients demonstrated a similar deficit [D 1 I]. Finally. irradiated, while pregnant. for diagnostic or thera-
the deficiency in breast cancer among women treated peutic purposes, and the other is to examine the
for cervical cancer [BIZ] may be due to a different children of women irradiated at the time of the atomic
cell-sterilizing effect. Ovaries subject to substantial bombings. T o date, the findings from the two sources
irradiation may become deactivated. thus indirectly seem contradictory. The findings are summarized in
protecting the breast from carcinogenic effects. Higher- Table 14, which only provides published estimates of
order terms in dose-response curves may not be trivial the approximate average relative risks. and does not
ones. and dose-response estimates should take them directly reflect the controversial aspects of these
into account: this is increasingly relevant as therapeutic studies, which will now be discussed briefly.
radiation concentrates higher dosages on smaller and
better-defined tissue areas. On the other hand. the 156. Two large-scale investigations have undertaken
relatively lower dose outside the primary target area to assess whether the fraction of children exposed to
may have the inadvertent effect of generating some x-irradiation in utero was higher for children who died
secondary cancers in cells that would have been of cancer (generally, prior to age 10-15) than for
sterilized by less advanced equipment and techniques. control children who did not die of cancer. One of the
studies was in the United States and the other in Great
Britain; both have now been accumulating evidence
B. TISSUE SUSCEPTIBILITY IN CHILDREN for about three decades. The first to be reported was
the Oxford survey [S5]. It suggested a radiation effect.
152. Tissues differ substantially in their susceptibility a cumulative relative risk (which was only crudely
to radiation carcinogenesis, and the age and sex of the correlated to dose) of around 8.25 in the first trimester
exposed individual may also affect their responses. and 1.45 in later trimesters. a linear dose-response
These differences are seen in sites with very low or pattern, a relative risk that decreased with historic
very high relative risks for given exposures, in patterns time, and an age-onset distribution with a slightly
of latency o r the cell types of post-irradiation turnours. higher mean age among cases judged to be radiation-
in age and sex vulnerability. and in some aspects of induced than among all cases in the population [S6];
the age of onset of such tumours. It is enlightening to the reasons for the latter finding. if i t is other than a
examine the relationships between age at exposure and statistical artefact, are not evident.
tumour onset and between proliferating and non-
proliferating tissues, as well as the life-cycle e\.ents of 157. This study [SS] has been criticized because the
specific tissues as they relate to susceptibility in that T65 data on the survivors of the atomic bombings at
tissue. Hiroshima and Nagasaki exposed in utero, a direct
and prospective set of observations. d o not suggest
153. Data on these Special tissue effects come from such an effect [I I , J I ] and because the British results
several sources, including (a) in utero exposure and apparently conflict with animal data (see [B5. UI]). In
(b) age at exposure for tissues with marked periods of particular, i t has been suggested that various biases
proliferation o r development. The special vulnerability exist in the data. factors that would lead a woman
o r insensitivity of tissues is informative, for i t may who was predisposed to bear children prone to
identify the process by which radiation induces cancer juvenile onset cancers to be more likely to be
in specific tissues and the special risks attendant on irradiated during pregnancy (for example, t o diagnose
certain types of exposure. Such knowledge could problems already manifest in the pregnancy) [D3].
refine our understanding of which human subpopula- That poor health might predispose one to be exposed
tions are more susceptible to radiation effects, relative to irradiation was suggested in a study in the United
to radiation protection guidelines or to medical States showing an excess risk in white. but not in
therapeutic practice. black children [D3]. The excess risk persisted after
considering sources of bias, which were comparable
between the two ethnic groups: this suggests that the
1. Exposures in utero effect is real in whites. However. the authors propose
an ethnic-specific difference in radiation susceptibility.
154. The risks to the irradiated embryo or foetus were for which there is no other basis. making it more
discussed extensively in Annex G of the UNSCEAR likely that aspects of black-white differences in socio-
1977 Report [UZ] and again in Annex C of the economic or environmental conditions are responsible.
UNSCEAR 1986 Report [Ul]. Those findings are
briefly reviewed here, summarizing the best currently 158. Stewart and Kneale [KI. K2] have addressed
available dose-response estimates and considering how these issues in several ways. primarily by using Mantel-
current data on prenatal exposure relate to the biology Haenszel [M6] multiple contingency table methods t o
of radiogenic cancer. assess associations between various risk factors. irra-
diation and childhood cancer. The factors examined
155. If cancer is caused by a series of mutational include socio-economic status, birth order of the
steps. along with the effects of growth proliferation affected child, age of the mother at pregnancy and
birth year. They were indeed found to influence the biological variables (e.g., social class, birth order and
occurrence of childhood cancer, but a radiation effect age of mother). and that, therefore. the estimates of
persisted even after they had been taken into account relative risk derived from these retrospective data.
statistically [KI]. Stewart and Kneale also contend while valid in regard to the association they show
that there is a detectable dose effect, that the first between various factors, including foetal irradiation.
trimester is a period of high sensitivity, and that the do not demonstrate a causal relationship between prior
extra x-rayed cases in their survey are indeed radiation- irradiation and cancer. These criticisms have received
induced. response [K4, T3]. There arc also problen~swith the
effects-measure and the dose-response data. First,
159. Mole [M7] has argued from data on twins that relative risks of radiation carcinogenesis, for similar
the selection factor was probably not a serious estimated dose. have declined over historical time. for
potential bias. Twins are known to be about five times unknown reasons. Second, dose estimates are not
more likely than singletons to be irradiated in utero, directly available, and crude, uncertain measures (i.e..
but Mole found their post-irradiation risk of cancer to number of exposures) have been used as a surrogate.
be basically the same as that of singletons; hence, at
least this particular factor predisposing to foetal 163. In sum, these studies habe shown an association
irradiation did not seem to lead to an altered risk. of childhood cancer with prior irradiation but have left
Twin foetuses are not more susceptible to diseases doubts about the nature of the sample. especially in light
than singletons so that their predisposition to be of the J a ~ a n e s eobservations. so that one cannot be
irradiated may be different from the data on non- certain th'at radiation is involved. On the basis of all
twins reported by Stewart and Kneale. On the other the evidence. a selective factor of susceptibility to
hand, it is curious that twins d o not, overall, general ill health in the exposed seems unlikely to
experience more childhood cancer than singletons, as explain the result, although limited medical care in
would be expected based on the greater likelihood of Japan just after the war might account for some of the
their having been irradiated [B 151. difference in the findings [Ill. Another study. in the
United States. by Monson and MacMahon [M8] lends
160. This was confirmed by an investigation of some support to the general conclusions of Stewart
32,000 twins in Connecticut, United States, born from and Kneale by replicating some of their results. These
1930 to 1969; however, this same study found that the authors compared exposure in a population sample of
frequency of x-ray exposure was 2.4 times as high in all births with that in a sample of retrospectively
twins who suffered childhood cancer as i n a fourfold ascertained children who died of cancer. i.e., i t did not
greater set of matched control twins [H 1 I]. rely on retrospective matching of controls.
161. The Connecticut study was of twins who had 164. In particular. the kinds of confounding noted
received a dose estimated to range between 0.0016 and by Totter and MacPherson were considered. but nor
0.04 Gy, with a median of 0.01 Gy. After follow-up to found, in the Monson-MacMahon study. and there is
15 years of age, the crude relative risk associated with no proof of better access to medical care for those
prenatal exposure was 1.8 (95% C1: 1.4- 1.9), and even destined to develop post-natal cancer, as Totter and
after adjustment for confounding factors which could MacPherson hypothesized. Thus, while there are
be studied in the sample, the relative risk range was problems with these studies, they suggest a 1.4 or 1.5
1.4-1.9. The relative risk for leukaemia was 1.6 (95% cumulative relative risk of prenatal exposure, with no
CI: 0.4-6.8) and for all other cancers of childhood 3.2 reliable data on dose-response patterns. The relative
(95% CI: 0.9-10.7). While the magnitude of the risk of solid tumours is slightly. but not significantly,
confidence intervals shows that nor all of these results less than that of leukaemia. A study in Finland [S7]
are significant, the data agree generally with those disclosed a comparable leukaemogenic effect. but it
from the British and other United States studies. was not statistically significant. Other studies with
suggesting that the effect is real. even if a radiogenic similar findings include [D3], [M9] and [St%]; two
cause cannot directly be proven. small surveys [C3, 011 reported no increase but were
not large enough to exclude a 40% excess.
162. T65 data from Japan [ I l l reveal no dose-
response pattern in those resident in Hiroshima and 165. Several other factors are of interest. The greatest
Nagasaki, although the zero-dose group had a higher effect in the Steivart and Kneale survey seemed LO
rate of leukaemia than the not-in-city group. Further. have been in the first trimester, and the discrepancy
the highest risk group. which had received 0.5 Gy or between their data and the atomic bomb data has
more as foetuses. showed no leukaemias. Hence. there been attributed to the greater cell-sterilizing effect of
is no evidence for an excess risk. Because subsequent high, early prenatal doses [M7] or to radiation-
analyses in Japan have continued to confirm this (and induced immune deficiencies (e.g., [I I]. [K3]. [K5] and
for leukaemias these analyses now include follow-up [UI]). However, there was an excess of overall
through 1979, i.e., adult ages as well as childhood [I I]), mortality i n Japan only in those who had been
and for other reasons related to various aspects of the irradiated in the third trimester of their gestation [K6],
data available to Stewart and Kneale, the findingsof the but these children had no excess cancer [Ill, and these
latter have come under frequent criticism. Most are the foetuses most likely to survive irradiation. A
trenchant has been Totter and MacPherson [T2], who bias does not seem likely. therefore, in the Japanese
showed that the Oxford su wey's x-rayed control data. Monson and MacMahon [M8] showed that the
individuals had not been similar to controls who had only radiation excess was in those leukaemic individuals
not been x-rayed in regard to confounding social and who had been irradiated in the third trimester of their
gestation. Hence dose-effects or gestational-age-effects exposed parents in Japan. Here, within a cohort of
are difficult to show or to assess, and no unmistakable 52.725 individuals followed prospectively. 50,689 of
pattern has been seen. I t is also of relevance that dogs whom have individual T65 dose estimates. 36 deaths
d o not show the specific trimester effect. There were attributed to leukaemia through 1979, of a total
remains the possibility that concomitant sources of of 3.552 deaths [I 1, SZZ]. The frequency of death due
variation, and not irradiation, produced the cancers. to leukaemia is not functionally related to the sum of
These problems are discussed in detail in the UNSCEAR the parental exposures: indeed. Ishimaru found the
1986 Report [Ul], which concluded that there was no standardized relative risk of the offspring of parents
firm evidence of a trimester effect. collectively receiving 0.01 Gy or more of gonadal
exposure to be 0.8. Ten leukaemia deaths were
166. Another relevant question is whether these data observed where 11.9 had been expected [II]. There
afford a basis for inferring a genetic susceptibility to was, moreover, no indication of an increase in any of
radiation carcinogenesis. Such a susceptibility might the solid tumours of childhood [S22]. These studies
be expected. or is at least plausible, given the known have, of course. relatively low discriminatory power; it
genetic susceptibility to perinatal cancers such as was estimated. for example. that 23 cases of leukaemia
retinoblastoma and Wilms' tumour. Kneale and Stewart would have had to have occurred among the 16.713
[K3, K5] found a correlation between childhood offspring born to exposed parents for a radiation
diseases and cancer in those who had been x-rayed, effect to have been demonstrated.
perhaps indicating susceptible genotypes. The fact that
this was not observed in those who had not been 169. I t is appropriate to summarize the conclusions
x-rayed does not offer strong support for a genetic offered by the UNSCEAR 1986 Report [U I]. The lack
hypothesis; instead, it suggests that the irradiation of an effect on early childhood cancers even after
may have had an immunosuppressive effect (but. see higher doses in Japan is a ground for considerable
[L18]). Genetic susceptibility would be difficult to caution in interpreting the positive effects from the
demonstrate, however, if such genes are rare and the medical irradiation studies, especially in light of the
probability of cancer, even in those individuals. is many possible confounding or biasing factors. In a
small. similar way, the fact that early post-natal irradiation
in Japan showed carcinogenic effects only many years
167. The BElR 1980 Report [C4] concluded that later (agreeing with other data on post-natal radiation
there was probably a cumulative relative risk of 5.0 effects), whereas the medical series showed their
for a first trimester exposure and 1.47 for later effects soon after birth, raises serious radiobiologica1
trimester exposures. with the increased risk appearing problems if both observations are strictly the result of
as tumours prior to 12 years of age for leukaemias and radiation. The doubts are enhanced by the absence of
10 years of age for solid tumours. The risk was serious effects i n animal experimental data. Also, the
estimated at 15 excess fatal leukaemias per 10.000 constancy of relative risk values for many cancer sites
exposed children per PYGy. and 28 excess fatal in the medical series is at variance with other data that
cancers of other types. These estimates must be viewed suggest site-specific effects. Finally, haematopoietic
circumspectly for a number of reasons. including stem cell differentiation does not occur during the first
(a) the lack of clear effect of gestational age on the trimester of foetal development, so that the excess
occurrence of leukaemia and the small effect for other leukaemogenic effect in first trimester irradiation is
tumours in the study by Monson and Machdahon difficult to understand.
[M8]; (b) the fact that these authors found only a
1.06 relative risk in recent data for solid tumours;
(c) the declining radiation risk o i t r time observed in 170. I t is patent that the existing data cannot resolve
the Oxford sun-ey; and (d) the finding of later cancer the question of pre-natal irradiation with clarity or
risk in survivors. now adults, exposed in utero in much confidence. However, it would be prudent to
Japan [Y8]. Finally, although there had appeared to assume that pre-natal irradiation does have an effect,
be a linear dose-response relationship at least down to especially with regard to leukaemogenesis. If pre-natal
doses between 20 and 25 mGy [S5], this, too, is now irradiation is rcduced or largely replaced by ultra-
suspect, for it was not found by Monson and sonography, thc problem may become less critical, but
MacMahon [M8] and the Knealr and Stewart estimate it would be incorrect to assume that this reduction or
was based on heterogeneous data in which exposures replacement will be an immediate. world-wide pheno-
were not accurately known. menon or that accidental or industrial pre-natal
exposures will not occur. Thus, it is important to
168. While it is not strictly classifiable as an in utero continue to collect data on this point.
exposure, the exposure of a mother prior to concep-
tion may also provide information about radiation
cancer risks. A considerable amount of work has been 2. Exposures in childhood
done in animals along this line (see [B5] and [UI]),
but only a little in humans. The human data [GI, S8, 171. The age at exposure to radiation may have a
S9, U l ] have shown a significant excess of malignant profound effect on the susceptibility of the individual
tumours among the offspring of individuals irradiated to the induction of cancer. especially in those ages that
prior to conception (even prior to marriage [S9]), are known to be characterized by high rates of stem-
though the effects are not large. The relative risks are cell proliferation. One of the most obvious of these
about double the expected cancer rate. Again, these cases is exposure in childhood. While in a sense
data are not consonant with data on the offspring of childhood is a continuation of the in utero growth and
development (which would make childhood experience known to be genetically susceptible to cancer: of
merely an extension of the in utero experience), in fact 96 second tumours in such children. 42 (44%) were
there may be different sensitivities in childhood and radiation-associated [M28]. The expected rates were
in utero. based on the United States Connecticut Tumor
Registry, although the cases were international. Hence.
172. There are several sources of data on childhood while the qualitative conclusions seem sound and
exposure, but four predominate: (a) children exposed agree with what is known genetically and biologically.
to therapeutic radiation to treat other primary cancers; the details of the results may not be precise.
(b) children exposed for the treatment of non-
cancerous diseases: (c) children exposed to radiation 176. In a study of the leukaemogenic risk posed by
from the atomic bombs, to fallout from nuclear therapy in these children. it was found that the use of
weapons tests or to accidental discharges from nuclear alkylating agents was associated with elevated risk
power reactors; and (d) female children whose breasts while the use of radiation therapy was not [T18],
were exposed to radiation in childhood and peri- consistent with the findings of other studies summarized
menarchial ages. These groups may not be comparable in this Annex.
directly, because the first group is largely composed of
individuals with a genetic predisposition to cancer. 177. In a detailed study of bone sarcomas i n the Late
The groups will be considered separately. although Effects Study Group, Tucker et al. [TI71 found that
risk summaries for the cancer-treated group and all among the 9,170 children in the analysis, the relative
other groups will be presented. risk of bone sarcoma was 133 (95% CI: 98-176). There
was a 20-year cumulative risk of 2.8%. or 9.4 cases per
(a) Children exposed to radiation for I reatmen1 lo4 PY. A comparison was made between 64 of these
of primary cancers children for whom detailed treatment data were
available and 209 children who had not developed
173. Though the number of such cases is small, bone cancer by the time of the study. The radio-
because childhood cancers are infrequent, second therapy relative risk was 2.7 (1.0-7.7). after mean
primary malignancies have occurred in children who doses to the bone site in question estimated to be
received radiation for the treatment of an initial 27 Gy: there was a sharp dose-response gradient
cancer. These populations are of interest because they reaching a relative risk of 38.3 with doses above 60 Gy
contain a high fraction of children who are genetically but decreasing above 80 Gy, and an overall excess
susceptible to cancer. These individuals may be relative risk of 0.0006/Gy. No excess risk was detected
distinct from the general population of children. They with doses under 10 Gy. Eighty-three per cent of the
are all, however, children in whom actively growing tumours were within the field of radiation. Osteo-
tissues had been subjected to high doses of radiation. sarcoma had the highest relative risk value, followed
by chondrosarcoma.
174. There have been two major studies of the risk
of second primary cancers in children irradiated for 178. An investigation of 64 cases of second cancers
cancer: one. b) Li and colleagues. who used data from in children in the Federal Republic of Germany
the United States National Cancer Institute [LI. LZ]; found mainly osteosarcoma. thyroid cancer, and acute
and the other, a survey of data from the United States. non-lymphocytic leukaemia (ANL); 36 of 50 irradiated
Ital). Federal Republic of Germany. Canada, England. children manifested their second tumour in the
France, and the Netherlands, known as the Late irradiated field: a separate chemotherapy effect was
Effects Study Group [MlO. M28. T4, T17]. Both not seen [G 141.
studies suggest a 15+ relative risk of a second cancer
of any site (i.e.. pooling data on all primary sites and 179. Overall. these studies indicate that the general
counting all secondary sites). with a 3-12% or more range of absolute risk per unit dose of a variety of
cumulative probability of cancer by age 25. About second tumours is within about a single order of
68% of all second tumours in the Late Effects Study magnitude and much less than, for example, the
Group survey developed in the field of the original variation in absolute risks for a comparable set of
irradiation. The median latency time was I0 years. but adult-onset tumours. Solid as well as haematopoietic
only 5 years for second tumours not associated with tumours resulted from this irradiation. and they
radiation. Retinoblastoma and nevoid basal cell carci- affected many organs. Although interpretations based
noma patients. however, had a reversed latency on heterogeneous data collected retrospectively from a
pattern. Good dose-response information is generally widely dispersed group of hospitals must be guarded,
not available from these data. i t is probably safe to assume that there is a general
radiation-induced risk of second tumours in children.
175. Tables 15 and 16 provide basic data from the
Late Effects Study Group [MIO. M28, TJ]. These 180. To determine whether orthovoltage (140-500 kV
Tables show two concentrations: (a) that of second peak range energy) or megavoltage (10 M V energy)
tumours in patients originally treated for tumours of therapy is safer, a study was made of 330 children in
genetic origin, i.e., children probably genetically sus- Minnesota, United States, who had been given mega-
ceptible to cancer; and (b) that of primary tumours in voltage therapy [P16]. Only second tumours arising
sites known to be radiogenic (haematopoietic, bone). five or more years after irradiation were considered.
The presence of a primary tumour may imply that the and all children known to be genetically susceptible
child is especially radiosusceptible. Second tumours were excluded. The 30-year cumulative risk of cancer
were frequently associated with radiation in children was 9.6%; this is somewhat less than the orthovoltage
risks [Ll]. Nine of 14 second tumours were within the childhood or early adulthood are osteogenic sarcomas.
radiation field; five children had received chemotherapy At present it seems that these cancers result from the
as well, and two tumours developed outside the production of a second mutation in a n exposed
radiation field in these children. Thus, the apparent osteoblast. The osteoblast becomes homozygous for
radiosusceptibility in children treated for primary the chromosome 13 gene deletion, just as the retinal
cancer cannot be ascribed solely t o chemotherapeutic cell does. leading to the neoplasm [D4, D19. H18].
effects o r to genetic susceptibility. This could even occur in individuals who d o not carry
the familial retinoblastoma gene [Dl91 and is being
181. In the Late Effects Study Group osteosarcoma seen in some other radiogenic second tumours (osteo-
study [T17], mega- and orthovoltage therapy had sarcomas of the orbit [S41]). Because osteosarcoma
similar risks. There were also comparable risks follow- occurs even in non-irradiated bones, bone growth a n d
ing chemotherapy in these patients, but the radiation development must involve the same genes involved in
was shown to have risks independent of chemotherapy. the development of the retina. The concentration of
osteosarcomas in these patients during childhood and
183. Table 17 provides details of the cancer risk early adulthood shows that the tumours occur during
following irradiation for three cancers of which a the normal cell proliferation periods for this tissue. It
substantial fraction are known to be familial (retino- is now known that these tumours are generally caused
blastoma. Wilms' tumour, Ewing's sarcoma). Most of by somatic recombination, leading to cellular homo-
the subsequent tumours are sarcomas. especially in zyosity for the deleted or inactivated gene.
irradiated bones: however, carcinomas can arise in
heavily irradiated epithelial tissues, as the Wilms' 185. Family members of retinoblastoma patients
tumour data disclose. The general range of risk is who d o not themselves manifest that disease seem to
1-3% at 10 years post-exposure, rising to 15-35% or be somewhat more susceptible to other cancers than
more after 30 years, based on life-table methods of the general population, although the reasons for this
calculation. One can assume that virtually all of the are a t present unclear [C5, S123. There are no data on
in-field tumours were radiogenic: but the spontaneous radiation effects in such individuals as yet.
rate in these patients is also quite high, sometimes
nearly as high for all sites combined as for the 186. A Japanese study of 2,609 cases of childhood
irradiated field. Hence, radiation interacts with host cancer has found roughly similar results [T12]. Seven-
susceptibility. perhaps causing it to be expressed in the teen of 50 second cancers were in retinoblastoma
specific target field. patients, and most were related to radiation therapy.
Of all second tumours, haematopoietic, bone, and
(9 Trearment-for retinoblastoma thyroid made up the bulk. Thus the pattern is present
in all ethnic groups that have been studied to date.
183. Retinoblastoma is an embryonal tumour of the
retina, usually occurring at, or shortly after, birth. It is 187. In several general studies, the risk of radiogenic
easy to diagnose and is restricted in age, largely second primaries has been estimated to be 1-15% in
because i t arises in a tissue where mitosis ceases at 20 years of follow-up [A8, F2, L1, T4, VI]; since the
about the time of birth. Though it is a rare tumour, its population risk of an osteogenic sarcoma of the
epidemiological importance has motivated several orbital area (or even of the skull) is very low. the
studies of patients in major referral centres. One of the radiogenic risks are well over 100 times the baseline
interesting facts about this tumour is that approximately risk in most estimates. Current dose rates are 35-60 Gy,
25% of cases are of a heritable kind; this is detectable using megavoltage equipment: this has been reported
either because the initial presentation is with bilateral to reduce the risk to 1-29? (see [F2] and [Vl]), which
and/or multifocal disease or because other family is lower than the risk associated with orthovoltage
members are affected [Vl]. Epidemiological and mole- equipment. It is not clear whether there is a cell-
cular data have shown convincingly that this heritable sterilization effect.
form of the disease is attributable to the inheritance of
a single damaged gene region on chromoson~e 13: 188. In retinoblastoma. not only genetic susceptibility
retinal cells which then suffer a somatic mutation at but also concurrent chemotherapy must be considered.
the same region on the homologous chromosome are The literature is consistent in finding that almost all
malignantly transformed. The tumour cells are clonal independen1 second tumours have been observed in
descendants of the first transformed cell. familial cases [A3, D15, F2, VI]. The effect of
combined therapy is discussed in section V.C. where it
184. Osteosarcoma is a tumour to which genetic is shown that an excess risk is experienced, at least in
retinoblastoma patients are known to be at high risk genetic cases [ D 153.
as a second primary malignancy [F2, VI]. Studies
consistently show that about one third of the second 189. Two studies warrant special discussion [A3,
primary tumours in these patients are osreosarcomas; S26]. Abramson et al. [A31 followed 693 patients with
the remainder consist of soft-tissue sarcomas, brain bilateral, presumably heritable, retinoblastomas a n d
tumours, leukaemias, and melanomas. Osteosarcomas 18 patients with unilateral retinoblastomas. These
may occur in the irradiated field, but will spontaneously data are summarized in Table 18. Although previous
occur in distal. non-ocular sites not subject to radiation estimates from this series on the risk of second
therapy and in non-irradiated patients. While other tumours have been between 10% and 15%, they did not
malignancies are seen in retinoblastoma patients, fully account for the variable length of follow-up. If
about 80% of all second tumours occurring later in the time-specific incidence rates are computed, using
the number of new cases divided by the number of 194. A study of 882 retinoblastoma patients in
individuals not yet affected up to the time of follow- Britain reported results that were qualitatively similar
up, time-specific cumulative risks can be calculated but that, quantitatively, showed less risk [D 151. In this
and a life-table cumulative incidence obtained. With series, 30 second malignant neoplasms were seen. The
this method, Abramson et al. found a mean latency of results are presented in Table 19. Twenty-six of the
10.4 years. For individuals undergoing neither radia- second tumours occurred in the 384 patients with
tion (or with second tumours outside the irradiated genetic retinoblastoma; using life-table methods to
field) nor chemotherapy (and yet surviving, having account for differential follow-up times, the risk of a
been treated by enucleation alone), the incidence of second tumour was estimated to be 8.4% after 18 years
tumours was 10% after 10 years, 30% after 20 years, (6.0% for osteosarcoma alone). Of these 26 tumours,
and 68% after 32 years. 12 had developed outside the radiation field (a risk of
3.0% after 18 years), all of them osteosarcomas (2.2%
190. For all patients, the risks of second tumours among those with neither radiation nor chemotherapy.
were considerably higher. After 10 years, the risk was i.e., the baseline risk level). The British population
projected to be 20%; after 20 years, 50%; and after 30 risk of osteosarcoma by age 18 years is about lo-', so
years, 90%. This is much higher than reported in other that the relative risk in genetic retinoblastoma was 200
instances, at least partially because of the method of (95% CI: 50-500).
computation which accounts for differential follow-up
and at-risk periods. These results need to be con- 195. Within the radiation field. where second turnours
firmed. Tumours that developed outside of the radia- are probably radiogenic, the risk in the genetic cases
tion field (or in non-irradiated individuals) had was 6.6% after 18 years. Average doses were 35-40 Gy.
significantly later ages of onset than those in the field. with little variation. While the radiation effects in
these data are not dose-specific, they do indicate the
191. By comparison. the Late Effects Study Group nature of the risks. The follow-up period was shorter
sample of retinoblastoma patients exhibited a 14% than that reported by Abramson et al. [A3]; other-
cumulative risk after 20 years [T17]; this group wise, the difference in risk is probably due to different
included a mixture of heritable and spontaneous cases, efficiencies i n the ascertainment of secondary neo-
which may account for some of the difference with the plasms. Whether the true actuarial risk is as high as
Abramson study. It found that the relative risks of Abramson et al. suggest, or somewhat lower, retino-
second bone cancers following primary therapy for blastoma patients are obviously at very high risk of
retinoblastoma were similar to those following compar- secondary neoplasms.
able therapy for other childhood cancers, presumably
196. A brief report by Koten et al. [K27] has given
because the baseline bone cancer risk is higher in
an estimate of 19% for second tumours after 35 years
pa~ientswith retinoblastoma than in patients with
in patients in Holland. This is intermediate between
other types of childhood cancer. That is, rrtino- the other studies.
blastoma patients have higher baseline osteosarcoma
rates, so that a larger numerical excess number of 197. All of these children were irradiated at or near
cases produces only a modest relative risk. birth, that is, at about the same age, so there are no
data on the effect of age at exposure and no effort has
192. Dose effects have been estimated in a general yet been made to project the lifetime risk, although
way for the Abramson study data. Thirty-seven the two major studies d o offer some indications. In
patients received orthovoltage therapy only, with Abramson et al. [A3], the cumulative incidence curve
doses ranging from 3.5 to 260 Gy. Thirty-five received in those without radiation effect (but who are geneti-
betatron radiation (3.5-120 Gy). Fifteen received com- cally susceptible) is slightly concave upward from
binations of these with some other miscellaneous birth to age 32, the maximum number of years of
treatments. Life-table analysis showed that the risks of follow-up. The curves for tumours inside and outside
second cancers following one course of betatron the radiation field show similar shapes through age 25,
radiation (3.5-4.5 Gy) were not different from those after which the data are sparse. If this finding is
following multiple courses (70-90 Gy). Similarly. correct, then radiogenic turnours are occurring at
patients treated with orthovoltage doses of less than about the same ages as spontaneous tumours in these
110 Gy had the same life-table risks as patients treated children, as is the case with radiogenic adult-onset
with more than I I0 Gy. carcinomas generally (as will be seen below). The
cuniulative increase rises non-linearly with age of
193. In the second study [S26], Sagerman showed a follow-up. suggesting at least crudely that a multi-
2.5% risk of second tuniours for patients receiving plicative risk projection is more applicable than an
60 Gy. 5.5%. of those receiving up to 110 Gy, and 32% additive projection, again in agreement with most
for those receiving more than 110 Gy. The variability adult cancer patterns. The non-linear cumulation of
in follow-up times and the fact that those patients risk is also apparent in the study by Draper [D15],
receiving higher doses had longer follow-up complicate although less detail is given. As shown in Table 19, the
the interpretation of these results. Lower doses have absolute life-table probability of second cancers rises
been used more recently, and hence have shorter by a factor of two in the years 12-18, relative to the
follow-up times. The life-table methods of Abramson increase in the 12-year interval 0-11. This is true for
et al. did not demonstrate a difference related to dose. radiogenic as well as non-radiogenic second tumours.
Hence, it is not clear how much dose reduction,
fractionation or energy level of the therapy affects the 198. It should be stressed that retinoblastoma patients
risk in retinoblastoma patients. constitute the only significant group of human beings
in which the carcinogenic process can be observed, 10-15 Gy boost to a reduced field, over a six-week
after radiation, in exposed cells in which (a) radiation course of administration [Sl I]. Patients receiving
is in a sharply delimited area and can be compared orthovoltage radiation were ordinarily treated without
with the same area without irradiation and the rest of chernotherapy, whereas those receiving megavoltage
the body; (b) the cells at risk are effectively haploid in radiation had combined therapy. The increase in risk
regard to cancer risk; and (c) all exposed individuals is consistent for all studies. A dose-response of 7.2 cases
are of essentially the same age. The subsequent per lo4 PYGy and a cumulative risk of 35% over
projection effect should differ in ways that are 10 years have been estimated [SI I]. There also seems
informative relative to multi-stage models. because to be an increased risk associated with combined
only one second stage is needed for cancer t o occur in therapy, i.e., newer modalities may have increased the
these individuals. It would be useful to know how the risk of secondary malignancies. The evidence suggests
effect of cell sterilization. which must occur in the that bone tissue is susceptible to carcinogenesis if it is
periocular region after intense irradiation, manifests irradiated before o r during the adolescent growth
itself in regard to (a) the dose-response relationship spurt.
and (b) the probably smaller number of carcinogenic
events .ieeded to take place as a consequence of (iv) Trearmenr .for Hodgkin's disease
irradiation.
202. Some information exists on the risk of second
(ii) Treatmenr for Wilms' rumour tumours after irradiation in childhood for the treat-
ment of Hodgkin's disease. Although data from the
199. There has been considerable work, mainly by Li treatment of this malignant disease in children are
and colleagues (e.g., [L3]), on the risk of a second limited, the radiosusceptibility of certain tissues. spe-
neoplasm after radiation treatment for Wilms' tumour cifically, bone. haematopoietic. and thyroid, has been
of the kidney in childhood. After nephrectomy, reported [T4]. However, in children treated with
patients receive radiotherapy to any areas that might radiation alone. solid second primary tumours have
be the site of further tumours or potential metastases, occurred, leukaemias occurred only when chsmo-
usually the renal fossa, elsewhere in the abdomen. or therapy or combined radiation and chemotherapy had
in the thorax. In 487 patients and 4,255 person-years been given [M28]. This is consistent with findings in
of observation, Li et al. observed 1 1 second tumours, adult Hodgkin's patients. There was no indication of a
with latent periods ranging from 7 t o 34 years. Most familial susceptibility to Hodgkin's disease in these 40
patients were given orthovoltage therapy with average children. Dose information is not available.
doses of 25 to 30 Gy to the abdomen; other sites
received varying doses. There was a second tumour in 203. T o summarize, the evidence from children
2.8% of the patients. Nine of the second malignancies irradiated to treat a primary cancer shows very high
were solid tumours and occurred in areas that had susceptibility to second cancers and promises to be
been given 6-40 Gy. One was in a non-irradiated area. informative concerning the nature of the genetic
There was one case of acute myelogenous leukaemia. changes caused by radiation and their relationship to
The cumulative risk of a second tumour was 18% (SE: carcinogenesis. However, since these children are
6%) in 34 years after diagnosis of Wilms' tumour. probably not generally representative of the whole
population, these results are not useful for estimating
200. The relative risk of radiation itself was not risk coefficients o r for risk projection for the general
estimable (i.e.. was not finite), since no case occurred population.
in the 75 non-irradiated patients. Another study has
yielded similar results, with 2.3% of cases having a (b) Children exposed ro radiation for treatment
second tumour [SIO]. A third study reported a variety of benign conditions
of sites for second tumours, including the thyroid,
gastrointestinal sites, and bone, all with relative risks 204. There have been a multitude of uses of irradiation
over 80 [T4]: leukaemias were increased 13 times. for the treatment of benign conditions in childhood.
Many of these sites, e.g.. the thyroid, are unlikely to The exposures in question primarily involve (a) the
have been in the intended irradiated field. and the head and neck, to treat tinea capitis (scalp ringworm)
authors d o not report radiogenic cases separately. [M 13. RI, R22. S161: (b) the thymus. to treat what
Wilms' tumour, too, may be heritable in a large was thought t o be a pathologically enlarged thymus
fraction of cases. Its controlling gene region, along [H 1. S141: (c) the neck, to treat tonsilar and naso-
with the gene for insulin and the H-ras-l oncogene pharyngeal conditions [S15]: and (d) various sites, but
(rat sarcoma), is on chromosome 1 1 and, as is true for especially the head and upper body. to treat haemangio-
retinoblastoma, somatic homozygosity at the relevanr mas (benign superficial tumours usually present shortly
loci may be sufficient to produce the disease. after birth) [LIO].
(iii) Trearmenrfor Ewing's sarcoma 205. The tumours induced by these exposures are
primarily leukaemias and cancer (as well as benign
201. Ewing's sarcoma is a form of bone cancer, lesions) of the thyroid. Risks of these tumours
typically treated by local irradiation and chernotherapy. attendant on exposure of the head and neck in
Lately, long-term sunvival rates have improved. and children are summarized in Table 20. At doses of less
several studies have demonstrated a substantial risk of than 1 to about 8 Gy, the absolute risk of radiogenic
secondary osteosarcomas in the irradiated field [G2, cancer varied from <O.1% at 10 years to about 8% a t
S11, T4]; there may also be a risk of leukaemia [T4]. 30 years after irradiation for malignant neoplasms of
These patients received 44-55 Gy. followed by a the thyroid a n d was much lower for leukaemias. One
study IS271 has reported an increased incidence of children in the population around the city of Rochester,
basal-cell skin cancer in tinea capitis children; risk New York, United States [S38]. In the latter instance,
rates are difficult to calculate because of the complex a cohort of about 2,650 children irradiated from
ascertainment of cases, mixed ethnicity. and other risk 1926 to 1957 and 4,800 sibling controls were followed
factors, but among white children, there is an increase. for about 30 years. The doses ranged from 0.05 to
Some aspects of this study are discussed in the I I Gy, with 62% having received less than 0.5 Gy; the
sections on host factors and on the interaction of mean was 1.2 Gy. Those who had received higher
irradiation with environmental factors. Other cancers doses were treated earlier in the time period and hence
have been reported as well: brain and parotid tumours have a longer follow-up. The dose-response data are
have arisen in small but excess numbers in the tinea summarized in Table 21. Recently, the pathology of
capitis series and bone sarcomas have developed in 75% of the reported benign thyroid nodules was
children treated with radium for bone tumours. studied, and many were reclassified as non-neoplastic,
thus sharpening the dose-response estimates. Almost
/i) Thjlroid and thymus exposures all of these children had been irradiated in their first
year of life. In many ways. this makes the cohort
206. The thyroid gland is susceptible to radiation- similar to that of the retinoblastoma patients (who
induced cancer, especially when exposure occurs in the exhibit no excess of thyroid cancer following radiation
first two decades of life. The effect of internal of the orbit). The relative risk, after 29 years of
irradiation in children exposed to "'1 in the Marshall follow-up, was 49.1. based on sibling controls. and the
Islands, where a special age effect was not seen, will be SMR was 44.6 (based on New York Stare cancer rate
discussed later. The risk coefficient estimate from data); for benign thyroid adenomas the relative risk
many studies is consistently in the range of 1.6-9.3 cases was 15.0. These values are significant at much less
per lo3 PYGy [C4] in mean doses which ranged from than the 0.001 level. They also show the sensitivity of
0.09 to more than 10.0 Gy (see [S13], [S38]) in the relative risks to the choice of controls.
childhood exposures. These values are based on thymus
irradiation [HI, 514, S381, on tonsilar x-irradiation
210. Figure I indicates the dose-response pattern. An
[S15], head and neck exposure [M13]. and on the additive model yielded 3.46 k 0.82 excess cases per
follow-up of the tinea capitis patients [RI, S161, as lo4 PYGy; the sex difference was marked with risks of
well as on the Japanese data. A summary estimate
5.25 per lo4 PYGy for females and 2.05 cases per
based on data from North American childhood lo4 PYGy for males, which is similar to estimates
exposure to under 15 Gy was 2.5 cases per lo4 PYGy from other studies. In Japan. exposed persons under
for exposure under age 18 when both sexes were age 19 showed a value of just over 2.1, with a sex ratio
pooled [N53. Animal da:a and the Japanese atomic of about 2.9 (derived for all ages) [W5]. The dose-
bomb experience suggest about a twofold higher response pattern fitted a linear model (P < 0.0001).
susceptibility for childhood exposure (under age 18)
not improved by adding a quadratic rerm. The
[N5]. There is a marked excess of cases in females, in authors also fitted a relative risk model to their data,
general 2-3 to 1 [N5, S131, uniformly across many based on the Cox regression method. This fitted well
studies; this ratio is similar to the sex ratio in (P< 0.00001) with a linear dose term (not improved
spontaneous cases and does not indicate a particular
radiosusceptibility in females [S 131.
207. Several other studies of cancer after miscellaneous
exposures of the thyroid have reported similar results
[B6. C4, D5, M!2]. Jewish children may be especially
susceptible [C4, S13, S14. W1 I]: when matched to
comparable non-Jewish children, the relative risk has
been at least as high as 3.5 [S14, Wll]. Whether this is
an artefact of the exposure regimen or is due to other
factors is not certain.
208. Because spontaneous thyroid cancer is quite
rare, it is likely that most of the observed tumours are
radiogenic. The bulk have been of the papillary type
[C4], and there appears to be a latency period of at
least 5 years [C4, S131, perhaps with a peak excess risk
about 20 years later [C4], though excess risk has been
seen to persist up to 40 years after exposure [S15,
S381. Consistent with studies of specific radiation
exposures, a retrospective examination of female
thyroid cancer patients (i.e.. ascertained because of
thyroid cancer not because of irradiation) showed an
increased risk with radiation and with younger age at 0 f I I I I
exposure. a relative risk of 16.5 overall. but 42.2 for 0 2 4 6 8
exposure at less than 20 years of age [M 141.
THYROID DOSE (Gy)
209. The best dose-response data come from Japan Figure I. Thyrold cancer lncldence In relation to thyroid dose.
[W5] and from a study of the thymus-irradiated [S381
by adding a dose-squared term), and the relative risk them were subjected. However. a radiogenic excess of
estimate after exposure was 1.58 times the prevailing thyroid cancer may also have been reflected even at
risk. Data for benign adenomas were similar, both the population level. In a study in the state of
qualitatively and, to a great extent, quantitatively; the Connecticut, United States, based on its tumour
relative risk was 1.44. Figure I yields a risk coefficient registry, an excess of thyroid cancer was correlated
similar to the figure from Japan, for lower doses, but with the childhood time period during which these
in the Japanese data the risk falls after about 3.5 Gy. exposures occurred [PSI. In several instances. the risk
has continued to be elevated as much as 35 years after
2 1 1. This study [S38] also allowed a dose-fractionation exposure, so that the lifetime excess in thyroid cancers
assessment. Such data are rare in general, and the results may be more substantial than the very small and
are summarized in Table 22. In sum. the low-dose per uncertain excess in the first decade or so after
fraction group had higher risks per Gy, which is not esposure.
consonant with the decreased effect of dose fractiona-
tion that has commonly been theorized. The results (ii) Leukaemia as a general ourcome in e-vposed
were the same for adenomas (not shown in the Table). children
Thus. neither the number of fractions nor their dose
was protective. 217. At present. the evidence for excess leukaemia in
exposed children comes largely from two sources:
212. Finally, Shore et al. [S38] examined the projec- children exposed in Hiroshima and Nagasaki and
tion effect in this cohort. The excess in thyroid cancer children exposed to treat various benign conditions of
began 5-9 years after irradiation and seems to have the head and neck. specifically of the thymus and
continued even after 40 years of follow-up (i.e.. in scalp (tinea capitis). The Japanese data are reviewed
patients irradiated in the 1920s). However. there in section 1II.B.Z.c.
appears to have been a slight decrease in the excess
after about 25 years (although adenomas continue to 218. Studies of children with scalp irradiation to
increase). The mean latency time was 29.3 years, with treat tinea capitis [Rl, R22] have produced results in
somewhat shorter latencies (27.4 years) for those accord with the Japanese studies. The relative risk of
having received the highest doses. The Japanese data tumours of the head and neck was 3 in a matched
also show a continuing effect after at least 35 years case-control study of 10,833 cases in Israel, and for
[W5]. These data follow the age-specific incidence leukaemia. specifically, 2.3. The marrow dose was
distribution of spontaneous thyroid cancer in adults. about 0.3 Gy. leading to an increase of 0.9 excess
which reaches a peak in early adulthood and changes leukaemias per 10' PYGy. There was also a clear
relatively little thereafter. increase in brain tumours. Mean follow-up time was
26 years. Children of less than 10 years of age who
213. This study agrees generally with the Japanese were irradiated had higher risk than those exposed at
T65 data [P4] in suggesting a linear dose-response older ages. Latency for leukaemias was 9.3 years. No
pattern for thyroid cancer in irradiated children (as other causes of death were elevated. Other studies
well as adults). Data from tinea capitis patients are have found comparable results [A4, M13, S16].
similar in this regard, although the slope appears to be
steeper. Japanese data [P4, W5] suggest a higher risk 219. In a study on thymus-irradiated children there
in childhood than adulthood. In North American was a relative risk of leukaemia of about 3.1 [HI],
children having received doses in excess of 15 Gy, though a dose-response relationship could not be
however, a reduction of effect appears to occur, estimated.
presumably as a consequence of cell sterilization [N5].
220. There are no precise estimates of the dose-
214. Although these thyroid neoplasms are of the response risks of leukaemia in children. The general
relatively benign papillary type (and radiation effects range of risk for single or short-duration exposures
include purely benign nodules as well) they may combining data from all ages, over the 25-year risk
eventually pose a serious risk. Thyroid neoplasms of period following irradiation was estimated in the
whatever aetiology can become life-threatening, and BEIR 1980 Report to be between 0.01 and 2.2 excess
the mortality after 25 years of follow-up is about 7% cases per IOVYGy, or 0.25-55 cases over the 25-year
[NS]. Thus, the risk in children may be substantial, risk period [C4].
and further time may be necessary to assess its actual
level. 221. Approximate risk coefficients from [RI] can be
derived as follows. Ron and Modan report 10 leukaemia
215. As was discussed briefly earlier, there has been cases in 10,842 irradiated children and seven in 16.241
speculation on whether radiation-induced thyroid non-irradiated controls. They report that the sex-
cancers differ from naturally occurring thyroid cancers. adjusted risk of leukaemia was 4.0 cases per lo4 in
It has been found that radiogenic thyroid cancers, males and 6.0 per lo1 i n females. These persons were
somewhat more often than their naturally occurring followed for an average of about 22.8 years, so that
analogues, tend to be of the papillary type, and to the number of excess cases was 0.18 per 10' PY in
have metastatic lymph nodes [T13]. males and 0.26 per 10' in females. At an average dose
of 0.3 Gy, this corresponds to 0.60 male and 0.87 female
216. Some concern has been expressed about whether cases per 10' PYGy. These are crude estimates which
the apparent excess in the exposed individuals is a assume that age is not a material factor. so that all
function of the detailed follow-up to which many of person-years of observation are equivalent. They agree
roughly with the BEIR estimates. Because the results were primarily exposed internally, to I3'I). Three other
are not statistically significant, only the mean estimate groups have also received some attention: namely,
is given, with no confidence interval. children exposed to radioactive fallout from [he
distant atmospheric testing of weapons, children
(iii) Exposure of rhe cenrral nervous sysrem exposed to accidental discharges from nuclear power
222. The Israeli tinea capitis study [Rl, R22] has installations, and children exposed to relatively elevated
found an excess of brain cancers, with a relative risk levels of cosmic radiation by virtue of living on the
of 2.5 (95% CI: 0.9-7.4), with males appearing to be Colorado plateau in the United States or at similar
more susceptible. The dose to the brain was 1.2-1.4 Gy altitudes; the last-mentioned children have been studied
to the upper layer and 0.95-1.2 to the layer 2.5 cm only cursorily, e.g., all of them lived in industrialized
below. The risk coefficient estimates, in excess cases countries and none lived at elevations as high as the
per lo4 PY, were 2.3 for irradiation less than four Andean altiplano or the Tibetan plateau. The cancer
years of age, 7.5 for five to nine years, and 3.2 for ages risks resulting from these exposures are consistent
above 10. Another study of irradiated children has with the risks from other exposures (reviewed above);
produced a risk coefficient estimate of 2.9 1 2.4 brain there is a susceptibility to leukaemia. to thyroid
cancers per lo4 PYGy from five to 22 years after cancer. and, in a special and only partially understood
exposure [Ll I]. No significant increase in intracranial sense, to breast cancer (see below). In fact, the
tumours has been seen in Japan among any of the age leukaemia risk has been satisfactorily studied only in
groups [S23]. Japan: other studies of it remain controversial.
(iv) Exposure o f the skin to rrear haemangioma and 226. Thyroid. The risk of thyroid cancer has already
orher skin disorders been reviewed in connection with other exposures. and
some of the Japanese findings have been given. In
223. Many children were irradiated to treat haeman- Japan, about 3.6 additional incident cases per lo4 PYGy
giomas, in general in visible areas of the skin, from were seen among females exposed before 20 years of
roughly 1910 to 1960. Treatment was by 226Ra age, as contrasted with one additional incident case
implants. Over 20,000 of these patients have been among males in these same years. There is mounting
followed in Sweden [F12]. Among 10,000 of these support for a lessened susceptibility in those over
patients [LlO], 75 cancers occurred during the registry 20-30 years of age at the time of the bombing [B5, P3.
period 1958-1979. Only 55.6 had been expected, based P4]. In the Marshall Island cohort, a group of 250
on the same registry and a national birth record individuals that has now been followed for 30 years,
system, yielding a relative risk of 1.35. Although this the only substantial risk is that of thyroid cancer due
was a prospective investigation in that a cohort was to ingestion of I3'I, I3'I etc., with doses estimated to
identified as being at risk and compared with the be 7-14 Gy in young children and perhaps 20 Gy in
nation as a whole, cases were ascertained retrospectively infants (< 1 year) [C5. C6]. No tumours were detected
from a registry. and some cases may have been in the first 10 years of follow-up. Only one case of
overlooked. A preponderance of tumours of the leukaemia has been seen. While there have been cases
central ncrvous system, breast, and thyroid was found of benign thyroid nodules, it is uncertain how much
[LlO, H221, confirming both the radiosusceptibility of excess of malignant thyroid cancer has occurred. Only
these sites and the reliability of the data. Furthermore, papillary cases have arisen, and the relative risk of the
the frequency of birth defects among the mothers in non-metastatic carcinomas has been 0.82 for indi-
this study was close to that expected, suggesting that viduals exposed before 10 years of age and 3.94 for
this was a representative cohort. The occurrence of those exposed after this age (computed from [C5]).
thyroid malignancy supports other studies and indicates The risk shown in Table 20 is 1.8 per lo4 PYGy for
that over-screening bias is not the only reason that the children: curiously. this study is unique in finding
excess thyroid tumours have occurred in other children a smaller risk in younger children, but this could be
given radiation to the head and neck area. artefactual. The thorough search for thyroid anomalies
224. There has been widespread use of radiation has led to the surgical removal of most benign cases,
(generally of "soft" x rays) to treat acne in adolescents. perhaps sparing some individuals the risk of devel-
Some of the doses were administered with cone oping thyroid carcinoma. Furthermore, the long
shielding, to protect the thyroid and other areas; duration of the excess risk for this tumour means that
others were administered without such shielding. Data increased risk may continue to reveal itself.
from the United States thus far provide no evidence
that this use of radiation has led to thyroid or other 227. In an investigation of thyroid malignancy in
cancers [G8]. The doses were fractionated, and the children exposed to atomic testing near the Nevada
patients were generally 16-18 years of age or older. test site, United States, there was an excess of cases
when the thyroid appears to be less radiosusceptible relative to expectations based on data for the whole
than in early childhood. United States, but no excess relative to expectations
for neighbouring states [23].Sample sizes were small,
Children exposed ro atomic bombings and fallour and it was concluded that the numbers of exposed
(c) children might not be large enough, given current risk
225. Several groups of children have been studied estimates for thyroid cancer, to demonstrate excess
who were exposed to radiation caused by the detona- risk from nuclear-testing fallout.
tion of nuclear weapons. The best documented are the
children exposed in Hiroshima and Nagasaki and the 228. The most recent report on the population of the
children exposed in the Marshall Islands (the latter Marshall Islands [H32] has found an inverse relation-
ship between the prevalence of thyroid nodules and disappeared by about 1959; that is. after 15 years or so
the distance from the BRAVO explosion to the atoll [03]. The latency time is shortest in exposed children,
of residence at time of exposure. The results suggest a i.e., it is inversely related to age at exposure [I7]. Most
linear dose-response relationship and an increase in cases were of acute leukaemias, and these showed the
the risk estimate by 33% to 11 cases per lo4 PYGy. most age-dependent subsequent risk; chronic granulo-
cytic leukaemias showed very little age-dependence
229. Finally, a recent case-control study in Japan [I7]. The subsequent risk can be fitted adequately to a
has found that irradiation of the head, neck, or chest log-normal distribution [I7].
in infancy to doses of 0.0002-0.4 Gy was the only
identifiable risk factor for the occurrence of thyroid 231. At a dose of I Gy. the relative risks for children
cancer in teenagers [Y7]. (< 19 years) and adults have been estimated to be 6.2
and 3.3. respectively [PIS]. Overall relative risks (i.e..
230. Leukacmia. The leukaemia data from children for all doses > 1 Gy and all ages > 15 years at the
irradiated by the atomic bombings have recently been time of the bombing) are 31-33 [S17]. The risk
reviewed [e.g.. C4, F3. PIS]. Where i t had once been coefficient for Japanese children has been estimated at
thought that the distinction between Hiroshima and 2.8 additional cases per lo4 PYGy (T65 kerma). with a
Nagasaki would be informative with respect to the lower risk in those exposed between ages 10 and 19
different RBEs of high- and low-LET radiation, it [F3]. This finding is similar to that for adults, except
now appears that there is little useful data in that that the cell types in children have been of the acute
respect, owing to the revision of the dose estimates. In lymphocytic and the acute and chronic granulocytic,
Japan, the most informative data are the contrasts in which are typical of spontaneous childhood Ieukaemias.
risk after exposure between the 0-0.09 Gy and the The highest sensitivity seems to have been for chronic
> I Gy groups, under age 10. Figures 11 and 111 show granulocytic leukaemia.
the general risk pattern quite clearly for children and
for adults (from [B24], based on T65 doses). The 232. For leukaemias in children exposed at less than
latent period is brief, beginning 3-5 years after 10 years of age, sex ratios were 0.76 (M/F) for
exposure and reaching a peak 7-8 years later [F3], doses < 0.1 Gy: 1.90 for doses 0.1-0.99 Gy: and 3.71
after which time the excess risk levels off: subsequent for doses > 1 Gy. For children 10-19 at the time of the
studies have shown that significant excess cases bombing, the respective values were 1.05, 10.32 and
0-10-
C
W
a
ul
x
Ln
I
-
....................................
I- I-
" 4
1
0-
1950 1954 1958 1962 1966 1970 1973 1950 19k4 i9!iu 1962 19d6 1970 19j4
20
2 above 50 AT8
a
W
above 1 Cy
........ 0-0.09 G y
Figure II. Cumulative deaths from leukaernia, 1950-1974,per 1,000persons alive In 1950,for varioue
age groups at the time of the bombings (ATE).
tB241
risk (>1 Gy / 0-0.09 Gy)
........
Relative
Absolute r i s k (deaths per 106 PY)
U I I I I I I I "
0 10 20 30 40 50 60
AGE ATE
Figure Ill. Absolute and relative risks 01 leukaemia by age at the lime of the
bomblngs, 1950-1974. average for both Hlroshlma and Nagasaki, T65DR doses.
18241
0.84 [CJ]. However, the background rates are higher excess in cancer (at all ages) at known radiosusceptible
in males, and the relative risk is not statistically sites. Because of problems with its methodology. the
different between the rwo sexes [P15]. an argument Johnson study has not generally been accepted as
favouring a multiplicative projection model. valid. In a study, which attempted to determine if
Johnson's results could be correct, Machado et al.
233. There is no excess of childhood cancers other [M20] restricted their analysis to a small area of
than leukaemia and breast cancer in these children. southern Utah. In the proper time period following
Evidence is now available on their later adult experience. exposure to fallout. 1955-1980, there was a small
but to date there are no new adult-onset tumour risks excess number of leukaemias with onset at ages 0-14
clearly identified with childhood exposure, with the (RR = 2.84 for exposed children, much less than
exception, perhaps, of stomach cancer (4.7 cases per found by Johnson) [M20]. There was also an excess of
1 O4 PYGy) [S 17, W5]. cases at all ages (RR = 1.42). Machado et al. estimate
that the doses were between 0.001 and 0.021 Gy, so
234. Most of the controversy in the United States on that small effects, at most, would be expected.
distant nuclear fallout exposures has centred on its
possible leukaemogenic effect. Comparisons have been 236. There may. accordingly, be a small increase in
made for all childhood cancers and separately for the rate of leukaemias in these exposed children,
leukaemias, based on mortality data for counties with although more accurate estimates of dose in other
high and low exposure before, during, and after parts of Utah might reduce the size of this effect.
fallout periods. I t has been argued that the data However, since southern Utah rates were about 35%
supported an excess in the high-exposure areas of higher than expected from the rates in the United
southern Utah [L4], which excess was correlated in States as a whole, at least some of the increase is
time with the period of exposure to fallout and which probably real. The individual doses are not known. so
was not evident in low-exposure areas. This inter- a dose-response analysis is not feasible.
pretation has been criticized, in particular because the
data are not compatible with a simple radiogenic 237. Analysis of leukaemia mortality rates in the
effect; rates in different areas over these time periods United States through the period of atmospheric
do not vary simply as a function of exposure. nuclear testing has suggested patterns \vhich are
suggesting that other factors are involved (e.g.. [B6]. consistent with fallout effects [A18]. States were
[L5] and [RJ]). Reviewing a broader set of data, Land classified according to the level of exposure based on
et al. [L5] argued that in southern Utah the leukaemia the assessment of strontium-90 in COW'S milk samples
rate has been lower than in other parts of the United in 1959-1960, in human bone in 1966-1967, and in
States in years prior to the exposure. Further, there total diet in 1964-1965. The leukaemia rates during
was a deficit in juvenile cancers at the remaining sites 1950-1976 were correlated with exposure in states
in the exposed area. classified in high, intermediate and low exposure
groups. The pattern of leukaemias showed a 5.5-year
235. On the basis of Utah-wide data on fallout, Beck latency and a 15-year plateau, and were only of the
and Krey [B7] have contended that the suggested low- acute and myeloid types. consistent with what is known
dose area in northern Utah actually received higher from other studies of radiation-induced leukaemias
mean doses. so that the gradient in risk described by in children. There was also a consistent nation-wide
Lyon et al. [L3], even if correct. does not correspond pattern of these types of childhood leukaemias, and
to exposure. Johnson [J2] used a large interview study no other exposures to radiation or other agents
of Utah Mormon families to argue for a very large could be identified by the author to account for
this. The estimated risk coefficient was 6.46 0.16+ host factors, specifically the endocrine and cell pro-
excess leukaemia deaths per lo4 PYGy. The author liferation status of the exposed breast tissue. modify
reviews other data on childhood leukaemia. arguing the susceptibility and latency of radiogenic breast
that his risk estimates are consistent with those, cancer [B6. H6, T6]. Data on age at exposure are
further supporting a fallout-related explanation. available from women receiving chest fluoroscopies
for pneumothorax monitoring in New York [L6. S I],
238. Recently, two preliminary surveys of the fre- Massachusetts [D8] and Canada [H6]: from women
quency of cancer among young people living near treated for mastitis in Massachusetts [B3. L6]; from
nuclear power installations in the United Kingdom, women treated for benign breast disease in Sweden
specifically at Dounreay and Sellafield, reported an [B8]. and from atomic bomb survivors [TI. T6].
increase in leukaemia [G 19. H261. Since the estimated
radiation doses in the vicinity of these plants seem too 241. These data consistently disclose a declining
low to account for the increase, other studies were relative risk of cancer with increasing age at exposure.
initiated. One of these addressed the situation at and a markedly high relative risk for exposure in
Dounreay [D23]. These authors conclude that their adolescence and young adulthood. For individuals
findings weigh heavily against the hypothesis that the
under age 25 at exposure. there is a latency period of
increase had been due to radioactive discharges from at least 15 years, and excess risk persists for 40 years
the plants, unless the doses to the stem cells from or more [H6]. A linear model gave the best fit in the
which childhood leukaemia originates have been grossly Japanese [T6], New York, and Massachusetts series
underestimated. Cook-Mozaffari and her associates [H6], but a quadratic model fir better in a combined
have undertaken a far more comprehensive study of
analysis of the Canadian fluoroscopy data [H6]. Except
mortality in the years 1959-1980 in the vicinity of all
in the case of the Japanese study. the young women
of the nuclear installations in England and Wales
ordinarily received courses of treatment involving
[C 191. Their findings are succinctly summarized in
several ( I - 10) exposures and a total of about 1.5-2.5 Gy
[F14). Briefly, there was no evidence of a general to the breast. With the possible exception of a large
increase in cancer mortality near nuclear installations
Canadian study (to be discussed later. in the section
in the 22-year period. Leukaemia in the age group
on adult breast exposures), the evidence does not
0-24 years may be an exception, however: standardized
document a fractionation effect [B6]. The absolute
mortality rates for lymphoid leukaemia increased with
risk is in the range 3-8 additional cases per l V PYGy
increasing proximity to an installation. In Local [B6. T6] based on a linear model. with higher values
Authority Areas where at least two thirds of the
having been found in women who were younger at the
population resided within six miles of an installation, time of exposure. Women irradiated at the time of
relative risks were invariably greater than I, ranging
their first pregnancies were especially vulnerable [B6].
from 1.12 (British Nuclear Fuels Limited, Capenhurst,
Because the Japanese women who were less than
not statistically significant) to 3.95 (Amersham, statis-
15 years old at the time of the bombing are only now
tically significant at the 5% level on a one-sided test),
reaching the ages when breast cancer becomes most
a s compared with Local Authority Areas not in the
conlmon, it is not yet possible to derive satisfactory
vicinity of nuclear installations and selected to have a
lifetime dose-response estimates.
similar urban-rural status and population size.
239. Over all installations. the relative risk for 242. Several major findings have recently emerged
leukaemia within the six mile distance was 2.0. Since from Japan [P15, T6]. In corroboration of the studies
the individual exposures are unknown, no dose- reviewed above. an elevated risk among women aged
response estimate was possible. The investigators 10-19 at the time of exposure has been clearly
noted that it was not clear whether the effect could be shown. The relative risk for women who received I Gy
d u e t o a general confounding of other environmental when they were under the age of 19 has been
o r socio-economic factors. One of these may be the estimated to be 2.5 1 ( 20.75). compared with a relative
venting of pesticides into the air when the cooling risk of 1.45 (f0.24) for exposureover that age in the
towers were cleaned. Although it is known that the extended Life Span Study (LSS-E85) using the T65DR
subsequent risk of leukaemia among inrlividuals ex- dose estimates [P15]. At present. the data are not
posed in the first two decades of life is substantially completely consistent with respect to the level of risk
higher than among those exposed later in life, based for post-menopausal exposures, and further studies of
o n the Japanese experience and a linear dose-response the exposed cohorts are needed. The most important
model, a doubling of the risk would imply a dose of result may be the finding that women under age 10 at
hundreds of mGy which seems unlikely given present exposure exhibit an excess risk ([T6. T7, T141; see
estimates for exposures within a few miles of a nuclear Table 23). The excess is related to dose, but did not
installation. Thus, while the risk observed may be real, appear until this cohort reached the ages at which
it cannot be accounted for on the basis of the doses breast cancer normally arises, consonant with previous
received. age-onset results. These are higher relative risks than
observed in any other age group having received
(d) Exposure of rhr female breasr in childhood comparable doses. Absolute risks are high at ages
and or perimenarchial ages 10-19 [T6], though they seem roughly comparable to
ages < 10 [T13]; that is, childhood may be the peak
240. In general. radiogenic breast cancer follows the years for susceptibility. The Japanese findings are
natural age distribution for this tumour, suggesting summarized and discussed in more detail in section
that, as they d o with spontaneous breast cancer, other III.C.4 on adult exposures. Breast-tissue susceptibiliiy
below age 10 has also been seen among infants teristic patterns to the expression of that risk. Tumour
irradiated for thymus enlargement [HI91 and in types arise at ages that are typical of the spontaneous
children irradiated for other primary cancer [L 121. childhood tumours of the same sites, but exposure in
childhood also appears to generate tumours that are
typical of adults and that appear in the usual adult
3. Tissues apparently not susceptible to ages rather than in childhood. There are indications in
radiation-induced carcinogenesis the case of second tumours following retinoblastoma
treatment that a multiplicative projection model may
243. There is accumulating evidence that certain apply. as i t does in the case of most adult tumours;
tissues, generally those involving non-proliferating data from other sources are at present still too sparse
cells, are relatively non-susceptible to radiation-induced to reach any general conclusions.
cancer. In children, cancer caused by radiation is
restricted commonly to the white blood cell and bone- 247. With the exception of the Japanese data. the
forming tissue and to the thyroid. Except for breast studies on childhood induction of cancer following
and perhaps stomach there are not much specific data ionizing radiation provide convincing evidence that
in regard to solid adult cancers. However, the indica- there are effects, but they do not provide risk
tions from the most recent Japanese (DS86) data coefficients useful in lifetime risk projection for adult
suggest a high general susceptibility, expressed at the tumours.
normal adult ages for carcinomas [S49]. Children
surviving irradiation to treat childhood cancers may in
coming decades reflect risk at a variety of irradiated C. TISSUE SUSCEPTIBILITY IN ADULTS
sites.
248. It is to be expected that age is a critical factor in
244. The information presently available thus suggests determining the radiation risk, since childhood is a
that if there is an effect of radiation in childhood for period of tissue generation and, for many tissues,
other sites, the result will be similar to that found in differentiation. The question is, how different is
the breast. in that excess cancers will arise at roughly susceptibility in the tissues of adults?
the same ages at which they do naturally. If this
occurs, then a variety of tissues may be shown to be 249. The bulk of our knowledge of dose-response,
susceptible to radiation in childhood, but perhaps age and projection patterns after adult exposure
without an unmistakable excess susceptibility due to comes from three studies: women treated for cervical
the young age of the exposed tissues. This would cancer, patients (mainly men) treated for ankylosing
provide an important contribution to our under- spondylitis, and the Japanese exposed to the atomic
standing of radiation carcinogenesis and of the tissue bombings. These studies will be presented in detail in
biology of epithelia. chapter V1. In this section, their results and those of
the remaining literature will be summarized in the
context of the biological issues involved.
4. Summary of exposure effects in children
250. As was seen with juvenile exposures, there may
245. In summar). the experience of children who be biological differences between tissue types of adults
have received substantial doses of ionizing radiation relevant to their radiosusceptibility. The assessment of
demonstrates the susceptibility of the thyroid, bone, radiation effects must be made in the context of the
bone marrow and the breast. The bulk of the children exposed populations that are available for investiga-
who have been successfully treated by radiation for tion. Most adult exposures occur as a result of
cancer initially presented with tumours characterized treatment for disease; such individuals may not be
by a large heritable component. From observations on biologically representative of the population at large,
some of those children who received neither radiation either because they are genetically different or because
nor chemotherapy, it can be seen that they are their disease itself changes their susceptibility to
obviously more prone to develop cancer than normal radiation. This is likely to be especially true of
children. In general, certain sites are susceptible, and individuals irradiated for the treatment of cancer
the evidence is now clear that this has to do with gene itself.
regions expressed in both the tissue involved in the
original primary tumour and in the tissue of the 25 1. Two principal sources of possible non-represen-
second tumour, particularly in the case of secondary tativeness are important in the interpretation of cancer
osteosarcomas occurring in treated retinoblastoma induction in irradiated cancer patients relative to
patients. Individuals with the hereditary form of this other adult cohorts. First, i t is known that a fraction
tumour are known to develop osteosarcomas away of any population is genetically susceptible to cancer,
from the irradiated fieid or in the absence of irradia- e.g., cancers of the colorectum and the breast. Second,
tion. There is also evidence that other relatives of most cancers are thought to result from specific
some retinoblastoma [C5, S 121and rhabdomyosarcoma environmental exposures [D13]: cancer patients may
[S50] patients are at excess risk of cancer of various not be representative of their population in terms of
types at a number of organ sites. their history of exposure to such risk factors. To the
extent that this is true, their tissues may already have
246. Current evidence, though not conclusive, suggests been partially affected by these risk factors. Comparing
that children are susceptible to the induction of most their post-irradiation experience with that of their age-
cancer types by radiation, and that there are charac- and sex-matched peers may not be an appropriate way
to estimate the effects of radiation. Evidence on this [B20]). Second tumours may also be systemic ones
point will be given later. such as leukaemias, presumably caused by a trans-
formation of the cells in exposed bone marrow.
252. There are important informative cohorts of Finally, second tumours sometimes occur at remote
adults who were initially exposed for other diseases, sites; whether such tumours could be radiogenic, e.g.,
including tuberculosis, mastitis, thyroid anomalies. due to scatter, is essentially impossible to determine.
benign gynaecological problems, conditions requiring
diagnostic x-ray examinations, and ankylosing spondy- 257. Since many cancer survivors treated by radio-
litis. It is difficult to know, however, if these patients therapy were also treated by chemotherapy. it is
are random representatives of their populations; there necessary to ascertain what portion of the second-
are indications that some, at least. are not. Their risk cancer risk is due to the chemotherapy or to an
should be compared with that of the most represen- interaction between the two modes of therapy. This
tative possible unexposed groups. can be difficult. Alkylating agents have a high
carcinogenic potency; they are delivered in large
253. Several other cohorts of individuals, in effect doses. and most of the body is exposed. Radiation is
randomly selected from their populations, have been locally delivered, in general. Interactions will be
exposed to large doses of radiation, and they are considered in chapter V.
naturally the most reliable sources of data on the
susceptibility of normal adults. They include occup- 258. In the case of leukaemia following radiotherapy
ationally exposed groups (radiologists, radium dial for lymphomas, it is presently difficult 10 differentiate
painters, miners, nuclear workers) and individuals between truly radiogenic second cancers (i.e., leukae-
exposed to nuclear testing or to the atomic bombings mias) and leukaemias that have been caused by the
in Japan. To gain information on the biological conversion of an initial lymphoma cell to leukaemic
aspects of radiogenic cancer, it must be determined if form; this has been suggested to be a normal stage in
these groups have different experiences. the natural history of lymphon~as, although some
studies reveal that it is not [e.g.. BIO]. Molecular
254. As essential as it is to consider separately the genetic methods may be able to resolve this issue if the
risk for individuals who may be susceptible to original lymphoma cells have specific genetic markers
radiation carcinogenesis and the risk for those who for which one could screen the subsequent leukaemia
are probably more representative of their population, cells.
it is equally essential to consider the risk in terms of
the nature of the tissues exposed to radiation. There 259. Only a minority of irradiated patients develop
are different tumour groups in this regard. The first is radiogenic second tumours. The relative risks are
haematopoietic tumours following irradiation of the often rather small. especially for cancer patients who
bone marrow and osteogenic tumours. The risks here are elderly and have fewer years of life during rvhich
are unique. Due to the widespread distribution of to be at risk.
active bone marrow:. such tumours have been observed
following many diffcrent exposures. The second group (a) Trearmenr for Hodgkirj 's disease
is nerve and connective tissue tumours, where tumours
that occur in normally dividing cells should be 260. One of the most intensively studied groups of
differentiated from those in non-dividing cells. The adult cancer survivors, in terms of risk of second
third and largest group of adult tumours is carcinomas cancers, is that of persons treated for Hodgkin's
of epithelial tissues, which tissues have life-long disease. While the treatment modalities varied, they
patterns of cell division and specialization. often involved radiation to affected lymph nodes. In
some patients. no other therapy (or only surgery) was
carried out, but in the majority of long-term sunlivors
1. Adults exposed to radiation for treatment of Hodgkin's disease, chemotherapeutic agents were
of primary cancers also used. The results of several studies are reviewed
here [B9, B10, Bl1, B37, C7. C8, G4, P121; [Bll] is a
255. Relatively little is known on a population basis summary of results reported to 1984.
about the risk of radiogenic second tumours in the
many adults who have been exposed to treat a 261. The most notable second cancer in these patients
primary malignancy. To date. most of the evidence is leukaemia, specifically, acute non-lymphocytic
has been derived from investigations of the conse- leukaemia (ANL), although solid lumours and other
quences of radiotherapy for cervical and ovarian leukaemias have also been observed. In the many
cancers. for Hodgkin's disease and non-Hodgkin's studies reported, the results are similar. X-ray therapy
lymphoma and for the tumours of childhood reviewed alone does not seem to be a risk factor for the
earlier. There has also been one large general study of leukaemias. and it may or may not be a risk factor for
secondary leukaemias in cancer patients. solid tumours; evidence on the latter point is conflict-
ing, and since the latency period is longer than for
256. Second tumours in adult cancer survivors may leukaemia, there may not yet be sufficient data on
take the form of local solid turnours in the irradiated long-term survivors.
field, if cell sterilization has not been excessive.
Radiogenic sarcoma has been observed to arise from 262. Boivin and O'Brien have analysed data pooled
the area of skin, or the underlying fascia, i n an from seven reports of second-cancer risk after treatment
irradiated area or even from a radiation ulcer (e.g.. for Hodgkin's disease [B37]. After radiotherapy, the
relative risk values for solid tumours were as follows: all 267. A recent study of Hodgkin's disease patients
sites. 2.2; bones and joints, 20.0; soft tissues, 18.3; non- treated with chemotherapy and radiotherapy at the
Hodgkin's lymphomas, 8.1; melanomas of the skin, 6.7; United States National Cancer Institute has been
buccal cavity and pharynx, 4.1: nervous system, 3.6; reported [B35]. As had been found in other radiogenic
respiratory system, 2.5; and digestive system, 1.8. leukaemia studies. the excess risk in this small series of
Unlike for leukaemias, no elevated risk of solid 192 patients was expressed in only a small window of
tumours was found in the chemotherapy-only group. time, in this case from three to 1 1 years. Of course, such
possibly because the studies had shorter follow-up second tumours, all acute non-lymphocytic leukaemias.
times. were only observed in survivors of the original disease;
moreover, the authors did not isolate the effects of
263, Chemotherapy has been strongly associated radiation therapy from those of chemotherapy. Two
with subsequent tumours and with the special risk of other studies appear to confirm this report [P12, T191,
acute non-lymphocytic leukaemia; combined therapy although there are reports of elevated risk in compar-
appears to lead to an increased risk based on the able groups for a period of up to 20 gears [KX].
interaction between the radiation and chemotherapy.
However. support for an excess effect of x-ray therapy 268. Recently. another indirect risk of treatment of
is weak [BI I]; the re1atil.e risk of combined therapy Hodgkin's disease has emerged. In a study of female
versus chemotherapy uithout radiotherapy was slightly, patients in Houston, Texas. United States. cervical
but not significantly. lower (125 vs. 136) in one series conditions resulting from infection by human papillo-
of patients from the United States [BIO, BII]. and mavirus were found to be considerably more prevalent
there was no interaction effect in another [C7]. than expected in a general population of the same
Briefly. there is little evidence for a radiation hazard ages. A twofold to fivefold increase in the risk of
relative to secondary acute non-lymphocytic leukaemia carcinoma in situ and of invasive carcinoma of the
in treated Hodgkin's disease patients. These data are certix and anogenital region is seen in these ufomen
summarized in Table 24. [Kg]. Although this has not been reported in other
Hodgkln's disease series, the connection is plausible
but will require longer follon-up to be ascertained
264. It is appropriate to note that effective chemo- (this study entailed a detailed retrospective review of
therapy is relatively recent and that in the past, with Papanicolaou tests of the patients over many years).
only x-ray therapy available. survival was not sufficient In an immune-suppressed individual, vulnerability to
to provide much information. Data are accumulating human papilloma virus infection appears heightened
that may permit the statistical isolation of the indepen- (paragraph 302); this infection progresses over a
dent effect of chemotherapy, but this urill not be period of years, in some individuals to carcinoma
feasible until some years at-risk have accumulated. [Kg]. I t is not possible, from the available data, to
There are no systematic dose-response data as yet. identify radiation effects independently, because most
patients received combined therapy.
265. The cumulative relative risk of acute non-
Iymphocytic leukaemia due to chemotherapy of various (b) Treatmenr for cervical cancer
types is high, sometimes in the hundreds: for other
leukaemias it is about I0 a n d for solid tumours, about 269. Cervical cancer is commonly treated by external
3-3; individuals older than 40 at treatment are at beam therapy and/or by the implantation of intra-
higher relative risk than those who ivere younger, a cavitary radium sources in the vagina and the uterus
somewhat unexpected finding [C7, G4]. The risk of for extended periods of time. In the cohorts that have
solid tumours appears to be increased about 3-1 times been studied, radiotherapy has usually involved two
by combined therapy. In a study of United States 36-hour applications of 2.6 lo9 Bq of radium. followed
patients, Boivin and Hutchinson report that the risk by 20-70 Gy from external beams delivered in 2-Gy
of a solid tumour was 1.8, relative to the expected fractions over several weeks [BIZ]. Both orthovoltage
number, for those with no intensive therapy (raising a (200-400 kV cobalt-60) and megavoltage (2-33 blV
question about the appropriateness of the expected photons from betatrons o r other devices) external
rates), 2.1 for radiation only, 1.8 for chemotherapy radiation have been used, with a typical dose being
alone, and 3.3 for combined therapy [BIO]. After a 20-70 Gy to the pelvis, delivered in fractions of several
latency period of 10 or more years, the relative risks Gy over a 4-8 week period. Risk analysis was initially
were statistically significant only in the case of the carried out by classifying the tissue sites into three
radiotherapy-only group, for whom the relative risk of groups based on general level of dose. The greatest
solid tumours was 25 (95% CI: 8.1-58.4). dose is received by the entire pelvic area and the
lateral lymph nodes; other heavily exposed organs
include the bladder, rectum, endometrium, colon,
266. A n increased risk of acute non-lymphocytic ovaries and bone. The kidney, gallbladder, stomach.
leukaemia has been seen in children treated for pancreas. and liver are exposed to an intermediate
Hodgkin's disease [T4]; however, there was no case in level of radiation. Finally, remote sites such as the
children treated with radiotherapy alone [M28]. While buccal cavity, lung, breast, brain, salivary gland a n d
it is conceivable that individuals with Hodgkin's thyroid receive little radiation. Nearby sites have doses
disease have a natural proclivity to develop leukaemia, in the tens of Gy: intermediate sites. 1-10 Gy, and
the evidence suggests that leukaemias occur after remote sites, tenths of G y [B12].
chemotherapy and in all stages of Hodgkin's disease,
but very rarely in the absence of chemotherapy [BlO, 270. The largest study of second tumours in cervical
Bl I , G4]. cancer patients is the International Radiation Study of
Cervical Cancer Patients (IRSCCP) [B 12, D9]. Over three groups. Of 5,146 second cancers. at most 5%
182.000 women from eight countries (Canada, Den- (162) were attributable to the exposure to radiation.
mark. Finland. Norway. Sweden. United Kingdom. Pelvic irradiation with high doses seemed to be
United States and Yugoslavia) have been followed from associated with some increased risk of cancer to the
the time of diagnosis of cervical cancer. Over 1.3 million exposed organs. including the bladder. rectum. bone.
person-years of observation have accumulated, includ- connective tissue, ovary. small intestine and kidney.
ing 623.798 person-years to women who were treated by The risk of bladder cancer was also increased in
irradiation and 178,243 person-years more than 10 years women with similar diseases who had not been
after irradiation. The average follow-up was 7.6 years. A irradiated; however, the relative risk increased, over
high fraction of cancers was confirmed histologically. time post-exposure. only in the irradiated group,
a n d it is believed that the participating registries were suggesting a radiation effect [B12]. The risk of cancer
able to ascertain the vast majority of cancers that of the uterine corpus was consistently below expected
occurred; data from the separate registries and details levels. Figure IV provides the probabilities (relative
of the investigation are reported most fully in [D9]. risks) and confidence intervals for various second
Since most other studies of cervical cancer have as cancers in irradiated women at least one year after
their subject the same individuals included in [D9], irradiation.
only the latter results will be reported in detail.
272. The risk of leukaemia was elevated in these
271. In addition to classifying the sites according to data. but the elevation was similar for exposed and
distance (close, intermediate or remote) from the non-exposed. The dose to the bone marrow is estimated
radiation source, the IRSCCP study divided the to have ranged between 3 and 15 Gy. and hundreds of
women into those with invasive cancer who were radiogenic leukaemias would have been expected.
treated with irradiation, those with invasive cancer However, fewer than 100 were observed. suggesting
who were treated without irradiation, and those with that cell sterilization was an important factor. The
in situ cancer of the cervix treated without irradiation. relative risk of non-lymphocytic and acute leukaemias
Relative risks for women followed more than 10 years was small. 1.4 (95% CI: 1.1-1.8). and may reflect lower
are given in Table 25 (the table contains data from levels of exposure at more remote marrow sites, where
another study. to be discussed below). Interestingly, cell sterilization was not important. In one of the
the pattern of relative risks was similar among the studies of which the IRSCCP series was composed
GLADDER
EO:X
+b
-
BREAST 0
C3tC:I 4+
C9:iNEiTIVE 7 ISSUE +
KIDtIEY I+
LUIiG 4
OESOPHAGiJC +
OVARY +
PA:JCREAS f
RECTUM 4
SHALL I N T E S T I N E
STONACH -a-
THYROID -
UTERUS f
CHRONIC LYMPHOCYTIC
LEUKAEMIA -- -
t.lULTIPLE HYELOMA
r I I I I I i
0.1 0.2 0.5 1 2 5 10 0.1 0.2 0.5 1 2 5 10
RELATIVE R I S K RELATIVE R I S K
Figure IV. Reiallve risks of malignancy at rpeclfled slter after radiotherapy for cervical cancer bared on a cohort series [El21 and a
care-control rerler [838].
[S34], doses to the marrow of about 7.8 Gy did yield a in German concentration camps during World War I I
relative risk of 2.5 for leukaemia: however, although who are now manifesting colon cancer in areas
the sample base was 25.718 women, this was not surrounded by radiogenic tissue damage [R15]. The
significant. Leukaemia was slightly elevated in the lack of excess colon cancer in cervical cancer patients
Surveillance, Epidemiology, and End Results (SEER) (at a statistically significant level) could be the result
programme patients studied in the United States by of cell sterilization [B12]; however. rectal cancer was
Curtis et al. [C8], and the relative risk of leukaemias increased in the same IARC series only among
in another large case-control study in the United irradiated women. implicating the therapy [BIZ].
States [B26] was 2.3 (95% CI: 0.2-24.4). Since non-irradiated cervical cancer patients exhibited
a risk pattern similar to that of those who were
273. To understand this apparent leukaemia deficit irradiated. other interacting factors must be suspected.
better. a case-control study of leukaemia in a sample
of the IRSCCP patients has been done [B36], using 276. There was no excess of cancer of the stomach.
individual patient records from 196 leukaemias and pancreas or kidney, all of which organs had received
750 matched controls (cervical cancer patients not intermediate doses in the IRSCCP patients. The
developing leukaemia) to estimate the doses to each of results for pancreas and kidney are not surprising,
14 skeletal components of bone marrow. Using a because in other major series these sites were not
marrow-component-weighted dose-response function, highly susceptible. However, the stomach received
the best-fitting models included a negative exponential substantial doses and would have been expected to
(cell-sterilization) term. Linear and quadratic terms, show elevated risk.
relative to the effects at low doses, could not be
distinguished statistically in this study, although the 277. For organs receiving low levels of exposure, no
latter yielded higher risk estimates at low doses and excess risk was seen other than to the lung and oral
were preferred by the authors. This suggested to the cavity. Younger as well as older irradiated women
authors that in therapeutic doses. cell killing is showed a reduced risk to the breast, for which the
responsible for the deficit in leukaemias noted above. authors offer the explanation that radiation-ablation
The risk of chronic lymphocytic leukaemia (CLL) of the ovary has a protective hormonal effect: how-
(RR = 1.03) was not elevated. but the overall relative ever, the effect was also seen in women irradiated
risk for radiogenic leukaemias was 2. l(90% Cl: 1 .O-4.3); post-menopausally [B12].
risk increased until 4 Gy, with a 0.88% excess relative
risk per 0.01 Gy, and at 1 Gy the relative risk was 278. The deficit in uterine sarcomas- is interesting.
1.88, based on the linear term of the dose-response because an excess of such tumours occurs in women
function. If the exponential term is included, the irradiated for benign gynaecologic disorders (see
relative risk at I Gy reduces to 1.7 in this study. below): the deficit in the cervical cancer group may be
Women treated over age 55 experienced no excess due to a higher proportion of the women having
risk. The difference between the relative risk in this undergone hysterectomy as part of their cervical
sample and the relative risk of 2.3 for the entire cohort cancer treatment, leaving fewer women at risk of
was attributed to increased sample sizes in the more uterine cancer [B12]. Excess risk to the uterus has
recent study [B36]. The estimated excess number of appeared in a study in China, where 8,704 women
cases per lo4 PYGy was 0.48.. treated for cervical cancer received 5.5-12 Gy to the
uterus; in this group, 12 uterine cancers occurred five
274. The authors [B36] concluded that this analysis, to 19 years after exposure [Y4].
incorporating both cell sterilization and local marrow
exposure considerations. not only explains the deficit 279. Smoking-related sites (lung, oropharynx. bladder,
in leukaemia in the IRSCCP group relative to other oesophagus) have shown elevated risk in the IRSCCP
groups receiving smaller mean doses (e.g., women series. Some excess was also seen in patients not
treated for benign gynaecologic problems and atomic irradiated. There nlay be an interaction between
bomb survivors) but also provides an estimate of the smoking and other factors to produce cervical cancer
maximum leukaemogenic effect of radiation. This is a (see section V.A).
relative risk of about 5; doses sufficient to generate
greater re!ative risk values will, by virtue of the cell 280. The IRSCCP study population has been used
sterilization effect, fail to do so. Radiotherapy was for a case-control study [B38] to provide more precise
judged to be a much weaker leukaemogen than chemo- relative risk data than is possible with the more
therapy. heterogeneous total cohort. The case-control study
included 4.200 patients with second cancers for which
275. For unknown reasons, colon cancer occurred at histological confirmation was possible and 10,200
similar rates in irradiated and non-irradiated women. matched controls (patients without second cancers).
This was unexpected, since other studies (e.g., [ D l I] These relative risk values and estimated excess cases
and [S3]) have found evidence for radiogenic colon per lo4 PYGy are shown in Table 26 [B38]. Details of
cancer, and the rapidly dividing cells of the mucosa of the dose-response patterns are provided in the original
the colon should be susceptible to radiation. However, study [B38] but are too extensive to be given here; the
a study of Swedish patients, while revealing excess results are broadly consistent with the fullcohort
cancers of the bladder, endometrium. ovaries. and study [B12, D9].
rectum, also did not find an excess of colon cancer
relative to the general Swedish population [P17]. On 281. In the case-control study of the same series
the other hand, there is a report of teenagers sterilized [B38] it was found that the dose-response pattern
increased with dose, even for high doses, for most nine years of follow-up, but there were no tlme
pelvic organs other than the colon. Indeed. rectal, patterns. The relative risk values were roughly constant
bladder, uterine, vaginal and ovarian cancers all from two to 9+ years, which is too soon after
showed dose-response increases up through doses in exposure to draw meaningful conclusions about pro-
excess of 100 Gy. These tissues should also have jection effects. Dose information was not available.
experienced a cell-killing effect, as indicated for the
colon, and the fact that they did not casts some doubt 286. In one of the groups, the non-irradiated patients
o n the explanation of the lack of colorectal cancer had a relative risk of 0.3 of developing leukaemia, but
excess in this series. irradiated patients had a corresponding risk of only
1.3 (not significant); however. in the other group, who
282. Figure IV presents comparisons of the relative had been given chemotherapy only, the relative risk
risks based on both the whole cohort and the case- was a significant 9.3 (95% CI: 5.2-15.3). In 1,399
control analyses of the cervical cancer series. There ovarian cancer patients, Greene [G3] evaluated the
are some substantial, difficult to explain differences. risk of subsequent acute non-lymphocytic leukaemia
highlighting the importance of using appropriate as a function of treatment. In women treated by
control o r referent data. radiation alone. no acute non-lymphocytic leukaemia
occurred; in those treated with both radiation and
283. A prospective study in Japan of 1,572 women chemotherapy, the relative risk was not different from
treated with radiotherapy for cervical cancer (1,478 that in women treated with chemotherapy alone
cases) and ovarian cancer (94 cases) revealed eight (combined therapy: RR = 120.95% CI: 44-261: chemo-
cases of leukaemia (five non-lymphocytic, one acute therapy: RR = 100. 95% '01: 37-218) [G3].
monocytic, and two chronic myeloid leukaemias)
where 0.45 would have been expected, based on the 287. Greene also reported an excess of colon, but
rates for the general population [M26]. The period of not rectal, cancer after at least five years of follow-up,
follow-up ranged from six to 20 years. The relative whereas, as noted above. in the cervical cancer group,
risk was 11.2. The average mean marrow dose was rectal cancer was significantly elevated but colon
1.2 Gy, and the absolute risk coefficient was 0.45 cancer was not.
excess cases per lo4 PYGy to the bone marrow. Four
of these individuals were in a high-dose-rate group 288. Lymphoma and bladder cancer were increased
treated with both a linear accelerator and remote only in the- irradiated group. No excess of leukaemia
afterloading using radium, and a fifth had been occurred in one of the series: however, in the other.
treated with the linear accelerator alone. there was a total excess of leukaemias (acute non-
lymphocytic leukaemias), with RR = 171.4. Most of
284. In a subsequently published series from Japan these cases had received radiotherapy. but all had also
of 19,384 women with uterine carcinoma of whom received chemotherapy. This study [G3] was the first
12,729 had been given either radiation alone (4,310) or report to raise the possibility of a causal role for
radiation combined with surgery (8,419), statistically radiation in bladder cancer and in lymphomas in
significant increases in leukaemia and cancer of the ovarian cancer patients.
rectum were observed [A14]. The relative risks were
3.9 and 2.9, respectively. 289. Another large study (9,726 cases) from the
United States [C8] found the following relative risks
(c) Treatnzent for ovarian cancer of leukaemia: 10 for radiotherapy with no known
chemotherapy and 9.5 for chemotherapy, both signi-
285. Two groups of patients from the United States ficant at the 1% level. When only acute non-lymphocytic
initially affected with ovarian cancer have been leukaemia was considered, these relative risks were even
studied by Reimer et al. [RI I]. In all. 45.903 person- higher (2 1.1 and 22.2, respectively). These results are
years of risk were observed, with a mean initial age of not consistent with the minimal radiation effects in the
56 years. Patients had been given varying treatments. absence of chemotherapy in other studies described
There was a n overall relative risk of cancer of 1.4; the earlier, and there is at present no clear explanation
relative risk was 1.5 in the irradiated patients and 1.1 for the difference. However. chemotherapy is used
in non-irradiated patients. Sites included the endo- increasingly t o treat ovarian cancer and radiotherapy
metrium, colon. bladder, breast and haematopoietic decreasingly; therefore, the estimation of the cancer
system. In the first two years of follow-up, the risk risk from radiotherapy may be more relevant to
was greatest for endometrial cancer. Since the rates of radiobiology than to practical problems in human
hysterectomy were not known for the computation of health. The Japanese investigation of cervical cancer,
expected and observed rates, this finding may be cited earlier, reported an excess of leukaemia in a
spurious. However, the uterine corpus of post-meno- population of 1,572. of whom 94 had ovarian cancer
pausal women is known to be susceptible to rapid [h126]; whether this suggests a special risk only, o r
carcinogenesis after the administration of exogenous mainly, in the small subset cannot be determined
hormones (e.g. [S29]). Reimer et al. found a non- adequately.
significant excess of breast cancer, raising the possibility
that other hormonal or therapeutic factors interacting (d) Trearmenr for breast cancer
with treatment may be involved. Their data are
summarized in Table 27. Values given in the table are 290. In a series of second breast cancers in women
relative risks. The study reported relative risks after irradiated for a primary cancer of the breast, Hankey
less than two years, 2-4 years, 5-9 years and more than et al. [HI31 found no significant evidence of a
radiogenic risk to the second breast (from scatter) but 294. A small number of the survivors of the atomic
did find a relative risk of 3.2 for all second primary bombing of Hiroshima and Nagasaki have developed
breast cancers, when compared to the overall popula- more than one primary cancer [M 16, R6]. Specifically,
tion. For breast cancer patients treated only with three women have been identified, all of whom
surgery, the relative risk was 1.2-1.4, perhaps reflecting initially had breast cancer and subsequently developed
a generally elevated susceptibility of patients with a a second malignancy. All had undergone radiotherapy.
primary breast cancer. This study involved a five-year Two developed acute granulocytic leukaemia, one
follow-up of 27,175 patients in the state of Connecticut. four years after radiotherapy and the other eight years
United States. In a comprehensive study of the after; their estimated atomic bomb doses (T65DR)
Connecticut Tumor Registry for the period 1935-1982. were 5.94 and 3.64 Gy, respectively. The third woman
Harvey and Brinton [H20] found the relative risk of a (atomic bomb dose 0.31 Gy) developed cancer of the
second tumour to be 2.0 (95% CI: 1.9-2.1), compared lung beneath the treated breast some eleven years after
to 1.5 (9% CI: 1.5-1.6) for women treated without radiotherapy. While it is probable that the carcinoma
radiation; 20 years after irradiation the two risks of the lung was radiotherapeutic in origin, it is moot
became equal (at RR = 1.7, based on the Connecticut whether the two cases of leukaemia were attributable
population). The relative risk for a second breast to the therapy or to the atomic bomb exposure.
cancer was 3.9 for irradiated and 2.8 for non- However, the time that intervened between first and
irradiated patients. Relative risk values for other second malignancy was in both cases consistent with a
second tumours are given in Table 28; the treatment radiotherapeutic origin, and the treatment doses had
data refer only to initial treatment, and there may be been high.
some false negatives. Note that an excess of chronic
lymphocytic leukaemia was reported; this is not 295. A study undertaken in the United States of
thought to be a radiogenic tumour and suggests that 8.483 women has found a significant excess of acute
these results may confound other sources of variability. myelogenous leukaemia after irradiation for breast
cancer, but not in those not irradiated [FI 11. Many of
these cases had also received adjuvant chemotherapy.
291. Among 14,000 British women treated between
1946 and 1982, 194 developed a second tumour in the +
The post-irradiation risk was 1.29 0.5% after 10 years.
contralateral breast more than one year after the
initial diagnosis [B28]. There was no evidence for 2. Adults exposed to radiation for immune suppression
radiation induction in the second breast, based on a
comparison with a matched control group. 296. Total-body immune suppression has been induced
in numerous patients to treat leukaemia or Hodgkin's
292. In another study of initial treatment for breast disease. to prepare the patient for a bone-marrow
cancer [C8], the relative risk of leukaemia associated transplant following the eradication of leukaemia or
with surgical treatment alone was 1.0, for radiation- to prevent host-versus-graft disease in recipients of
only 1.7, and for chemotherapy alone a significant 3.8 kidney transplants. The treatment effects have been
(Table 29). The risk for radiation alone, when all types discussed above. The use of a bone-marrow transplant
of leukaemia were considered. was not significant, but to replace leukaemic immune system cells has been
the relative risk for acute non-lymphocytic leukaemia successful in up to 60% of cases with acute myeloid
alone was 3.7 (95% CI: 1.6-7.2); compared with the leukaemia, and, to date, only two second malignancies
significant RR of 6.7 (95% CI: 4.5-32.3) for acute non- have been noted [B14, L8, T83; doses range between
lymphocytic leukaemia following surgery or chemo- about 7 and 12 Gy. It is too soon to summarize the
therapy. The latency period suggested a causal effect risks associated with this treatment. for there are as
of the treatment to the authors, because the excess risk yet few surviving patients. However, one report has
did not occur until at least three years after irradiation shown a 2% risk of second malignancies. over 2-5 years,
(but, the same was true of the chemotherapy-only in individuals treated with total body irradiation [T8].
group). Patients with local disease had no excess Complicating these results is the fact that some
leukaemias. but patients with regional stage disease chemotherapy before or accompanying the irradiation
exhibited relative risks of 2.7 for all leukaemias and 5.5 has probably been given to these patients.
for acute non-lymphocytic leukaemia. The regional-
local distinction was found for chemotherapy as well as 297. Some credence is lent to these estimates of risk
radiotherapy. As this finding had not been reported in by Greene et al., who have scrutinized individuals
any previous systematic examination of breast cancer treated for non-Hodgkin's lymphoma (NHL) [G3,
patients, the authors suggest that unreported chemo- G9]. Among 517 patients, in whom marrow dose
therapy could have occurred, though there may be could be estimated, there were nine acute non-
some radiogenic effect [C8]. No dose-response data lymphocytic leukaemia cases observed where essentially
were available for these patients. none (0.08) had been expected, a relative risk of 105
(95% Cl = 48-199). This was after 2,203 person-years
293. A study of 1.359 Japanese breast cancer patients of observation. a mean age at diagnosis of 43.4 years
showed a 1.29-fold higher risk of second cancer in and an average of 4.3 years of follow-up. For total
patients without a family history of cancer. but with a nodal irradiation, the relative risk for acute non-
family history of breast cancer the relative risk was 3: lymphocytic leukaemia was 28.0, and for total-body
a radiation-associated relative risk of 1.62 was observed, irradiation, 7.0, both significant. Greene et al. found
but no increase was associated with chemotherapy suggestions of a correlation between cumulative radia-
P31. tion dose to the marrow and relative risk of subsequent
acute non-lymphocytic leukaemia, independent of leukaemia. specific to type of treatment administered
chemotherapy effects, but the numbers were small and for the primary cancers. A significant excess of
no dose-response pattern could be derived from the leukaemias in general and of acute non-lymphocytic
data. leukaemia specifically, for those patients given chemo-
therapy (Table 29). is described. Relative risks associated
298. In this study, the relative risk after combined with exposure to ionizing radiation in the absence of
chemotherapy and radiotherapy was 6.0, also signifi- chemotherapy were inconclusive: small. non-significant
cant (p < 0.05). Controlling for chemotherapy, there excesses were observed for cancers of the mouth.
was still a n increasing acute non-ly mphocytic leukaemia stomach. rectum, larynx. lung, connective tissues.
risk with increasing cumulative bone marrow radiation breast, endometrium, ovary, prostate, testis, bladder.
dose. which was significant (p < 0.005). The relative kidney and renal pelvis, and for multiple myeloma.
risk was 8.1 for doses greater than 7 Gy, compared to The excess risk of bladder cancer associated with
doses less than 7 Gy. When acute non-lymphocytic radiation for primary ovarian cancer agrees with the
leukaemia patients were compared to a fourfold larger results found in the study of ovarian cancer patients
set of non-Hodgkin's lymphoma patients without discussed above [RI I]. The overall relative risk of
subsequent acute non-lymphocytic leukaemia, a risk acute non-lymphocytic leukaemia among patients
coefficient of 0.03 additional cases of acute non- receiving neither radio- nor chemotherapy was 1.2
lymphocytic leukaemia per lo4 PYGy was estimated. (not significantly different from 1.0); the correspond-
ing risk was 2.5 with radiation and 4.5 with chemo-
299. It may be that the lower doses generally given therapy, both significant at the 1% 're~~el. All of the
t o treat non-Hodgkin's lymphoma patients had pro- elevated risk was due to acute non-lymphocytic
duced acute non-lymphocytic leukaemia, whereas the leukaemia. These patients may develop increasing
higher doses given to treat Hodgkin's patients has had relative risks with time, and solid tumours may also
a cell-killing effect and produced no acute non- arise. Studies in the Connecticut Tumor Registry
lymphocytic leu kaemia. [C14] showed an increase in leukaemia after radio-
therapy for cancers of the uterus o r ovary, but
300. These patients received total-nodal, hemi-body chemotherapy as a joint cause was not examined in
o r total-body irradiation or some combination thereof, detail.
exposing large volumes of marrow to a relatively low
a n d fractionated dose, with single doses of about 304. Although only three (3.95) of the tests shown
0.1 Gy given over a period of months and totalling a in Table 29 were significant at the 5% level. the overall
few Gy. Hodgkin's patients, by contrast, typically result (not shown) was significant at p < 0.01 in both
receive 2 Gy per day, administered over a period of
radio- and chemotherapy groups. Hence, the results
weeks and leading to a cumulative dose of tens of Gy d o not appear simply to be statistical artefacts of
[G3] with substantial cell sterilization, which may multiple testing.
explain the absence of radiogenic acute non-lymphocytic
leukaemia in them. 305. A case-control study of radiation-induced leukae-
301. Danish patients treated for Hodgkin's disease mias in cancer patients has recently been reported. based
and non-Hodgkin's lymphoma had the following on United States tumour registries from the states of
combined relative risks of developing acute non- California. Connecticut, Kansas, and Massachusetts
Iymphocytic leukaemia: 8.4 within 10 years of initial [B26]. Cases consisted of individuals with two cancers,
treatment and 8.9 thereafter [S39]. Other patients in the second being leukaemia occurring more than one
this registry developed an excess of lung cancer year after the diagnosis of the first tumour, and
(RR = 1.8). female breast cancer (RR = 2.1). and controls consisted of those with no second tumour.
bladder cancer (RR = 2.6); the Connecticut Tumor Controls were matched on sex, age at first diagnosis,
Registry did not find an excess of bladder cancer, but site of first cancer, and survival after first tumour
did confirm breast and lung cancer, along with diagnosis; matching was 2 to 1. Chronic lymphocytic
thyroid and buccal cavity cancer [C14]. leukaemia was considered separately from all other
Ieukaemias. which were pooled. This study involved
302. Patients immune-suppressed for renal transplant 166 chronic lymphocytic leukaernia second tumours.
seem, like Hodgkin's patients, to be susceptible to 232 second leukaemias. and 781 controls.
infection by human papilloma virus and hence to a
risk of cervical and related tumours [Kg, S21]. in 306. As chronic lymphocytic leukaemia has not yet
these studies, the effects of irradiation and of chemo- been shown to be a radiogenic tumour, it served as a
therapeutic immune suppression cannot be separated: data quality control. The relative risk of chronic
in any case. the effects are not dose-dependent, lymphocytic leukaenlia after radiotherapy was 0.7.
because the result is not a directly radiogenic cancer that is, there was no significant difference from unity.
but a susceptibility to cancer clearly produced by For all other leukaemias collectively. the relative risk
unrelated agents. was 1.6 for all irradiated sites and 2.4 for only trunk
sites. Both values are statistically significant. Among
specific-site cancers, those of leukaemia after breast
3. Leukaernogenesis in cancer radiotherapy generally and uterine corpus were elevated, and in this and all
other regards the results are similar to those of other
303. Curtis et al. have reported the results of a studies of radiation of active bone marrow in adults.
survey of 440.000 patients in the United States treated Results after cervical cancer were positive, with
for all types of cancer [C8]. They assessed the risk of RR = 2.3. but not significant. No dose data were
available, and no information about the nature of the 3 11. Thorotrast (thorium dioxide) is an alpha-emitter
radiation treatments was given. that was used from about 1930 through the early
1950s for a variety of diagnostic roentgenographic
307. Study of the Danish tumour registry has found purposes. Two series of European patients have been
relative risks greater than 1 for acute non-lymphocytic followed in detail and have shown an excess of
leukaemia following initial irradiation to treat for head haematopoietic tumours [K 16. M251. In one, involving
and neck cancers (RR = I . 1 ), genital cancers (RR = 1.9). 3,772 Portuguese, Danish, and German patients [M25].
female breast cancer (RR = 2.7) and lymphoma the total cumulative whole-body dose was determined,
(RR = 8.4) [S39]: with the exception of lymphomas 30 years after treatment, to have averaged 2.7 Gy
and breast cancers, for which the relative risk was 2.3. following the use of 25 ml of Thorotrast, on average.
the risk for acute non-lymphocytic leukaemia 10 years The first appearance of leukaemias was eight years
after irradiation was not significantly different from after treatment, with cases continuing at least to 1978.
1.0. If, in fact. acute granulocytic leukaernia ( A G L ) can be
308. The question of whether an interaction exists induced at all by high-LET radiation. the small
between radiation and chemotherapy in leukaemo- number of acute granulocytic leukaemia cases seen in
genesis is of importance [see also G3, G9]. The this group of patients may be an indication of cell
incidence of excess acute non-lymphocytic leukaemia sterilization having occurred. Conjectures about the
in Hodgkin's and non-Hodgkin's lymphomas is similar, dose-response relationship in this and similar instances
must be guarded. however, because of the wasted dose
implicating combined therapy or just chemotherapy
with alkylating agents. Data from ovarian cancer and the concentration of the isotopes in bone marrow.
patients, though inconsistent, suggest that chemo- The long period of excess risk expression is not
therapy is responsible. but those from non-Hodgkin's inconsistent with the results from single-exposure
patients suggest an interaction. In the non-Hodgkin's studies of radiogenic leukaemias, because the emis-
patients, whole-body or broad tissue exposure is sions in bone-resident nuclides persist indefinitely.
common, but the relative risks of acute non-lympho- 312. In another series of over 5.000 German patients
cytic leukaemia following total-body or nodal irradia- [K 161, exposures ranged from 0.5 to 4 Gy after similar
tion are both elevated (7.0 and 28.0, respectively). The Thorotrast dose levels. While the commonest resulting
results of the general study [CU] were inconclusive cancers were those in the liver (see paragraph 403).
regarding radiation but agreed with other studies in there were 27 leukaemias instead of the two that
showing a marked chemotherapeutic effect. Good would be expected. The shortest time to appearance of
dose-response data are not available from these leukaemia was five years, Most of these tumours were
general cancer-treatment surveys. reticulosarcomas.
3 13. The effects of "'ll, a beta emitter. used to treat
4. Adults exposed to radiation for treatment hyperthyroidism, d o not appear to include leukaemia
of benign conditions [H 12, H 141.
314. Radiologists who entered their profession
(a) Haenlaropoietic risslre between 1920 and 1939, had an increase in leukaemia,
309. The haemaropoietic system, or some portion of but those entering thereafter have shown no effects
it, is in the field of most radiation exposures. This [C4, M181. The doses received are difficult to estimate,
system is actively mitotic throughout life and, with its but probably range from 6 Gy for those entering in
own process of differentiation and cell division. is the 1920s to 2.4 Gy for those entering in the 1930s.
histologically distinct among tissues. I t also behaves The extended time of exposure did not reduce the risk
epidemiologically in a different manner from other below that observed after single high-dose. highdose-
tissues in regard to radiogenic cancer, in which respect rate exposures [M 181.
it is similar only to bone cancer after brief exposures
315. Some cases of leukaemia have been found in
[C4]. Despite the sometimes negative findings of the radium dial painters [C4, P191, but it is not obvious
above-mentioned studies on the effects of radio- whether there has been a significant excess. Also not
therapy to treat cancer, where doses are often high, yet established is the possibility that these individuals
the haematopoietic system is highly vulnerable to have experienced an excess of myelomas. The data are
radiation carcinogenesis. There are relevant haemato- reviewed in [RIO]. One difference between the excess
poietic data from most cohorts exposed to radiation; leukaemias associated with "'Th and the apparent
the results are remarkably homogeneous and permit a absence of leukaemia after exposure to 226Ra and
fairly unambiguous characterization of the risks. 224Ramay be the length of time that the individual is
exposed. The reasons for this difference require
3 0 Leukaemia. The bulk of our information comes further study.
from Japan and the British studies of ankyiosing
spondylitis patients. who received only short-term 316. Table 25 shows that excess leukaemias were
exposures. Before reviewing these data. the results of observed in several groups of women treated for
other exposures, in particular, those which occurred benign gynaecologic disorders [W6]. In the benign
over long time periods. will be summarized. These disease patients, the risk of leukaemia declined as
results come from Thorotrast patients. from other doses to the pelvic marrow increased. In a series from
patients given radium-224, from women exposed to Massachusetts, United States. [B 121, the latency period
radiation to treat gynaecological disorders, from was similar to that in the Japanese survivors and the
radiation workers and from radium dial painters. spondylitics; however. the numbers were quite small.
317. Detailed studies of the projection effects in and on earlier dose estimates. The pattern has
Japan will be presented in chapter VI of this Annex; persisted in recent reports from Japan [03, P6], but a
however, the T65 data on the Japanese atomic bomb thorough analysis of the revised dose estimates (DSS6)
survivors [Life Span Study (LSS)] and the British is not yet available. For all acute leukaemias pooled.
ankylosing spondylitis patients have been compared as there is a distribution of excess cases which is a
well as analysed jointly [Dl 11. based on the data function of age at time of exposure. The younger the
described in [K7,S3 I]. The relative risks for leukaemia age at exposure, the shorter the latency. These
are given in Table 30. In both studies, the first patterns have been fitted empirically to a log-normal
manifestation of excess risk occurred within five years distribution.
after exposure; the relative risk rose thereafter, and
persists for at least 40 years [S49]. I ALL FOfU4S OF LEUKAE11IA
cz
20 -
u
a 10- w 10-
->
+
4
5 -
>
c'
4
5-
2
2
W W
a P:
I I I 1 1 I 1 I 1 I I I
cZE 25- 30- 45- 55, <15 1:- 25- 35- 45- 55+
AGE AT EXPOSURE AGE AT EXPOSURE
Flgure VI. Relative rlsk of leukaemia in relation to age at exposure, tlme slnce exposure, and age at observation for the ankylosing
spondyiltls serles and for the Llle Span Study sample (T65DR doses). Lines marked wlth clrcles are lor unadjusted data. Lines
marked wlth squares are adjusted by Including a llnear trend In log (relative rlsk) with tlme slnce exposure In the model. For the
plotted polnls, tlme slnce exposure has been chosen so that the lnltlal point coincides with the unadjusted value.
[Dl11
(RR) with age at exposure, other than the excess 326. I t should be kept in mind that the point of
susceptibility in those under age 15 (children) in reference for the discussion in this section is the
J a p a n , discussed above. Darby et al. found evidence exposure of non-cancer patients in view of the
of a linear trend in log RR with time since exposure. possibility that cancer patients are more cancer-prone
so the data were analysed both including and not than the population at large. Indeed. the regular
including this trend (see figure). In neither series was pattern of effects seen in non-cancer patients is less
there evidence that the rate at which the excess risk perceptible in patients treated for cancer. In particular.
declined with time since exposure was a function of individuals irradiated for leukaemias and lymphomas
age at exposure. have not consistently manifested leukaemia as a
second radiogenic cancer [G3].
325. Relative risk is higher in the Life Span Series,
even after eliminating childhood exposures; this could 327. Mulriple myelonta. Multiple myeloma remains
be due to cell-killing in the spondylitics o r to the one of the most enigmatic candidates for the list of
effective amount of marrow exposed. The difference radiation-induced malignancies. The Japanese atomic
between acute and other leukaemias can be seen in bomb survivors have been studied in regard to
Figure VI; when adjusted for a trend in time since multiple myeloma by Ichimaru and colleagues [HS.
exposure, the pattern of relative risk for acute 121. Data were based o n 29 cases occurring in the
leukaemias differs substantially from the unadjusted period 1950- 1976. The age-standardized relative risk
pattern. The most recent spondylitis data [D21] show increased with absorbed dose in the bone marrow,
that leukaemia excess R R does not disappear completely with no differences between cities or sexes. Based on
by 25 years after exposure. the T65 doses, the excess risk estimate is 0.48 cases per
10' PYGy. As in other series, latency is 15-25 years. other childhood cancer patients. However, some of
with a long-lasting period of excess risk (at least these tissues are still growing in early childhood. and
30 years). A longer latency after younger ages at ex- it would be worthwhile to determine whether normally
posure follows a carcinoma-like pattern. The sponta- non-dividing tissue is radiosusceptible.
neous incidence of multiple myeloma increases with
about the 5-6th power of age, which is similar to the 334. In general. spontaneous adult-onset tumours in
behaviour seen for carcinomas. non-dividing tissu; appear to be very infrequent. The
most recent comprehensive reviews of radiation carcino-
328. Darby et al. [ D l l , D20] found evidence of genesis. including the UNSCEAR 1977 Report, have
elevated myeloma risk in their combined analysis. An either ignored radiogenic cancer at these sites or
increase in risk has also occurred among radiologists judged it to be rare or even absent [B6. C4]. Heavily
who entered their profession since 1930 [M18], and irradiated parts of the central nervous system, excluding
the Hanford radiation workers, as well as other the brain, in ankylosing spondylitis patients have
exposed cohorts, appear to have experienced a small manifested excess cancer, although this finding is
excess of multiple myelomas [C 10. G 12. H 161. based on only four cases (0.5 expected) in 14.000
patients. two of which may already have been present
329. Many chronically exposed occupational groups at the time of irradiation [S28. S3 I]. The spinal cord is
were reviewed by Cuzick [CIO]: nuclear workers. heavily irradiated in such patients. The paper by
radium dial painters, uranium millers and miners and Smith et al. [S31] appears to be the first substantial
radiologists. The overall relative risk is between 1.4 report suggesting that these tissues are radiosuscep-
and 2.9. Multiple myeloma was also more common in tible. In the atomic bomb survivors. there is a
radiation workers in the United Kingdom. based on a similarly elevated relative risk of cancer associated
recent study of the Sellafield nuclear workers [S54]. with heavy irradiation of the spinal cord and nerves
though not in another of the employees of the United [S23]. suggesting that the data in the spondylitics may
Kingdom Atomic Energy Authority [B22]. be reliable. he cell type of these cancers was not
given [S23. S28, S3 I].
330. Cuzick [ClO] reviewed the effects of diagnostic
and therapeutic exposures on the induction of multiple 335. Other individuals who may have received heavy
myeloma. The exposed groups included Thorotrast doses to'the central nervous system include the radium
patients. spondylitics. and groups exposed during dial painters, who did not. however, experience an
fluoroscopy or for treatment of gynaecologic dis- increase in brain tumours [RIO]. Swedish patients
orders. Results were similar: although many studies treated with '"I for hyperthyroidism exhibited only a
yielded confidence limits that included a value of 1.0, slight, non-significant excess (cell type not specified)
there was. overall, a small increase in the relative risk. [H 141. Radiation workers. including radiologists. have
about 1.6 (range 1.1-3.3). shown similar results [e.g., M18].
331. Cuzick also assessed the relative risk according 336. A case-control study in Los Angeles. California.
to type of radiation to determine if the effects of United States, of women irradiated for medical and
internal alpha-emitters (radium dial painters, Thoro- dental diagnostic purposes found a relative risk of 4.0
trast patients and nuclear workers) had been different for all forms of meningiomas after exposure under the
from those of gamma-emitters or x rays (atomic bomb age of 20 and of 2.1 for patients irradiated before
survivors, radiologists, nuclear workers. spondylitics, 1945. both of which values are statistically significant.
fluoroscopy patients and gynaecologic therapy The majority of tumours arose after age 50. The
patients). His summary is given in Table 32. Uterine authors think that there is an early age susceptibility,
cancer patients are an exception to the pattern of although these women, albeit aged less than 20, were
excess risk, and for them the risk is higher with high- not all irradiated as children [P 181.
LET internal emitters than with low-LET sources.
337. In sum, many individuals have received irradia-
332. The IRSCCP cervical cancer study [B12] found tion to considerable areas of muscle. nervous. and
only marginal support for an excess of multiple other connective tissue. The fact that tumours have
myeloma; however, the general deficit of leukaemias only rarely arisen in these areas is in general agree-
in this group, attributed to cell sterilization. may be ment with the requirement that a tissue be mitotic to
imporrant. Both leukaemias and myeloma are B-cell be radiosusceptible. If it can eventually be shown that
diseases, as are some cases of chronic lymphocytic radiation induces mitosis, or if these tumours are
leukaemia. which has never appeared to be radiation- actually in mitotic cell types (e.g., glial cells), radiation
related. may increase tumours in these tissues proportionately
(b) hbn-dividing tissue to their natural incidence. However, these tumours are
so rare naturally in adults that it is difficult to detect a
333. Many tissues in adults are con~posedof cells small increase from the available data.
that do not normally or frequently divide. These
include muscle and the neuronal tissue of the brain
and central nervous system (CNS). As reviewed
(c) Dividing non-epithelial tissue
earlier, tumours of the central nervous system are 338. While much of the nervous and connective
known to occur following exposures of the head and tissue of the body is not normally mitotic in adults,
neck in children; rhabdomyosarcoma may also occur, this is not true of all tissues. Notable exceptions are
rarely. as the second tumour in retinobiastoma or glial cells and the cells involved in the remodelling of
bone. These divide. at least in response to stress or to since the tumours are otherwise quite rare and the
demands for repair. As has already been noted, these alpha-emitters provided continuous exposures. The
tissues are radiosusceptible in childhood, and osteo- excess occurred over an extended time. from seven to
sarcomas and neuroblastomas of various kinds are 59 years. The radioisotopes z26Raand ?I6Rahave long
among the most consequential childhood tumours. half-lives (1,600 and 6.7 years. respectively) and are
removed slowly from the bone. I t is not possible to
339. The data on risk for actively dividing mesen- quantify the latency period of these tumours in ternms
chymal tissue are strongest, and clearest for cancers of of time after exposure, since the exposure was
the tissues in the periosteum, i.e.. osteosarcoma and continuous. In such individuals exposure is not
other bone cancers. Indeed, ionizing radiation is the measured in terms of Gy but in terms of Bq, the
only welldocumented risk factor for such cancers. inferred total systemic activity; however. the rota1
exposure of the bone ranged from about 0.1 to
340. There are, basically, three different kinds of 500 Gy. In 2.135 patients injected with Thorotrast,
exposure for which data on bone cancer exist: per- which contains 232Th.a long-lived alpha-emitter, there
sons exposed to bone-seeking radionuclides, internally were three bone cancers when one had been expected.
deposited, often of high-LET alpha-emitters; persons Tumours of the sinuses of the head in these individuals
exposed to high doses of external irradiation; and may be due to the presence, for appreciable amounts
adults irradiated to intermediate doses during a single of time, of radon gas (222Rn)in the sinuses [e.g.. R131.
exposure in Hiroshima and Nagasaki. Internal emitters
have been of two types, long and short half-life 344. The experience with persons exposed to short-
isotopes, with differing epidemiological results. lived alpha-emitters is different, because the exposure
can be dated and the dose and dose-response relation-
341. Individuals receiving exposure to bone-seeking ship more easily quantified. The most important
internal emitters include watch dial painters whose cohort is a group of 898 German patients given
mastoid and other cranial sinus epithelial linings were injections of 224Ra to treat ankylosing spondylitis,
exposed to radon decay products and whose bones bone tuberculosis and other diseases [M22]. These
were exposed to '26Ra and "8Ra and patients who individuals experienced an increase in osteosarcomas.
were given radioactive x-ray contrast medium (i.e., with onset from 3.5 to 25 years after the initial
Thorotrast). Underground miners, who are exposed to injection, which is very similar to the onset observed
radon gas. have not exhibited an excess of osteo- in radiogenic leukaeniias (Figure VII). Such an early
sarcomas. There is much literature on this subject onset period contrasts with the continuing occurrence
from animals (see Annex B of the UNSCEAR 1986 of bone cancer after 226Raexposure; presumably the
Report) [UI]. Osteoblasts are the most common cells shorter half-life makes the 224Raexposure more like a
of origin of osteosarcomas. The internal high-LET brief exposure. All ages were affected.
alpha-emitters, ?"Ra and 22%a, are among the best-
documented radiogenic causes of bone cancer. Radium- 345. The mean dose to these patients was 11.0 Gy in
224, a short-lived isotope, emits radiation on the surface children. administered over 11 months, and 2.05 Gy in
of the bone where the active target cells are located, adults, over six months. The distribution of induction
whereas '26Ra, a long-lived radioisotope, is distributed times was the same in adults as in children. As noted
more evenly throughout the bones, and its emissions earlier, this is not consistent with causation being a
are more effectively shielded from these cells. function of the number, or proportion. of actively
dividing cells, which should be greater in children.
342. Radiogenic osteosarcomas tend to occur in the
same locations of the skeleton in which spontaneous 346. Unlike in groups exposed to radioisotopes
osteosarcomas occur, especially near the epiphyses of having longer half-lives. there have been no sinus
rapidly growing long bones: risk is highest in the knee (paranasal, mastoid air cells) cancers in this group.
joint and lowest in the vertebrae. Even with high This may be due to the fact that the decay products of
spinal doses, there has been only a single vertebral :"Ra do not include long half-life gases [M22].
osteosarcoma in 14.000 ankylosing spondylitis patients
[E3]. Bone sarcomas have been observed in individuals 347. The RElK 111 Committee attempted to summarize
first exposed to 224Raat ages ranging from 2 to 56 years the dose-response pattern, and their table of risks
[M22]. is reproduced as Table 33. Original dose-response
patterns, developed by Rowland, were modified to
343. The effects of exposure to long-lived alpha- remove exponential terms of the form exp(-cD)
emitting radioisotopes is largely known from the because these were nunmerically close to 1.0 [C4]. Both
experience of the radium dial painters and other linear and quadratic forms have been given because it
individuals totalling about 3,000 in number; this work was judged impossible to differentiate confidently
is summarized in [R 101. An excess of osteosarcomas in anmong the models based on the available data. For
various bone and head/sinus carcinomas has been protracted exposure to alpha emissions from Z24Ra,
observed; for example, Polednak and his colleagues Mays and Spiess have estimated 200 bone sarcomas
[P19], in a study of 634 women who worked in the per lo4 PGy of average skeletal dose. They estimated a
radium dial painting industry' from 1915 to 1929, ratio of 7.5 for the effective endosteal dose to a given
observed 22 deaths from bone cancer where only 0.27 level of average skeletal dose; based on this, the risk
had been expected on the basis of age/time/cause- coefficient is 27 per lo4 PGy, as shown in the table
specific death rates for United States females. Most, if [C4, M221. As most of the risk experienced by the
not all, of these cases were probably due to radiation, series of patients given 224Rain the Federal Republic
I .... - Bone sarcomas I
YEARS A F T f R IRRAOl AT I O N
of Germany seems to have passed, this estimate the environment. In radiation exposures, unlike many
should be close to the final risk for this series [M22]. chemical exposures, the protective normal mechanisms,
Dose-response curves are difficult to conipute because such as buffering layers of mucus, are ineffective.
of the different types of radiation involved in exposed Epithelial tissues are all characterized by layers of stem
cohorts, but linearity cannot be excluded [C4]. cells, which normally divide throughout life to produce
the differentiated functional cells that are the basis of
348. Thomas and McNeill have fitted dose-response the organ systems. The number of stem cells, their
patterns for bone and head sinus cancers to a model
with cell-killing:
RR = ( I+bDc)(0.5)U'd RADIU!.1 D I A L PAINTERS
-
Y
d
353. The relative risk of skin cancer for radiologists 359. In a study of the "soft" x-rays (Grenz, or Bucky,
in the United States has been between 2.4 and 3.3 over rays) used in Sweden to treat a variety of dermatological
the past 65 years [M 181. Exposures have varied greatly conditions in 14.237 patients from 1949 to 1975.
over this period. In a series of about 2,200 children Lindelof [L 15, L 171 found a RR of 1.45, significant at
irradiated for tinea capitis. the relative risk was 7.1 the 5% level, of non-melanotic skin cancer. Malignant
[C4. Si6, S271, and a relative risk of 5.4 was found in melanonia was not elevated (RR = 1.07).
children who were thymus-irradiated [H 1 , C4]. Other
studies of skin cancer following various types of (ii) Breasr
radiotherapy have found similar results.
360. In this century, large numbers of women have
354. Table 34 provides data on the relative risk of received irradiation to the chest to treat a variety of
skin cancer among whites exposed to treat tinea medical conditions. Among these arc chest fluoros-
capitis, in terms of age at exposure and time since copy administered to follow the progress of artificial
exposure [C4]. The expected numbers of cases were pneumothorax treatment. radiotherapy for various
derived from national data from the United States; non-malignant breast disorders. including post-partum
given the unreliability of such data for skin cancer, the mastitis, and the radiation received by the atomic
excess could be attributable to closer follow-up or bomb survivors.
361. Although there are difficulties in estimating risk estimated from mortality data. Relative risk data
doses and in other aspects of these studies. risk from these four study populations are summarized in
appears consistently to increase with increasing dose Table 36. Table 37 provides details on relative, as well
and to decrease with increasing age. The bulk of the as absolute. risk differences for three of the major
information suggests that the dose-response pattern is investigations, subdivided according to age at observa-
linear, although one Canadian fluoroscopy series has tion and age at exposure; the similarities in the
obtained a better fit with a quadratic model [H6]. different data sets can be seen.
Radiogenic breast cancers occur at the same ages at
which breast cancers occur naturally: elevated risk 364. A recent case-control study of breast cancer
appears to persist throughout life, after an initial following irradiation to treat tuberculosis in Denmark
latency period. Latency is rather long (> 10 years): it has found no significant increase [S53]. U'hile the
may also vary, being an inverse function of age at study was too small to rule out an effect. it was large
exposure. I n general, cases of exposure at post- enough to confirm that other studies in the literature
menopausal ages have not been studied in numbers are not underestimating the risk. A similar negative
sufficient to allow a reliable assessment of effects. and result. and interpretation. has also been reported by
there may be a decreased susceptibility with increasing Davis et al. [D27] based on a study in blassachusetts.
age [TlJ]. However, elposed Japanese of this age Doses were smaller than in other series (0.66 Gy) and
have a relative risk of 3.1 [L6, T6. T14]. The the average age at exposure higher (28) than in other
possibility of a cohort effect, associated with the studies.
increase in breast cancer in Japan since 1945. should
be considered. As discussed earlier. it has now been 365. Acute post-partum rnastitis patients have no%
shown that exposure at ages below 10 leads to a been followed for up to 45 years. with an average
substantial risk of breast cancer. iollow-up time of 29 years [S47]. Relative to controls
and female siblings of patients. rhe R R value for
362. The details of the relative risk of breast cancer breast cancer in the irradiated breast, age- and
from incidence data collected in Hiroshima and interval-adjusted, is 3.2 (906 CI: 2.3-4.3). The risk
Nagasaki for the period 1950-1980 are summarized in increased by 40% per Gy with an essentially linear
Table 35 [T14]. .A trend of increasing susceptibility dose-response except for a diminution at doses above
with decreasing age, within a given dose level, can be 7 Gy, with no fractionation effect. A multiplicative
seen. Figure X shows the decrease in relative risk with projection model was a better fit than an additive one.
increasing age at exposure. for the 0-0.09 and the and the RR did not change with time since exposure.
0.51 Gy (T65) groups [TIJ].
366. The absolute risk in Japan has been estimated
363. The Japanese results can be compared with to be between 3.0 and 4.0 ? 0.7 cases per 104 PYGy.
those of two other studies from the United States. a with a pattern that is roughly linear and no inter-city
Massachusetts tuberculosis fluoroscopy and a Rochester difference [T9. T141. Risk coefficients in the various
series of post-partum mastitis patients [B2. C4, L6, fluoroscopy and mastiris series range from 6 to 8.5
S47]. Howe has also reported fluoroscopy data from cases per lo4 PYGy [CJ]. As previously noted, with
most provinces in Canada [H6]. Total relative risks. the exception of the Nova Scotia series, these data are
for doses from 1 to 4 Gy. are consistently between 2 consistent with a linear dose-response pattern (see
and 3, with values of 4-6 for those exposed at younger Figure XI and Table 38). The New York mastitis data
ages. At doses higher than 4 Gy, most studies have for uni-lateral breast exposure suggest that doses of
only small samples; however, the largest of these has 4-14Gy have a cell-killing effect [B2, C4. L6].
found a relative risk of 14.6 at high doses [H6]. tiowever, for bilateral breast exposure. even at higher
Incidence data from Japan suggest a corresponding doses (in some instances tens of Gy) no downturn in
relative risk of about 4 [W5], indicating perhaps that the dose-response curve was observed. The fluoroscopy
survival from breast cancer depresses the true relative series, especially in Nova Scotia. were highly frac-
AGE ATB
Figure X. Relatlve rlsk of breast cancer In atomlc bomb survivors for the 0.5
or more Gy relallve to the 0-0.09 Gy done group (T65DR kerma doses).
[TI41
MASSACHUSETTS (670)
u I , #j
0, I
& 300-
a
?
5 200-
-
m
E
U
u '00-
U
Z
-
W
a A
r-
u 0C
ibo 2b0 3b0 4b0
BREAST DOSE (Gy) tIU>!BER OF FLUOROSCOP l ES
Flgure XI. Breast cancer incidence in relation to radiation dose in atomic bomb
sunivors (T65DR doses), mastltis patients,and fluoroscopicstudies in Massachusetts
and Nova Scotla.
[B21
tionated, and this may make a difference at high 368. Two studies have examined the possibilities of
doses. Mastitis may also have its own biological synergism between several other risk factors in women
relationship to breast cancer after irradiation [L6]. irradiated for post-partum mastitis [B30. S371. These
factors include family history of breast cancer, late age
367. Besides the slight indication of non-linearity at of parity, oral contraceptive use. menopausal hormone
high doses in [S47], the other exception to a simple use and various ovarian-related factors. Women with
linear model is from a record-linkage study of data benign cystic breast disease and those irradiated at the
from nearly all of Canada. A pure quadratic model time of their first childbirth were at increased risk, but
appears to fit these data best. though a linear- other women were not.
quadratic model fits almost equally well [H6].The
departure from linearity is evident in the lower (iii) Lung
reiponse per unit dose bf women in the Canadian
369. Most of the exposures to the breast or chest
provinces other than Nova Scotia, where the doses also involve the lung, and there are several cohorts of
ranged up to much higher values [H6]. In Nova individuals who received internal exposures specifically
Scoria, the patients were examined in the anterior- to the lung. principally underground miners who
posterior position (facing the x-ray tube) whereas in inhaled radioactive radon gas. Exposures to the lung
the other provinces the patients were mainly examined from therapeutic radiation have been experienced by
in the reverse position, resulting in doses per fraction patients with ankylosing spondylitis. These and the
about 20 times smaller. The absolute risk on a linear other groups have experienced most of the kinds of
basis in the range 0-2 Gy, which contains the major exposures needed to understand the radiosusceptibility
fraction of the cancer cases, appears to be about three of the lung. In particular, the miners were exposed to
times smaller for those provinces than for Nova Scotia moderate doses of high-LET radiation over long time
alone. Based on the evident lack of excess cancer for periods, the atomic bomb survivors were exposed to a
the lower dose range (0 to 0.99 Gy) in the Canadian single dose, and the radiotherapy patients received
study as a whole [H6]. this factor would be considerably fractionated. moderate-to-large doses over a short
greater at low doses. This one series contributes the time period.
bulk of the data above 4 Gy. Howe argues that
because in other instances high-dose information is 370. There appear to be no risk differences between
relatively sparse. and because it is in the high dose males and females, after accounting for the effects of
, range that non-linearity is expected to be most smoking. Most of the available information, however,
apparent, a linear-quadratic model is the prudent comes from males; data on both sexes come primarily
model to adopt in the establishment of breast-cancer from Japan and clearly suggest no difference except
dose-response patterns [H6]. that which is due to smoking [S49].
371. Relative risks from exposures to brief external in unit risk of 1.0 per lo6 PY-WLM corresponding to
x- and gamma-irradiation are 1.2-2.0 [K7, S28, S31, 1.67 per lo4 PYGy.
W5]. In the miners, who had variable levels and
durations of exposure to inhaled alpha radiation. 375. Thomas and McXeill have fitted the dose-
because relative risks are dose- and duration-dependent response dara to additive and multiplicative models
and because there may be interaction between the for exposure to alpha-emitting radionuclides [TI 1.
exposures and smoking, this aspect of the data will be T201. Results are provided in Table 10. The models
discussed in section V.A. The mining data come from fitted were linear cell-killing models of the form (using
uranium miners in Czechoslovakia [S19, S511, the their notation)
United States [C20. I1 I. S20] and Canada [C4. G10, -
R = (a bDc)(0.5)"/*
H 15, M 191: from Swedish metal and Canadian gold where a. b, c and d are the parameters estimated from
miners [A9, D 12, E l . M19, R5, R7]: and from a few
the dose-response relationship, fitted by weighted
other reports [C4, R7, T I 1. T201. Thorotrast patients
least-squares. and R refers to both additive and
were exposed to thoron (120Rn) gas, also an alpha-
relative risk (in the case of additive risk, a was set at
emitter, as a n exhalant; these patients manifest an
0.0. and in the case of relative risk, to 1.0). The second
excess of lung cancer (40 cases vs. 34 expected) after
exponential term models cell-killing effects. .A linear
doses ranging from 0.3 to 14 G y [K16]. The smoking
dose-response is modelled by setting c = 1.0. For
habits of these patients do not differ from those of
details on the justification of this dose-response
the general population of the Federal Republic of
model. see [TI 1, T20]. Thomas and McNeill found some
Germany.
evidence of a departure from linearity in the dosc-
response patrerns of the mining data (Figure XII).
372. Radiogenic lung tumours appear preferentially
in the epithelium of the upper bronchial tree, unlike in
376. An extensive analysis of lung cancer in miners
experimental animals given radioactive inhalants o r
exposed to radon daughters has been published.
intratracheal instillation. One mechanism for the
reporting on results from four studies of six miner
upper bronchial effect of natural exposures to radon
groups in Czechoslovakia [SSI]. The lung cancer rate
daughters is the adsorption of the free-ion fraction,
increased as a function of exposure. Excess risk
that is, ions not bound to dust particles (see Annex G
appeared about 5 years after the onset of exposure.
of the UNSCEAR 1977 Report [U2]), Most data
peaked at 20 years. and. though excess persisted. it was
suggest that the cell types do not significantly differ
no longer significant after 30 years (the approximate
from those in non-radiogenic lung cancer [C4, C12,
limit of follow-up to date in these subjects). Unlike
S20].
some other studies of miners who began exposure
under age 30, there was a detectable excess risk before
373. The ages of onset of radiogenic lung cancers are
age 40. However, relative risks were higher with
similar in general t o those of spontaneous lung cancer:
greater age a t onset of exposure. The data from the
there is little evidence for excess risk before age 35
Czechoslovakian uranium miners appear to be essen-
[C4]. This suggests that the latency period is a
tially complete for group S (miners first exposed
function of age at exposure; however, not all of the
between 1948 and 1957) [S51, K281; the total lifetime
data are consistent. The minimal latency period has
risk can thus be calculated directly without the use of
usually been at least 10 years, roughly independent of
a projection model, suggesting an average lifetime risk
age at exposure in spondylitis patients and in Swedish
of approximately 4.5 10 * per WLM. Other findings
[R5] and Canadian miners [C4]. In other mine studies
of importance were: (a) a documented excess of
and in the Japanese atomic bomb survivors, latency
lung cancer at total exposures less than 50 WLM:
has been dependent on, and negatively correlated
(b) an approximately additive effect of smoking: and
with, age at exposure: early exposure has led to longer
(c) possible evidence for a cell-sterilizing effect at high
latency and, perhaps as a result of increased years at
doses for small cell lung carcinoma, but not for
risk o r increased years at observation, higher absolute
epidermoid cancers.
o r lifetime excess risks. The data from the United
States are not entirely clear. In one study of Colorado 377. Further data on the Ontario miners have also
miners (where dose rates may have been higher than become available [M40, M421. These too indicate that
elsewhere), there was a shorter latency period in the minimum latency period for appearance of excess
exposed smokers than in non-smokers, but doses may lung cancers after first exposure to high concentra-
have been overestimated due to the way in which tions of radon daughters is 5 years. not 10 years a s
exposures were sampled [C4, R5]. Moreover, the previously assumed. This conclusion is substantiated
follow-up times for individuals initially exposed at by studies of the Eldorado uranium miners in Canada
younger ages may be insufficient. Excess risk is known [H25, H3 I]. It also appears that excess lung cancers in
to persist for at least 50 years after exposure began. these uranium miners reached a maximum about
10- 15 years after first exposure and decreased towards
374. The overall data suggest that the relative zero about 20 years after last exposure [K28. M40,
biological effectiveness (RBE) of alpha-radiation to S51]. The risk coefficient derived from the Ontario
the lung relative to gamma-radiation, is 20, although miners study suggests an average lifetime risk of about
there is much uncertainty in this estimate, largely 1.7 per WLM for miners exposed to 1 W L M per
ascribable to the difficulty of converting data on year from age 20 t o 55.
WLM to absorbed doses in G y [C4]. A reference
conversion is 6 mGy per WLM for mean bronchial 378. The range of risk coefficients derived from
dose and usual conditions in mines [I 1 I]. This results various studies of uranium miners is very broad b u t is
CZECHOSLOVAKIAN URAIIIUM MINERS COLORADO PLATEAU URANIUt.1 MUERS
-
Y
ul
ci
->
Y
t
u
-I
u
a!
Y
20 - **..* 0 Nagasaki
- 15 -
"l
w
Y
2 10-
+
u
2
s 5-
0 I 1 I I 1 I 1 I I I
100 200 300 400 500 600 700 1 2 3 4
CUMULATIVE EXPOSURE (WLH) OOSE EQUIVALENT ( S v )
Figure XII. Lung cancer risk In five groups of miners and in atomic bomb s u ~ l v o r s
(T65DR doses).
IT111
in general compatible with the central value of about only recently begun to be estimated. Extensive indoor
10 excess cancers per 106 PY and W L M (additive risk survey results are becoming available, but there are, as
model) or ab.out a 1% increase in normal incidence (as yet, few studies of the lung cancer risks associated
suggested in ICRP 50) of lung cancer per WLM with living in such environments for long periods.
(multiplicative risk model). When applied to the adult
male population of North America, these risk coeffi- 380. In an initial study from Sweden, Svensson et al.
cients suggest an average lifetime risk of about 3 reported on a case-control study of the association
per WLM for uranium miners age 20 to 55 at the time between lung cancer and radon in houses in the area
of exposure [M40]. Recent data from those studies in around Stockholm [S52]. Study subjects had lived in
which most attention was given to reassess exposure the area for 30 years o r more. There was a statistically
data are compatible with the range of 1.5-4.5 lo-$ per significant relative risk of 2.2 (95% CI: 1.2-4.0). a n d
WLM for adult male miners. as was estimated in 4.1% of cases in this group appeared to be attributable
ICRP 32. to the exposure. There was an indication of a dose-
response pattern, with increasing cumulative exposure,
379. As mentioned briefly in chapter I, in many as seemed similar to results from miners in the United
areas of the world houses have been built with or on States and in Czechoslovakia.
materials which contain 2'6Ra from which radon gas is
released into the air of the living space. Exposure to 38 1. Other data have not shown an effect of domestic
the alpha emissions from the radon daughters is a radon daughter exposure on lung cancer. A recent study
potential risk factor for lung cancer. as demonstrated by Gjorup and Hansen [G20] compared Denmark to
in miners, but the risks from exposures in homes have Sweden. which has 2.1 times the radon exposure levels
in homes. There was no evidence for an excess of lung have already been reviewed (paragraphs 20621 6).
cancer in Sweden. Potential differences in other risk Adults have been treated with radioactive iodine for
factors. such as smoking. were not studied in this hyperthyroidism, without showing any documented
report. excess of true thvroid cancer [C4. H12. H 141. In
adults as in children. the anaplastic, and highly
382. The ICRP issued in 1987 a summary of the risks dangerous, form of thyroid cancer apparently has not
associated with exposures to radon [I1 I]. This study occurred following irradiation.
covered the existing literature in detail up to about
1986, and considers many aspects of exposure of the 387. A recent report has examined thyroid cancer in
lung to high-LET radiation. Its conclusions and adults as well as children exposed to fallout from the
lifetime risk projections are given in chapter VII. Nevada, United States. atomic test site [Z3]. No excess
was observed. and it is apparent that very large
383. The BEIR IV Committee [CZO] has recently samples would be required to detect such an excess.
issued an appraisal of the effects of radon exposure. The doses received by the Nevada population are in
This report was received too late for review by the range 0-1.5 Gy, usually below 0.4 Gy in adults.
UNSCEAR, and only a brief Secretariat review is Based on these and other data, including the risk to
considered here. The BEIR IV Report reviews all of the thyroid from external x rays. the authors estimated
the high-LET data available to it through 1987. for all the absolute excess risk to be between one and four
types of exposure, and provides extensive dose- cases per 104PYGy. The BEIR estimate was four
response modelling and statistical fitting. as well as carcinomas per lo4 PYGy, including some occult
lifetime risk projections. carcinomas [C4]. There is insufficient information on
which to base estimates of the effect of age at
384. After reviewing the literature on radon, the exposure.
BEIR IV Committee considered the best way to
obtain a single numerical estimate of the risk from 388. Two reDorts from Sweden have examined thvroid
radon exposure is with the following equation: cancer in adults and to a smaller extent in children
r(a) = r,(a) [ I + 0.025g(a)(Wl + 0.5W2)] following the administration of diagnostic amounts of
"'I which delivered doses to the thyroid gland of
where r(a) is the lung cancer mortality rate at age a;
0.5-1.5 Gy at dose rates of 2-6 mGy per hour [H27,
r,(a) is the baseline lung cancer mortality in the
H281. In the first and preliminary study [H27] the
United States 1980-1984population; g(a) is a coefficient
incidence of thyroid malignancies in about 10,000
equal to 1.2 for ages less than 55 years. 1.0 for ages patients receiving typical administrations of Z MBq was
55-64 vears, and 0.4 for ages 65 years and over; W , is
compared with the expected number of malignancies
the cumulative radiation exposure in WLM from five
computed from the age- and sex-specific incidence in the
to 15 years before age a: and W, is the cumulative
Swedish Cancer Registry. Eight cases were found in the
exposure 15 years or more before age a. This is a
patients after a follow-up of 17 years compared with 8.3
relative risk model which accounts for age at risk.
expected. The authors estimated that an excess of at
least 16 would be expected based on risk estimates for
385. The BEIR IV Committee [CZO] considered only
adults in the ~ a ~ a n eatomic
se bomb survivor population
occupational data. On the assumption that the occu-
(external acute low-LET irradiation). This study was
pational results can be applied to radon exposures in
analysed further in a report of the United States
houses. BEIR IV estimated that 1 WLM per year
would increase the number of lung cancer deaths in National Council on Radiation Protection and Measure-
ments [N5] which concluded that a risk reduction factor
both sexes by a factor of 1.5 with current patterns of
cigarette smoking. Occupational exposures to 4 WLM of at least 3 was applicable to iodine-131 irradiation
compared with high dose rate external irradiation.
per year from ages 20-40 were estimated to increase
Another review of this study is contained in the
the male lung cancer deaths by a factor of 1.6, most of
UNSCEAR 1986 Report [U I] which points out several
the cases being in smokers. Note, however. that the
factors which might account for the failure to observe
exposure estimates for two of the studies used for the
the predicted excess.
calculations done by the BEIR IV Committee. notably
the Beaverlodge data [H25] and Swedish iron miners
[R5], have been questioned by Frost, and Swent and 389. The above study has recently been expanded
[H28] to 35.000 patients receiving diagnostic '"I
Chambers (see [C20]). I t has also been argued that a
administrations with a mean absorbed dose of 0.5 Gy.
large part of the difference in risk estimates for the
followed for an average of 20 years. Again the
general population is due to differences in the assumed
incidence of thyroid malignancies was compared with
lung cancer rates in the reference populations rather
than to differences in the risk coefficients in BEIR IV the expectation based on Swedish Cancer Registry
[C20] and ICRP 50 [I1 I]. The BEIR IV Committee data. Record linkage identified 50 thyroid cancers
modelled the smoking data as interacting multiplica- occurring 5 or more years after the initial "'1
tively with radiation, but acknowledged that a sub- administration compared to 39.4 expected based on
multiplicative (but not additive or sub-additive) model general population rates. Patients who were examined
was consistent with the existing data. for a suspected thyroid tumour received the highest
doses and were at the highest risk. Patients given "'1
for other reasons were not at increased risk and
neither were those who were observed for 10 years or
386. The best data on thyroid cancer are from more. An expected excess of 41 thyroid cancer cases
children irradiated for a variety of conditions: these was computed from the age- and sex-specific risk
coefficients estimated by the United States National namely, the atomic bomb survivors. the ankylosing
Institutes of Health, Committee on Radioepidemio- spondylitis patients and women irradiated for malignant
logic Tables for external high dose rate irradiation by and benign gynaecologic disorders.
x or gamma rays [U4]. The authors concluded that the
thyroid cancer risk from irradiation of the thyroid 394. For many years i t had been thought that some
gland by I3'l might be up to four times lower than organs were relatively insusceptible to radiation carcino-
with acute external low-LET radiation. genesis. This notion stemmed from the lack of evidence
for a statistically significant excess risk or to the low
390. An excess of thyroid cancer has occurred in background risk of the malignancy itself. I t now
Japan [C4]. The approximate estimate for both cities, appears that most (indeed, probably all) organs arc
based on T65 doses, is 0.92 male and 2.40 female cases vulnerable to radiation-induced cancer. given the right
per lo4 PYGy [C4]. Relative risks have been about 4, conditions of exposure. In Japan, data still do not
with the excess appearing 15 years after the bombing support an excess risk or dose-response for cancers of
and persisting thereafter: whether risk has begun to the buccal cavity, rectum, pancreas, small intestine,
decline is not certain. Generally, the adult pattern is uterus or malignant lymphoma [P15]. These sites may
similar to the pattern in children. with latency and achieve significance as the exposed cohort passes
subsequent risk behaving as they do for other adult through the years of greatest background risk. since in
epithelial tumours. Despite the difference in the the last decade several sites not previously thought to
absolute risk of spontaneous thyroid cancer between be affected have shown a dose-response relationship.
males and females, the 3: 1 female to male case ratio is In patients irradiated for benign gynaecologic dis-
about the same as that in the unexposed population. orders, tumours of the buccal cavity. as well as of the
kidney and urinary bladder, have relative risks of
391. A recent summary of thyroid cancer risks issued about 2, which are comparable to the relative risk in
by the National Council of Radiation Protection and high-exposure Japanese (> 1 Gy) [WS] and in spondy-
Measurements [N5] expressed risk as follows: litics (average exposure 2 Gy).
Risk=RXFXSXAXYXL
395. In their comparison of the data from Japan and
where R is the absolute risk per lo4 PYGy for both the spondylitis patients, Darby, Nakashima and Kato
sexes in ethnically similar populations of children have suggested that there may no longer be any truly
exposed to external x-irradiation after a minimum radio-insusceptible epithelial tissues. This opinion is
induction period of five years. For the United States set forth in [Dl 11 and [D20]; the latter contains the
population, based on estimates derived from externally data on which the computations were based. Their
irradiated children, the report [N5] takes this value to conclusion was arrived at only when the data from the
be 2.5. F is a dose-effectiveness factor equal to 1.0 for two groups were combined and analysed jointly,
external x- or gamma-irradiation and for '321,I3'I and increasing the sample sizes sufficiently to show sta-
'"I and equal to 113 for ']'I and IZSI.S is a sex- tistically significant excesses. A summary of the risks
correction factor equal to 4/3 for females and 2/3 for based on this joint analysis is given in Table 40. For
males, assuming that females are twice as susceptible example, gallbladder cancer was significantly more
as males and that the value R is based on populations frequent than expected in the combined series than in
comprising equal numbers of males and females. A is either series alone. Darby et al. also described an
an age-susceptibility correction factor equal to 1 for excess of central nervous system tumours in their
exposure at ages under 18 and 1/2 for exposure at combined analysis, but see [P15]. This joint analysis
older ages. (If sex-specific R values are used, then will be referred to in the following paragraphs.
S = 1.0). Y is the average number of years of post- However, it should be noted that these estimates.
exposure risk in the group being evaluated. L is while they are the only joint estimates currently
lethality, equal to 0.10, assuming that only 1 case in 10 available and the only estimates based on a sample
is lethal (this factor is to be used only when estimating size large enough to detect significance for some sites,
the lifetime deaths due to radiogenic thyroid cancer). are based on obsolete doses and a shorter follow-up
than is now available. The estimates have been revised
392. The risk can be calculated for any study group recently. and while no new joint analysis is available.
using this formula. As an example. Table 39 provides the revisions will not reduce the qualitative evidence
risk estimates for an exposed United States population for excess risk at the sites reported by Darby et al.
[N5]. The report of the National Council on Radiation
Protection and Measurements compared absolute and 396. In addition to the cervical cancer patients.
relative risk models and found little difference in several other cohorts totalling about 14,000 women
lifetime estimates. This model was also tested against exposed to pelvic irradiation for a variety of benign
the Marshallese data, from which direct estimates of gynaecologic conditions have been followed [B6, C4,
risk are not reliable, and it gave an adequate fit [N5]. S3. W6]. While these women add information on
epithelial sites, they also pose further questions and
(9 Orher epirhelial tissues
uncertainties. Relative risk data for them were pre-
393. The literature on lung, breast, and thyroid sented in Table 25. Both radium and x-ray treatments
cancers has been reviewed separately because, of all were involved [B12, D9], and the exposures were
epithelial cancers, these are the ones for which the best external, low-LET ( x ray) and internal, high-LET
data are available. There are, however, many other [W6]. Doses ordinarily ranged from 20 to 70 Gy,
epithelial tissues in the body. Data on cancer in these given in fractions of a few Gy over periods of
tissues come mainly from three groups of individuals; 4-8 weeks [B 121.
397. In women treated for benign disorders. uterine 399. In their analysis of the Life Span Study data for
sarcomas were increased about eightfold and female the years 1950-1978. Kato and Schull [K7] concluded
genital and urinary organ tumours about twofold. that the mortality experience of this cohort supported
Exposure to radiation may lead to relatively advanced. a relative risk model more strongly than the additive
aggressive uterine tumours when the original reason one. This assessment has been further supported by
for pelvic irradiation is 10 treat a malignant, rather the more formal adoption of the relative risk model in
than a benign, condition [M35]. An elevated risk of the Life Span Study Reports 10 and I I [P15, S39].
uterine sarcomas was seen in one ovarian cancer series Muirhead and Darby reached similar conclusions
[RI I ] but not in another [C8] nor in the cervical [h136, M371. The excess deaths from all cancers other
cancer series [ B 121. than leukaemia and bone cancer increase with age at
death for the same age cohort in proportion to the
398. The joint analysis of [he Japanese data and age-specific death rate from cancers in the population
the spondylitis data [Dl I . D20] (see Table 40), serves of all Japan and do not show a constant excess value
to summarize the available literature on a variety by age at death for the same age cohort, as predicted
of exposed sites. A multiplicative projection model by the absolute risk model.
describes the combined data reasonably well. Age-
specific relative risk is roughly constant as a function 400. Darby et al. also examined the post-exposure
of age once the latency time is over. For heavily risk for a pooled series of selected epithelial sites for
irradiated sites. both sets of data show a positive which data are available from both the spondylitis
correlation between the excess risk and the baseline series and the > I Gy group in Japan [Dl I , D201.
prevalence of the tumour (Figure XI 11). This correla- These sites. which the authors referred to as "selected
tion suggests that radiation magnifies processes already sites", include the pharynx. oesophagus, stomach,
at work multiplicatively. pancreas, larynx, lung, ovaries, skin. and bones. They
EXCESS R I S K R E L A T I V E R I S K
LIFE SPAN STUDY SAHPLE (above 1 Gy 1 0-0.09 Gy) LIFE SPAN STUDY SAMPLE (above 1 Gy 1 0-0.09 Gy)
I
Leukaemia
Lung
Breast Stomach
a
Liver
09 ~tomach
0 I I I
Lung
Y
m
20 1 Leukaernia
5 4- Leukaemi a
Ston~ach Lung
o h I I I I
0 20 40 60 80
Flgure XIII. Excess and relatlve risks 01 cancers in the Llle Span Study sample (T65DR doses) and in the ankyloslng spondylltis
series lor varlous cancer sites compared to expected population Incidence rates.
[Dl11
also found that the relative risk model describes the common in women. Most of the spondylitics were
data on the pooled sites. men; the gallbladder was given little dose in the
cervical cancer patients. There is little statistical power
401. However, the latest report from the ankylosing in the available data. although the recent report [P 151
spondylitis series [D21] differs somewhat from the from Japan estimated a small effect (relative risk at
other data in regard to epithelial cancers other than I Gy about 1.15).
colon cancer. The authors have found that 25 years
after irradiation, the RR values return approximately 407. The pancreas seems to be of uncertain sus-
t o normal, contrary to the essentially permanent effect ceptibility [Lll]. Risk cannot be assessed from the
seen in other studies. Age at irradiation did not available data, and expected rates are complicated by
significantly affect the subsequent relative risk for problems in late and sometimes difficult histologic
these tumour sites (no patients where such an effect diagnosis. In many countries pancreatic cancer is a
has been seen were under age 15). common cancer, and one might therefore expect the
evidence to be more clear-cut; this is not the case at
402. The relative risk is higher in females than males present.
in Japan for many epithelial sites (it is lower for
leukaemia). This is shown in Table 41, taken from 408. Cancer of the small intestine is generally rare,
Life Span Study 10 (T65). For oesophageal and lung and it is still difficult to know if there is a radiogenic
cancer. the difference is probably due to different effect. The data come mainly from some cervical
smoking habits. cancer patients, but, as noted earlier, both irradiated
and non-irradiated subjects had similar excesses.
403. Because differences have appeared between the Colon cancer has already been discussed in the
Japanese and spondylitis study, and the doses have context of the cervical cancer patients. where incon-
been revised, one must interpret the parallel analysis sistent results were obtained. In Japan, mortality data
of Darby et al. with caution: ow ever, the new data show an increase in the Life Span Study sample using
seem unlikely to change the support for the relative as the T65 doses [K7,PIS] and the new DS86 doses [Sag].
opposed to the absolute risk model for excess solid Only a non-significant increase was reported in the
cancer risk, even if the relative risk is found to be a spondylitics: however, a possible association between
function of sex. age at exposure. and time since spondylitis and ulcerative colitis casts doubt o n that
exposure, as suggested by Muirhead and Darby [M36, result [ D l 11. Rectal cancer seems to be a consequence
M37]. Similarly, Darby et al. used pooled data to of exposure to ionizing radiation, but a dose-response
demonstrate escess cancer risk at many sites for which pattern is not estimable and the dose may need to be
a n excess could not be documented in either study more than 1 Gy to produce a detectable effect.
alone. This is probably a reliable indicator that those
sites are susceptible to cancer from exposures to 409. Genito-rcrinarjq sysrcm. The mortality data from
ionizing radiation Japan still d o not support a dose effect for uterine o r
uterine cervis cancer. and the evidence comes almost
104. In analysing the available data on these epithelial esclusively from those women irradiated for gynaeco-
tumour sites, especiall!. those of the digestive system, a logic disorders. The only evidence of the inducibility
variety of observations are worth summarizing. of prostate cancer comes from the Nagasaki Tumour
305. Digerriv~sysrenr. Little data exist on salivary Registry; considering all cases, including those dis-
gland tunlours from Japan and the spondylitis series. covered only at autopsy, the absolute risk is 2.1 cases
partly because of the low exposure levels. Howeler, per lo4 PYGy based on a linear model [LI 1, W5].
from the essentially consistent results of eight studies This has not been confirmed. a1 least as yet, in the
of medical therapeutic exposures, Land [L 1 I] estimates mortality data [S48]. Prostate cancer is a disease of
that the absolute risk of salivary gland tumours is advancing age, and most cases are not discovered
0.26 i 0.06 cases per loJ PYGy after the first five clinic all^^ and would not be reflected in mortality data.
years post-exposure, with little evidence of an associa- Land speculates that a small radiogenic risk would be
tion between response and age at exposure. The data even less detectable in the much higher background
are summarized in Table 42. Most of these exDosures prostate cancer rate in Europeans and North Americans
are in children. including two tinea capitis series [M13, [LI I].
S161. and head and neck exposures in five studies [H 1. 410. A recent study in Japan [TZI] has shown a
54, h l l I, S15, S401, or in middle-aged women treated statistically significant dose-response pattern for both
with radioactive iodine [H?l]. In the Japanese data, malignant and benign neoplasms of the ovary, with a
dose estimation is complex. but the risk is estimated as latency period of at least 15-20 years.
0.056 2 0.036 per 104 PYGy for malignant salivary
+
gland tumours and 0.063 0.035 per 10' PYGy for
benign ones [ 0 4 , T15]. Recent data have established
the existence of a dose response for oesophageal 4 l I. Some\vhat more detail is available for liver
cancer and for stomach cancer, but it is still difficult cancer after radiation exposure. The liver had been
t o obtain accurate estimates of the lo\ver bounds of regarded as being relatively radio-insusceptible. How-
the effects [03]. el3er. the Japanese data have now revealed a slight
increase in liver cancer. H hen "not otherwise specified"
406. No single data set supports an excess for cases are included [P15, S49]. It bears mcntioning that
gallbladder cancer; the main risk factor for this very the liver is a common site of metastasis for other
rare tumour is gallstones, which are relatively rare radiation-induced cancers. e.g., those of the lung,
(but becoming more c o m n ~ o n )in Japan and more stomach and breast. and that death certificates will
commonly fail to distinguish between a primary and a 414. Data are also available from Japanese military
secondary malignancy. particularly in the absence of patients treated with Thorotrast to diagnose war
supportive pathological information. The increasing injuries [M29. M311. In these patients the risk for
use of radioisotopes for diagnostic liver scans or other hepatic cancer was 40.0 relative to a military control
radiotherapeutic purposes makes more data available group and 22.2 relative to population-based controls:
and also underscores the importance of a better the relative risk in both cases was 1.3 (not significant)
knowledge of the liver's susceptibility. The best data for other tumours, which included a variety of sites.
come from the Thorotrast patients (indeed. Thorotrast After 35-43 years. there have been 50 hepatic tumours
use was stopped in about 1955, when its liver in 254 subjects, a cumulative incidence of 19.2%.
carcinogenicity was discovered [M26]). Most cancers Based on autopsies from these individuals, the mean
caused by this agent are bile duct carcinomas. dose rate for the individuals with hepatic cancer was
hepatocellular carcinomas or angiosarcomas [C4]. estimated to have been 0.29 Gy per year. low-LET
equivalent, with a mean total dose of about 9.20 Gy
412. Thorotrast data are reviewed in [Cj], and [K18] of this high-LET exposure. after a mean 36.1-
details specifically from the Federal Republic of year latency period.
Germany series are in [K 161. The average dose to the
liver from the 25 ml of alpha-emitting substance 415. Other individuals have been exposed to alpha-
injected was about 0.25 Gy per year; about 65% of the emitters deposited in the liver. particularly =''Pu. in
amount injected was deposited in the liver. From these the case of nuclear workers. The available data d o not
exposures. the risk estimate was about 300 liver show an effect but are compatible with an effect no
cancers per lo4 PGy [C4], projecting c ~ m u l a t i \ ~risk
e greater than 10 times that of Thorotrast [CJ].
to the lifetime of the exposed cohort of individuals.
For an average of 23 years at risk beyond the first
10 years in this group, the estimated risk rate 5. Occupationally exposed adults
coefficient was 13 liver cancers per lo4 PYGy. Com-
plicating this assessment were the conceivable effects
of Thorotrast toxicity, on the one hand, and radiation- 416. As was noted earlier. studies of the effects of
produced cell sterilization, on the other. Tumours began ionizing radiation on adults exposed in the course of
to appear about 10 years after initial exposure. and their employment or military service have focused
the period of elevated risk may have extended beyond largely on radium dial painters and radiologists in the
40 years [K 161. United States and the United Kingdom or on indivi-
duals engaged in nuclear weapons research and
413. The cun~ulativeincidence of liver tumours in fabrication, in the activities of nuclear power stations,
the Federal Republic of Germany series is presented in in the maintenance and outfitting of nuclear-powered
Figure XIV, for different liver dose rates measured by naval vessels, primarily submarines. or in nuclear
x-ray film and whole-body counter assessment. Because weapons tests. The findings on the radium dial
deposited radioisotopes can be visualized and quantified painters and radiologists have been described else-
on x-ray film, the dose-response pattern has been where in this document; this section summarizes the
estimated for liver cancer. Risk as a function of time findings of one large case-control study of radiological
since exposure rises more steeply in the more heavily technicians [J5] and of the other studies of occupa-
exposed [K 161. tional, including military-service-related, exposure.
-
/
Number o f p a t i e n t s : 207
Thorotrast amount: > 20 m l
Mean dose per y e a r : 0.3 Gy
---
/ /'
Nunher of tumours: 237
Thorotrast amount: 11-20 m l
Mean dose per year: 0.18 Gy
.......Number o f turnours: 133
Thorotrast amount: 1-10 rnl
20 30
EXPOSURE TIME (years)
C . INTERACTION BETWEEN THERAPEUTIC 476. In the data on Wilms' tumour [L3], combined
MODALITIES chemo- and radiotherapy was given to four of the
nine radiation-associated second tumour patients.
473. The findings in patients given combined radia- Combined therapy did not increase the risk of cancer
tion and chemotherapy for cancers, especially adult relative to radiation therapy alone, when all cancers
cancers, were described earlier. Generally, the strongest were considered. The relative risk of chemotherapy,
effects were those of chemotherapy. and some studies among irradiated patients, was 1.02. However, if only
found no specific radiogenic effect on solid tumours tumours arising in the field of irradiation were
or on acute non-lymphocytic leukaemia (ANL), only a considered, the relative risk of chemotherapy was
chemotherapeutic effect. Some applications of radia- 1.50, significant at the 5% level. These patients
tion have probably led to intense local irradiation and received orthovoltage therapy.
cell sterilization, which may actually weaken the
combined effect of the two types of therapy. It is not
known if either the presence of disease or the method D. STATISTICAL REFLECTION
of applying the therapies affects the nature of any OF HIGH POPULATION RISKS
interaction. As reviewed above, in several adult cancer
series, the relative risk of persons who had not 477. In the parallel analysis of cancer data from
received radiotherapy was greater than 1.0. which shows ankylosing spondylitics and the Japanese series, Darby
how important it is to have proper reference groups et al. [Dl I] plotted both the relative risk and the excess
when comparing the effects of different modalities of risk of various cancers against the expected risk in the
therapy. Even if those treated with combined therapy two populations. These are shown in Figure XIII.
show greater cancer risks, if the patients do not Most of the tumours cluster in a small area on such a
represent the population at large, the inferences about graph (RR< 5: risk per lo5 and year< 25). The
the effects of therapy, including radiation, will not be points for stomach cancer. which is very prevalent in
precisely applicable to a general population of exposed Japan, and for lung cancer, which is very prevalent in
individuals. In any case. chemotherapy is commonly the United Kingdom, are among the few outliers on
part of the treatment in which radiotherapy is used, so the respective graphs. Both exhibit very low relative
that the potential effects of the latter alone cannot be risk contrasted to their population risks. It appears
readily assessed; this is particularly so in view of the that the pattern observed by Darby et al. is, with the
constantly changing therapeutic schedules and agents. exceptions of leukaemia and CNS tumours, a linear
one, with the relative risk roughly between 1.5 and 3
for all epithelial sites.
474. Gne of the most interesting sets of subjects in
which to examine the effects of combined radiation 478, Central nervous system (spinal cord and nerve)
and chemotherapy is the set made up of patients who tumours were much elevated, relative to their normally
were treated for retinoblastoma. Since, as noted rare occurrence. This is probably because these tissues
earlier, about 25% of patients with this childhood are seldom exposed to environmental mutagens (blood-
tumour have a genetic susceptibility to it and to other CNS barrier), with almost no mix of spontaneous and
cancers also, this cohort provides an opportunity to radiogenic tumours in the data sets. For leukaemias, the
examine the effects of the different therapies both relative risks were different in the two groups (about 3 in
inside and outside a well-delimited radiation field. For spondylitics and 9 in the Japanese survivors), but the
patients receiving no chemotherapy, there are good population prevalences were similar. The relative risks
baseline data. for both sites (CNS and leukaemia) were different
from the relative risks for most carcinomas. The
475. An analysis of British retinoblastoma patients explanation for this is not clear, but the discrepancy
has been reported by Draper [Dl51 (Table 43). The highlights the difference between haematopoietic and
small sample sizes and the fact that most patients epithelial tissues and perhaps serves as indirect evi-
given chemotherapy were genetic cases limited the dence for the importance of environmental risk factors
analysis to those with the genetic form of the disease. in the epidemiology of radiogenic carcinomas.
472
E. GENERAL CONSIDERATIONS ABOUT They also show that whole-population exposures may
INTERACTIONS in many ways be more informative than exposures of
selected population subsets, and that internal controls,
479. The many factors discussed in the previous rather than the whole population, may be the most
sections indicate that there are numerous ways in appropriate comparison group. In the instance of the
which radiation could have. or could appear to have, cervical cancer data, the appropriate comparison
an effect on the irradiated individual. Clearly, it is group is probably the benign gynaecologic disease
very important to ensure that the expected rates with group (to the extent that they in fact did not receive
which the risk in irradiated subjects are compared are radiation therapy themselves). The data from Hiroshima
representative of their population. The 1980 BEIR Ill and Nagasaki are as close to the ideal in this regard as
Report [C4] attempted to derive summary risk coeffi- any available.
cients of the excess cancers to be expected per
10' PYGY.
VI. SUMMARIES OF RISK ESTIMATES
480. The BEIR 111 estimates [C4] were developed by IN MAJOR COHORTS
considering all the data available. in an effon to
synthesize the information from a variety of hetero-
geneous data sets. There are, however, pitfalls in such A. STUDIES PROVIDING SUMMARY RISK
an approach. One reflection of the uncertainties ESTIMATES
surrounding the use of these estimates shows up in a
conlparison contained in one of the reports by the 483. This chapter provides overall summaries of
international group studying the risk of second cancer radiogenic cancer effects from the most comprehensive
in cervical cancer patients [B12, D9]. This comparison data sources currently available. Details from studies
showed a poor correspondence between the number of of tissue-specific exposures or susceptibilities were
excess cancers (based on the expected number of cases reviewed in chapter 111. Here, results relevant to risk
in the referent populations of the eight collaborating estimation and projection are given.
tumour registries) and the number of excess cancers
that was predicted by applying the BEIR 111 risk 484. There are only three sets of data from which
estimates [C1] to the doses and exposure times in the radiation effects can be estimated for a large variety of
cervical cancer data. The comparison is given in sites: those for the Japanese atomic bomb survivors.
Table 44. It should be remembered that the expected the ankylosing spondylitis patients and the cervical
cases were based on risk coefficients per lo4 PYGy cancer patients. In all three, the sample was large. the
derived largely from the Japanese T65 dose estimates, individuals were followed for long time periods and an
and the comparison in Table 44 is based on the essentially similar kind of exposure was received by
cervical cancer data in [B 121. many parts of the body. Each set of data has its own
characteristics. The Japanese data included internal
481. The biggest difference is in the leukaemias; the controls, as did the cervical cancer data (i.e.. patients
authors attribute this difference to cell sterilization in treated without radiation). All the data are for short-
the pelvis and hence to an overestimate of the effective term. low-LET exposures. In the spondylitics and the
dose [B12], and which their case-control study, taking cervical cancer patients, groups of tissues receiving
marrow-weighted doses and cell-sterilization inro approximately the same level of dose were analysed
account, showed to be an artefact of assuming uniform jointly; the whole-body exposures experienced in
dose to all marrow (i.e., when marrow-weighting is Japan could not, of course, be included in this
done, the discrepancy largely disappears [B36]. Dose- analysis. Only from Japan do we have effective
fractionation may also have reduced the apparent comparisons of the exposure effects in males and
relative risk per unit dose relative to that found in females. The Japanese cohorts also provide the most
other studies [B36]. However, the difference is too comprehensive data from which to estimate dose-
large to be attributed solely to that factor. In addition. response patterns.
more excesses of lung cancer have been observed than
were predicted and fewer excesses of most other 485. The most commonly used measure of the effect
cancers, notably breast, kidney and bladder. These of exposure on a given site is the number of excess
have plausible explanations which were reviewed cancer cases per 10,000 persons exposed to I Gy after
earlier (paragraphs 269-284). In general. however, it one year (10' PYGy), although some estimates count
must be emphasized that (a) cancer patients are not experience only after a five-year or 10-year latency
representative of the population at large in respect of period. The methods by which this number has been
many risk-factor exposures; (b) risk-factor exposures computed were discussed in chapter 11.
may be relevant to more than one type of cancer; and
(c) radiation itself may have direct or indirect effects 486. Summary estimates of sire-specific risk coeffi-
on the risk of cancer in other organs. Thus, to cients are available for the Life Span Study in Japan
understand the true risk associated with radiation may [K7], the Nagasaki tumour registry [WS], the ankylosing
be difficult, since good background cancer risks are spondylitis patients [S31], the BEIR 111 Report [C4]
not usually available for the special subset of indivi- and an older report from the ICRP [I9]. Land [ L l l ]
duals exposed to ionizing radiation. has collated some additional data. These risk estimates
can now be revised in the light of newer dose estimates
482. These facts stress the importance of taking and longer follow-up times. In this chapter. the latest
other environmental and host factors into account. reports available are summarized.
8. PROJECTION OF RELATIVE RISK received to treat cervical cancer. the authors have
IN THE MAJOR STUDIES analysed the joint manifestation of second primary
cancers occurring in heavily irradiated sites; that is,
1. Results from exposure to treat cervical cancer sites close to the irradiation and likely to have
received more than 1 Gy (stomach, small and large
487. For most sites, the international study of intestine, liver, gallbladder, pancreas, uterine corpus.
cervical cancer patients [B12, D9] found that the ovary, other genital organs, kidney, bladder. bone and
number of excess cancer cases was smaller, except for connective tissue). These will be referred to as heavily
the lung. than would have been predicted based on: irradiated sites. In general, the pattern observed agrees
(a) the number of person-years at risk; (b) the with what has been found in Japan and in the
expected number of cases in the appropriate registry ankylosing spondylitics [Dll]. The details of the
populations; and (c) the BEIR Committee estimates separate registries and site-by-site analysis may be
[C4] of the excess number per lo4 PYGy for the same found in [D9]; the results are summarized in [B12],
sites. This difference has already been set forth in from which the following is taken.
Table 44, at which point the question was raised of
how well the irradiated subjects typified their larger
489. The minimum latency period for the heavily
populations.
irradiated sites after cervical cancer was about 10 years:
488. Pooled heavily irradiared sites. To summarize the excess risk thereafter did not diminish for at least
the general effects of heavy irradiation such as was 30 years. Figure XV compares these exposed patients
[ EXPOSED
' 0
! 5 10 15 20 25 30+
YEARS AFTER CERVICAL CANCER TREATClENT YEARS AFTER CERVICAL CANCER TREATi4ENT
Figure XV. Rlsk of a second primary cancer occurring in or near the pelvis (close and Intermediate sltes), related
to tlme of dlagnosls of cervlcai cancer, for patients treated wlth and wlthout radlatlon. The number of cancers are
glven above the 80% confidence bars.
RELATIVE R I S K ABSOLUTE R I S K
0
20-29 30-39 40-49 50-59 60+ 20-29 30-39 40-49 50-59 6 b
AGE AT I R R A D I A T I O N (years) AGE AT I R R A D I A T I O N (years)
Flgure XVI. Relatlve and absolute rlsks for second primary cancers occurring In or near the
radlatlon field (close and Intermediate sltes), related to age st exposure, excluslve of the flrst
10 years of observation, for women treated with radlatlon. The number of cancers are given
above the 80V0 confldence Intervals.
PI21
30' 30- 30-
%ADDER EREAST COLON
10 - lo-
-Y
VI
a
x
2
a
-
w
>
I-
3
-----------------------
W
4
W
1
r a a
0.3- 5.3 -
6
O
,l. , I I I I I 0.1 I I I I I I 0. I I I I I I I
0 1 5 10 15 20 25 30+ 0 1 5 10 15 20 25 30+ 0 1 5 10 15 20 25 301
YEARS AFTER IRRADIATIM4 YEARS AFTER IRRADIATION YEARS AFTER IRRAOIATION
30' 30' 3p
KIDNEY LUNG MULT lPLE MYELOMA 2
10- Y 10- 2
2
CT
2
a a
W
I- t
a
------ -I
CL
--
11
0.3- 0.3- 0.3-
0.1 , I I
0.1 I I O.lb1 I I
0 1 5 10
1
15
I
20 2; 30+ 0 1 4 10
I
15 20
I
25
I
30+ 0 1 5
I
10
I
15 20 25
I
301
YEARS AFTER IRRADIATION YEARS AFTER IRRADIATION YEARS AFTER IRRADIATION
10 x 10-
47
-
u
>
I-
3
- -----s a - - - -- --
3-
4
w
z W
0
a
2 RECTUM
3 10
STOMACH
1
3 UTERUS
0.1 !
I 4
0.1 4, I 0.1 1 I I I I I
o ib 15 lo 2'5 jc+ 0 1 4 Ib I
15 20 $5
I
301. dll 5 10 15 20 25 301
YEARS AFTER IRRADIATION YEARS AFTER IRRADIATION YEARS AFTER IRRADIATION
Yl
"
0.1 I
0 1
5 10 15 20 25 30+
YEARS AFTER IRRADIATION
Flgure XVII. Relatlve r l s k ~of aecond cancen In women lrradlated to treat cenlcal cancer.
[B121
with non-exposed cervical cancer patients, who mani- typical of radiogenic lung cancer. The deficit of breast
fested no increased risk when all the heavily irradiated cancer is attributed to ovarian ablation by the
sites were aggregated. Many of these women were radiation, which indirectly has a protective effect.
followed for the rest of their lives (some lived into
their nineties) and i t was seen that risk apparently 495. Haemaropoieric tissue. Figure XVII shows the
continues to remain elevated during all post-irradiation overall pattern of relative risk of leukaemias following
life [B 121. irradiation. Pelvic marrow in these women received
3-15 Gy. While there was a marked deficit in leukaemias.
490. In terms of relative risk, women are more relative to the BEIR 111 estimates (see Table 44). the
sensitive if irradiated under the age of 30, but pattern of excess leukaemias matches the pattern, with
thereafter age at irradiation appears to have little regard to projection effects, that is expected for
effect for these pooled sites. Since the background risk radiogenic leukaemias (an excess beginning two to five
of cancer at these heavily irradiated sites increases years after exposure and diminishing after about
with age, the absolute risk rises with age at exposure. 20 years). The relative deficit in excess cases is attributed
This is shown in Figure XVI. The Japanese data have to local cell killing [B36]: the dose received by the
typically showed high sensitivity among those who peripheral marrow is estimated to have been < 1 Gy,
were young at the time of the bombings. a dose which is leukaemogenic. The figure also shows
the small excess of multiple myeloma and its persistent
49 1. Individual heavily irradiared sires. These same increase.
data have been analysed separately for each site [B 12.
D9]. Some of these findings are important enough to 2. Results from exposure to treat ankylosing
warrant review here. The patterns of relative risk spondylitis
following exposure at some of these sites are given in
Figure XVII. Table 26 gives the most recent relative 496, Results have recently become available that
risk values for these projection effects, pooling data summarize some of the effects seen in the patients
on all ages at exposure, based on a subset of the exposed to treat ankylosing spondylitis. The analysis
cervical cancer patients and a control group for presented here pertains only to the effects of single
comparison. courses of x-ray treatment [D21. S28. S311. The
expected numbers were derived from British national
492. Figure XVII shows that bladder cancer increased mortality statistics. Table 45 presents the relative risks
gradually with time, with a relative risk of about 3.0. for major groups of sites as a function of time since
The projection effect appears to be radiogenic. As irradiation [D21]. In these data the relative risk for
noted earlier, however, bladder cancer was among the leukaemia can be seen to rise rapidly and to persist
smoking-related sites with similar patterns in the non- beyond 25 years after exposure. The relative risks for
irradiated; but in the non-irradiated i t decreased with the other sites remained approximately constant for
time. While it is curious that rectal, but not colon, the first 25 years after exposure, with values between
cancer was elevated, the projection pattern of rectal 1.5 and 2.5, but then tended to disappear. Little effect,
cancer is clearly the kind of pattern to be expected for overall, was seen in lightly irradiated sites.
radiation-related malignancies, and i t obtained only
among irradiated patients [B 121. Endometrial cancer 497. The site-specific projection effects are given in
(corpus uteri) had a relative risk of less than 1.0; this more detail in Table 46, also from [DZI]. The authors
may be due, at least in part, to a high prevalence of found that for several sites the relative risk was
hysterectomy. The increase in the relative risk 10 years elevated as early as up to two years after exposure as
after irradiation, with a levelling off afterwards, well as from three to nine years after exposure. They
suggests a radiation effect. The marked and significant attributed this unexpectedly early appearance of excess
increase in "other genital cancers" refers mainly to an relative risk to the possibility that tumours that had
increase at the vulva, vagina, and unspecified sites; existed had been mistaken for ankylosing spondylitis.
these sites probably share risk factors (e.g., HPV and they suggested that the relative risk at six to eight
susceptibility) and may not reflect a radiogenic effect; years' post-exposure was only slightly different from
they were at elevated risk in all groups in the study. 1.0 [S31]. In their view, these data are consistent with
the Japanese and other results for solid adult tumours
493. The bladder cancer projection is typical of a in terms of the first appearance of excess risk, though
radiogenic epithelial cancer, except that it appeared in not in terms of the disappearance of excess risk after
the first 10 years after irradiation. Boice et al. [B12] 25 years.
attributed this to mis-classified cervical metastases.
After a 15-year latent period, there was no association 498. Table 47 gives the relative risk values for the
between risk and age at exposure. The high level of same series of patients as a function of their age at
risk and the increase over time suggest that more than exposure, for leukaemia and for the heavily irradiated
the confounding effects of smoking are involved sites. The relative risk for leukaemia appeared to be
[B 121. slightly lower among those exposed at under age 25
and roughly constant afterwards. but none of the
494. In terms of sites remote from the source of differences were significant. Also, the differences were
exposure, an increase in smoking-related cancers was not significant for all heavily irradiated sites combined.
found. most dramatically in the lung. The incidence
pattern (relative risk highest five to 10 years after 499. A recent study has improved the dose estimates
irradiation and no excess cases after 20 years) is not for the spondylitis patients [L 161. Earlier estimates, in
particular the BEIR I11 estimates, were very different rive in nature, and it is to be read carefully in regard
from these new values, so that summary tables of the to carcinoma risks more than 25 years after exposure.
new values are included here for reference (Tables 48
and 49). This study was based on a sample of 934 501. With these cautions in mind. Table 40 gives
patients (1/15 of the total series), for 903 of whom joint. summary relative and absolute risk values for
organ dose estimates are reported in the tables. the Life Span Study [WS] and the spondylitis patients
Estimates were based on an Oak Ridge Laboratory [S28]. This paper [ D l l ] provided some summary
program [W19] that models the process based on a statistics on projection effects, with regard t o a series
mathematically defined human phantom. I t is clear of selected sites for which results between the two data
from the tables that there was great inter-individual sets could be meaningfully compared.
variation in dose; thus, dose-response patterns from
the entire series of over 14.000 patients are not based 502. In the spondylitics. absolute risk standardized
on precise individual exposure estimates. The new for time since exposure increased rapidly with age at
dose estimates are about 19% higher than prior exposure: in the Life Span Study, there was less
estimates and very different from BEIR 111 [C4], evidence of such a trend. The result was similar for
although they are close to recent estimates by Drexler absolute risk by time since exposure standardized for
and Williams [D22]. age at exposure: a trend in the spondylitics but not in
the Japanese. For the studies t o be compared more
directly, the observed Japanese risks were standardized
3. Joint analysis of Japanese (T65D)and to the same exposure-time distributions seen in the
ankylosing spondylitis data spondylitics, aid this produced clear trends in the
data from Japan for age at exposure and time since
500. The detailed analyses of the risk effects from exposure. The joint estimate was an absolute risk of
Hiroshima and Nagasaki, based on the revised (DS86) 3 1.7 per 10' PY (SE = 8.5) for every 10-year increase
dose estimates, constitute the most important single in age at exposure, and the studies did not differ
data set on risk effects in existence. However, to significantly. In Japan, but not in the spondylitics.
augment the information from this and the large series there was a statistically significant (p < 0.05) trend in
of ankylosing spondylitis patients, Darby et al. [Dl I] time since exposure. The combined analysis showed
analysed the Japanese and spondylitis data jointly. A no significant difference ( p > 0.10). and the joint
summary of their results and of some of the basic data estimate was an average increase in absolute risk with
are presented. However. it should be noted that (a) the time since exposure of 34.0 per 1@ PY (SE = 15.7) for
data from Japan apply to the old dosimetry (T65DR): each ~ i x - ~ e time
a r period. This was significant at the
(b) the spondylitis doses have been revised [L16]; and 5% level.
(c) the spondylitis risks have been revised [D21] since
this joint analysis was prepared. Therefore, the joint 503. Relative risk results are summarized in Figure
analysis must be considered only rough and qualita- XVIII, which shows that in the ankylosing spondylitis
1 ' I 1 I I
<25 $5- 35- 45- 55+
AGE AT EXPOSURE AGE AT EXPOSURE
Figure XVIII. Relatlve risk of cancer In selected sites combined In relation to ageat exposure and timesince exposure lor theankyloslng
spondylltls serles and for the Life Span Study sample (T65DR doses).
[Dl11
patients there were no trends in relative risk for age at nated in March 1986 in a consensus system known
exposure, and only before 10 and after 22 years did as the Dosimetry System 1986 (DS86). The principal
relative risk fall below its generally flat projection differences between this system and the T65 dosimetry.
pattern: there was no evidence that these two factors the heretofore most commonly used system (see
interacted [Dl]]. The data from Hiroshima and Table 50), are as follows [R20]:
Nagasaki showed significant linear and quadratic (a) the yield of the Hiroshima weapon is now
trends in relative risk with age a t exposure (declining presumed to have been approximately 20% greater
with increasing age), and a log-linear trend in relative than had earlier been thought; that is, I5 rather
risk could be fitted to the data. The trend in relative than 12.5 kilotons:
risk with time since exposure was roughly level, both
before and after incorporating a log-linear trend in (b) although the free-in-air (FIA) gamma doses are
relative risk with age at exposure. In analysing these somewhat greater at distances of 1.4 km o r more
jointly. Darby et al. found no trend in the relative risk in Hiroshima, neutron exposures are less in both
in time since exposure; for five to 30 years after cities. and substantially so in Hiroshima, about
exposure, the relative risk remained about constant. 10% of their previously estimated value (30% in
Jointly there was a significant log-linear trend in Nagasaki). Since delayed radiation from the
relative risk for age at exposure, with the joint fireball makes a relatively greater contribution to
estimate of the trend in log ( R R ) with exposure age of the total DS86 dose. the loss or gain of shielding
-0.5 (SE = 0.13). as a result of the blast effect, particularly in the
first several seconds following the detonation of a
bomb, could substantially influence kerma in
4. Recent results from studies of the Japanese shielded areas and, ultimately, organ absorbed
exposed to the atomic bombings dose. Time-dose dependencies have not. however,
been taken into account either in this new system of
504. The Atomic Bomb Casualty Commission and dosimetry or the old;
its successor, the Radiation Effects Research Founda- (c) attenuation of the FIA gamma kerma by wooden
tion. have at various times used a variety of measures Japanese structures, houses and tenements is
of individual exposures t o the atomic bombings of approximately twice as great under the DS86 than
Hiroshima and Nagasaki. These included distance under the T65 dosimetry (the average transmission
from the hypocentre [M38]; the presence o r absence of factors under the two systems are 0.90 (T65)
the symptoms associated with acute radiation illness versus 0.46 (DS86) in Hiroshima and 0.80 versus
[NlO]; and, now, no fewer than three separate physical 0.48 in Nagasaki). However, attenuation of the
dosimetries, namely, the T57 [R 19, A171, (for an neutron kerma by such structures differs much
application of these doses, see [IIO]), the T65 [M24], less strikingly (the average transmission factors
and the new Dosimetry System 1986, or DS86 [M39. are 0.36 (T65) versus 0.31 (DS86) in Hiroshima
NI1, R20]. Each successive method of expressing and 0.41 versus 0.35 in Nagasaki);
doses has necessitated a re-estimation of the risk (d) transmission of gamma rays through tissue is
coefficients associated with the various known effects significantly higher, at least for the deeply situated
of ionizing radiation and a re-examination of the organs. than had previously been estimated [K 141.
dose-response relationships. With these changes there I t must be borne in mind, however, that in the
has emerged a better ability to estimate the risk T65 system each specific organ transmission
coefficients in terms of organ absorbed doses o r organ factor is a constant averaged over all postures.
dose equivalents rather than in terms of kerma. orientations and ages; tvhereas in the DS86system,
whether free-in-air or in-house (shielded). fixed values are not used for the proximally o r
"heavily" exposed (defined as those survivors
505. The newest system of dosimetry is an outgrowth within 1.600 m in Hiroshima and 2,000 m in
of a series of events. In 1975, Preeg of the Los .4lamos Nagasaki), where detailed exposure histories are
National Laboratory (United States) re-examined the generally available, Their organ doses reflect
gamma-ray and neutron spectra from the Hiroshima the circumstances of their individual exposures.
a n d Nagasaki atomic bombs using a one-dimensional including posture, orientation and age at the time
model and discovered that they differed considerabl! of the bombing. The increased tissue transmission
from the spectra used in calculating the T65 doses. for most organs tends t o offset, wholly o r largely,
Simple calculations based o n these spectra suggested the changes in the shielding transnlission factors;
that the T65 neutron dose was markedly overestimated (e) finally, for some 18% or so of the exposed
for Hiroshima. Subsequently, Loewe and hiendelsohn niembers of the Life Span Study cohort (largely
at the Lawrence Livermore National Laboratory individuals suryiving in concrete buildings o r
(United States) and Kerr and Pace at Oak Ridge factories), doses cannot as yet be computed, a n d
National Laboratory (United States) independently the new dosimetry improves but does not clarify
calculated the air doses at Hiroshima and Nagasaki all of the implausibly high exposures seen with
a n d reported that both the neutron and the gamma the T65 system. There remain a number of
doses differed substantially from the T65 estimates. survivors whose estimated whole-body shielded
These findings prompted a complete re-evaluation of kerma exposures exceed 4 Gy or, in some cases,
the atomic bomb radiation dosimetry (for a fuller 6 Gy. These are doses at o r above the recently
account of the events that preceded this reassessment, estimated LD95 in these cities [F13]; given the
see [R20]). The reassessment, begun jointly by the virtual obliteration of the immune system at
Governments of Japan and the United States, culmi- doses in excess of 7 or 8 Gy, survival under the
circumstances that obtained in these cities would 10%. For organ absorbed dose (Table 54). with the
be most unlikely. Better means are needed exceptions of cancer of the female breast or the ovary
to address these incongruities than the simple and other uterine adnexa, the risks are invariably
truncation of dose, since their inclusion in analyses lower with the DS86 doses and as much as 30% lower
can affect the shape of the dose-response relation- in the case of cancers of the stomach (excess relative
ship as well as estimates of its parameters [G13, risk).
G 18, 561.
5 10. Over the range of doses from 0 to 6 Gy, there is no
506. As previously seen with the T65 doses, a clearly significant evidence of non-linearity (although
statistically significant increase in the frequency of other forms of response fit the data), so from a purely
deaths with increasing dose is observed for leukaemia, statistical point of view linear risk estimates are a
cancers of the oesophagus. stomach. colon, lung, breast, reasonable summary of the dose-response. Moreover,
ovary and urinary bladder and multiple myeloma. No when linear. quadratic. and linear-quadratic models
significant increase is as yet observed for cancers of (with o r without provision for cell-killing) are fitted to
the gallbladder, pancreas, uterus and prostate o r for the data on all cancers except leukaemia and on those
malignant lymphoma. The most recent report was five sites where a clear dose-response curve had
extended to include other sites of cancer. such as previously been obtained (i.e., leukaemia, and cancers
bone, pharynx, nose and larynx, and skin except of the stomach. colon, lung and female breast). a
melanoma. but none of these sites showed a significant simple linear model fits the data on leukaemia,
dose-response relationship [S49]; however. mortality cancers of the stomach, lung and female breast, a n d
from tumours of the central nervous system other than all cancers except leukaemia better than the quadratic
the brain tends to increase with dose (0.10 > p > 0.05) model and as well as the linear-quadratic model. as
(mortality from brain tumours alone does not). judged by the deviance (that is, twice the difference in
the log likelihoods under the full model, which exactly
507. While the excess in leukaemia mortality has
fits the data, and under the model based o n the
declined with time, it none the less remained signi-
parameters that have been estimated). Inclusion of
ficantly elevated as late as 1981-1985, showing that the
cell-killing does not significantly improve the fit,
period of risk is at least 40 years rather than the
except in one instance where leukaemia mortality
commonly supposed 25. For cancers other than
under either the linear or linear-quadratic model fits
leukaemia, excess deaths continue to increase with
somewhat better with a cell-killing term. These findings
time in proportion to the natural cancer rate for the
hold true both for organ absorbed doses and shielded
attained age. and the relative risk remains unchanged
kerma.
over time for all specific age cohorts except the
youngest, i.e., 0-9 years at the time of the bombings.
511. Under the DS86 system. the neutron doses.
For the latter cohort, unlike the older ones, the time
although not wholly negligible, are so small that
from exposure to death is shortened with increasing
meaningful estimation of the neutron RBE is difficult,
dose for all cancers except leukaemia, and the relative
if not impossible. Reasonable RBE estimates cannot
risk decreases with time (Tables 5 1 and 52).
be derived directly through maximum likelihood
508. Tables 51 and 52 show the time course of excess estimation: however, some insight is possible if it is
risk in the DS86 subcohort data as a function of age assumed that the small inter-city differences that still
at and time since exposure, for relative and absolute obtain reflect differences in neutron exposures. With
excess risk, in 10-year groups. The relative risk at the DS86 organ doses. assuming an equality of excess
1 Gy changes significantly with time after exposure. relative risk between Hiroshima and Nagasaki, the
The magnitude of this change is known only over a neutron RBE for ieukaemia is 20-30; for all cancers
limited time period (about 40 years) since exposure. except leukaemia, 30 or more; and for cancers of the
stomach, lung and female breast, less than 1. Based o n
509. Tables 53 and 54 give three summar) measures an equality of excess deaths between the cities. the
of risk, namely, the excess relative risk at 1 Gy, excess neutron RBE for leukaemia or all cancers except
deaths per lo4 PYGy and the attributable risk. for all leukaemia is 30 or more; for lung cancer. 10-20; and
malignant neoplasms, leukaemia, all cancers except for cancers of the stomach and female breast, less than
leukaemia, and eight specific sites of solld tumours 1. The disparity between these estimates attests further
based on the T65 and DS86 systems. These risks were to the difficulty of deriving meaningful estimates of
derived by fitting a linear dose-response model to the the RBE with the new dose estimates for the survivors.
data from both cities, both sexes and all ages at
exposure within that subset of individuals in the Life 512. The differences between the cities are smaller
Span Study sample for whom both T65 and DS86 under the new system than under the old for all sites of
doses are presently available (some 82% of all exposed cancer, including leukaemia. and are no longer statisti-
individuals in the sample). Nore that in so far as cally significant. However, at face value, mortality in
shielded kerma is concerned (Table 53), under the Hiroshima remains higher at most doses than in
DS86 system. the excess relative risks are increased Nagasaki, for leukaemia as well as all cancers except
from 35% (stomach cancer) to as much as 53% leukaemia. This fact. when coupled with a similar
(cancer of the ovary and other uterine adnexa). For consistent tendency for other indices of radiation
excess deaths, the corresponding figures are 31% damage (such as the frequency of chromosomal
(multiple myeloma) and 61% (cancer of the ovary and aberrations, lens opacities. and epilation), suggests
other uterine adnexa). However, for no site o r group that some explanation for the small inter-city difference
of sites does the attributable risk change as much as in dose response is still necessary.
C. UNCERTAINTIES ASSOCIATED sites are lower in developing countries, so that the
WITH RISK ESTIMATES absolute excess, and perhaps even the relative risks for
the same dose, may be different. Most large popula-
513. Even after many decades of study. the un- tion exposures studied to date have occurred in
certainties that surround estimates of the carcinogenic industrialized nations; there are few data and perhaps
effects of radiation are many and fundamental. less exposure in the developing countries.
Indeed, there is still no model of the underlying
process that is clearly the correct one. The importance 519. In addition to changing baseline cancer risks
of a good theoretical model is greatest where the data and the effects of other exposures, there is uncertainty
are weakest, at low doses of low-LET radiation, so over the dose-response pattern. Most current studies
that our ability to estimate these risks is severely use a linear model for breast and thyroid cancer and a
limited. linear-quadratic model for other sites; these are the
best-available models only, for the data do not really
514. Because the majority of all cancers appear to permit the validation of a specific model with con-
have an environmental origin in the sense that fidence. It is unfortunately true that most estimates of
avoidable exposure to environmental risk factors is low-LET. low-dose effects are based on extrapolations
involved [D13], much of this Annex has dealt with the from high-dose data.
problems in risk evaluation caused by the existence of
multiple risk factors. In addition to environmental
risk factors, there are also many host factors, such as D. UNCERTAINTIES ASSOCIATED
genes. age, hormonal status, sex and the like. that WITH RISK PROJECTIONS
affect risk.
520. The many uncertainties involved in the estima-
5 15. It is probable that in any population exposed to tion of risk from observations on exposed cohorts
ionizing radiation there is variation in the exposure to have been reviewed in this Annex. The main limita-
other risk factors. At low levels of radiation. this tions may be stated as follows: (a) no single large
variation may be greater, perhaps much greater, than cohort has as yet been followed throughout its entire
the risk produced by the radiation itself. It is not lifetime, so that the lifetime effects of exposure cannot
surprising that it is difficult to estimate risk at low be empirically determined; (b) the data that are
doses or that different results are often obtained. The available are most incomplete for those who were
methods used to estimate confidence intervals tacitly young at exposure: these individuals have not reached
assume that all exposed individuals in a given category an advanced enough age for the bulk of their risk to
(e.g., age. sex or dose) have equal risk. which seems be expressed, yet their lifetime risks may be the
unlikely to be true. greatest; and (c) there are not now, and for the
foreseeable future will not be, sufficient data on low
516. The most important documented other risk doses to allow useful risk estimation.
factor is smoking. Another source of bias is the
"healthy worker effect": in occupational cohorts, 521. In the face of these limitations. there are
workers are often healthier than the general popula- formidable problems in determining what modcl(s) to
tion so that their baseline cancer rates may differ from use in projecting risk forward into the unobserved
the rates of the larger population, complicating the future lifetimes of potential cohorts. Once the current
problem of determining the expected number of cases cohorts have been completely observed. risk projec-
in these cohorts unless control groups from within the tion will have a sounder empirical basis.
cohort are used. 522. The work of Muirhead and Darby [M36, M371,
cited earlier, as well as models applied by the Radia-
517. The twentieth century has been a period of tion Effects Research Foundation (RERF) [S49], shows
rapid change in levels of exposure to cancer-causing clearly that, depending on what covariates are con-
agents in all populations in which radiation exposure sidered and on how their effects are modelled, one can
data are available. This is reflected in changing cancer obtain strikingly comparable degrees of fit even to the
rates within populations over time. All of the major best available data on the major exposed cohorts. In
cohorts used in radiation biology to estimate cancer the Muirhead and Darby models, the parameter y
risks have experienced changing exposure levels, though expressed, at values of 0 and 1, the 'pure' multi-
it has not been possible to account for this well in any plicative and additive projection effects; however, the
study. Estimates of risk derived from cohorts that most likely value of this parameter was sometimes
have been followed for the past half-century to the statistically indistinguishable from either of these
present will have inexact application to cohorts models under certain combinations of covariates.
exposed now or in the future, and the degree of the With an intermediate value of y, the intuitive bio-
inexactness is not known. logical meaning of the model becomes unclear, and
the model is probably best thought of as an empirical
5 18. There is substantial variation in general mortality one only. Given this, it is clear, as noted in Muirhead
rates in different countries. Exposed individuals may and Darby [M37] that a variety of models could be
be expected to experience somewhat different lifetime constructed with approximately equivalent goodness-
risks in a developing country as compared with an of-fit.
industrialized one. However, much of this difference
in overall mortality occurs during childhood and 523. Although the goodness-of-fit of several projec-
would have little effect. Also, cancer rates for most tion models to the empirical data may be comparable,
their projected lifetime risks may not be as close. (d) the poor knowledge of the doses received and their
Being, therefore. currently unable to make lifetime distribution over sites; and (e) the nature of the
projections with much confidence. alternative models comparison groups used.
have to be presented, which, hopefully, bracket the
true risks. Even so, there is no way of specifying
quantitati\,ely the degree of uncertainty in these 1. Whole-body risk coefficients
alternatives.
528. Some of the numerous studies described else-
524. Until very recently. it had appeared from where in this Annex, although important in their own
experimental animal data and empirical data on right. are of limited value for projection purposes;
humans that the relative risk projection model was the they provide the relative frequency of occurrence of
more appropriate of the two models for most solid cancer in an exposed group. as contrasted with a non-
carcinomas. However. if the excess risk of these exposed referent one. but often at only one of the
tumours eventually declines with advancing time since many sites of interest. a n d the dosimetric uncertainties
exposure. as some data now suggest, then neither make estimates of the risk of cancer per unit dose
simple additive nor simple multiplicative projection difficult. Commonly. doses in these particular cohorts
effects will pertain, and none of the models, even have been concentrated in one part of the informative
hybrid models such as those of Muirhead and Darby. range for estimating dose-response patterns, making it
which describe the effects of time since exposure in a difficult to estimate effects at low or intermediate
monotonic way, will be applicable. doses. Three studies, namely, those of the ankylosing
spondylitis patients [Dl 1, D211, the women treated
525. These are fundamental problems, for i t does not with radiotherapy for cervical cancers [B12] and the
currently appear possible to discriminate among the survivors of the atomic bombings of Hiroshima and
various projection models based on their fit to Nagasaki [S48. S49J. have been the bases for estimating
empirical data. The only practicable solution to this the frequency of occurrence of cancer. per unit dose,
problem may be to wait until the experience of the at multiple sites of malignancy. But. even here,
Japanese, the spondylitics and the other cohorts is however. derivation of a combined risk coefficient is
more fully expressed than at present and t o derive difficult and has not been attempted.
empirical projection models. Even so. changes in
baseline risks, as well as confounding cancer risk 529. While these three studies agree generally in
factors. may make such projections inaccurate for identifying the sites at which the frequency of cancer is
future cohort experiences. elevated following exposure to ionizing radiation. the
study-specific estimates of the excess relative risk for
specific malignancies per unit dose, based on the
information currently published vary. particularly
VII. RISK PROJECTIONS in so far as the cervical cancer series is concerned.
There are numerous reasons why this should be so.
A. GENERAL CONSIDERATIONS but especially pertinent are the conditions of exposure,
the nature of the dose data presently a\failable,
526. In chapter I1 of this Annex. the various differences in the age or sex distribution of the
concepts related to risk projection, the kinds of data exposed individuals in the study sanlples, the dissimilar
required, and past efforts to estimate lifetime risk periods of follow-up, and the background rates used
from exposure to ionizing radiation were discussed. In to compute the expected number of cases. Table 55
this chapter. the most appropriate existing data will be summarizes the main characteristics of these three
used to compute estimates of lifetime risk for those studies and illustrates the differences between them in
cancer sites for which sufficient information exists to the respects just enumerated. These points were
make meaningful projections. The purpose is t o derive reviewed in chapters I11 and IV.
approximate estimates of the risk of exposure t o low-
LET radiation, taking into account sex, age at 530. Exposure of the patients with cer\,ical disorders
exposure and time since exposure for the lifetime of an or ankylosing spondylitis occurred because of illness;
entire exposed population. this was not the case among the Japanese survivors.
The reasons why these patients may not be represen-
527. Radiation-induced mortality in a population tative of the general population were discussed in
may be represented in a number of ways, most chapter IV. In the two patient series, exposure was to
commonly as either the expected lifetime number of either x rays or gamma rays. whereas the atomic
excess cancer deaths in the exposed population o r the bomb sur\~ivorsreceived a mixed dose of gamma rays
number of person-years of life lost because of cancer and neutrons. albeit primarily the former. The Japanese
deaths, both per unit collective dose. Estimation of sample alonc includes a full representation of sexes
these expressions of risk remains formidable. as does a and ages; the other tulo studies are restricted either
meaningful synthesis of the estimates that are already wholly or largely to one sex. and they d o not include a
available. The task is complicated by one o r more of the sufficient number of individuals beloit the age of 25 at
following main difficulties: (a) the unique nature of the time of exposure, when the excess relative risk
some of the samples from which risk coefficients have appears to be larger, to provide an estimate applicable
been derived; (b) the differences between studies in to a general population. Individual estimates of dose
sample sizes and in the periods of follow-up; (c) the are not available for all (or even the majority) of the
methods ofcase ascertainment that have been employed; patients with cervical disorders or ankylosing spondyl-
itis. Risk coefficients have been derived from the with fixed values of RBE varying from I to 20. I t will
mean dose among a 7% random sample of the be noted that the risk coefficients for both leukaemia
spondylitis patients, and dose-response estimates. based and all cancers other than leukaemia become smaller
on the individual doses received by the cervical cancer as the assigned RBE increases. Over the range of 1 to
patients in that series, encompass only a subset of the 20. the risk estimates based on shielded kerma
patients. However. mean doses are often poor descrip- diminish by about 54-72%; however, the estimates
tors of the dose distribution, notably among cancer based on organ dose equivalent diminish by only
patients, because of the highly skewed nature of the 15-20%, reflecting the higher transmission values
individual doses and their wide range. As t o the associated with gamma- and neutron-radiation under
periods of follow-up, the maximum length of follow- the DS86 system of dosimetry. Elsewhere, Shimizu et
u p of the first sample members is similar in the three al. [S48] have shown that the use of a variable RBE,
studies, but since enrolment proceeded over a longer one changing as a multiple of the inverse of the square
period of time in the two patient series, the mean root of the neutron dose, would have an approximately
years of surveillance for them is substantially shorter equivalent effect on the projections. Thus, for example,
than for the atomic bomb survivors. In terms of the estimate of the excess deaths from leukaemia,
sample size. the atomic bomb survivors and the using an RBE equal to 1 / 1 D,., where D, is the
cervical cancer series are approximately equivalent. neutron dose in gray, is 2.93; whereas that based on
but the number of the person-years at risk in the study an RBE equal to 2 0 / 1 6 is 2.47. Similar changes
on the atomic bomb survivors is much larger. In the occur for excess deaths attributable to cancers other
cervical cancer and spondylitis series, unlike the than leukaemia: the risk coefficient changes from
atomic bomb survivors, the variation in doses among 10.08 to 8.86 excess deaths per lo4 PYGy. or slightly
exposed organs is very different, because the treatment less than 20%.
was concentrated on one part of the body. This makes
whole-body equivalent dose estimation difficult. There
have also been marked changes in the nature of x-ray 2. Site-specific risk coefficients
equipment and in therapeutic methods. Finally, there
are differences in the nature of the referent groups in 532. In addition to the three studies that involved
the three studies: these were thoroughly discussed (albeit under different conditions of exposure) the
earlier in this ,Annex (see chapters I and Ill). A simultaneous irradiation of many tissues in the body
summary of the excess relative risks per gray obtained and from which risk estimates could be extracted a n d
in these three studies is provided in Table 56. their relationships analysed, there are a large number
of other studies in tvhich single tissues were exposed t o
531. A special feature of the atomic bomb survivors radiation for a variety o f purposes and from which
is that they received esposure from low-LET radiation risk estimates 10 individual tissues have been derived.
and from neutrons simultaneously. I t is important as reviewed in detail in chapter 111. The risk coeffi-
therefore to consider how the projections to follow cients resulting from these studies are summarized in
would be affected by the assignment of either a fixed this section.
o r a dose-variable RBE for neutrons, relative to
gamma rays. Figure XIX provides. in graphical form, 533. Since the UNSCEAR 1977 Report [U?],in which
the change in the estimated number of excess deaths radiation carcinogenesis in humans was last reviewed.
several organizations have estimated summary risk
coefficients (absolute or relative) for a variety of
major organ sites. These include studies by BEIR 111
[C4] in 1980 and by the United States Nuclear
Regulatory Commission in 1985 [GI I]. and the
United States National Institutes of Health. also in
1985, in the radioepidemiological tables [U3]. Their
A 1 1 except leuhaenla reports attempted t o combine the literature available
Organ dose
Shielded kerma at the time. The BEIR 111 Report synthesized individual
Leukaemi a
studies along with the most recent Japanese data then
Organ dose available: Gilbert [G 1 1 1 and the radioepidemiological
0 Shielded kerma tables relied heavily on BEIR 111, modifying their
estimates according to a few other reports but mainly
basing them on the then-latest data from the patients
treated for ankylosing spondylitis and the atomic
bomb survivors. Each of these studies, to which the
reader is referred, discussed the reasoning behind its
respective site-specific coefficients. For comparison
purposes only (because the information on which they
are based is now out of date), the summary risk
coefficients for each study are given in Tables 4 and 8
RELATIVE BIOLOGICAL EFFECTIVENESS (RBE) [C4, G I I].
Figure XIX. Changes in rlsk coetllcients lor varying values of
the RBE of neutrons, reiatlve to gamma rays, based on 534. Because these studies appeared in the period
Japanese DS86 data. 1980-1985, they could not include the results of the
[S481 latest data and dose revisions in Japan [R20, S49] a n d
in the spondylitis series [D21, L161, nor could they 539. Breasr. There are no data on breast cancer in
include the recently published risk coefficients from males. Tables 36, 37 and 38 summarize the details of
the cervical cancer series [B36, B38]. Site-specific risk risk coefficients from a variety of studies. For adult
information from the most recent studies is given here exposures, the range of absolute risk coefficients is
in Tables 26, 46, 51, 52, 53 and 54. These tables 3-10 per loS PYGy, and that of relative risk coefficients
provide the current estimates of risk from the three is 2-5. For juvenile exposures the data are less reliable,
largest studies based on age a t exposure, time since but absolute risk coefficients are 3-8 per lo4 PYGy
exposure and sex. The scientific details of these studies [B6. T6] and the excess relative risk a t 1 Gy, based on
were discussed earlier, along with the limitations and death certificates, is about 0.69 in the most recent
specific characteristics of each study population. T65D data from Japan [P15].
540. Thj~roid.Thyroid cancer risks (incidence) are
535. Chapter 111 of this Annex reviewed many other summarized in Tables 20. 21, 22 and 39 and in Figure
studies in which site-specific risk coefficients were I. Other estimates are 1-4 per lo4 PYGy [C4. 231 for
estimated. While they vary greatly in their particulars, adults and 1.5-9.5 for children [S13, S381. as judged by
e.g.. sample size and the like, it is worth summarizing a variety of studies, including those of exposure to
the risk coefficients from these studies. For each site. fallout. A major recent report discusses thyroid cancer
reference will be made to the tables and figures, induction in detail [NS]. There is about a 3:1 sex ratio
discussed in chapter 111, that provided the best data of cases, with females predominating. and it has been
o n risks. Also. the principal bibliographic references estimated that only about 10% of all cases become
for each site will be given. as will be the general range fatal: many benign tumours also arise. The latency
of risk estimates from other studies not already period for fatal cancers appears, however, to be very
included. Note that the estimates in the following long (even up to 40 years or more). so that the current
summary that are derived from the Japanese or data may still be incomplete.
spondylitics are based on the old dosimetry and do
not include the most recent data reports (these values 541. Skin. Satisfactory summary risk estimates for
are given in Table 561. skin cancer incidence do not exist. The BEIR 111
estimates (see [C4], Table A-32) of between 0.44 and
536. Leukaetnia. While many studies of different 1.02 cases per lo4 PYGy, based on scalp and thymus
types of exposure have found an excess of leukaemia. irradiation. are not consistent with the chest fluoroscopy
the best risk coefficients come from the spondylitis data. In uranium miners, Sevc [S5 I] has estimated one
patients [D21. L16, S311. the Japanese data [S48, excess case of basal cell carcinoma of the skin per
S491, and, very recently, from the marrow-weighted IOS PYSv. Information is not yet available from
study of cervical cancer patients [B36]. These indivi- .lapan.
duals received exposures to external IOU-LETradiation.
The risk coefficients are included in Table 56. Some 542. Lut1.q. Other than the Japanese and spondylitis
other dose-response data, from gynaecologic patients, patients, the best data on lung cancer are derived from
were summarized in Table 31. The BEIR I I1 Conlnlittee individuals who inhale alpha-emitting radionuclides.
estimated the absolute risk coefficient for briefexposure Alost data come from males, except in Japan. and the
in childhood to be about 0.01-2.2 excess cases per occurrence of this cancer is seriously affected by
IOJ PYGy [C3; see Tables V- 17 and Cr- 181. and Ron smoking interactions; there is as yet no consensus on
and Modan [Rl] estimated absolute risk to be 0.60 male whether the effects of smoking are more additive in
and 0.87 female cases for the same unit of exposure. nature o r more multiplicative. Thomas and McNeill's
although this difference was not statisticall! significant. [TI 1. T20] summary of these risks is provided in
Table 10. These absolute risk coefficients are in units
of million person-years per working level month
537. ,Mulriple tt~j.eloma.Risk coefficients for multiple (WLM); as discussed earlier, an approximate factor
myeloma are summarized in Table 32. The most for converting from cases per lo6 PY WLM to cases
important reference for these data is [CIO]. A recent per 104 PYGy is 1.67 (with 1 WLM corresponding to
estimate from Japan gives 0.48 incident cases per 6 mGy absorbed dose in the bronchial tree). The
1 0 V Y G y bone marrow dose [Hj. 121; however. the absolute estimates range between 5 and 50 cases per
latter estimate is based on the T65 dosimetry. 10' PYGy. As noted in chapter 111. even when they are
based on the same data, the estimates do not always
538. Bone. Table 33 provides a s u m m a 9 of risk agree. and they must be treated as uncertain. Most
coefficients for bone cancer based on an analysis by estimates of relative risk from brief external exposures
BEIR 111 [C4]. Figure VIII presents dose-response to doses of less than 10 Gy are 1.2-2.0. Full treatments
data. Other estimates for gamma-emitting radionucli- of risks to the lung will be found in [C20. 11 I].
des are 2.4 excess cases per lo4 PYpCi for long-half-
life isotopes (absolute): 1.8 (children) and I (adults) 543. Digestive system. The estimates presented from
for short-half-life isotopes: and for alpha-emitting Japan and the spondylitis patients (see Table 56)
radionuclides (absolute) 200 per IO' P1'Gy [TI I]. constitute the best information available on most
There are many cases of bone cancer in exposed digestive system cancers. As previously discussed, the
children, but dose-response estimates are unreliable data from the spondylitis patients are not reliable in
relative to a general population since most of the regard to colo-rectal cancer because of their high
children, exposed during treatment of retinoblastoma, spontaneous rates of colo-rectal disease, and the
are genetically susceptible to osteosarcoma even in the results from studies of pelvic irradiation to treat
absence of irradiation (see section 1II.B). gynaecological disorders are inconsistent and appear
to be affected by cell sterilization and other biological 547. In addition to excess cases per 1.000 persons
or environmental effects. Most liver cancer data come exposed to 1 Gy, estimates will be provided of lost life
from internal emitters, particularly the Thorotrast expectancy in person-years per 1,000 persons.
patients. The Japanese and the spondylitis patients
show uncertain results. and neither the studies by
themselves nor their joint analysis has found an excess 1. The basic projection model
sufficient to derive useful risk coefficients (the BEIR 111
best estimate is given in Table 4). The liver is a site of
frequent metastasis, and risk estimates may confound 548. The lifetin~erisk coefficients estimated in this
primary and secondary hepatic cancers. chap~er have been computed using an interactive.
parametric demographic projection model developed
544. Salivary glands. Detailed risk coefficients for by the Centre d'Etude sur I'Evaluation de la Protec-
salivary gland cancers, based on results of many tion dans le Domaine NuclCaire (CEPN, France) in
studies. are given in Table 42. These were derived by 1985. I t eniploys classical double-decrement life-table
Land [Ll I] in a summary analysis of this site. Land techniques and is not dependent on the data nor
estimated the best overall absolute risk coefficient for ass~~mptions used in the present calculations. The
this site to be 0.26 10.06 cases per lo4 PYGy. A recent model is sufficiently general to permit a wide rangc of
estinlate from Japan, based on T65 dosimetry, is choice of demographic, epidemiological and biological
0.056 f 0.036 per lo4 PYGy 104. TlS]. data or assumptions. Several kinds of computations
can be made. including: ( a ) the effect of a single
545. As has been noted, the inter-srudy spread of exposure on a cohort of a given age and sex. and
values observed for single tissues is large, sometimes (b) the effect of a single exposure to a given population
very large, presumably owing to the differences of mixed ages and sexes.
mentioned in paragraph 527. There is no fully
satisfactory way to make suitable allowance for these
differences in generating a combined estimate. Thus. 2. Analytical expression of the model
there are only two options: either to combine the data
without regard to the important differences enumerated
above, a step that does not appear defensible; or to select 549. The analytical formulation for calculating life-
the best possible set of estiniates from among the various time risk is the following: at age a and for a dose D,
studies. Therefore, the Committee compares in the the absolute excess mortality rate V(a,D) is considered.
section to follow the data from the atomic bomb If an exposure at age a, is assumed, the corresponding
survivors, the ankylosing spondylitis series and the lifetime risk U(a,,D) is
1 on
series of patients irradiated for cervical cancer.
U(a,,D) = V(a.D)[N(a.D)/N(%)lda
a,
2. The population of children as a part of the population 579. The main difficulties in assessing the impact of
exposure on the young arise when one attempts to
575. The epidemiological evidence accumulated to evaluate the interaction between these two aspects for
date strongly suggests that the initial relative risk of the purpose of calculating an overa!l measure of risk
subsequent malignancy following exposure to ionizing for the whole population. considering each age class
radiation is appreciably higher when exposure occurs separately. In fact. each age class will be characterized
early in life (within the first two decades after birth). by its own coefficient of risk and its own demographic
From what is so far known about the biological future. Since it appears from Tables 51 and 52 that the
aspects of cancer induction. this finding is not excess relative risk does not systematically change for
unexpected. However, apart from the data on the ages above 20. and certainly not for ages above 30 (at
youngest age at the time of the bombings cohorts in least for solid cancer), the Committee has not attempted
the Japanese Life Span Study, there are few data from to calculate the whole extent of these changes. It
which specific risk coefficients can be derived, and should be pointed out that the observed values at the
even among the Japanese survivors the coefficients younger ages, based as they are on a relatively small
available are based on small case numbers and have number of cases, have large and unequal sampling
relatively large sampling errors. These cohorts, further- errors. Previous attempts to take age-related coeffi-
more, are those with the largest expected numbers of cients into account have relied solely upon a statistical
years still to live, and i t is far from clear whether the smoothing of the observed values. The Committee
high excess relative risks presently seen will persist. It believes, however, that the observed changes in
is true that the Japanese data suggest a declining risk, susceptibility as a function of age are not related to
both for leukaemia and all cancers except leukaemia, time alone, but also to the biological stages in
notably among survivors exposed before the age of 10 developn~entthat are unique to certain ages, such as
(the trends seen in Tables 51 and 52 for the 0-9 age puberty and its associated hormonal changes.
group are statistically significant). These cohorts have
only recently entered those years of life when the 580. Under these circumstances the Committee
background rates for virtually all solid tumours, as decided to make two separate sets of projections.
well as for, the chronic forms of leukaemia. increase using the multiplicative and the additive projection
markedly. Thus, it will be several decades before their models: (a) the lifetime excess mortality and loss of
cancer experience as middle- and older-aged indivi- life expectancy as it applies to a population for which
duals is clear. This poses a dilemma for the projection the same risk coefficient is taken for all ages and (b)
of lifetime risks. On the one hand. i t would be unwise the lifetime excess mortality and loss of life expectancy
to assume that the risks will decline, for if they did as it applies to a population at ages 0-9 and 10-19.
not, the indices of harm could be grossly under- with coefficients specific for these age groups. These
estimated. On the other hand. to assume that these latter coefficients are as follows:
excess relative risks will persist throughout life, if in Age at irradiation
fact they do not, will project a harm that is much too 0-9 10-19
high for these cohorts. It is largely for these reasons Leukaemia
that the Committee has elected to examine the Excess relative risk 19.1 4.5
childhood population separately. Excess deaths 3.42 1.52
576. There are two separate aspects of the irradiation O ~ h e malignatlcies
r
of young cohorts: first. their apparently greater Excess relative risk
susceptibility to the carcinogenic effect of radiation Excess death
(this aspect can be studied by a discussion of the
declining risk coefficient as a function of age) and These values have been taken from [S49] (Appendix
second, their longer life expectancies relative to adults Tables 5a and 5b), averaging over the two sexes.
581. For the multiplicative model and for excess and lower 90% bounds of the risk estimate are used
lifetime mortality, the difference in the final effect (see Table 54). It shows that. under the conditions
introduced by using a measure of risk related to the specified above. one would expect to observe a total of
specific age at exposure rather than a constant risk, about 71 extra fatal cases under the assumption of a
that is a risk averaged over all ages and exposure. can multiplicative projection. compared with about 45 cases
be substantial. The computations show that one for an additive projection model.
obtains three to four times more deaths due to
leukaemia and all other cancers for the ages 0-9 at the 586. The first method (Table 62) may overestimate
time of exposure by using the age-specific risk. For the the lifetime excess mortality under the multiplicative
ages 10-19 at the time of exposure this difference in model as the excess relative risk in the younger age-at-
risk tends to reduce to 1-2. In both cases this exposure groups has been falling with increasing time
difference will be expected to decline further as the since exposure (see Table 51). On the other hand. this
average age in the cohorts increases and the coefficient method may well underestimate the lifetime excess
of risk adopted approaches the coefficient for the mortality using the additive model, as the excess risks
whole population. This phenomenon is repeated in the have been increasing with time since exposure in the
projections for loss of life expectancy. younger age-at-exposure groups (see Table 52). Con-
versely, under the second method (Table 63) the
582. For the additive, rather than the multiplicative, multiplicative model may underestimate the lifetime
model, the difference between the excess mortalities harm for the younger age-at-exposure groups. but the
calculated using the constant coefficient and the age- harm for these groups under the additive model may
related coefficient is very small for leukaemia. and it be overestimated. With the multiplicative risk projec-
even tends to reverse for the age cohort 10-19. This tion model there is about a 30% decrease in estimated
accords with the fact that the risk coefficient for this lifetime mortality from all malignancies using the
particular age group happens to be lower than the second method compared with the first, while with the
average value adopted for computations on the whole additive model the second method leads to about a
population. As is true for the multiplicative model, 50% increase.
these effects are almost repeated in the projections for
ioss of life expectancy.
3. Extrapolation to other populations
583. T o provide estimates of risk to be applied t o the
whole population. computations have been made 587. Risk coefficients are always estimated, a n d
using the various age-at-exposure classes, attributing lifetime risks projected. in the context of a particular
to each of them the coefficient that applies t o that population. Each exposed population from which risk
particular class. projecting the risk of that class over coefficients are estimated has its own background
the appropriate period of time (40 years o r lifetime) mortality rates from all causes of death, and its own
and summing up the overall effects over all age-at- age- and sex-specific cancer rates. Indeed. not all
exposure classes. This was done for both the multi- individuals within any given population are at the
plicative and the additive projection models and for same risk. Considering this. it is fair to ask what use
excess lifetime mortality and loss of life expectancy, can be made of risk coefficients obtained from one
separately. The final results of these summations are population for predicting lifetime risks in any other
given in Table 62. population. The projections given in this chapter have
been derived by applying the closest possible expected
584. Considering the number of fatalities from leukae- rates of death (from cancer and from all other causes);
mia and other malignancies together (upper part of namely, thosc from the same country as the esposed.
Table 62). it is seen that between about 42 and about Even so, baseline risks in the Japanese exposed to the
107 deaths would be predicted by the additive and the atomic bombs, a wartime and post-war environment.
multiplicative model. respectively. The lower half of were not the same as those of current Japanese. nor
the Table shows that between about 950 and 1.370 even precisely of those of Hiroshima and Nagasaki
person-years can be expected t o be lost if the whole today. It is known that there are changes occurring in
population is exposed to 1 Gy under the conditions Japan in regard to baseline mortality rates and that
specified. there are also regional differences in Japan. as in every
other country. Similarly. the all-United Kingdom
585. There is a different way of arriving at similar mortality patterns are certainly not exactly those of
projections; namely. to use a single risk coefficient the ankylosing spondylitis o r the cervical cancer
which does not take age at exposure into account patients.
explicitly. It should be noted that this method of
projection has its own shortcomings, for a risk 588. Because baseline mortality is always changing
coefficient so estimated is essentially a weighted in every population, and this includes major changes
average of the age-specific relative risks with weights in a variety of cancer risk factors, it is difficult t o
proportional to the numbers of cancer deaths in the know how accurate lifetime risk projections might be.
specific age groups. Thus most of the weight will be One way to place outer limits o n this error would be
given to the older age groups whose actual relative to compare the lifetime risk estimates based o n the
risks are smaller. Nevertheless, t o provide a compari- same risk coefficients and different baseline mortality
son, this has been done in Table 63 in respect to the patterns. For this Annex three populations have been
population of Japan. The values in parentheses chosen to compare projected risks. T o d o this, the
provide the corresponding numbers when the upper absolute and excess relative risk coefficients derived
from the experiences of the atomic bomb survivors information on second cancers at selected sites. Most
have been applied to (a) the Japanese population of these studies make some contribution to quantita-
using the Japanese 1980 national mortality patterns, tive risk estimates.
representing the nearest available representative rates
for those coefficients; (b) the United Kingdom, repre- 593. The atomic bomb survivors are especially im-
senting a rather typical older industrialized nation; portant and provide the largest single data set over a
and (c) Puerto Rico, representing (as best as world- range of doses. In this population the data have now
wide data will permit) a population with high infant accumulated over three additional time periods since
and infectious disease mortality, and low cancer rates. the 1977 Report was written. viz. 1975-1978. 1979-1982
and 1983-1985. These are important time periods for
589. The populations are compared in Table 64, and the expression of solid tumours, 30-40 years after
the results of this comparison for leukaemia, other exposure to the bombs. Not only has the total amount
cancers and all malignancies are given in Tables 65 and of data on excess cancers increased by approximately
66. The latter Tables show that across these three threefold, but the extension of the data in time and the
populations there is virtually no difference in risks increasing information for all age cohorts, especially
projected by the additive model. Even for the multiplica- the young, provide further tests of models and thus
tive model, the maximum difference, using Japan as the aid in methods of projection and in knowledge of age
basis of comparison. is a factor of 71/58 = 1.2. This dependence. Furthermore. the dosimetry of the sur-
clearly shows that the lifetime risk projections are very vivors has been evaluated (and measured in the
insensitive to differences in overall. and cancer-specific survivor range by thermoluminescent methods) and
mortality differences within the range of contemporary tends to increase risk by factors, when expressed in
large national populations, and for leukaemia or all terms of shielded kerma, between 1 and 2 depending
cancers pooled. Thus, the risk projections derived here on the cancer site. Some improvements have also been
would seem to have rather broad generality and made in statistical methods.
applicability. Much larger proportional differences
may apply to site-specific cancer with large inter- 594. The atomic bomb survivors have been used in
national variation in risk, such as female breast, this report as the main source of risk estimates, while
stomach. large bou,el and lung. the Committee notes that other sources of data such
as the ankylosing spondyliris patients are in general
590. I t should be pointed out. however. that this terms consistent with these estimates. especially when
conclusion applies to only one of the uncertainties in the mode of delivery of the exposure is taken into
the extrapolation of risk projections to other popula- account. The Committee has not itself made primary
tions. I r is no1 yet known how much the risk estimates of risk in the Japanese atomic bomb
coefficients themselves might vary bctween different survivors, but has relied on risk estimates developed in
ethnic groups or populations with differing exposures recent publications for the appropriate period of
to other carcinogens which could act synergistically; observation. These risk estimates have then been
the range of today's knowledge is limited essentially to projected to a lifetime separately by the additive and
data from Japan and from a variety of industrialized multiplicative models and for both an age-structured
populations. Within this context. and given the population and for risks averaged over one inter-
statistical problems in estimation. the range of risk mediate age range. Lifetime risks have been estimated
coefficients is rather small, well below a full order of separately for an adult population alone and an entire
magnitude. population of all ages.
Study
population
slze
Atomlc bomblngs
Resldents of Hlroshlma and Nagasakl 91.000
Nuclear w e a p o n s testlng
Mllltary test observers 10,000
Populatlons near test sites 500,000
Marshall Islanders 250
Uedlcal therapeutic exposure:
Ankyloslng spondylltls patients 14.000
Cervlcal cancer patlents 1 80,000
P a t l e n t s recelvlng chest Irradiation 10,000
Patlents recelvlng Thorotrast lnjectlons 2.000
Patients recelvlng head and thymus lrradlatlon 20.000
Hodgkln's d l s e a s e patlents 10.000
Patlents Irradiated for lmnunosuppresslon
H e m n g l o m patlents
Chlldhood cancer patlents b/ 10,000
Fetus recelvlng pre-natal examlnatlon 1.000
Occupatlonal exposure
Nuclear shlpyard workers 24.000
R e a c t o r a n d processing plant personnel 30.000
Underground mlners 22,000
R a d l u m dldl palnters 4.000
Radlologlsts 10,000
Natural background
Persons w l t h elevated exposure due t o geography
Persons llvlng ln houses hlth hlgh radon levels
Nuclear accidents
Indlvlduals In publlc. workers, emergency c r e w s
Cohort studjes
P r o s p e c t i v e follow-up
S u r v t v o r s of atomlc bomblnqs
Marshall Islanders
Retrospectlve/prospectlve follow-up
Indlvlduals ldentlfled from medlcal records
Patlents lrradlated therdpeutlcally
Radlologlcal workers and radlologlsts
Indlvlduals ldentlfted through employment records
Occupatlonally exposed lndlvlduals
Mllltary test observers
Indlvlduals identified through geoqraphlc d a t a
Populatlons In high natural background a r e a s
Indlvlduals llvtng ln local fallout areas
Case-control studles
Retrospective ascertainment
Pre-natal exposures
E x p e c t a t l o n o f cancer ( p e r c e n t )
Mortality/
lncldence
S l t e of Males females ratlo
cancer
Oesophagus
Stomach
Intestine
Pancreas
Lung
Urlnary
Lymphoma
Breast
Thyrold
Llver
T a b l e 4
Males
Thyroid
Lung
Oesophagus
Stomach
Intestine
Llver
Pancreas
Urlnary
Lymphoma
Other
A l l sltes
Females
Thyrold
Breast
Lung
Oesophagus
Stomach
Intestine
Llver
Pancreas
Urinary
Lymphoma
Other
All sltes
a/ Average o f t h e a g e - s p e c l f l c c o e f f t c l e n t s . w e l g h t e d according t o
t h e age d l s t r l b u t l o n o f t h e p o p u l a t l o n o f t h e U n i t e d S t a t e s .
T a b l e 5
Excess deaths
T a b l e b
Llnear-quadratlc 71 226
Llnear 167 501
Quadratic 10 28
Llnear-quadratlc 61 169
Llnear 158 403
T a b l e 7
Llfetlme
(0.01 Gy/year) Llnear-puadratlc 2.4 7.5
Llnear 2.6 8.1
T a b l e 8
Leukaemla Absolute,
linear-quadratic 2 25
GI cancer b/ Relatlve.
1 lnear-quadrat lc 10
a/ Flrst coefflclent ls for exposure under, second for exposure over age 20.
b/ lncludlng cancers o f the oesophagus, stomach, colon, rectum, pancreas, and
-
other unspeclfled gastolntestinal cancers.
c/ lncludlng all cancers except leukaemla.
T a b l e 9
T a b l e 10
Ontarlo Uranlum
Ontar lo Gold
Newfoundland Fluorspar
Czechorlovakla Uranlum
Sweden
Klruna Iron
Zlnkgruven Lead.zinc
Malmberget lron
Ndtlonal survey
Devlance a/ Devlance a/
Covarlate Mlnlmum Y a t y = O aty.1
of rlsk deviance (Multlpllcatlve (Addltlve
a/ b/ rlsk model) rlsk model)
None (constant
rlsk)
Sex
Age
Tlme slnce
exposure
Sex, a g e
Sex, time since
exposure
Age, tlme slnce
exposure
T a b l e 12
Stage affected and tumour slte Population studled f xposure type Ref.
T a b l e 14
Bone 67
Soft-tlssue
sarcomas 59
Haematopoletlc 59
Sk l n 30
Braln 28
Thyrold 26
Breast 13
A l l others 24
T a b l e 16
D e v e l o ~ m e n to f recond p r i m a r y cancers I n c h l l d r e n
[ T4 I
Percentage
P r l m a r y cancer Number o f u l t h second
children cancer
Increased
second cancer
rlsk ( X )
Disease Slte Dose Second cancer type Ref
lrradlated range
10 30
(Gy) years years
a/ Orthovoltage therapy.
b/ Megavoltage therapy.
T a b ! e 18
Bilateral 693 89 5R 31
Unllateral 18 5 a/ 7 3
Radlatlon 688 89 b2
No radlatlon 23 5 1
T a b l e 19
Cumulatlve lncldence
Number of Type of Number (per cent) at
Slte of second cancer patlents second cancer of
second
cancers 1 2 years 18 years
T a b l e 21
Oose-response relatlonshlps
for thyrold cancer In chlldren Irradlated for enlarged thymus
[ 538 I
Control
0.01-0.49 0.50-1.99 2.00-3.99 4.00-5.99 >b.OO
a/ Expected based on age and sex-speclflc thyrold cancer rates for New York
state 1969-1971.
T a b l e 22
Number of fractions
1 0.74 29414 7 5.1 2.9
2 1.5 22417 6 9.7 1.S
3 2.5 5445 9 7.3 3.8
T a b l e 23
Observed 6 5 5 5 3
Expected 13.2 5.45 3.56 0.85 0.93
T a b l e 24
R l s k s o f leukaemta and o t h e r c a n c e r s
I n p a t l e n t s t r e a t e d f o r Hodqkln's d l s e a s e
a/ R e l a t l v e r i s k s a r e observed/expected.
Rlsk r a t e d a t a a r e cases/persor-year e x c e p t f o r t h e l a s t , whIch Is a
cumulattve (actuarial) r l s k a f t e r 7 years p o s t - e x p o s u r e .
C/ NO second cancers were observed I n t h e s e g r o u p s , so b a s e l l n e v a l u e
( r e l a t l v e r l s k ) may be s e t t o 1.0.
T a b l e 25
Relatlve rlsk ot second cancer followlnq radiotherapt
for benlqn qynaecoloqic dlsorders and tor cervlcal cancer
[Ha. BIZ]
[Cancer patlents followed for at least 10 years; other patlents
followed for a variable length of tltne. but generally m o r e than 10 years.
Rlsks slgnlflcant at the 0.05 or better level a r e underllned.)
Relatlve rlsk
Hlgh doses a/
Colon 1.1 1.1 1.3
Rec t urn -
1.8 1 .2 1.4
Uterlne corpus 1 .O 2.8 -
0.1
Ovary 0.9 0.5
Bladder -
3.5 2.1 -
1.2
Other genltal -
3.2 -
2.8
Intermediate doses b/
Stomach 1.0 0.8 0.6
Panc rear 1.2 0.5 0.9
Kldney 0.8 2.1 2.1
Oesophagus 1.1 0.0
Small bowel 2.4 1.3 5.0
Gallbladder 0.8 0.9 1.5
L o w doses (remote sites) c/
Lung 2.3 0.9 -
2.2
Breast 0.7 0.9 0.9
Thyrold 1.4 0.6
Oral cavlty -
1.7 1.9 1.7
Sallvary gland 1.7 0.0
Braln 0.b 2.0
General systemlc cancer
of unknown orlglnal slte
Leukaemla 0.9 2.3 0.6
Multlple myeloma 1.4 0.0
Lymphoma 1.3 2.3 0.3
Hodgkln's dlsease 1 .C 1.1
a/ For cancer patlents around 10 Gy; for non-cancer patlents 1-10 Gy.
b/ for cancer patlents 1-10 Gy: for non-cancer patlents comparatlvely
smaller.
c_/ For cancer patlents around 0.1 Gy: for non-cancer patlents
cornparatlvely smaller.
T a b l e 26
(90% c o n f i d e n c e I n t e r v a l s I n p a r e n t h e s e s . )
Relatlve r i s k l x c e s s cases
Second cancers a t 1 Gy a/ p e r 104 PYGy
a/ See o r l g l n a l p u b l l c a t l o n f o r d e t a l l s o f t h e calculations.
T a b l e 27
( R l s k s s l g n l f l c a n t a t t h e 0.05 o r b e t t e r l e v e l a r e underlined.)
Relatlve r l s k
All sltes
Bladder
Breast
Colon
Connectlve t l s s u e
Lndometrlum
Leukaemla
Lung
Lymphoma
Myeloma
Rectum
Stomach
R e l a t l v e r i s k o f second c a n c e r s I n p a t l e n t s t r e a t e d f o r b r e a s t cancer
[HZ01
Relatlve r l s k
S l t e o f second c a n c e r
Irradiated Non-lrradlated
patlents patlents
Kldney 1.9
Oesophagus 1.7
N o n - H o d g k l n ' s lymphoma 1.7
C h r o n i c l y m p h o c y t t c leukaemla 1 .2
Acute non- l y m p h o c y t l c leukaemta 2.5
Lung. 1 0 - 1 9 y e a r s a f t e r l r r a d l a t l o n 2.3
Lung. 20-29 y e a r s a f t e r l r r a d l a t l o n 4.8
R e l a t l v e r i s k o f leukaemla t o l l o u l n q t r e a t m e n t
o f o t h e r p r l m d r y cancers I n a d u l t s
Oral/buccal
Oesophagus
Stomach
Co 1on
Rec t um
Larynx
Lung/bronchus
Connectlve
Helanoma
Breast
tndometrlum
Ovary
Prostate
Testls
Bladder
Kldney/renal
Thyrold
n u l t l p l e myeloma
A l l other
All sltes
T a b l e 30
Ankyloslng spondylltls
pattents 4.19 (3.4- 6.6) 1.96 (1.24-2.88)
Atom\c bomb survlvors 9.38 (1.0-12.6) &/ 3.95 (3.04-4.86)
T a b l e 31
Relatlve
Dose ( G y ) Condltlon treated Cases rlsk
T a b l e 32
Relatlve rlsk of multlple myeloma iollowlng varlous radlatlon exvosures
[ClOI
(Rlsks slgniflcant at the 0.01 or better level are underlined.
t h e others a r e slgnlflcant at the 0.05 level.
9 0 X confldence Intervals In parentheses.)
R l s k c o e f f i c i e n t s f o r r a d l a t l o n - I n d u c e d bone sarcomas
e s t i m a t e d I n t h e BEIR 1980 R e p o r t
[c41
Cumulative Rlsk
Type o f r a d l a t l o n and model rlsk rate
coefflclent coefflclent
p e r l o 4 PGy p e r l o 4 PYGy
Alpha particles ( h l g h - L E T )
Llnear 27 1
Dose-squared 3.7 a_/ 980 b/
B e t a , garnna. and x r a y s (low-LET)
Llnear 1.4 0.05
Dose-squared 9200 a/ 24000 b/
a_/ Per l o 4 P G ~ ? .
b/ Per 104 P Y G Y ~ .
P r o v l s l o n a l c o e f f l c l e n t s f o r e n d o s t e a l doses up t o a few G y .
The r l s k - r a t e c o e f f l c l e n t 1s d e t e r m l n e d b y d l v l d l n g t h e
c u m u l a t l v e r l s k b y 27 y e a r s , t h e t o t a l r l s k p e r i o d , for
alpha p a r t I c l e exposure.
T a b l e 34
R e l a t i v e r l s k o f s k l n c a n c e r I n p a t l e n t s who r e c e i v e d s c a l p I r r a d l a t l o n
t o t r e a t tlnea c a p l t l s
[C41
Number
Age o r t l m e ( y e a r s ) of s k l n Relative
cancers risk
Age a t e x p o s u r e
1-19 0
20-24 0
25-29 4
30-34 8
35-39 12
40-44 5
>4 5 0
Tlme s l n c e exposure
1- 9 0
10-1 4 0
15-19 1
20-24 7
25-29 14
30-34 9
T a b l e 35
Kerm (Gy) a/
Age
at
the 0.0 0.01-0.09 0.10-0.49 0.50-0.99 1.00-1.99 2.00-2.99 3.00-3.99 >4.00
t \me
of
bomblng Average t l s s u e dose ( G y ) a/
a/ Based on Tb50R.
b/ T o t a l s o b t a l n e d f r o m [Tb).
T a b l e 36
R e l a t l v e r l s k o f b r e a s t cancer l n f o u r d l f f e r e n t s t u d l e r
( M o d l f l e d f r o m [Hb]. based on data t r o m 183. Hb. 16. 51. 7141)
B r e a s t cancer l n c l d e n c e l n women
R e l a t l v e r l s k a t age
Study Age a t Number o f
sertes exposure breast
cancers 20-29 30-39 40-49 50-59 60-69 >70
Rochester 20-29 18
masiltls 30-39 13
patlents
T a b l e 30
Data g l v e n a r e r e l a t l v e r a t e s of b r e a s t cancer e x c l u d l n g t h e
f l r s t f l v e years o f post-operatlon observatton l n a l l except
t h e Canadlan s e r l e s , t o exclude non-radiogenic cases.
a / Based on T65DR.
-
T a b l e 39
Annual excess
Internal &/ 0.28 0.56 0.56 1.12
External b/ 0.84 1.68 1.68 3.36
Llfetlme excess
Internal a/ 2.74 6.80 4.83 10.50
External b/ 8.22 20.40 14.50 31.50
T a b l e 40
Relatlve rlsk of cancer In heavily lrradtated sltes
for comblned data of
ankyloslng spondylltIs patlents and the Japanese Llfe Span Study
[Dl1 I
(Rlsks slgnlflcant at the 0.05 or better level are underltned.
90% confldence Intervals In parentheses.)
T a b l e 42
E f f e c t o f t ~ D eo f t r e a t m e n t on c u m u l a t l v e l n c l d e n c e
o f second D r l m a r y cancers I n D a t l e n t s w l t h q e n e t l c r e t l n o b l a m
[Dl51
Curnulatlve l n c l d e n c e
Type o f S l t e of Number o f Number (per cent) a t
treatment second cancer patients of
second
cancers 12 years 18 years
No radiotherapy.
no chemotherapy A l l s l t e s
T a b l e 44
Stomach 1.68
Colon 1.12
Llver 0.70
Pancreas 0.99
Lung 3.94
Breast 5.82
Kldney 0.88
Bladder 0.88
Thyrold 5.80
Lymphom 0.27
Acute and NL 2.70
leukaemla
R e l a t l v e r i s k of cancer m o r t a l t t y
l n a n k ~ l o s l n q~ ~ o n d y l l t pl sa t l e n t s
r021 I
Tlme s l n c e f l r s t t r e a t m e n t ( y e a r s )
Total
T a b l e 46
R e l a t l v e r l s k o f cancer m o r t a l l t v a t s p e c l f l c s l t e s
l n ankyloslng spondylltls pattents
[021 I
( R l s k s s l g n l f l c a n t a t t h e 0.05 or b e t t e r l e v e l a r e u n d e r l l n e d .
R e l a t l v e r l s k computed as observed/expected r a t i o . )
Tlme s l n c e f l r s t t r e a t m e n t
Total
>5
(5 5-25 >25 a/
Mouth
Pharynx
Oesophagus
Stomach
Rectum
Llver
Pancreas
Larynx
Lung
Breast
Uterus
Ovary
Prostate
Kldney
Bladder
Sk ln
Splnal cord
Other CNS
Bone
Hodgkln's disease
O t h e r lymphoma
M u l t l p l e myeloma
Other
Total
Mean of Medlan of
Organ estlmated estlmated Standard Range 10-90%
doses doses devlatlon range
Adrenals
Bladder
Braln
Gastrolntestlnal tract
Stomach
Upper large lntestlne
L o w r large lntestlne
Small lntestlne
Oesophagus
Genltalla
Testes
Ovarles
Other than above
Heart
Kldneys
Llver
Nasal reglon
Pancreas
Pulmonary reglon
Lungs
Maln bronchl
Trachea
Skeleton
Pelvls
Rlbs
Splne
Other than above a/
Skln
Trunk sktn
Skln excludlng trunk a/
Spleen
Thyrold
Uterus
Totals
Trunk
Legs
Head
Total body
Proport lon
of t o t a l red Mean o f Median o f Standard Range 10-90%
Marrow s l t e bone marrow estimated estlmated devlatlon range
mass doses doses
(XI
Arms
Legs
Cranlum
Mandlble
Clavtcles
Scapulae
Rlbs
Pelvls
Upper s p l n e
Mid s p l n e
Louer s p l n e
Total marrow
T a b l e 50
Shleldedkerma 0586 41719 295 287 8 31044 304 295 10 10675 267 265 3
T65DR 41316 414 350 64 26146 442 344 99 15170 366 362 4
Large i n t e s t i n e OS86
T6 SOR
Lung
Stomach DS86
TbSDR
Female b r e a s t 0586
TbSOR
Bladder DS86
T650R
Ovary DS86
Tb5DR
T a b l e 51
Age a t t l m e o f d e a t h
Leukaemla
0-10 44.16 3.41 8.64 0.95
10-19
20- 29
30-39
40-49
>50
Total
A l l cancers
except leukaemla
0-10 (70.07) 5.89 1.96 1.86
10-19 (40.90) (0.82) 1.66 1.59 1.68
20-29 (1.38) 2.09 1.74 1.37
30-39 (0.84) (1.12) 1.11 1.23 1.48
40-49 (1.25) (1.12) 1.13 1-33
>50 (2.58) (0.95) 1.15
Total 75.32 2.22 1.60 1.58 1.39 1.13 1.29
Stomach c a n c e r
0-10 ( 0 ) 7.22 1.30 1.54
10-19 ( 0 ) (0.82) 1.26 1.21 2.88
20-29 (0.82) 2.66 1.93 1.77
30-39 (76.88) (1.00) 0.97 1.18 1.48
40-49 (160) (1.17 1.05 1.24
>50 (3.30) (0.92) 1.12
Total 0 1.30 1.26 1.70 1.40 1.06 1.22
Lung cancer
0-10 ( 0 ) 0.84 0.82 0.83
10-19 ( 0 ) (0 ) 0.81 5.56 1.50
20-29 (0 ) 0.83 1.75 1.03
30-39 (0 ) (0.81) 1.49 1.50 1.26
40-49 (0 ) (1.58) 1.34 1.40
>50 (0.85) (2.29) 1.44
Total 0 0.84 0.82 2.32 1.57 1.44 1.39
Breast cancer
0-10 ( 0 ) 0 0.92 3.04
10-19 ( 0 ) (0 ) 10.48 2.16 4.21
20-29 (2.10) 0.81 2.05 5.78
30-39 (0.83) (0.80) 2.86 2.28 1.03
40-49 (0 ) (0.82) 1.13 0.82
>50 (8.16) (0.82) 1.37
Total 0 0 3.72 1.63 2.57 1 . 1-01
T a b l e 52
( R l s k b e f o r e t h e assumed mlnlmum l a t e n c y p e r l o d o f 1 0 y e a r s
I n d i c a t e d I n parentheses.)
Age a t d e a t h
Leukaemla
0-10
10-19
20-29
30 - 39
40-49
>50
Total
A l l cancers
except leukaemla
0-1 0
10-1 9
20-29
30-39
40-49
>50
Total
Stomach c a n c e r
0-10
10-19
20-29
30-39
40-49
>so
Total
Lung c a n c e r
0-1 0
10-1 9
20-29
30-39
40-49
>50
Total
Breast cancer
0-10
10-19
20-29
30-39
40-49
>so
Total
T a b l e
- 53
A1 1 ma1 tgnant
neo~lasms
Leukaemta
A l l except
leukaemla
Oesophagus
Stomach
Large l n t e s t l n e
except r e c t u m
Trachea.
bronchus
and l u n g
Female b r e a s t
Ovary and o t h e r
u t e r l n e adnexa
Bladder. o t h e r
unspeclfled
urlnary
H u l t l p l e myeloma
Lung
T a b l e 55
ABSOLUTE RISK
(excess deaths p e r l o 4 PYGy)
T a b l e 58
Rlsk coefflclents for adults from t h e atornlc bomb,
ankvloslng soondylltls and cervical cancer serles
(These coefflclents were used for the calculatlons In Tables 59 and 60.)
Average 0.35 16
PLATEAU = 4 0 years
Average 42 34
Total ( 1 ) + (2) 51 44 35 12
(average)
PLATEAU = llfetlme
Hallgnancy Sex
Other
mallgnanctes M 41 30 23 1.8 -
(3) d/ F 52 42 -
Average 47 3b
Projection o f l o s s o f l t f e e x p e c t a n c y
f o r an a d u l t p o p u l a t l o n of b o t h sexes (1000 males o r 1000 females)
exposed t o 1 Gy o f organ absorbed dose o f low-LET r a d l a t l o n a t h l q h dose r a t e
PLATEAU = 40 years
kllgnancy Sex
Uultl- Uultl- Uultl-
pllcatlve Addltlve pllcatlve Addltlve pllcatlve Addltlve
Other
mallgnancles M 400 500 200 120
(2) dl f 530 700 -
Average 470 600
PLATEAU = l l f e t l m e
Malignancy Sex
Uultl- Uultl- Uultl-
pllcatlve Addltlve pllcatlve Addltlve pllcatlve Addltlve
Other
mllgnancles U 420 510 210 120
(3) d/ F 570 710 - -
Average 490 61 0
ADDITIVE MOOEL
Age at exposure
Organ or tlssue
Age at exposure
Organ or tlssue
T a b l e 62
for :
P r o e c t l o n s of excess llfetlme mortallty and loss of llfe expectanc
populatlon of both sexes (500 males and 5 0 0 females) and all a&
exposed to 1 Gy of orqan absorbed dose of low-LET radlatlon at hlqh dose rate
uslng aqe-speclflc rlsk coefflclents
Uultlpllcatlve Addltlve
rlsk projectlon rlsk projectlon
mdel model
Leukaemla a/ 10
Other mallgnancles b/ 97
All mallgnancles 107 42
Uultlpllcatlve Addltlve
rlsk projectlon rlsk projectlon
model mode 1
Leukaemla a/ 260
Other mallgnancles b/ 1110
All mallgnancles 1370
a/ Plateau: 4 0 years.
b/ Plateau: llfetlme.
T a b l e 63
Multlpllcatlve Addltlve
r l s k projectlon rlsk projectlon
model model
A l l mallgnancles 71 45
Multlpllcatlve Addltlve
r i s k projectlon rlsk projectlon
mode1 model
T a b l e 64
a/ Age-standard1 zed.
T a b l e 65
Total 71 45 76 40 58 50
T a b l e 66
Excess rlsk coefflclents derlved from atomlc bomb survlvors (Table 56)
and the assumptlons glven ln Table 57.
T a b l e 67
Excess relatlve rlsk per 1 Gy of orqan absorbed dose In the low dose ranqe
[ 549 I
Type of cancer
< 6.0 < 1 . < 0.5 > 0.5 a/
(105 (average
( Bq/m3 ~q h/m3) (%) ales Females Total both sexes)
Radon-222 daughters
Indoors p/ 15 0.90 9.0 54 11 32 7.2
Indoors b/ 15 0.23 2.3 14 2.7 8.1 1.8
Outdoors 4 0.040 0.52 3.1 0.62 1.9 0.42
Radon-220 daughters
Total 13 79 16 47 10.5
a/ At home.
b/ Elsewhere.
T a b l e 69
Multlpllcatlve AddltIve
Malignancy risk projectton risk projection
msdel model
Remalnder 11.4 b/
11.8 c/
Tota 1
P r o j e c t t o n o f l o s s o f l l f e expectancy f o r s p e c l f t c c a n c e r s
p e r p e r s o n e x ~ o s e dt o 1 Gy o f orqan absorbed dose
o f low-LET r a d t a t l o n a t h l q h dose r a t e
(Based on t h e p o p u l a t t o n o f Japan.
90% c o n f t d e n c e I n t e r v a l s I n parentheses.)
Multlpl\cattve Addltlve
Ualtgnancy r l s k proJectton r l s k projection
model model
lotal
a/ These v a l u e s have t o be d l v l d e d by 2 t o c a l c u l a t e t h e t o t a l
and o t h e r o r g a n r l s k s .
b/ T h l s v a l u e l s d e r l v e d by s u b t r a c t l n g t h e sum o f t h e r l s k s
a t t h e s l t e s s p e c l f l e d from t h e r l s k s f o r a l l c a n c e r s
e x c e p t leukaemla.
c/ T h t s v a l u e I s d e r l v e d by f l t t l n g a l l n e a r r e l a t l v e r l s k
model t o t h e b a s i c cancer data a f t e r t h e exclusion o f t h o s e
cases o f cancer a t t h e s p e c l f t c s l t e s l l s t e d .
0.19 excess r e l a t l v e r l s k p e r Gy and 1.87 p e r 10 PYGy).
d/ Red bone marrow p l u s a l l o t h e r cancers.
4
Coefftclent
g / R e d bone marrow p l u s o t h e r l n d l v l d u a l s l t e s I n c l u d i n g
remalnder.
T a b l e 71
S u m r v of prolectlons o f l l f e t l m e r l s k s
f o r 1000 persons (500 males and 500 f e m a l e s 1
exposed t o 1 Gv o f oroan absorbed dose
o f low-LET r a d l a t l o n a t h l q h dose r a t e
(Based on t h e p o p u l a t l o n o f Japan.)
a/ D e r l v e d f r o m T a b l e s 62 and 63.
b/ D e r l v e d f r o m Tables 59 and 60.
C/ Age-speclflc r l s k c o e f f l c l e n t .
d/ Constant (age-averaged) r l s k c o e f f l c t e n t .
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ANNEX G
CONTENTS
Porogrophs Paragraphs
IhrTRODUCTION ........................ 1-9 4 . LDsoJW in man ............. 157-162
5. Skin ....................... 163-170
6. Lung ...................... in-174
7. Gonads .................... 175-179
I . PATHOGENESIS AND DOSE-RE-
SPONSE RELATIONSHIPS ........ C. lnterl~alenlitters ................ 180- 193
A . Cellular effects .................. D . Biological and other variables ...... 194-206
B. Tissue effects ...................
C . The radiation syndromes ..........
I . The prodromal phase ........ I11 . PROGNOSTIC INDICATORS AND
2. The neurological (neurovascular) BIOLOGICAL DOSIMETRY ........ 207-287
syndrome .................. A . Prognostic indicators ............. 207-239
3. The gastrointestinal syndrome I . Dosimetric data ............. 208-2 15
4. Haematological and immuno- 2. Clinical data ................ 216-221
logical effects. and the bone 3. Biological data .............. 222-239
marrow syndrome ...........
D . Effects on other tissues ...........
B . Clinical and biological dosimetry ... 240-287
1. Dosimetry based on haemato-
I . Skin ....................... logical data ................. 24 1-256
2. Oral rnucosa ................ 2. Dosimetry based on biochemical
3. Eye ........................ data ....................... 257-265
4. Lung ...................... 3. Dosimetry based on cytogenetic
5. Testis ...................... I data ....................... 266-279
6. Ovary ..................... 4 . Dosimetrv based on neuro-
physiological data ........... 280-284
5 . Other dosimetric findings ..... 285-287
11. DOSE-RESPONSE RELATIONSHIPS
IN MAN .......................... 90-206
IV . CONCLUSIONS ................... 288-322
A . Acute doses ..................... 90-138
I . The LDSo/M, ................ 90-113 Page
2. Doses for very low and very
high mortality in man ........ 114 Tables ............................... 598
3. Geometry of exposure and
depth-dose distributions ...... 115-1 19
4 . Dose inhomogeneity. shielding APPENDIX
and bone marrow distributions 120- 126 ACUTE RADIATION EFFECTS IN
5. Radiation quality ............ 127-131 VICTIMS O F THE CHERNOBYL
6. Modification of the LDS0/60 by NUCLEAR POWER PLANT ACCIDENT
post-irradiation treatments .... 132-138 Paragraphs
I3 . Effects of dose protraction ........ 139-179 ........................ 1-15
I . Prodromal responses ......... 144- 148 Inrroduction
2. Intestinal responses .......... 149-150 A . Initial diagnosis of acute radiation
3. Haematological responses .... 151- 156 sickness ........................ 16-20
Paragraphr
Paragraphs
I
B. The bone marrow syndrome and its 6. Treatment of radiation burns and
treatment ....................... 2139 other injuries ................ 73-83
C. Other injuries and their treatment .... 50-83 D. Conclusions ..................... 84-89
1. Intestinal syndrome ........... 56
2. Oropharyngeal syndrome .......
Page
57-58
3. Lung reactions ............... 59 Tables .................................. 628
4. Causes of death .............. 60-63
5. Eye damage ................. 64-71 Refere~ces .............................. 632
C. T H E RADIATION SYNDROMES
-
-
-
the gastrointestinal syndrome and the neurological (or [C36. G2]. After supralethal doses of several tens of Gy,
neiirovascular) syndrome. Representative data for all individuals begin to show all symproms characreristic
animals are shown in Figure 111. Doses (Gy) are of this phase within five to 15 minutes. The reaction is
quoted as approximate maximum tissue doses. With mediated through the response of the autonomic
mice a n d monkeys. doses in the target tissues, i.e., nervous system -and is expressed as gastrointestinal
marrow, intestine and CNS, probably are within 10% and neuromuscular symptoms. The former symptoms
of these doses. With swine and goats, doses in the are anorexia, nausea, vomiting, diarrhoea, intestinal
marrow and intestine may be less than the quoted cramps, salivation and dehydration. The neuromuscuIar
doses by slightly more than 10%; for swine, this figure symptoms are fatigue. apathy, listlessness, sweating.
may be about 20% for bone marrow and could be up fever, headache and hypotension, followed by hypo-
to 30-40% for the intestine if the dose in the middle of tensive shock. The reaction after high doses is
the abdomen is the most relevant dose. The percentage -
maximal within 30 minutes. then diminishing until it
for goats is uncertain, as the irradiation was unilateral merges closely with the neurological syndrome or, later,
using mixed gamma rays and neutrons. Man is with the gastrointestinal syndrome. Leukaemic patients
expected to conform to a similar pattern of response given 10 Gy to the whole body at 0.05 Gy per minute
versus dose (dotted curve, Figure 111). Figure 111 in many cases had a fever, occasionally associated
shows that in the interval of dose from roughly 2 to with chills at the end of irradiation, but they were
10 Gy, where the bone marrow syndrome occurs. usually afebrile by 24 hours [Di7]. After lower doses.
survival time decreases with increasing dose; survival the symptoms are delayed, fewer and less severe.
time remains relatively constant between roughly 10 to comprising mainly anorexia, nausea, vomiting and
50 Gy. where the intestinal syndrome prevails; at still fatigue. Vomiting is infrequent after doses below I Gy
higher doses, the neurological syndrome becomes [B32, D9. L8]. The responses can be produced by
predominant and over this interval survival time again separate irradiation of the head, thorax o r abdomen,
becomes very dependent on dose. It should, however, the last being the most sensitive region [G2]. Also, the
be emphasized that the syndromes are idealized region below the umbilicus is less responsive than the
clinical pictures, which are difficult to distinguish in region above it, as shown by prodromal responses in
practice, particularly when the inhomogeneities in cancer patients receiving half-body irradiation at
dose are very pronounced and when injury from other 3-10 Gy [FI 81. In monkeys, vomiting is suppressed
causes is present [B57, W28, W291. during incapacitation after high doses [M29].
A Accident
A Therapy
0 Conposite
Expert opinion
0.01 i I I i
0.5 1 10 100
DOSE (Gy)
Flgure IV. Relationship between tlme of onset 01 prodromal symptoms and dose In man. Dose rates ranged from very high
(accident cases) down to 0.3 Gy per minute (radlotherapy patients). Approximate mldllne doses are quoted.
(Modified from [B33].)
followed by transient periods of depressed or enhanced
motor activity leading to total incapacitation and
death.
Burro
Do9
Gerbi 1
Goat
Guinea p i g
Hamster
Marmoset
Flonkey
Mouse
Pig
Sheep
Rabbit
Rat
+ Precursor
cells White blood c e l l s
Stem c e l l s
IIegaXaryocytes
T and B lymphocytes
irradiation; the hierarchy of haemopoietic cells is few Gy, resulting in the bone marrow syndrome, a
shown diagrammatically in Figure VIII. The longer relative trebling of macrophages and stromal elements
the animal survives. the greater will be the contribution has been reported [SZI]. Bone marrow cellularity
to survival of cell progeny from primitive surviving reaches a minimum value by days 3-4 after 5 G y or
precursor cells in the marrow. Hence. in the short term, above and by days 5-7 after 2-4 Gy. Regeneration can
rescue of the animal will be assisted by survival of the be detected in the marrow at days 4-6 by the presence
more mature precursors, e.g., the granulocyte/macro- of colonies of undifferentiated cells. The phase of
phage colony-forming cells (GM-CFC); and, in the pronounced aplasia is characterized in the marrow by
longer term, rescue will be dependent on the survival of oedema, a lack of adipose cells and a cellular
multipotential stem cells. GM-CFC are assayed in composition of mainly lymphocytes. monocytes and
vitro, and differences in radiosensitivity have been plasma cells. When regeneration occurs, the number
reported among species (reviewed in [H 1 I]). GM-CFC of undifferentiated cells increases to a maximum at
in dogs are more sensitive than in mice or in man. days 14-20. It has been reported that after doses of up
However. in view of the marked differences in to 10 Gy cell regeneration in the marrow begins earlier
apparent sensitivity of human GM-CFC measured than after lower doses [B38. VIZ].
using different culture conditions [B28], it is not clear
whether the differences reported among species are 45. Various attempts have been made t o construct
artefactual or absolute. dose- and time-response curves for the changes in
concentration of platelets, lymphocytes and neutro-
43. The sensitivity of haemopoietic stem cells has phils in the peripheral blood of healthy humans
been measured using the spleen colony technique in receiving whole-body exposures [A 14, B3 1. C37, PI 3,
the mouse [T8] and in the rat [C8], but not in other W2]. A schematic picture of the smooth average time
animals. The possibility exists t o measure the radio- courses for the various blood cell types after different
sensitivity of rhese cells in other species from the ranges of dose (Figure IX) was deduced from acci-
formation of foli of undifferentiated cells in irradiated dental human exposures [H9. C15, G9, H6. B29. 54.
bone marrow [H48, S471. The precursor cell type that T5, B17, S6, C l l ] . The values in these idealized
can be grown in vitro from different species and which pictures are expressed as percentages of average levels
is so far known to be nearest to the stem cell in the in the normal population. Control ranges ( t 2 SD)
hierarchy is a cell that is capable of forming colonies measured in five separate studies have been summarized
in vitro comprising many haemopoietic cell types [T29]. The extremes are 4-1 1 lo9 WBC/I for males and
(Table 1). The concentration of these cells in bone 4-9 for females; 4-6 lo1' RBC/I for males a n d 3.7-5 for
marrow is very low, as expected, so it is difficult to females; 34-5496 haematocrit for males and 33-48%
measure their intrinsic radiosensitivity. Their sensitivity for females; 130-176 g haemoglobin/l for males a n d
has been measured in mouse and in man, but not in 1 13- 162 for females.
other species.
46. The patients irradiated prior to kidney trans-
44. In human bone marrow, the total number of plantation showed a n earlier and more rapid decline
nucleated cells is reduced at day 1 by 10-20'37 after in numbers of lymphocytes and granulocytes than the
1-2 Gy. by 25-30% after 3-4 Gy, by 50-60'35 after accident victims a t Oak Ridge (Y-12) a n d Vinca
5-7 Gy, and by a maximum of 80-85% after 8-10 Gy, irradiated with comparable doses. Also, in the patients
Resistant cells remain. such as macrophages, stromal the nadir levels (minimum values) were lower, but the
cells, vascular endothelium and some mature granulo- regeneration of granulocytes began earlier a n d rose to
cytes a n d eosinophils [M25]. At day 1 after doses of a higher levels. These differences would be compatible
PLATELETS
LYMPHOCYTES
0 10 20 30 40
TIME AFTER EXPOSURE ( d a y s )
Flgure IX. Schematic plcture of average tlme courses for varlous cells
In the blood, after varlous doses of radlatlon In man, derlved from
accldent cases.
(Redrawn from [WZ].)
with higher effective doses t o the patients, because been suggested as contributory factors [TIO, T11,
after the Y-12 accident the individuals receiving the T121.
higher doses, compared with those receiving low
doses, had a greater fall in granulocytes but earlier 47. A greater-than-expected haematological response
regeneration reaching higher levels by day 60 [A2]. was also observed in patients with chronic granulocytic
The greater response in the transplantation patients is leukaernia [All exposed to 0.25 Gy and 0.5 Gy (rnid-
difficult to explain, although it should be noted that line doses) whole-body irradiation, in spite of the low
many of the patients were anaemic and they had a exposure rate of 0.0012 to 0.0076 Gy per minute (at
short expectation of life. Different marrow doses, the midline). The rate of recovery of blood cell counts
differences in the uniformity of dose, the contribution was slower than in the transplantation cases discussed
from neutrons in the accident cases and the con- above. These differences have been taken to indicate
founding influence of concomitant disease have all that data pertaining to irradiated patients suffering
from haematological diseases are not applicable to populations: this extends to about day 15 and is
healthy individuals [All (except, perhaps, those data followed by a second decline to about day 25, due to a
pertaining to patients in remission) [B41]. lack of recovery in the stem-cell population. The
absence of a second rise in granulocytes is indicative
48. Figure IX shows that the lymphocyte count is of the failure of haemopoiesis to recover permanently
the most sensitive index of radiation injury in the [B16]. The second abortive rise is not seen after doses
blood, in the sense that, for the same dose, nadir levels higher than 5 Gy (Figure A.V (left panel)).
are reached earlier than for other cell types. Lympho-
cytes die in interphase, and doses of 1-2 Gy cause their 50. With whole-body doses in excess of 6 Gy the
numbers to decline to about 50% of normal by 48 hours. critical level of neutrophils is reached in 7-9 days; after
Decreases can also be observed during irradiation. For 4.2-6.3 Gy, it is reached in 10-20 days. With doses
example, at the end of a 4-hour period during which lower than 4 Gy, the critical level is generally reached
10 Gy was delivered to leukaemic patients in remis- after 20 days or more [U6]. The dose-dependence of
sion, the lymphocyte count was 50% of pre-irradiation the white cell count is shown in Figure A.V (left
levels, and it subsequently declined with a half-time of panel), which depicts the time to the minimum
about 30 hours [D22]. A plateau was then reached number of granulocytes; alternatively, Figure A.V
which is dose-dependent, remained for about 45 days (right panel) shows the time to reach the critical level
and was followed by a slow recovery over several of 500 granulocytes per pl (see below). From Figure
months. The dose-dependence of the plateau level has A.V (right panel) it can be seen that after about 6 Gy,
been estimated in two reports from accident cases the granulocyte level would be reduced to 10% (from
[W2. P131, and the results of the two reports are fairly 5,000 to 500 per p1) in 12-14 days. In Figure X, the
consistent, one with another (Figure X and Figure nadir is also 10% after 6 Gy, but it is reached
A.1I.b). somewhat sooner, after about 7 days (Figure IX).
DOSE (Gy)
Keratinised
(Mature)
Granular
1
Spinous
t (Maturing)
Stemlproliferative
(Basal)
Figure XI11. Dlagrammallc reprerentallon ol the hlererchy of cell population types In the
epldermls, drawn from a vertlcal sectlon through normal human epidermis.
(Adapted from [P28].)
61. The effects in skin are very dependent on the [DlO]. The survival parameters were Do= 0.7-0.9 Gy,
dose and on the area of skin irradiated (e.g., [A34, n = 10-16 (Table 1). The keratinocytes were more
E12, H19, P281). Erythema proceeds in waves. After sensitive than epidermal clonogenic cells assayed in
doses greater than 10 Gy, there may be an initial situ in mice or in pigs.
phase, which reaches a peak around day 1, followed
by a second wave between one and four weeks. Higher 65. The time to full depletion of the epidermis after
doses produce erythema of increasing severity, and the high doses corresponds to the transit time from the
latency interval is shorter. After very high doses, least-differentiated committed progenitor cell in the
erythema can appear and disappear several times. basal layer to the surface in unirradiated epidermis
Erythema was used as a biological dosimeter in the [P8]. This was deduced using a model applied to
early days of radiotherapy, and the "threshold erythema different types of epithelia, in which it was assumed
dose" varied with energy, dose rate and field size that the clonogenic stem cells were sterilized after high
[E12]. Erythema is less easily recognized in pigmented doses. and also that the few divisions of committed
skin and in exposed skin areas. The dose resulting in a proliferative cells, together with the processes of
visible erythema reaction within four weeks in 50% of differentiation, maturation, and migration, were very
individuals (not the initial transient erythema appearing radioresistant and hence unaffected. The normal
within hours) after an acute single exposure with turnover time of the epidermis would be expected to
200 kVp x rays over a 10 X 10 cm2 field on the medial be longer than the above transit time by an amount
surface of the forearm is about 5.7 Gy [D6, L4]. equal to the lifetime of the stem cells in the basal
layer. The time to full depletion of the epidermis after
62. In patients given radiotherapy to a 3 cm diameter irradiation would be shortened where there is an
area of the scalp with 100 kVp x rays the percentage acceleration of cell depletion as it proceeds after
of abnormal hairs increased between days 4 and 10 irradiation [P8, P281.
[V4]. The incidence of abnormal hairs rose above 10%
only after doses to the hair roots of 0.75 Gy or more. 66. The degree of skin desquamation is markedly
The incidence was about 50% on day 10 after 1.5 Gy, dependent on the area of skin irradiated. This has
and doses above 2.5 Gy resulted in abnormality in been studied in radiotherapy patients [C6, E2, 56. 57,
100% of hairs [V4]. Temporary epilation is produced M 1, P2, V8], and some of these findings are summarized
after doses of 3-5 Gy and is most severe in the second in Figure XIV and in Table 6. Some investigations
and third weeks [D2], as noted, for example, in were confounded by the use of various degrees of
patients receiving whole-body irradiation prior to reaction acceptable as "tolerance" in different field
kidney transplantation [TI 1, T121. Similar time courses sizes, e.g. [J6], as discussed in [H19]. In general, the
were observed in the survivors of the atomic bombs, effect of field size is similar for single or fractionated
and if regrowth of hair occurred it was observed by doses and can be described by either of the formulas:
12-14 weeks after irradiation [05]. Epilation may be Dose = k(area)-O-I6
permanent after doses greater than about 7 Gy. Hair
on the scalp is more sensitive than the beard or body Dose = k(diameter)-0-33
hair. where k is a constant [C7. V8].
63. Desquamation reactions appear following marked 67. The extrapolation of the above formulae to areas
erythema, after acute radiation doses greater than greater than 400 cm2 is uncertain, because evidence for
about 12 Gy. The severity of the reaction depends on very large areas relates only to the use of lightly
the anatomical location, the vascularity and oxygena-
tion of the skin, and the genetic background, age and
hormonal status of the exposed individual [R12].
Dose-time and dose-incidence relationships have been
studied in radiotherapy patients receiving doses to
relatively small fields. Moist desquamation is pro-
duced in 2-3 weeks in 50% of individuals after a dose
of about 20 Gy to areas of 35-80 cm2 [A4, E2.56, L4,
P2]. The maximum reaction occurs at about three
weeks. After whole-body irradiation with such doses,
the individual will have died from the intestinal
syndrome before the desquamation reactions occur,
except when the irradiation is poorly penetrating, as in
the treatment of skin diseases or in direct skin
exposure to short-range fallout radiation.
>
W
n
0
82. Threshold doses and dose-incidence relationships x
3.
for pneumonitis can be deduced from whole-body
--
IA 6 -
radiotherapy treatments of leukaemia prior to marrow C
w
transplantation. or half-body treatments for metastases. $- 4 -
The effects are variously confounded by the concomi- 2
tant use of cytotoxic drugs. e.g.. cyclophosphamide. A 2 2-
sunrey was made of 15 centres in Europe giving W
g
whole-body irradiation before marrow transplantation m 0-
L
to a total of about 400 patients [B32]. The dose rates =,
z
0 1 2 3 4 5 6 7 8 3
ranged from 0.025 to 0.35 Gy per minute, and the T I M E OF ONSET OF PNEUMONITIS (months)
lung doses from 6 to 10.5 Gy. The incidence of
pneumonitis increased above 8 Gy and was dependent Flgure XVI. The frequency dlstrlbutlon of the Ume of onset of
radlatlon pneumonitis for 52 pallents who developed the
on the dose rate. Included in this survey were patients compllcatlon.
from the Royal Marsden Hospital in London. and a [V31
separate report described 107 of these patients with
acute leukaemia given whole-body irradiation resulting
in 9.1-10.5 Gp to the lungs at a dose rate of 0.025 Gy
per minute. Eleven (10.3%) developed interstitial
pneumonitis and five (5%) died of it [B49]. Sixty of
them were irradiated and received a bone marrow
transplant when they were in their first remission, and
they were considered to be in a good clinical condition. 1T Standard
deviation
about
83. Irradiation to the upper half of the body was the mean
given to 245 patients for the palliation of disseminated
cancer [F12]. The dose rates ranged from 0.5 to
4.0 Gy per minute. The results of these treatments, Mean
together with those given to a further 58 patients, were
analysed subsequently in terms of corrected doses to
the lung. Patients with significant previous and sub-
sequent lung irradiation, with previous lung disease or
with known tumour masses in the lung were excluded
DEPTH (cm)
Figure XXI. Estimates of dose-survlval curves for man, at 60 days. Curves A and 0: Standard error
llmlts (dotted curves at both sldes of curve A, dashed curves at both sldes of curve B) calculated
uslng problt analysis; Curve C: The line Is drawn assuming a coefflclent of variation of 0.24, derived
uslng several species of large animal [M28]. The left arrow extends to approximately the LD,,
calculated using lower levels of survlval at the 90% Poisson probablllty level, and the right arrow Is
included speculatively for completeness. Curve D: Arrows denote standard error Ilmlts. The dose-
survlval curve estimated from the population In Hlroshima receiving atomic bomb lrradlatlon Is
expected to Ile in the range between curves A and 0 .
[L4, L11. M27. M28. M31,R203
group of 159 labourers were exposed when shielded by was higher than that of adults irradiated in other
wooden buildings about 1,000 m from the hypocentre buildings who had apparently lower doses.
at Hiroshima, and of these 58.554 died between day 20
and 38 [05]. Using the revised doses, as in the 97. A recent detailed analysis of weighted data
preceding paragraph, the tissue kerma of about 2.4 Gy concerning deaths versus distance from the hypo-
multiplied by a factor of 0.79 gives marrow doses of centre, including those occurring on the first day after
1.9 Gy, and possibly 2.1 Gy if prompt and delayed exposure. has given a value for L D , , of 2.1-2.5 Gy
radiation components are considered separately [ F 151. marrow dose, the value depending on the mathe-
.L\lso. of 193 workmen exposed unshielded at 1,000 m matical model used to fit the data. A probit fitting of
from the hypocentre. only 10 surv~veda marrou dose the data gave a value for LD,,, of 2.2 Gy, and for
currently estimated to have been about 3.3 Gy [F15]. LD,,,, of 5.8 Gy [F15]. It was considered that the
value of LD,,,,, may be too low by up to 17% because
96. Other groups of individuals were exposed inside of the contributions to mortality estimates from
concrete buildings. Ninety 15-year-old girls were deaths on the first day and of the severely injured.
exposed in the Central Telephone Office of Hiroshima This was estimated in a separate smaller study of 184
at 550 m from the hypocentre. Of the 59 who survived individuals. 84 of whom died on the first day, where
to 24 hours. 29 (49%) died between one and ten weeks the LDso,,b~lwas calculated using probit analysis to be
after exposure. The majority (20) died in the fourth, 3.2 Gy or 2.6 Gy marrow dose when the above early
fifth and sixth weeks. From measurements made years deaths were respectively excluded or included. Hence
later of chromosomal aberrations in the T-lymphocytes the true value of LD,,,,,, may be around 2.5 Gy or
in the survivors [F15], the dose was estimated to have higher. The true value of LD,,,, is even more
been 6.5 Gy. Although this is similar to the value of uncertain. I t may also be higher, or lower down to
6.0 Gy according to the T65D estimates, the revised 4.5 Gy [F15]. In view of these uncertainties. it is
estimates of dose are lower, perhaps as low as 4 Gy concluded that the dose-survival curve for the Japanese
[F15]. None the less, the survival rate of these girls exposed to atomic bomb radiation in Hiroshima is
likely to be similar to curves deduced for ill radio- red-cell infusions were administered when considered
therapy patients receiving whole-body irradiation (in necessary. Thirteen patients received allogeneic marrow
the range of curves A and B. Figure XXI). transplants and six received embryonic liver transplants.
In the lowest dose group, 31 individuals received
98. There have been many radiation accidents in- relatively uniform bone marrow doses of gamma-
volving single individuals or a few individuals, often irradiation of approximately I to 2 Gy. In the
with very inhomogeneous doses from gamma rays or second dose group, 43 individuals received marrow
x rays, or mixed radiation, including a neutron com- doses between 2 and 4 Gy: in many cases higher doses
ponent. These accidents have been summarized by to the skin from beta-irradiation were also received.
several authors [B7. B31, D24. D25, L12, M19, U4]. None of the patients of this group died up to 60 days
The most comprehensive listing is probably the after irradiation, but one died at day 96. A further
REAC/TS Radiation Accident Register [L 121. Between 21 persons received marrow doses between 4 and 6 Gy.
1944 and October 1983. 188 accidents were recorded Seven of them died between 16 and 48 days after
involving 928 persons, 22 of whom died from acute irradiation, and six of these seven had severe skin
effects [FIO]. One hundred and forty-four individuals injuries, which contributed greatly to their death. In
received whole-body doses greater than about 0.25 Gy, the highest dose group. 20 individuals received doses
and eight of these died; 46 received, in addition, local between 6 and 16 Gy. One person died at day 10 after
irradiation with doses greater than 6 Gy, and eight of irradiation. 17 died between 14 and 48 days, and two
them died; 62 received high internal doses, and four died at days 86 and 9 1 , respectively. The individuals in
of them died; 110 Marshall Islanders received both this dose group had severe skin injuries to 40-90% of
internal and external irradiation, and one of them the body that were probably lethal, as well as severe
died. In March 1987 these numbers were updated to signs of radiation sickness (Table A.7). These observa-
284 accidents involving 1,358 persons, 33 of whom tions, in particular the survival of 43 individuals in the
died from acute effects (excluding Chernobyl) [L38]. dose group 2 to 4 Gy surviving more than 60 days,
suggest that the LD,,, for this irradiated population
99. Before the accident at Chernobyl ([U6] and the was at least 4 Gy.
Appendix), the accidents involving the largest number
of individuals, and therefore the most useful for 101. Various groups of cancer patients have been
analysis. were those in 1958 at Oak Ridge. United given acute whole-body irradiation. Some were rela-
States [02. H23] and at Vinca, Yugoslavia [H22, 11, tively i l l people with advanced disseminated cancer
54, M491. The doses received by these individuals are and others were relatively healthy individuals irradiated
still a matter for debate; some recent estimates are while in remission or when bearing metastasizing solid
reported in Table 12. The various estimates depend on tumours. A group of 19 children and adolescents with
the assumptions about the position and orientation of Ewing's sarcoma and one with leukaemic infiltration
the individuals, and the dose and RBE of the neutron of bone received 3.0 Gy from whole-body irradiation
component. None the less, there was only one death, with cobalt-60 gamma rays given in 15 minutes (dose
individual V at Vinca. who received a marrow dose homogeneity to within + 10%) [R6]. None of these
estimated recently to have been approximately equi- 20 individuals died within one year. They were given
valent to 4.5 Gy of low-LET radiation (Table 12). antibiotics when infection arose, blood infusions at
Although he had marked haematological responses, about day 30 to replace haemoglobin, and barrier
these were no1 the primary causes of death. Two of nursing during the phase of pancytopenia. According
the individuals irradiated at Oak Ridge received to Poisson statistics, zero deaths in a sample of 20
antibiotic treatment for respiratory infections. whereas individuals might be observed 1 in 20 times (i-e.. a 5%
the Vinca cases had barrier nursing. and a series of probability) if the true number of deaths on average
antibiotics. platelet and red cell concentrates, and later among many such samples was 3.7: that is, if the true
marrow cells. In one report, recalculation of the doses mortality was 3.7/20 = 19%. Hence it is possible that.
broadened the possible ranges of dose so that they over- although no mortality was observed in this particular
lap, depending on the uncertain aspect of exposure, sample, the average mortality level characteristic of
particularly at Oak Ridge, i.e.. from the side or from this 3.0 Gy dose could be as high as 1995, but not as
the front [B7]. Another report concluded that the data high as 50%.
from Oak Ridge were more reliable than those from
Vinca, because in the latter accident the exposures 102. An attempt was made to extend this type of
may have been more inhomogeneous [M 191. From a analysis to a total of 27 individuals, by including
re-analysis of the measurements of sodium activation, subjects A, C and D in the Y-12 accident. and subjects
it has been suggested that the doses at Oak Ridge V. M, D and G in the Vinca accident [M28]. Estimates
should be increased by about 10% and at Vinca, by +
of the total (n ;*) marrow doses that were used
about 30% (column 8, Table 12) [M26]. This could ranged from 2.8 to 3.3 Gy (colun~n7, Table 12). The
remove the apparent difference in clinical effect for one death (case V at Vinca) was attributed to marrow
estimated equivalent doses in the two accidents in failure for this exercise, in order to provide a
earlier reports. maximum value to the observed mortality. Using these
27 individuals, the statistical exercise in the preceding
100. In the accident at Chernobyl, described in the paragraph gives virtually the same result, with the
Appendix. 115 persons received doses ranging from possible average mortality being 2 1%. A further point
approximately 1 to 16 Gy (Table A.3). In most cases the is that if the true average mortality was 50% at these
individuals received antibiotics and were hospitalized, if estimated doses of about 3 Gy, as is suggested by an
necessary under aseptic conditions, and platelet and analysis of mortality in radiotherapy patients (see the
next paragraph). or more (colun~n8. Table 12), there sarcoma. Whole-body irradiation was given to these
would be a 5% probability of as few as six deaths out children and adolescents to sterilize [he metastases.
of a random sample of 27 individuals, in contrast with Three patients with localized disease given 3 Gy
only one death observed. Hence the data for the (midline dose) survived more than 60 days without
Eiving's sarcoma patients, with or without the inclu- needing supportive medications [M34]. Ten patients
sion of these accident cases, are inconsistent with an with localized disease given 3.0 Gy (midline dose)
LD,,,,, as low as 3 Gy. The revisions in the dosimetry survived more than 60 days [J17]. A larger series of
for the accident cases that increase their respective 20 patients was described, one of whom was diagnosed
doses [h?26] strengthens this conclusion, as does the subsequently to have had instead a leukaemic infiltra-
survival to 60 days of all 43 individuals receiving doses tion of bone [R6]. All 20 survived more than 60 days.
estimated to be between 2 and 4 Gy in the Chernobyl This indicates that the LD,,,,, of relatively healthy
accident (Table A.3). people is greater than 3.0 Gy, although it is not
known if these young people were more resilient to
103. One group of 163 relatively ill cancer patients irradiation than adults. The apparently high doses
was irradiated to the whole body with acute doses of tolerated by the schoolgirls irradiated by the atomic
low-LET radiation [Lll]. The estimated dose (with bombs [ K 171 would support this idea.
its standard error) giving 50% deaths within 60 days
was 2.5 (+0.98 -0.51) Gy, calculated using a normal 108. Attempts have been made to use experiments
distribution, and 2.35 (+5.06 -0.87) Gy using a log- with animals in order to predict the dose-mortality
normal distribution. The data were corrected for a death relationship for man. Two similar approaches have
rate of 4% in unirradiated patients, and average doses been described. The first approach [L4, M28] relies on
were given for a 26 cm diameter sphere in the epigastric the similarity of the coefficient of variation (CV) of
region. A similar analysis of 218 patients irradiated the LD,, [i.e., the inverse slope (probit width) divided
within an overall period of one day, gave an LD,,,,,, by the mean] among different species of large animals.
of 2.86 2 0.25 Gy [L4]. These two calculated dose- The CV for irradiated cancer patients was 0.58, which is
mortality curves (A and 9) are shown in Figure XXI. much larger than the CVs calculated for dogs (0. 15) and
monkeys (0.21) [L4]. This greater variability was
attributed to the marked heterogeneity of responses
104. An analysis of 110 patients receiving whole- among patients. The mean CV for dogs and monkevs
body irradiation from I to 10 Gy, either for various
(0.18) was applied to the data for 218 irradiated cancer
cancers and leukaemia or prior to kidney transplanta-
patients [L4], where the LD,, was 2.86 2 0.25 Gy, to
tion. indicated an LD,,,, of about 4.0 Gy [M31]. The
calculate the doses for 10% mortality (2.2 Gy) and
Committee's probit analysis of these data produced an
90% mortality (3.5 Gy). Mole [M27. M28] calculated
L D ,,, of 3.4 f 0.5 Gy (curve D, Figure XXI). The the weighted mean CV for five different species of
data for the patients with malignancies were not large animal (dog, sheep, goat, pig, donkey) t o be
significantly different from the data for the (fewer)
0.24. This value was used. together with pertinent but
patients with kidney debilities.
sparse information for mortality in "healthy" humans,
t o deduce a value for the LD,, in man of about 5 G y
105. Smaller groups of patients have also been given (Figure XXI). The information just referred t o came
whole-body doses of up to 3 Gy. without bone from the 27 individuals described in paragraph 102
marrow transplantation. For example, one patient [M28].
with metastatic bronchogenic carcinoma given about
3.8 Gy (midline dose) using 60Co died on day 20 after 109. The second approach was to take the ratio of
irradiation, and one with generalized neuroblastoma the doses that produced measurable, very low o r very
given about 2.6 Gy survived to 4 months after high mortalities [B6]. The ratio of LD,,/LD, or
irradiation [K 181. Of seven patients with advanced
colon and lung cancer irradiated with 2.0 Gy (midline
LD,,/LD ,,from 34 experiments in six species of large
animal was close to 2.0. This ratio was used, together
dose) using 60Co, two died within 60 days (at 28 and with the data for the Ewing's sarcoma patients, to
56 days) [S27]. Three patients, in a series of 18. in consider the LD,,or LD,, for man. The two approaches
remission from acute leukaemia were given 3 Gy are consistent with one another, and they suggest that
midline dose using '"Cs. and they survived more than the dose that would kill "few" healthy humans is
60 days [K23]. They received antibiotic therapy and about 3.0 Gy, the dose that would kill "most" is
transfusions of platelets and red cells when considered about 6.0 Gy [B6] and the LD, is 4.5-5.0 Gy [M27,
necessary. M28].
106. Since the LD,,, for ill cancer patients is 110. Estimates of dose-survival curves for various
confounded by their disease and other concomitant animal species are given in Figure XXII. Data from
treatment, it may be lower than the LD5,, for healthy many published experiments were reviewed by Baver-
people. The data in the last three paragraphs suggest stock [B6], and were re-analysed to obtain a mean
that for ill cancer patients treated with conservative curve for each species [T24]. Doses in each experiment
supportive medications and blood-cell infusions when for a given species were multiplied by the ratio of the
necesFary, the LD,,,, is about 3.0-3.5 Gy (marrow LD,, for that experiment and the mean LD, for all
dose). experiments. This assumed that variations between
experiments were due to dose-modifying influences,
107. The cancer patients considered relatively healthy e.g., to changes in dose rate or LET. The data for
at the time of irradiation were those with Ewing's mice were reviewed and analysed separately [H32].
I I 1 I I I I I I
1 2 3 4 5 6 7 8
DOSE (Gy)
Figure XXII. Midline dose-survival curves calculated from various published experiments using
different species of animal Irradiated bilaterally.
IT241
11 1. In the data for large animals reviewed by second month. unless the lungs are shielded. At even
Baverstock [B6], lower slopes correspond with higher higher doses (>I0 Gy) acute gastrointestinal injury
values of LD,, (see curves for goat and monkey in will become more prevalent.
Figure XXII). This indicates that heterogeneity in the
irradiated population is greater for species showing a 113. A summary of the effects and their time courses
higher LDI0, possibly because variations between after whole-body irradiation of man, prepared by the
individuals are greater in species with a high LDso or Committee, is given in Table 13. The Table lists
because the sensitivity of their target cells is less. possible therapies for the responses. More detailed
Evidence for the latter possibility is that the Do summary tables of symptoms and signs after various
for granulocyte-macrophage colony-forming cells is ranges of dose are available, for 0.5-1.0 Gy, 1.0-2.0 Gy
generally reported to be much lower in dogs (- 0.7 Gy) (Table 14), 2.0-3.5 Gy (Table 15). 3.5-5.5 Gy (Table 16)
than in mice (- 1.8 Gy) o r in humans (- 1.5 Gy) and higher doses [Y7].
[H 111. Data are not available for other species.
112. It is concluded from the preceding discussion 2. Doses for very low and very high mortality in man
that the LD,,,,, for acute irradiation is likely to be
around 3.0 Gy marrow dose in the case of humans 114. The dose-mortality curves for ill cancer patients
receiving no or little medical treatment, as deduced are shown in Figure XXI, together with a curve for
from recent analyses of the results of the atomic healthy humans described by an LD,,,, of 5.0 G y and
bombings in Japan. A similar value pertains to some a coefficient of variation of 0.24 [M27. M281. The
groups of ill cancer patients receiving good medical slope of the latter curve is consistent with the
care. The LDswmfor healthy humans receiving good conclusion of Bavcrstock [B6], using data for various
supportive medical treatment after irradiation (e.g., species of large animals. that the ratio of doses
barrier nursing. antibiotics symptomatically and blood (LD,,/LD ,,J or (LD,,/LD,) was about 2. Also, the probit
cell infusions) is likely to approach o r equal 5.0 Gy, in width, for this curve. of 1.20 Gy (i.e., 5.0 X 0.24 Gy)
particular for children. This is deduced from the lack would correspond to a D,, value for the bone marrow
of mortality in the young and relatively healthy target (stem) cells of 1.20/1.?, or 1.0 Gy, using the
Ewing's sarcoma patients given 3.0 Gy marrow dose. Poisson model described by Gilbert [G3]. From
the presence of only one death out of the seven Figure XXI it may be seen that a dose of 2 Gy would
individuals receiving the highest doses in the Vinca be unlikely to kill more than about 1% of a healthy
and Y-12 accidents; the survival of all 53 individuals population (curve C). This is compatible with the
receiving doses of 2-4 Gy and of 14 out of 21 indivi- Chernobyl experience (Table A.3) but not with the
duals receiving 4.2-6.3 Gy in the Chernobyl accident; atomic bomb data [F15]. By contrast, a dose of 2 Gy
and the data on dose-response relationships available could kill up to 30-40% of a population of very ill
for other large animals. It should be noted that the cancer patients (curves A , 6 and D). Similarly, a dose
LD,,,, can be further increased markedly by success- of 7 Gy would probably kill about 95% of healthy
ful marrow transplantation. probably up to about people (curve C) but 5-6 Gy to ill cancer patients
9 G y acute single dose. After these higher doses there could probably achieve the same level of mortality
may be some cases of pneumonitis occurring in the (curves A and B).
3. Geometry of exposure and depth-dose distributions the LD,,, if the conccntration of marrow cells critical
for survival is constant in all regions of active
1 15. Large animals irradiated unilaterally exhibit haemopoietic tissue. Since higher concentrations (about
greater LD,,, values than those irradiated bilaterally. twice as high) of critical stem cells have been detected
by about 20% for dog, sheep. pig and goat [M28] close to bone surfaces in the mouse [L7]. the above
(Table 17). Further information on the effect of figure of 9% may be slightly higher. KO information
exposure geometry is that the LD,, for goats irradiated is available on the measurement of such effects in
dorsally is 0.63 of the value for ventral irradiation large animals, apart from the lower concentration of
[B7]. Also, higher values for the LD,, of goats are granulocyte-macrophage precursor cells close to bone
obtained when parts of the vertebrae are specifically surfaces in human ribs [T33].
shielded from direct dorsal irradiation [B7]. Similar
effects would be expected for man. but no data exist
on this subject. 1. Dose inhomogeneity. shielding and bone
niarroH distributions
116. The interpretation of the differences in LD,
with the direction of esposure relates to the exponential 120. The effect of dose inhomogeneit\ on the hae-
relationship between cell survival and dose. Irradiation matological response and survival in rodents and dogs
of a cell population with a non-uniform dose is always has been reported in papers submitted by the delega-
less effective than a homogeneous irradiation with the tion of the USSR [D28]. In mice, the LD,,,, was
average dose of the distribution [Big]. In the case of about 5.5 Gy for whole-body irradiation. about 14.5 Gy
bone marrou,. the effects depend on the depth-dose when only the front half of the body was irradiated
curve for the particular radiation used and the and about 8 Gy when only the rear half was irradiated.
distribution of active bone marrow along such a The corresponding values for dogs were about 2.8 Gy
depth-dose curve. Models for these effects have been and 3.8 Gy. Different critical organs were probably
described [ B 18, B 19, T3]. responsible for death after these types of irradiation.
Thus. for both mice and dogs, larger average doses to
1 17. Depth-dose distributions are shown in Figure XIX the body could be tolerated when only the front half
for a variety of radiation qualities [BZO, S4]. These are was irradiated, and smaller average doses when only
expressed as percentages of maximum tissue-air ratios, the rear half was irradiated. compared to uniform
independent of the inverse-square law, and measured irradiation. Also. these average dose differences were
for large radiotherapy fields (> 20 cm X 20 cm) and reduced when both halves of the body were irradiated.
source-to-surface distances (SSD) greater than or
equal to 40 cm. No ideal comparison exists wherein a 121. When small portions of the body containing
full range of radiation qualities has been used with the active marrow are shielded during irradiation, the
same large field size and the same SSD. Hence the LD, can be markedly increased. This would also
curves shown in Figure XIX ~ . o u l dchange slightly. apply to some degree in the case of non-uniform
depending on the particular irradiation set-up. For irradiation. Shielding the right legs of mice increased
4 %I\' s rays, the highest energy considered. the the LD,,,,,,, from slightly less than 7 G y without
surface dose for tvell-collimated beams and short SSD shielding ( 7 Gy gave 70%#nmortality) to about 12 Gy
is between 40% and 50% of the maximum dose. For [CZ]. Shielding the right leg below the hip joint gave
low, energies and non-collimated beams. the surface 7 3 5 survival at 30 days after 10.5 Gy, in contrast to
dose is a greater percentage of the maximum dose. 0% without such shielding [Dl]. Shielding the leg only
With non-collimated be:~nms and \.cry long SSD. the bclou the knee joint. or below the tibia, did not cause
surface dose may be equal tu the maximum dose. For sur\.ival to drop below 70% [Dl]. These phenomena
fission neutrons, a significant build-up effect would be arc due partly to the migration to and repopulation of
unlikely. irradiated marrow by progenitor cells from the shielded
marrow and partly to the ability of the shielded
118. The averagc dose in bone marrow per unit marrou to increase its normal rate of producing
esposure is shown in Figure X X [15]. These cur\.cs maturing haemopoietic cells. In mice, a persistently
were obtained by calculation and measurement using reduced complen~enrof only 10-20'3 of stem cells
a phantom. Similar curves are available for the remaining during chronic irradiation [LZ] or after
average doses in the intestine and the gonads [J 101. repeated irradiation [HI41 can maintain a normal
output of mature haemopoietic cells into the blood for
119. N'ith low-energy rays there is an additional many months.
dose at bone surfaces due to the greater photoelectric
effect with the high-atomic-number elements (e.g.. 2 2 In dogs. shielding the skull reduced lethality
calcium and phosphorus) in bone. The greater dose after 4-5 G from 100% to 20%. and shielding
depends o : ~the x-ray energy and on the thickness of sternum, pelvis or skull doubled the LD, [A31]. .41so.
the bone. and the effect decays within a few hundred shielding, separately. the head and neck, chest, abdomen
microns of the bone surface. The increase in dose is as or pelvis gave no deaths in separate groups of 20 dogs
great as 5 0 5 on the bone surface using 250 kVp x rays each given 6 Gy, a 100% lethal dose if given to the
[E5]. and on average about 20% for a single layer of whole body [L31]. Shielding smaller volumes of
cells situated against the bone surface. This effect in marrow in dogs has also been shown to markedly
the mouse would increase the dose to the marrow on increase survival [D28]. Shielding one or two vertebrae
average by about 9% compared to the dose in soft was found sufficient to protect dogs from an otherwise
tissue remote from bone. and it should be reflected ir, fatal exposure to radiation [S41]. Shielding the limb
epicondyle resulted in 100% survival after doses three 5. Radiation quality
times the LD,,6,. but shielding only the third and
fourth ribs was insufficient [C34]. 127. Most accidental human whole-body exposures
to high-LET radiation have involved both fission-
123. The above data suggest that in man, the spectrum neutrons and gamma rays. Exposures from
shielding of perhaps as little as 10% of the active the atomic bombings also involved gamma rays and
marrow, while the remainder of the body receives a fission neutrons, but the revisions in dosimetry [K16]
dose close to the LD5,,,, may reduce the number of have reduced the estimate of the neutron component,
deaths to zero. The efficacy of shielding different parts particularly at Hiroshima (Figure XXIII). For example.
of the body in man depends on the distribution of at 890 m from the hypocentre in Hiroshima, where
active bone marrow. about 50% of individuals irradiated inside Japanese-
style houses have been considered to have died from
124. Various estimates of the percentage of active marrow failure, the contribution to the dose from
marrow residing in the different bones of man have neutrons has been calculated to be only about 2% of
been calculated from histological measurements using the total marrow dose [R20]. Thus the contribution
59Fe uptake. The values for humans aged around 40 from doses of neutrons to early effects in the
are compared with those for other species in Table 18. population at Hiroshima is now considered to be
Some of the values for humans were calculated from much less than had previously been thought and
the absolute weights of total marrow in the bones of approaches the level calculated for Nagasaki.
1 1 cadavers [M 121. These weights separately for each
cadaver were multiplied by the proportion of marrow
that was active. This proportion has been estimated by
various investigators on the basis of marrow cellularity
and uptake of 59Fe, and the values given by Cristy
[C12] for humans aged around 40 were used by lo4 1 HIROSHIMA Yield:
T65D 12.5 k t
Woodard [W8]. The absolute weight of active marrow
in a given bone was expressed as a percentage of the
total weight of active marrow. Finally, the average of
these percentages was calculated over the six males
and five females investigated. The averages differ in
many cases from the values presented by Ellis [E4], as
used by ICRP [I61 for reference man. The largest
differences are evident in the values of 3.9% for the
sternum (3.6% in females), given as 2.3% by Ellis [E4],
and 7.7% for the sacrum (7.4% in females), given as I Neutrons \ *'
-\-
13.9% by Ellis [E4]. Also, the percentage of active
marrow in the total marrow, 27.5% (28.5% in females),
was given as 50% by ICRP [16]. The values from
Woodard [W8] probably apply quite well for ages
above 20 years but not so well for younger people,
because the skull has a higher proportion of active
marrow than other regions of the skeleton [C12]. GROUND RANGE (m)
In diseased patients there may be significant extra-
medullary haemopoiesis, which would modify the
normal distribution. lo4 7 NAGASAKI Yield:
129. The RBE for exposures with fission neutrons 6. hlodification of the LD,,, by post-irradiation
appears to decrease with an increase in body size. For treatments
example, the RBE for LD,, in bilaterally-irradiated
pigs has been reported to be 0.4-0.54 [W9. B25], 0.73 132. The management of persons after irradiation o r
for LD,,, in goats and 0.83 for sheep [El]. There are combined injuries has been discussed in a number of
several reasons for this apparent reduction in RBE publications (e.g., [B57, C5O. C 5 1, W28, W291).
with an increase in body size. First, neutrons are However. the value of routine medical treatments
attenuated more rapidly in tissue than are gamma after irradiation in man is uncertain because there are
rays. so the dose at greater depths is less and is due no suitable groups, treated or untreated, with which
increasingly to gamma rays. Second, in small animals, the treated groups can be compared. The populations
a large part of the dose from neutrons is from charged in Hiroshima and Nagasaki received minimal medical
particles, whereas with large body masses neutron treatment owing to the destruction of the already
capture reactions dilute the dose from charged particles sparse supplies and facilities [05]. The Y-12 subjects
with dose from knock-on protons. Third, the dose at Oak didge were treated conservatively, and were
from neutrons in and near bone is less than in soft admitted to hospital two hours after the accident
tissue remote from bone. The dose from neutrons to a [B29]. Prophylactic antibiotic treatment was not given.
one-cell-thick layer on the bone surface can be up to nor were bone marrow trans~lants.Antibiotic treat-
20% less as a consequence of this effect [B22]. When ment was given to two patients for mild oropharyngeal
the doses in the experiments with sheep were expressed infections. The subjects at Vinca were treated more
a s average doses in a 7-cm-thick outer annulus. the extensively [J2]. hey received antibiotics on the day
RBE value increased to 3, as expected for haemopoietic of the accident and thereafter when necessary. They
failure [E I]. were barrier-nursed and given injections of packed red
cells and transfusions of platelets when necessary. The
130. The doses to the individuals in the Oak Ridge patient who later died had received a transfusion of
and Vinca accidents are calculated generally by foetal and later adult haemopoietic tissue. The other
summing the three components: (a) gamma ray dose four subjects apparently showed a favourable response
due to emission from the source; (b) gamma ray dose to the transplants, with parallel changes in the blood
from neutron capture in a 6 cm annulus of a 30 cm and bone marrow and clinical condition. However,
cylinder: and (c) first-collision, charged-particle dose because the haemopoietic cells were given at 27-36 days
multiplied by an RBE factor of 0.8-1.0 [M28]. All of after irradiation, when endogenous recovery would be
these components have uncertainties, in particular the expected t o have begun, i t is difficult to judge the
RBE. None the less, when the calculations are degree of efficacy of the transplants. The radiotherapy
performed and doses are estimated for the various cases [R6] were barrier-nursed. with antibiotics given
individuals (Table 12), the low mortality in this small for febrile infections. Platelet transfusions were given
number of exposed individuals is consistent with that on two occasions. The Appendix describes the exten-
in the Ewing's sarcoma patients irradiated with similar sive treatment, including marrow transplants, given to
doses of low-LET radiation [M28, B7]. the victims of the accident at Chernobyl.
131. With small animals, the RBE of neutrons for 133. The use of antibiotics is reported to have been
the gastrointestinal syndrome is often higher than for beneficial in large animals. Monkeys, whose LD5,, is
the bone marrow syndrome [B22], and the ranges of 6.0 f 0.2 Gy without the use of antibiotics. were given
dose resulting in the two syndromes often overlap. doses of 8.2 Gy, which would normally result in less
Thus. interpretation of the appropriate RBE values than 5% survival [B30]. Antibiotics given between
must take into account the times of death characteristic 1.5 days before and 14 days after irradiation increased
of each of the syndromes. With an increase in body the survival rate to 28% (7/25), and the addition of
typhoid vaccine to the treatment protocol to hasten 138. Clinical data on the efficacy of bone marrow
marrow regeneration gave a survival rate of 36% transplantation after irradiation refer mainly 10 the
(5/14). The estimated LD,,, was increased to 7.5 Gy, treatment of leukaemia: the results are confounded by
i.e., by a factor of 1.25. The medications prevented the disease itself, concomitant cytotoxic treatment and
most of the diarrhoea and anorexia observed in the other supportive measures. By extrapolating to man
monkeys who had been irradiated but not treated. the relatiorlship between body weight and the number
These latter animals died between days 10 and 13 of of injected autologous marrow cells required for
septicaemia due to enteric organisms. rescue of 50% of animals after LD,,, a value of
2 lo7 cells per kg was deduced for man [VI I]. For
134. Other studies with animals have combined 100% rescue, 4 lo7 cells per kg was estimated. The
antibiotics with other supportive treatments such as minimum cell dose for rescue after lethal whole-body
fluid replacement and blood or marrow transfusions. doses to leukaemic patients using HLA identical
In dogs, platelet transfusions. together with anti- allogeneic bone marrow cells is approximately I lo6
biotics, were successful in overcoming the critical per kg body weight [T6]. This is compatible with the
period of haemopoietic failure between day 10 and above extrapolations for healthy individuals, because
day 20 after doses near the LD, [S9, P4]. Mortality in mice and dogs approximately four times as many
after three dose levels, where the mean survival times allogeneic as autologous marrow cells are required for
were about 14 days. was decreased from 9/10, 5/5, rescue [V9. V 101. Foetal liver is also an important
and 5/5 to 2/10, 2/5, and 1/5, respectively [P4]. Six of source of haemopoietic stem cells for transplantation
12 monkeys. irradiated with lethal doses of 8-8.9 Gy purposes, e.g., [W30]. The experience with bone
and treated rrith autologous marrow and routinely marrow and I'oetal iiver transplantation to [he t~ictims
with antibiotics. survived to seven weeks, and five of of the Chernobyl accident is described in the Appendix.
these survived to at least one year [S2]. All seven
monkeys receiving the autologous marrow but anti-
biotics only symptomatically died between days 7 B. EFFECTS O F DOSE PROTRACTION
and 23. Also. six monkeys irradiated tvith 8.5-9.5 Gy
then treated by autologous marrow 2.2-12.9 1 0 ~ e l l s 139. Protracted or fractionated doses are usually less
survived over 50 days, in contrast with a mean injurious than are single doses, for two main reasons.
survival time of 14.5 days for six irradiated monkeys First, cells are capable of repairing sublethal radiation
that had not received the graft [C19]. Only three of damage. This process is complete in six to eight hours,
18 monkeys similarly irradiated but receiving 8 10' and the attending increase in survival is generally
homologous bone marrow cells survived to 30 days. greater after higher doses than after lower doses.
All of these monkeys de\,eloped graft-versus-host Repair of sublethal damage can also be described by
disease; 14 out of 18 showed recovery of haemopoiesis an increase in the total dose required to achieve a
from the donor cells, but only two survived to 30 days. given level of cell killing or tissue injury. The sparing
Another series of experimenrs with monkeys showed effects of protracted or fractionated irradiation are
that the LD,,,,,, could be increased by a factor of much less important after high-LET radiation. because
about 1.8 using injections of 2-4 10' autologous bone such radiation produces much more irreparable damage
marrow cells per kilogram body weight. and thrombo- than low-LET radiation.
cyte concentrates, erythrocytes and prophylactic anti-
biotics when necessary [B23]. 140. Second, repopulation of cells may take place
during the overall time of irradiation. The time of
135. From the limited evidence available. the efficacy
onset of compensatory proliferation is specific to a
of post-irradiation treatments after neutrons appears
given tissue. I t occurs once depletion of the normal
to be similar to their efficacy after low-LET radiation.
complement of mature cells has been recognized. In
The increase, by a factor of about 1.8, in LD, ,,
[he intes~inc,repopulation usually commences uithin
for monkeys, brought about by injecting 2-4 10"
a few days of the beginning of irradiation and in skin
autologous marrow cells per kilogram body weight it commences after about two weeks. The doubling
after irradiation. was found for both x rays and
time of regenerating clonogenic cells is usually about
fission-spectrum neutrons [B23].
one day, and may be less. The doubling time is longer
136. When the platelet level falls markedly below than the cell cycle time because of concomitant
30.000 per ill of blood. transfusion of platelets will differentiation of the clonogenic cells and hence their
help prevent bleeding. Infusions of granulocytes would loss from the precursor cell pool. The cycle time
be expected to help combat infections, but the short during regeneration is much shorter than before
+
half-life of these cells (6.7 1.4 hours in man [M6. irradiation, and there can be an increased number of
divisions in the amplifying proliferative populations.
A9, B 161) makes this procedure difficult to realize in
practice. leading to a transient overshoot in the mature cell
populations. Low dose rates, 0.4-2.7 Gy per hour, can
137. The studies with large animals described above block cells in the cycle and prevent cell division [M36].
demonstrate that conventional supportive medications
and transfusions of blood elements after irradiation 141. Of the main tissue responses described in this
can increase the LD,o,3, by as much as I Gy [B30. P?, Annex and occurring with~na few months of irradia-
S9]. Although this dose increment may appear small. tion. the lung shows a greater sparing effect of dose
the corresponding survival rate would increase quite protraction or fractionation over a week or two than
markedly because of the steepness of the dose- the intestine or skin CT24. U4] (the marrow shows a
response curve (Figure XXI). lesser effect). Empirical formulae have been devised to
describe the increase in dose that is tolerated with 5-7 Gy [C35]. In contrast, all seven patients with a
protraction or fractionation in radiotherapy. With similar condition treated by Thomas et al. [TI71
dose protraction, the increase in iso-effective dose developed nausea, and six out of seven vomited
with increasing irradiation time. T, can be described towards the end of irradiation. Prodromal symptoms
by the formula were more severe when the dose rate used to give 3 Gy
Dose = Constant X Tm to patients with Ewing's sarcoma was 0.3 Gy per
minute [R6], compared to 0.03 Gy per minute [M34].
where m is the exposure-time coefficient. Alternatively. With whole-body irradiation prior to marrow trans-
D = constant X Rm""'-I), where R is the dose rate. The ~lantation.it was noted that the onset of nausea and
formula is applicable over a limited range of exposure vomiting was related to total dose. but not to the rate
times, which. like the value of the coefficient, varies at which the dose was given. except possibly in the
between tissues [TZJ]. For human skin tolerance, m is case of dose rates of less than 0.06 Gy per minute
about 0.29. [B32]. The incidence of vomiting was about 10% in
the 64 Rongelap natives exposed to fallout doses
132. The most widely used description of fraction- estimated to have been about 1.75 Gy. where the dose
ation effects is the Ellis formula [E3], in which the rate decreased from about 0.055 Gy per hour at the
number of fractions and the overall time are variables. start of irradiation to about 0.016 Gy per hour after
According to Ellis. 50 hours [C 161; vomiting appeared in slightly less than
Total dose = NSD X N"-'JX Tall 40% of accident cases and radiotherapy patients after
estimated acute doses of similar magnitude (Figure V).
where NSD is the nominal standard dose and the There is no accurate information concerning high-
exponents 0.24 and 0. I I apply to early skin reactions. LET radiation.
The formula is generally considered valid for between
4 and about 30 fractions. and it is recognized that 145. In monkeys. the latent period to retching or
different exponents apply to different tissues [T24]. vomiting after 4.5 Gy was increased by a factor of 3
Variations on the formula that consider partial (from 30 to 90 minutes) when the dose rate was
tolerance. time-dose factors and cumulative radiation reduced from 1.2 to 0.07 Gy per minute [H35, H36].
effects (CRE) have been described [TZJ, U4]. Most of the increase occurred between 0.5 and
0.15 Gy per minute. In dogs, routine emesis during
143. An alternative to these power-law relationships irradiation with 18 Gy could be avoided by reducing
has been described more recently; the linear-quadratic the dose rate from 0.18 to 0.05 Gy per minute [H38].
relationship [D20]. I t is considered to be more
representative than the Ellis formula of the relation- 146. In the radiation accident in hlexico City in
ship between total dose and fraction size over a larger 1962. the individual receiving the highest dose delivered
number of fractions, when the overall time is less than at 3.0 Gy per day for seven days and 0.25 Gy per day
a few weeks and does not influence the dose required for a further 17 days, had anorexia and vomiting only
for a given effect [F4]. The effect E in a tissue of a after the seven days of exposure at the higher dose rate
series of n fractions each of dose d is given by: [M3]. In the individual receiving the lowest dose of
about 1 Gy over 106 days of exposure at 0.09-0.16 Gy
per day. fatigue was reported on day 36. but there
where a (Gy-I) and P (Gy-') are constants. When n were no intestinal symptoms.
and d are changed from n, and d , to n: and dl. total
doses D l and D, resulting in the same effect E are 147. An extensive series of studies was performed
related by on patients receiving abdominal radiotherapy with
45-55 Gy (midline dose) given in 2 Gy fractions. five
per week [B56]. Nausea and vomiting appeared after
The ratio t r / P is tissue specific. Lower values indicate a the first few sessions. These symptoms were highly
greater sparing effect of fractionation. e.g.. a//?- 2-4 Gy variable in severity and they lasted for about a week. The
for pneumonitis, and higher values indicate less of a effects were more frequent and intense after either the
-
fractionation effect. e.g.. a / / ) 10-20 Gy for early upper half of the abdomen or the epigastric region
had been irradiated. Diarrhoea occurred during the
skin reactions [T24].
third week when the total accumulated dose had
reached 25-30 Gy. particularly in women where the
1. I'rodromal responses field included the lower abdomen. Gastric pain was
experienced by men irradiated in the epigastric region.
144. Comparatively little is known about the effects but only rarely did diarrhoea occur in those who
of dose rate or fractionation on prodromal responses, received irradiation to the lower abdomen and pelvis.
but there is some decreased effect due to dose The apparent sex differences may reflect technical
protraction. The information comes mainly from differences in the irradiations.
radiotherapy treatments, and different centres have
used different dose rates. Even when the same dose 148. Retrospective studies on 2,000 patients receiving
rate is used, the severity of prodromal symptoms after whole-body irradiation showed increases in ED,
a given dose has differed between centres. For values when doses were protracted over eight days or
example, only two out of eight patients with haemato- more (Figure XXIV) [L9]. In 1,085 patients given
logical malignancies given 10 Gy (0.05 Gy per minute) small, daily whole-body exposures, 20-30 R (about
had nausea during irradiation, with vomiting after 0.15-0.20 Gy to the stomach) per day for 30 days or
1.69 2.24
ABDWINAL DOSE (Gy)
more were required to cause prodromal symptoms. The number of fibroblasts in the crypt sheath was
Exposures from 10-20 R (about 0.075-0.15 Gy to the depressed by the end of the fractionation schedule;
stomach) per day produced nausea infrequently, even this was followed by recovery, but there was a
when these exposures were delivered rapidly at approxi- subsequent depression at days 360 to 800 after
mately daily intervals for 3-4 weeks, and exposures of irradiation.
5-6 R (about 0.04 Gy to the stomach) per day produced
no symptoms [L9]. Patients irradiated at very low 150. Low-dose rate or multifractionated radiation
rates (less than 1.5 R, about 0.01 Gy per hour to the spares the intestine in all species quite substantially
stomach) and receiving less than 30 R (about 0.20 Gy [U4]. With radiotherapy treatments, tolerable frac-
to the stomach) per day also showed a lack of tionated doses are in the middle of the range accepted
prodromal symptoms, except'fatigue [R5]. for all tissues in the body [R12]. The small intestine,
rectum, colon and stomach, in this order, are the most
responsive regions [F2] and will tolerate not more
2. Intestinal responses than 40 Gy delivered over four weeks to large volumes
of tissue. Dose-mortality relationships for man due to
149. Studies of human intestinal mucosa have been protracted intestinal irradiation in man are unknown.
made during and after x-ray therapy. using serial
biopsies from patients irradiated to the abdomen for
malignant disease [T9].Exposures of 2,000-3.300 R 3. Haematological responses
(15-20 Gy to the intestine) delivered in daily fractions
of about 1-2 Gy produced during the treatment a 151. Protracted irradiation is generally less efficient
decreased mitotic activity in the crypts, a decrease in than acute irradiation in reducing the number of
the absorptive surface area of the bowel, and an blood neutrophils. However, this effect was not
increased infiltration of the lamina propria by in- detected when the overall exposure time was relatively
flammatory cells and plasma cells, with occasional short, as in the case of the Marshall Islanders given
crypt abscess formation. Both the mitotic activity in 1.75 Gy over 50 hours, where the haematological
the crypts and the mucosal surface recovered by two responses were those expected after a similar dose
weeks after the end of treatment. Gastrointestinal delivered acutely [C15, C13]. With further protraction,
malabsorption was reported in patients during irradia- there is less effect per unit dose. For example. in the
tion to the abdomen with daily fractions of 1-1.5 Gy, Mexican accident [M3], the one survivor received
to a total of about 30-40 Gy in five weeks [PI]. or between 9.8 and 17 Gy over 106 days, and his lowest
fractions of 2 Gy to a total of 45-55 Gy [B5]. Biopsies recorded blood cell counts were 2.000 white cells per pl
of rectal mucosa taken from radiotherapy patients and 70.000 platelets per pi.
receiving a total dose of 42.5 Gy in 10 fractions for
bladder and cervix cancer showed a depression in total 152. The dependence of the nadir in WBC count on
cells per crypt during treatment, with recovery to total dose and exposure time was described by Yuhas et
control values by day 70 after the last fraction [WIO]. al. [Y2], who analysed data for 121 patients with non-
haematoiogical malignancies receiving fractionated of GM-CFC in the blood of five patients receiving
ufhole-body irradiation over various periods of time. whole-body irradiation (1.5 Gy in 15 days) for various
The relationship was: metastatic cancers showed an increase around day 10
during the irradiation [TI 81.
Per cent U'BC = I( X 100 X D-" TT"
where K is a constant, required for extrapolation to 1.56. GM-CFC have also been measured in patients
the ordinate at zero dose because no effect was seen receiving fractionaled partial-bod! irradiation. .After
below 25 R (about 0.15 Gy to the marrow); D/0.0075 irradiation of 16q-30R of the total marrow in
is the total marrow dose in Gy; b i is the slope of per patients with various malignancies (carcinomas of the
cent WBC on D/0.0075: T is the tinle of protraction cervix, lung and rectum), a significant decrease in
in days; and b, is the slope of per cent WBC on T. For GM-CFC per millilitre of blood took place between
[he patients with non-haemopoietic malignancies and days 5 and I4 after the start of treatmenf, by which
with normal initial levels of WBC. b, = 1.04, b, = 0.63. time the cumulative doses were between 4 and I4 Gy
The contribution to the observed effect from the [B48]. Between days 15 and 24 after termination of
diseases of these patients is unknown. therapy delivered over several weeks. the GM-CFC
per millilitre of blood were about 12% of normal and
153. The recovery of marrow in irradiated leukaemic thereafter increased slowly to 2 4 5 on day 35. After
patients was slower than in patients with non- doses of 30-40 Gy (five 2-Gy doses per week) delivered
haematological malignancies [Y2]. This was deduced to 25-45% of the marrow of patients with Hodgkin's
from 2,000 case histories where fractionated treat- disease or non-Hodgkin's lymphomas, the ablated
ments had been given. Values of the coefficient b2 were marrow repopulated slowly over a period of months
markedly different from the value of 0.63 for patients (the repopulation was faster in larger irradiated
with non-haematological diseases. being 0.392 for \tolumes~[D16. M371.
patients with chronic myeloid leukaemia (CML), 0.221
for chronic lymphocytic leukaemia (CLL) and 0.231
for lymphosarcoma (LS). The values of b, were not 4. LD,,,,, in man
markedly different from one another, being 0.999
(CML), 0.91 (CLL) and 1.119 (LS). The analysis 157. There have been few instances where the number
indicated that the greater sensitivity of WBC levels in of individuals exposed to near-homogeneous protracted
leukaemic than in non-leukaemic individuals was irradiation has been sufficient to allow an estimate of
associated more with dose protraction and recovery the change in LD,,,,, with dose protraction. The only
phenomena than with total dose. information relates to a few accidents. from groups of
individuals receiving irradiation from atomic bomb
154. A study was made of patients in remission tests, and to radiotherapy patients receiving low-dose-
receiving fractionated whole-body irradiation over four rate or fractionated whole-body irradiation. Some
days prior to cyclophosphamide and bone marrow trans- examples of protracted whole-body exposures are
plantation for acute lymphocytic and non-lymphocytic given in Table 19. The 64 individuals exposed to doses
leukaemia and chronic myeloid leukaemia [S5]. Frorn of about 1.75 Gy from fallout radiation received most
blood samples taken during the fractionated course of of their dose in the first few hours. The average
irradiation, an effective Do of 3.7-5.4 Gy was deduced exposure rate over 50 hours was about 0.03 Gy per
for lymphocytes and about 10 Gy for granulocytes. hour. decreasing according to t-l.:. The haematological
This confirmed that the greater radiosensitivity of responses were those expected for similar doses given
lymphocytes (relative to granulocytes) applies also to at high dose rate. and hence any dose rate effect was
fractionated doses. The values of sensitivity refer to small [C15. C 131. The other individuals in Table 19
cell numbers measured within a feu' hours of a dose received exposures over 5-1 15 days.
fraction and not to the later nadir levels. In a similar
study using 11 fractions of 1.2 Gy given over four 158. .An accident occurred in Goiania. Brazil in 1987
days, the decline in lymphocyte numbers during [I231 which resulted in initial acute whole-body
irradiation was characterized by Do = 1.2 Gy [D22]. external exposures followed by low dose rate chronic
Further, the decline was similar for B- and T-cells and whole-body exposure from internally deposited "'Cs
for the OKT4 and OKT8 lymphocvte subsets. Low chloride (from a damaged teletherapy source). In
whole-body doses of 0.1-0.15 Gy. given twice weekly to addition, many persons received acute localized radia-
a total dose of 1-1.5 Gy for the treatment of generali~ed tion injuries (beta/gamma) to the skin and deeper
lymphocytic lymphoma and lymphosarcoma, produced tissues. Twenty-one persons required intensive medical
a drop in the white cell and platelet counts, both of care. Ten persons were critical with dose estimates
which reached a nadir at 4-5 weeks after completion (cytogenetic dosimetry) ranging from -1-7 Gy. Four
of the irradiation [J20, 5211. persons died as a result of their exposures. In addition
to good nursing care. antibiotics and platelet trans-
155. A continuing decrease in granulocyte/macro- fusions. the experimental drug granulocyte-macrophage
phage colony-forming cells (GM-CFC) in bone marrow colony-stimulating factor (GM-CSF) was administered
and blood during irradiation, followed by regeneration to eight patients suffering from the acute radiation
after irradiation, was reported in patients treated for syndrome. Four of the patients who received GM-
malignant lymphomas using whole-body doses of CSF subsequently died as a result of their radiation
0.1 Gy delivered three times per week to a total of insult. The efficacy of using GM-CSF was not
1.1 Gy [L19]. In contrast, studies of the concentration demonstrated.
159. Several formulae have been proposed to calculate 5. Skin
equivalent doses for mortality when the dose is
protracted, and these are empirical guides to changes 163. Information on the response of skin to frac-
in dose. One of the first to be proposed involved the tionated doses of irradiation comes mostly from
equivalent residual dose (ERD), which was the dose radiotherapeutic experience. This information was
required t o cause equivalent injury in a n unexposed reviewed in detail in the UNSCEAR 1982 Report
individual. [U4], and is summarized here, together with more
ERD = D,[f + (1 - Oe-'"1 recent information.
where D, is the dose delivered in a single exposure, f is 164. Dose-incidence curves for erythema using frac-
the fraction of the total injury that is irreparable, t is tionated doses (Figure XXV) have been measured using
the time in days that has elapsed since exposure and reflectance spectrophotometry [T21]. The measure-
r is a constant equal t o the repair half-time in days ments were made on patients irradiated using two
divided by 0.693 [L4]. The E R D during protracted parasternal fields, each 5 X 12 cm.
exposure at a constant dose rate is calculated as
165. A dose-survival curve for epidermal clonogenic
ERD = D, [ft + r(1 - f)(l - e-L/r)] cells in situ was measured in patients receiving frac-
where D, is the dose rate and t is the exposure time in tionated radiotherapy t o an area 22-24 cm X 15-18 cm
days [L33, N121. The recovery half-time in man was on the chest wall [A5]. The total doses ranged between
postulated to be 15-35 days and f to be lo%, on the 63 and 72 Gy and were given in 34 to 48 fractions.
basis of sparse clinical results a n d extrapolation from Cell sensitivity was characterized by Do = 4.9 t 1.5 Gy
animal data [L4,N 121. for these fractionated doses, a value compatible with
predictions from extensive information in mice.
160. A pourer function was proposed [L9]: 166. Data obtained by various radiotherapists since
Iso-effective (fractionated) LD,, = about 1930 were reviewed and analysed by Cohen [C7,
LD,, ( I week exposure) X to-l6 C211, and these data formed the basis for the Ellis
formula [E3]. The nominal standard dose (NSD) is
where t (in weeks) is longer than one week. This about 18 Gy for skin tolerance when areas of 35-100 cm'
formula was deduced from the whole-body irradiation are irradiated. The exponents of N (number of fractions)
of cancer patients, where the LD,, (one-week exposure) and T (overall time) also apply if the end-point is
was taken to be 3.45 Gy. It was suggested that the erythema, because the slopes of the iso-effect curves
exponent 0.26 might be 2 or 3 times higher for healthy are similar, but the doses are lower. Also, the same
people. exponents apply for different field sizes, where the
values of NSD differ according to the formula given in
161. Another formula has been proposed more section I.D. I.
recently for calculating accumulated iso-effective doses
u p t o 10 Gy [BlO. 821, MI91 and up to 100 days 167. For early skin reactions, the n/P ratio is
exposure [M2, H471. The operational equivalent dose generally considered to be in the range 10-20 Gy. For
(OED) for acute exposures is expressed by the formula erythema on the chest wall, ratios of 8.4 Gy, 21.9 Gy
O E D (Gy) = total accumulated marrow and 21.5 G y were determined at incidences of erythema
dose (Gy) - 1.5 - 0.1 t (days) of. respectively. 16. 50 and 84% [T21].
The formula was deduced from a large number of 168. The influence of dose rate on skin reactions is
dose rate and fractionation experiments in various known from the results of radiotherapy. Curves
animal species including mice, guinea pigs, sheep and relating total dose and dose rate to produce "tolerable"
swine [hf 191. The dose of 1.5 G y in the formula
represents the average amount of dose recovered in
the first day among all species, and thereafter an extra
dose per day (dependent o n species) is required to - 0 2 x 4 Gy per week
counteract repopulation. A dose of 0.1 G y per day is - 5 x 2 Gy per week
assumed for man. In view of the differences in the
values of the constants between species. the formula is
considered suitable only as a guide and not as an
accurate assessment [M13]. It is intended for applica-
tion in circumstances where a large initial dose is
given. The maximum value of O E D is transformed
into the expected mortality using the dose-mortality
curve for an acute exposure. Negative values have no
meaning. Also, the relationship applies only t o mortality
from marrow damage.
0 10 20 30 40 50 60 70 80
162. The above formulae are consistent with the data TOTAL DOSE (Gy)
for single and fractionated exposures in man (Tables 11
a n d 19). but they should be taken as only a very rough Figure XXV. Dose-Incidence curves for human skln erythema.
guide. IT211
reactions, mainly in skin, were presented by Hall [HI]. tant actinomycin D ) [PSI. The combined exponent
An equation describing the shape of these curves [03] was deduced from a series of 26 patients treated t o at
has the form least one whole lung for metastatic lung disease. using
cobalt-60 gamma rays or I-MV x rays, together with a
series of fractionation data using lethality in rats after
where T is the treatment time in hours using dose rate lung irradiation. Although the separate exponents of
r (Gy per hour X 0.01). N and T have not been estimated for man, in mice the
exponent of T is about 0.07 [U4]. The exponent of N
169. The time course of skin reactions is similar after is about 0.39 between one and eight fractions. and
neutrons or after x rays [FI]. The RBE value for about 0.25 between 8 and 30 fractions [U4]. Alter-
single doses of neutrons (16-MeV D on Be) producing natively, iso-effective doses for different fractionation
erythema on 5 cm X 4 cm areas of thigh skin is about schedules using short overall times can be calculated
3.0. with reference to 8-MeV x rays [FI]. Earlier work using the a//) formulation. where a / / ] for mouse lung
using 200-kVp x rays as the reference radiation [ S l l , is 2-4 Gy [T24].
S12] also gave a value of about 3.0 when the original
"doses" were converted to Gy [B15] and 3.5 when 174. A recent analysis has been made of 54 patients
using (8-MeV D on Be) neutrons. For fast neutrons. bvith various thoracic malignancies given irradiation t o
the exponent of N is reduced to 0.03 [Fl]. various lung volumes in daily fractionated doses
[M38]. No previous treatments had been given. The
170. Radiation-induced skin injury was evident in incidences of pneumonitis in five groups of these
19 patients involved in the Goiania accident (1987). patients are given in Table 20. The groupings were
Lesions were present on hands, feet, legs, armpits and made on the basis of biologically equivalent doses in
numerous small areas on chest, abdomen, face, arms different schedules. No significant differences were
a n d the anterior medical aspects of the legs. Skin observed in the incidence of pneumonitis for patients
injury was due to beta radiation from contamination given irradiation to less than one quarter of the total
(external) and t o deeper underlying tissues from lung volume and patients with irradiations of between
penetrating gamma radiation. Beta injuries healed one quarter and one half of the total lung volume.
within 3 months after exposure followed by expression
of gamma injuries to deeper tissues. None of the local
injuries among Goiania victims were as extensive as in 7. Gonads
the victims of Chernobyl. The clinical interpretation
of this difference was that the Russian victims suffered 175. Contrary t o what happens in other tissues.
from combined-injury disease including thermal and fractionated doses to the testis are more effective than
beta burns while the Brazilian ones were from single doses in damaging spermatogenesis in animals
radiation only. [U4]. because of the progression of cells into sensitive
stages. This is also observed in man [L13]. Compared
to single doses of the same total amount (5 Gy),
6. Lung 20 doses of 0.25 Gy produced a more rapid drop in
the number of sperm cells, and more time was
171. The lung is spared by the use of low-dose-rate required for recovery [L13].
o r fractionated irradiation [B32. K1, M38]. The dose
for 5% incidence of pneumonitis can be increased 176. Most of the quantitative data on the effects of
from 8.2 Gy to about 9.5 Gy using 0.05 Gy per minute fractionated irradiation on the testis come from the
instead of 0.3-0.5 Gy per minute [Kl]. The patients treatment of malignant disease by radiotherapy [19. U4].
receiving low dose rate also received chemotherapy, Fractionated doses of 0.5-1.0 Gy produce temporary
which may have reduced lung tolerance. Hence the aspermia beginning at about three months [Sl].
effect of reducing the dose rate may be greater than Fractionated doses of 2-3 Gy produce long-lasting
observed. This possibility is suggested by experiments aspermia at 1-2 months [SI 1.
with mice, where the ratio of LD, values at the two
dose rates was 1.8 without the use of chemotherapy 177. The few measurements of testicular hormone
[HI71 and 1.3 when cyclophosphamidc was given levels in accident cases receiving protracted irradiation
[L32]. are consistent with the planned study referred to earlier
using single doses [Rl I]. After accidental exposure to
172. With fractionated irradiation the total dose can iridium- 192 gamma rays for various periods of time in a
be increased even further [M38, P5]. With prophylactic seven-day period, the levels of serum follicle-stimulating
lung irradiation in the treatment of osteosarcoma, no hormone were constantly elevated and luteinizing
pneumonitis was seen in 40 patients given 20-25 Gy to hormone was variably depressed after a dose estimated
the lung in daily dose fractions of 1.5 G y [N8]. This to have been 1.75 Gy to the testes [W I].
was in contrast to seven patients in whom pneumonitis
was observed after 30 Gy delivered at 3 Gy per day. 178. The total doses of fractionated radiation needed
There was no pneumonitis in a further 14 patients to cause temporary or permanent female sterility are
given 24-25 Gy in 13 daily doses t o the lung [N9]. higher in some studies than in others using single
doses [19, U4], but i t is difficult to assess accurately
173. In the Ellis formula [E3]. the combined expo- the increase in the total doses. In mice. fractionation
nents of N and T were estimated t o be 0.43, with an clearly has a sparing effect on fertility [R 131. Frac-
NSD of about 9 Gy equivalent (7 Gy with concomi- tionated doses of 4-7 Gy to the ovaries of older
women induced artificial menopause in the majority about 50% of patients. Bone marrow depression may
of cases. Higher doses, 12- 15 Gy. were required in be observed after multiple doses or large single doses
young women [A((]. of I3'I; however, this can be avoided by administering
doses with individual activities not exceeding 5.500 hlBq
179. Serum gonadotrophin levels were unaffected by at intervals of two or more months [HZ]. The
doses of up to 1.5 Gy given in fractions over 28 days accuniulated dose to the blood can be as high as 5 Gy
to a series of patients treated for Hodgkin's disease [SX]. In d large series of patients, about 3 Gy were
by oophoropexy followed by irradiation [T7]. A series delivered to the blood from !"I-sodium iodide; after
of patients received pelvic irradiation for carcinoma of nausea. the most frequcnt serious complication was
the cervix, to a total dose of 60 Gy using doses depression of the bone marrow [D9].
of 9-12 Gy per week in 3-5 fractions [BIZ]. Levels of
follicle-stimulating hormone rose immediately follow- 183. Detailed immunological studies have been per-
ing doses of 5.6-24 Gy among different patients; the formed on 34 patients treated with 1-3 doses of
levels of luteinizing hormone rose after doses of 300-350 MBq "'I for toxic or atoxic nodular goiter
11-3-26 Gy. The levels of oestradiol in the peripheral [W27]. Blood lymphocyte counts were reduced to
blood decreased after doses of 6-12 Gy. 60-80% at both one week and six weeks after treatment.
and the frequency of lymphocytes expressing receptors
for C3 (EAC-rosette-forming cells) was also reduced.
At six weeks there was a small increase in the
C. INTERNAL EMITTERS frequency of T-cells. identified by Leu- I monoclonal
antibodies: this was due to an increased proportion of
180. Large amounts of internal emitters are required helper/inducer T-cells, identified by Leu-3 mono-
to produce early effects in man. Amounts this large clonal~. The "'I also decreased the capacity of
would be received in therapeutic treatments and. lymphocytes to secrete IgM when stimulated with
possibly, in accidents or from nuclear fallout [D23]; in pokeweed mitogen. Less effect was seen for IgG and
the case of nuclear fallout, however. external irradia- IgA. The mitogenic responses of lymphocytes to PHA
tion might provide the majority of the dose and could and ConA were not changed significantly.
therefore be responsible for producing the early
effects. Large amounts of internal emitters have been 184. Radiophosphorus (j2P)has been used widely for
used to treat certain cancers. The dosimetry is the treatment of polycythemia Vera. Single or multiple
conlplicated by tissue distribution, decay rates and doses are given to reduce the polycythemia. and the
clearance rates. More uniform distribution of dose to activity per treatment. 140-220 MBq, delivers a cumu-
the body is produced by elements that are not taken lative dose to the marrow of about 1.4 Gy [SIO]. The
up by specific organs (e.g., iodine by the thyroid, dose rate decays with a half-life of 6.7 days. Over-
phosphorus by the marrow), and the whole-body dose dosage was reported with a patient who received
depends on the circulation time before uptake. Dose 14.8 MBq per kg body weight [C33]. This patient
rate. cumulative doses, spatial distribution of dose and showed a mild and reversible pancytopenia. Two
the effects of' internal emitters on tissues in animals patients were given 1.850-2.220 MBq, which delivered
were discussed in detail in the UNSCEAR 1982 a cumulative dose of about 10 Gy to the marrow
Report [ i l J ] . [G16]. Three weeks later there was agranulocytosis.
severe thrombocytopenia and marrow aplasia. Haemo-
18 1. Haematological injury has been reported in man poiesis recovered spontaneously from day 40 after
after the therapeutic use of colloidal gold, radioiodine, treatment. Blood counts returned to normal in one
radiophosphorus and radiosulphur. Radiocolloids have patlent, but mild thrornbocytopenia persisted in the
been used to irradiate serosal surfaces follo*ing the other.
accumulation of fluid and disseminated tumour cells.
An activity of 550 MBq colloidal ' 9 8 A in
~ 40 ml saline 185. An immunological study was carried out on
injected into the peritoneal cavity resulted in total 16patients receiving a single dose of 150-305 MBq "Pfor
doses to the retroperitoneal lymph nodes. the omentum polycythemia [W27]. Blood lymphocytes were reduced
and the peritoneal serosa of 77.5. 67.5. and 47.5 Gy. 40% by 12 weeks after treatment. The B-cell component
respectively. Mild radiation sickness and haemato- was reduced most, but lymphocytes expressing T-cell
!ogical complications such as persistent leukopenia. markers were increased. IJHA reactivity was increased,
were reported [H7]. The dose to the marrow from this but Ig secretion in response to pokeweed mitogen was
treatment is unknown, but i t would have been v e n reduced.
inhomogeneous. Overdosage using 7.400 MBq of 1 9 b A ~
resulted i n estimated doses of 73 Gy to the liver and 186. The treatment of chondrosarconia and chordoma
spleen and 4.4 Gy to the marrow [B40, S231, giving by j5S is limited by the latter's haemotoxicity. In
rise to pancytopenia, with a tendency towards recovery 13 patients, the cun~ulativeactivity administered as
by day 60-70. However, on day 69 the patient died sequential amounts of 185-222 MBq per kg body
of cerebral haemorrhage, with concomitant severe weight, was 370-1.780 MBq per kg of body weight,
thrombocytopenia. giving a total dose to the marrow of about 9.9 Gy
[M7]. The first dose had minimal effects in most
182. The use of radioiodine to treat metastatic patients, but with each successive dose, marrow
thyroid cancer is limited generally by the dose to bone depression increased and recovery decreased. Thrombo-
marrow. Doses of 3,700 MBq of ''I1 delivered in excess cytopenia, leukopenia and, later, anaemia developed
of 0.5 Gy to the plasma and caused sialadenitis in progressively and were dose-related.
187. Severe acute injury to the intestinal mucosa has 191. Many cases of accidental ingestion of radio-
not been reported from internal emitters in man. The nuclides have been reported [FIO]. Bone marrow
highest radiation dose would be received by the large effects are particularly marked when the compound is
intestine, because the contents of the gut ha1.e a long taken up in the marrow (phosphorus) o r the bones
residence time at in this site. The critical cells are the (strontium. radium) and when the half-life is long.
stem cells in the crypts, the dose at this p o s ~ t i o nis the Haemopoietic injury has been reported after the
most important. Experiments in dogs indicated an ingestion of, and chelation therapy for. 37 MBq
LD,,,, corresponding to 130 MBq per kilogram body americium-241 delivering 5.5 Gy to the bones over
weight of 1 0 % ~ - l O b Rwhlch
h, delivered approximately five years [T22] a n d after the ingestion of radium
40 Gy t o the mucosa over about 18 hours [CIS]. giving 2 Gy over six weeks and more than 50 Gy over
Comparisons were made of doses from '"Pm or three years [G 141.
LU6R~-'06Kh resulting in death from gastrointestinal
injury. These isotopes have widely differing beta 192. Extensive internal contamination with '"CsCI
energies. and i t was calculated that a dose of 35 Gy of occurred in 22 persons in the Goiania accident (1987).
either isotope to the crypt cells resulted in the death of Internal contamination in these 22 individuals exceeded
50% of the dogs [S14]. This dose is comparable to a 85 mCi (3,100 kBq). One child in the Goiania accident
dose of about 13 Gy of external irradiation delivered had internal 13'Cs levels exceeding 30 mCi (1.100 MBq).
acutely [B 161. Values of 35-40 G y in these experiments Extensive "'Cs internal contamination prompted the
with dogs are compatible with similar doses of use of Prussian Blue for the first time in radia-
multifractionated external irradiations in man, which tion accident histor?. Prussian Blue was effective in
are considered to be tolerance doses in radiotherapy enhancing the foecal elimination of 13'Cs although
IR91. high levels of internal contamination remain in many
of these people.
188. In the few cases where doses to the human lung
from internal emitters have resulted in symptoms of 193. The treatment 01' individuals following ingestion
pneumonitis. the inhalation has been very protracted of large amounts of internal emitters has been
and the doses uncertain. For example. a chemist who discussed in various publications [D23. 12. 13. 14.
had been involved in the separation of radium and N 151. The treatments are based on reduced absorvtion
mesothorium compounds and who had inhaled radio- a n d Aretention, enhanced excretion o r diminished
active compounds over a long period showed signs of translocation. Internal emitters reaching the gut can
radiation damage to the lungs [D5]. Pneumonitis was be removed to some extent bv the use of emetics.
reported in a man who had been employed for a long lavage and precipitating agents. Colloidal ion-exchange
time in the luminous paint industry [RI]. Relation- carriers, e.g., zirconium citrate. are effective when
ships have been described between the initial dose rate administered within hours of exposure but are them-
in the lung following inhalation of radioactive particles selves toxic. Decalcification therapy, designed to
a n d their effective half-life in the lung, in relation to increase bone resorption, enhances only slightly the
the survival of different animal species from pulmonary elimination of radium and strontium. and i t does not
injury, extrapolated to man [W25]. It was deduced affect the non-alkaline earth elements. e.g.. plutonium.
that death from lung injury could be expected in all Chelating agents such as DTPA and. more recently,
individuals receiving as little as 7 MBq ot' an inhaled LlCAM C [M35] are efficient at complexing rare-
aipha emitter with an energy of about 5 MeV a n d an earth elements and actinides.
effective half-life greater than 100 days.
196. Radioprotectors have been considered as one 200. Three A T patients, children aged seven, nine
means of decreasing the effects of irradiation. These and 10, were reported to show unusually severe
radioprotectors include thiol compounds, which must responses to cancer radiotherapy, particularly in
be administered before irradiation, and immuno- respect to skin responses. Gotoff et al. [G5] described
modulators, which can be given afterwards [e.g.. G321. the case of a 10-year-old boy with palatal lympho-
Many studies, for example those using the Walter sarcoma who received 30 Gy to the nasopharynx out
Reed (WR) thiol compounds, have been carried out in of a total planned dose of 40 Gy. He developed
animals. Protection factors of up t o 3 have been marked erythema. severe dermatitis and subsequent
reported for the bone marrow in mice, and values of deep tissue necrosis. It was concluded that an unusually
between 1 and 2.5 for a variety of other tissues [D27]. high radiosensitivity was responsible for his death. A
This variation depends o n the radiation dose, lower nine-year-old boy with Hodgkin's disease received
values being observed at higher doses. in part to 27.5 Gy out of a planned dose of 40 Gy to the
differences in intrinsic oxygenation status among mediastinum [M20]. H e developed severe oesophagitis,
tissues. and perhaps also to their natural endogenous the skin became pigmented and desquamated and he
thiol content [D27]. later died of respiratory problems. Cunliffe et al.
[C20] reported a seven-year-old boy with a malignant
197. Previous irradiation may influence the response lymphoma in the upper lobe of the right lung. After
t o a second treatment if there has not been full recovery 20 Gy, dysphagia and erythema were noted, and after
of the tissue. This is a well-known phenomenon in 30 Gy the treatment was stopped because of the
animal tissues, particularly in the skin [B26, H131. At severity of the responses. He died three weeks later. In
times greater than six weeks after a large first dose, addition. successful treatment of medulloblastoma in
the tolerance dose is reduced by about 10'3, and it can an A T patient was reported using conventional
be reduced further by repeated priming doses [HIO]. techniques but reducing the dose to one third of
In man, there is little quantitative evidence pertaining standard, in accordance with their findings that the
t o skin, but some radical radiotherapy treatments to sensitivity of the patient's bone marrow cells was
the larynx, performed up to 30 years after moderately three times normal [H49]. In a survey in 1982 of all
high doses given for thyrotoxicosis, were tolerated known radiotherapy treatments of AT patients, five
remarkably well [H21]. Intestinal tolerance to second out of seven individuals were considered to be
irradiations in man is uncertain. In mice, there is a excessively sensitive to radiation [S30].
higher resistance [H3], which is due t o induced
hypoxia [R4]. With bone marrow in man, there is a 201. Cultured skin fibroblasts from AT patients were
greater response to a second irradiation given a few found to be more radiosensitive to gamma rays than
months after the first irradiation [M 18. T11. TI21. In those from normal individuals, by a factor of 2-3 [U4,
animals, the LD,,,,, for a second irradiation can be T2]. With 14-MeV neutrons. this factor was 1.2-2
greater than or less than the LD,,.,, for animals not [P26. P271. Heterozygotes have a sensitivity inter-
having received any pre-treatment; this depends on the mediate between that of homozygotes and of controls
size of the priming dose and the time between [C4. K2, T2], as detected for example between cell
irradiations [H 101. strains using low dose rates [P26. P27].
198. Many cytotosic drugs decrease the radiation 202. Peripheral blood lymphocytes from patients
dose required for a given effect. The effect is achieved whose illnesses were associated with autoimmunity,
by the direct cytotoxic action of the drug and/or by such as rheumatoid arthritis, systemic lupus erythema-
synergistic interaction with radiation. This informa- tosus and polymyositis. were found to be more
tion was reviewed in part in Annex L of the radiosensitive by a factor of up to about 4 than
UNSCEAR 1982 Report [U4]. Interaction effects are a lymphocytes from healthy volunteers or from patients
major confounding factor in analysing the radiation whose illnesses were not associated with autoimmunity
response of ill cancer patients treated with other [H43]. The increased sensitivity was associated with
cytotoxic agents. deficiencies in D N A repair.
199. .4 very small sector of the population may be 203. Other genetic disorders predispose t o increased
particularly radiosensiti\,e because of inherited genetic chromosomal injury a n d tumour induction after radia-
disorders. The relevant data were discussed in Annex I tion. These include retinoblastoma [H4]. basal cell
of the UNSCEAR 1982 Report and in Annex A of the naevus syndrome [T4, H4], Fanconi's anaemia [R3,
UNSCEAR 1986 Report [U4, UIO]. The best docu- B131. Down's syndrome [T2], xeroderma pigmentosum.
mented of these disorders is ataxia telangiectasia (AT). Bloom's syndrome [U4] and Huntingdon's chorea
which is an autosomal recessive disease. In this disease [M22, K2, A7, T2]. Although the lymphocytes from
homozygotes may be present at a frequency of 1 in some patients with Fanconi's anaemia were more
40,000 and heterozygotes at a frequency of between 0.5 sensitive to radiation-induced chromosome aberrations,
a n d 5% [S42]. The signs of A T are progressive cerebellar fibroblasts from the same patients showed n o increased
ataxia, conjunctival and cutaneous telangiectasia, fre- sensitivity, using colony formation as an endpoint
quent sino-pulmonary infections with sometimes [Dll]. No accurate estimates of increases in tissue
abnormal immunity, a generally hypoplastic lymphoid radiosensitivity are available.
204. Other genetic factors in the general population of a probable range of LD,,, between 2.5 and 5.0 Gy
that may affect radiosensitivity have been discussed in (Figure XXI), and comparing them with a n overall
[P7]. These include familial deficiencies in glutathione average LDw,, of about 3.75 Gy, for example,
metabolism and variations in genetic constitution corresponds to probabilities of mortality of about
mimicking the variations in radiosensitivity between 20% o r 90%. assuming the same form of dose-effect
mouse strains and mutants, particularly those with relationship. Figure XXI illustrates these variations,
haematological disorders. Also, the radiosensitivity of showing, for example, that the 10% probability of
natural killer cells in the immune system has been death lies between approximately 0.5 and 3.5 Gy and
reported to be controlled by X-linked genes [B35]. the 90% probability, between 4 and 7 Gy. The large
uncertainties preclude a formal prognosis only o n an
205. Skin fibroblasts were taken from unirradiated estimate of the dose to the bone marrow.
sites in six patients who had an unusually severe skin
reaction after radiotherapy. The fibroblasts were 210. The intensive treatments to which exposed
irradiated in vitro. and survival cunles were plotted individuals are always subjected may completely
for colony-forming ability. The cells from five of the change the prognosis. The treatments that are offered
six patients showed greater sensitivity than cells taken following accidental exposures are designed to combat
from individuals whose skin response to radiotherapy intercurrent infections and aplasia, and they may
was normal [S20]. increase the probability of survival. Those that are
offered to patients suffering from neoplastic disorders
206. In conclusion, it is believed that the proportion often involve cytotoxic agents, and they may decrease
of individuals in the general population who, because the probability of survival. In the first case, the
of genetic disorders, are likely to show a significantly individuals are mostly healthy; in the second, the
higher radiosensitivity for acute tissue effects is about disease affecting the patients is an aggravating factor.
1%. While some of these individuals could of course In accidents, the higher the dose. the more intensive is
occur in groups of irradiated individuals being used to usually the treatment; consequently, the slope of the
calculate the LD,,,,,, their rarity in the general dose-effect relationship may be less steep than the
population makes it unlikely that they would have any slope of the theoretical curve expressing LD,o,60 in the
significant influence on the calculated values. absence of treatment. It is possible that, after treat-
ment. the LD,,,,, may be increased by a factor of (at
least) 2 or (at most) 3 [L9, R6, TS].
111. PROGNOSTIC INDICATORS
91 1. The values of LD,,,, are influenced by a variety
AND BIOLOGICAL DOSIMETRY of factors. The main ones are (a) sex: women appear
to be slightly more resistant than men [F15]; (b) age:
A. PROGNOSTIC INDICATORS extrapolation from animals to man suggests that the
LD,, at birth is lower than the LD,, for adults by a
207. In cases where persons are exposed t o high factor of 2; the value for adults appears to be attained
doses, whether as a result of accidents o r of irradia- at around puberty. with a subsequent decrease to
tions for therapeutic reasons, it is essential to deter- minimum values in old age; (c) state of health: the
mine the prognosis as precisely a s possible in order to LD,, is lower in individuals affected by other diseases,
be able to decide on the best treatment. The prognosis particularly if they relate to the bone marrow o r if
after near-lethal exposure is based on three types of they reduce the natural immune responses; and,
data: dosimetric, clinical and biological. finally, the most important factor. (d) the protraction
and/or fractionation of the dose with time.
3. Biological data
228. The appearance and persistence of immature 233. Quantitative marrow scintigraphy can be used
cells in the circulating blood is a good sign, because it to evaluate the regions of the bone marrow that are
indicates a good bone marrow response. The cells still functional: this technique produces quantitative
most frequently found belong to the granulocyte findings quite rapidly [I14, P161. The pattern can be
lineage: pro-myelocytes. myelocytes and meta-myelo- followed for about a week. I t is possible to study, in
cytes. As a rule, they are present only in small each region of the bone marrow, the degree of iron
numbers. It is their continuing presence over a period turnover (incorporation by the erythrocytes and release
of days, rather than their absolute number, that is the by the reticulocytes) and its uptake. It is also possible
basis for a favourable prognosis. Likewise, the number to distinguish extra-medullary haemopoietic regions
a n d variation over time of reticulocytes are important. and to measure their relative effectiveness. However,
studies such as these relate to the erythroid lineage.
229. Other conditions such as a rare blood group, not to the most important granuloid lineage. a n d
repeated transfusion problems (shock, etc.), sudden transient erythroid recovery may occur in the absence
anaemia indicating haemorrhage, or leukocytosis of stem-cell recovery.
indicating an infection, are unfavourable prognostic
signs [HZO]. 234. Cytogenetic dosimetry, which may be performed
in a feu, days. allows a n estimate to be made of the
230. A detailed examination of the bone marrow is mean dose in the body. Counting the number of
essential for several reasons. A number of marrow abnormalities in circulating blood lymphocytes (mainly
punctures in widely scattered areas selected according dicentrics, rings and fragments) and comparing this
to the conditions of the accidental irradiation (that is, number with reference values gives an accurate estimate
the subject's position in relation to the source and the of the mean dose. This approach has its limitations in
part of the body that has probably been most cases of highly inhomogeneous acute exposures during
exposed) will give information about the uniformity of which only some of the lymphocytes are irradiated
the irradiation. The severity of marrow aplasia is and for which the dilution factor is not known. a s well
directly related to the distribution of the dose [I14]. as in cases of prolonged exposure. Study of the
hlarrow punctures give a much more reliable picture electroencephalogram is equally useful but has the
of the bone marrow state than does the circulating same limitations with regard to prolonged exposure.
blood. However. the prognosis is not necessarily poor All the above techniques are discussed in section 1II.B.
if the samples all show a severely depleted marrow; it
requires only a few stem cells to repopulate the 235. Urine analysis is useful from several standpoints
marrow, and direct examination ivith differential (see section III.B.2). I t evaluates the state of the
counting ofthe bone marrow cell types is an insufficient irradiated indi\pidual's renal function. which is essential
basis for a reliable medium-term prognosis. I t is not to outlasting the critical, life-threatening period. I t
unusual for an apparently depopulated marrow to may confirm hidden haemorrhaging. by indicating
become repopulated to a normal level. haematuria, or renal malfunction associated with
glycosuria or proteinuria. It is not. houever, essential
231. I t is then necessary to perform further tests on for determining the actual radiological damage a n d its
the bone marrow cells; the cells (e.g.. CFU-MIX) consequences.
closely related to the stem cells should be cultured,
because their existence indicates the likelihood of 236. Biochemical analysis may throw some light on
subsequent bone marrow restoration. There is. how- metabolic disturbances. These include disturbances
ever, a practical problem in that such cultures take that affect the regulation of the water balance. u'hich. if
quite a long time to grow (around one week). and they extensive. can jeopardize survival. The prognosis will
require fairly elaborate techniques that cannot nor- depend on the quality of the treatment utilized. and
mally be carried out on a large scale [I14]. Further- daily checks are indispensable. A routine check must
more, it is debatable whether they are useful in cover (a) renal functions (urea. creatinine. calcaemia.
patients with extensive aplasia, in view of the relatively phosphoraemia and blood ionogram); (b) liver func-
large marrow samples needed for the examination. tions (lactic dehydrogenase, transaminase, alkaline
Since it is exactly those individuals exposed to the phosphatase and bilirubin): and (c) nutritional indica-
highest doses who require a precise prognosis. this tors (electrophoresis of peptides and proteins. a n d
culture technique has its limitations. serum iron).
232. Because it is easier to take blood samples than 237. A thorough bacteriological check would make
marrow samples, cultures are generally made of the it possible, in the event that infection is discovered,
circulating progenitor cells (GM-CFC). This technique to take measures that would allow a favourable
has been used in cancer patients receiving partial-body prognosis. at least in the short term. The aim here
o r whole-body irradiation to assess injury and recovery would be to detect any latent infections (especially
in haemopoietic progenitor cells [T 181. There are dental, otorhinolaryngeal or urinary) or opportunist
difficulties here too, however. These circulating cells infections, which are frequent in subjects with immune
have a low concentration, the culture techniques are deficiencies. Again, the prognosis will depend on the
elaborate. and the number of GM-CFC in the blood effectiveness of the treatment. Septicaemia, fungal
infections and infections involving bacteria that are plasma) and in the haemopoietic tissues, and the
particularly pathogenic and/or resistant t o antibiotics examinations have to be more rigorous than routine
present special problems. examinations.
238. Sperm analysis is also a useful prognostic 242. The morphology of the cells can be changed by
indicator. Changes attributable t o irradiation are irradiation. Frequently. the number of binucleate
discussed in section I.D.5, and Figure XVIlI shows lymphocytes is higher than normal [H20.513. J 14. R171;
sperm counts as a function of dose and time. The how.ever. their appearance is generally delayed. so this
prognostic value of a sperm count is great. because the measure is of little interest for immediate diagnostic
changes are very sensitive indicators at relativelj low purposes. Other abnormal features have been observed
doses [I9]. A first sample must be obtained less than in the peripheral blood lymphocytes of persons
40 days after the accident and a second sample, after irradiated with high doses, including ( a ) nuclear
the second month. Table 10 shows the effects of changes; ( b ) nuclear pycnosis; and (c) micronuclei.
irradiation on spern~atogenesisand the prognosis for which are the result of chromosomal abnormalities
fertility [LA]. It should be noted that the threshold but can be detected more easily and more quickly
dose for permanent sterility does not rise significantly than karyotype abnormalities. These changes can be
when the dose is fractionated over some days or a few observed at relatively lou doses. typically 0.25 Gy in
weeks. This is attributed to differentiation of the vivo and 0.02 Gy in vitro [I 151.
spermatogonia, which pass from relatively resistant
early stages to type B, more sensitive, with a D, value 243. The number of peripheral lymphocytes display-
in the region of 0.2 Gy [U4]. ing a defective nuclear structure has been shown to be
related to dose for doses above a few Gy. administered
239. As is clear from the foregoing discussion, a in vitro and in vivo [W 141. This phenomenon has been
prognosis founded on only one parameter or one class studied in rats and in humans. but it cannot be readily
of parameters (dosimetric, clinical or biological) is used for dosimetric purposes because the damaged
bound to be very uncertain. T o be valid, a prognosis cells are trapped by the reticulo-endothelial system
must be founded on an entire range of data, and the and rapidly disappear from the bloodstream; blood
wider the spectrum of these data and the better their samples must therefore be taken soon after irradiation
coherence, the more refined will be the predictions. and incubated in a culture medium for several hours.
Table 23 summarizes the kinds of data that are useful
in prognosis [Il?]. and Table 28 recapitulates the
243. The incidence of nuclear pycnosis in lympho-
threshold levels of the signs and symptoms that can be
detected by specialist teams and that appear after low cytes irradiated in vitro is also related t o dose. In
doses [N5]. animals (rats, rabbits) there is a linear relationship up
to about I Gy, with a low threshold at about 0.05 Gy
[I15]. However, this method is unreliable because
pycnotic Iymphocytes vary so widely among non-
B. CLINlCAL AND BIOLOGICAL DOSIMETRY irradiated subjects. Moreover, it has been shown that
in animals, pycnosis varies tvith the size of the cell and
240. The many ways of estimating dose can be divided the nucieus/cytoplasm ratio [R18].
into two main kinds of investigation: (a) clinical
dosimetry, u.hich compresses the obsen.ation discussed 245. At doses between 1 and 8 Gy [115]. irradiation
in sections 1.C and 1.D (the relative value of these reduces the uptake of tritiated thymidine in vitro by
observations is discussed in section li1.A) and ( b ) bio- the lymphocytes following treatment with phytohaema-
logical dosimetry, which comprises all the laboratory glutinin. This explains the reduction in mitoses a n d
examinations that might allo\v an evaluation of the cellular transformations during irradiation. Although
dose received by the individual. its distribution in the it should be regarded as only semi-quantitative, this
body, the time span of dose delivery and the quality of method is sometimes used in cases of accidental
radiation involved. Biological dosimetry relies on irradiation [U'lj].
haematological. biochemical, cytogenetic and neuro-
physiological examinations [ElO. 113, J 1 1, J 12, K19. 246. Irradiation also affects the electrophoretic
KIJ]. which have different degrees of dosimetric mobility of lymphocytes and the distribution of
value. Some are only qualitative (biochemical exami- cellular volumes [S25]. This was noted in rabbits after
nations, for example), others have considerable doses of 2 and 3 Gy, where there was an increase in
prognostic value (cytogenetic and neurophysiological the number of large cells in the second week after
examinations. for example): the majority are difficul~ irradiation. At the same time, in the categories of cells
to interpret in cases of protracted or fractionated characterized by their degree of mobility, the category
exposures. showing the first changes manifested the phenomenon
only briefly, starting about five minutes after exposure
and lasting for about 30 minutes. The explanations
1. Dosimetry based on haematological data offered for this vary: an increase in cellular metabolism
that produces functional changes in the lymphocyte
24 1. Quantitative morphological haematology (cell or, alternatively, differences in the cell populations at
count, differential count, platelet count etc.) is dis- the outset, with the most mobile groups able to
cussed in sections I.C.4. and 1II.A. Irradiation causes undergo certain alterations outside the circulation and
changes in the circulating blood components (cells and then to reappear with a different volume [I 151.
247. Various immunological changes have been louler produce little change [K12]. After a few Gy in
measured after regional irradiation [W17]. in surface man, there is an initial drop in the mitotic index,
markers. mitogen and antigen responses and cytotoxic recovery at about day 8 and a further fall before it
functions (see section I.C.4). Some of these changes returns to near normal by day 34 [F9]. In the Y-12
persist for up to 10 years, but there have been no accident. the marrow of individuals who had received
detailed studies of their potential use as biological estimated doses of 2.4-3.7 Gy had practically no
indicators of radiation dose. mitotic cells. For higher doses, the cell count dropped
slightly from day 3 after exposure. The niost comnionly
248. Leucocytes other than lymphocytes also show observed morphological change was the presence of'
malformations after irradiation. There are few quanti- giant neutrophil precursors from day 2 to day 16.
tative data. and such data as there are. are of little use
in establishing a ciiagnosis or prognosis. These changes 253. Some authors have proposed a test based on the
only confirm exposure; it is not so far possible to marrow's capacity to respond to stimulation: injection
correlate them with dose or to know their relative of ethiocholariolon causes granulocytes stored in the
importance. The most common changes are ( a ) giant bone marrow to migrate into the bloodstream [G 18.1 15,
polynuclear cells lhypersegmented polyploid granulo- V151. The ethiocholanolon is a testosterone metabolite.
cytes); f b ) cells uith small alterations in their nuclear (5-4-androstane-3. 17-dionin. It is an androsterone
structure. such as small chromatin adnexa: ( c ) the isomer, with the configuration 5P-H (X:B cis); andro-
presence of immature granulocytes; and ~ d m~totic ) sterone has the configuration 5a-H (A:B trans). The
abnormalities in erythroblasts and granulocytes [B16. etliiocholanolon tcst was first used in patienrs suffering
F5, 115, 1161. Tlirse abnormalities occur only infre- from malignant blood disorders: given the relationship
quently. The reduction in the number of rnonocyles between the responses to this test and the qualit? of
may be related to the inhomogeneity of the dose, in the peripheral granulocytic cell pool. i t was considered
the sense that when severe nlonocytopenia appears to be a good guide to the therapy of these blood
rapidly, it is d sign that a very large proportion of the diseases [V15]. Furthermore, ethiocholanolon affects
bone marrow has been irradiated [I 151. Conversely, if neither the mononuclear nor the thrombocytic cell
a significant part of the haen~opoieticmarrow has lines. The granulocyte outflow starts quickly and lasts
escaped irradiation, [here may he only a temporary for about 16 hours after the injection. Because of its
reduction in the number of monocytes. or even low toxicity and the good reproducibility of the
monocytosis with an increase in the number of response, the method using ethiocholanolon is superior
immature cells [I IhJ. to methods using other leucocyte-mobilizing agents. .4
positive response indicates active medullary produc-
249. Er~throblastscan be Sound in the blood stream tion of'granulocytes.
after irradiation. illways in very low proportions [B16,
1 1 51. Reticulocytes are useful indicators in prognosis
254. Many of these niethods have now been supcr-
[H20]; a dramatic fall in reticulocyte count is often a
seded by cell culture techniques for bone marro\\.
sign of early fatalit).
These techniques are at present fairly reproducible:
mixed-cell colonies originating from cells closely
250. Serum glycoproteins increase in the presence of
rel;ilcd to the stem cells and gran~~locyte/macrophage
~nfcction.inflaniniation or neoplastic and idiopathic
colonies arising from grani~locyticprecursor cells may
disorders. The effect of irradiation on the conccntra-
appear i n cultures even using marrow punctures that
tion and distribution of protein-bound carbohydrates
have indicated, morphologically, a lack of haenio-
in the serum of mice and dogs has been studied [I 151.
poiesis. Quantitative medullary scintigraphy, in con-
A considerable increase has been reported in animals
junction with the iron-59 test, gives a picture that can
exposed to lethal doses. while no notable change has
be used to assess the impairment of the marrou.
been reported in animals receiving lower doses. I t is
not possible to treat all glycoproteins as one entity to
be used as a dosimetric indicator. However. following 255. Because the mature cells are resistant and have
the separation of various elements, changes in concentra- a long lifetime (approximately four months), it is
tion have been noted for transferrin. haptoglobulin. difficult to use erythrocytes directly as early biological
the /I2 glycoproteins and the ( I : macroglobulins [E8]. A indicators of radiation damage. although the erythroid
common feature of all these proteins is their richness precursor cells are radiosensitive. Iron is incorporated
in bonded carbohydrates. only into the precursor cells, and the iron-59 test. in
conjunction with the other tests of medullary function.
251. Because the bone marrow function is extremely allows the erythroid cell populations to be evaluated.
important for prognosis. all tests of its proliferative
ability may a priori be regarded as useful dosimetric 256. A greater denaturation of haemoglobin in
indicators. The analysis of bone marrow cannot in any crytl~rocytes by phcnylhydrazine was reported in
case be a substitute for studies of' the peripheral blood. occupationally exposed persons, compared with the
which are currently the most reliable biological nor~nalpopulation [G22]. I n patierlts ~31thbronchial
dosimeter. carcinoma given fractionated doses (1.2-1.5 Gy per
day). an increased denaturation was observed when
252. The mitotic index in bone-marrow cells is one the cumulative dose reached 7-9 Gy [G22]. However.
of the most accurate biological indicators, and also no increase was noted when erythrocytes from normal
has a certain prognostic value. Changes in the mitotic individuals were given doses between I and 8 Gy in
index are related to the dose. hut doses of I Gy or vitro [G23].
2. Dosimetry based on biochemical data 261. There is a general increase in the levels of
amino acid in the urine of animals and humans during
257. Any changes in the blood biochemical para- the first day after irradiation [S39]. The relative
meters ma!, be regarded as interesting signs. Glycaemia enhancement depends on the absolute excreted amount
cannot be taken as a biological indicator because of its and on the metabolism of the specific amino acids.
high degree of stabilit! in the body. It is not unusual Because these factors are very complex and different
to observe hyperglycaemia from day I , followed by for each amino acid (a decrease in urinary escretion
pronounced hypoglycaemia (0.5 g/l) on about day 3 can occur with some) no general rule is observed [S39,
and a return to normal that takes about a w.eek. after 5141. Accordingly. the excretion of amino acids is not
some fluctuation around the normal level [J13, 514, usually a n appropriate indicator.
Jlj]. In the same way, fluctuations in plasma elec-
trolytes and plasma proteins increase as the dose rises. 263. There are. ho~ve\~er, some amino acids o r their
However, tne data are not accurate enough for these nletabolites that show a dose-dependent change in
~ndicatorsto be used q u a n t i t a t ~ ~ e [l J\ 151. The features urinal? excretion after irradiation. One of these is
often noted are disturbances such as hypochloraemia. taurine, which is the metabolic end-product of cysteine.
hyponatraemia o r hypokalaemia during the first week Its excretion increases 1-2 days after irradiation in the
[J13]. Electrophoretic analysis of the protein fractions urine of rats and mice [K22. S26, S381. Excretion
shows the largest reduction (greatest at about two increases with radiation dose in the range 0.75-2.5 Gy.
weeks) in the albumins. A dose-dependent appearance In man. a n enhanced urinary level of taurine was also
of a humoral factor in blood serum. which inhibits observed after accidental irradiation [X29, J14J. It has
incorporation of ""VdR into cells in culture, was been suggested that the increased excretion of taurine
reported in mice [F7]. The technique has not yet been after irradiation may be related to intracellular taurine
developed for man, partly because the thymidine elimination due to changes in cell permeability [S26]
concentration is only one-tenth that in mouse serum and to the breakdown of lymphatic tissues [D12].
a n d partly because of other technical difficulties [F8, However, metabolic studies in mice show that the
S391. biosynthesis of taurine is also altered [H41. S40).
260. After radiation exposure, there is a considerable 164. Creatinine could serve as a measure of radio-
enzymatic breakdown of nucleic acids and proteins. logical damage to the irradiated muscles that are n o
especially in lymphatic [issues [A29, H42. S381. As a longer able to metabolize it in the normal way [G20].
consequence. the urinary excretion of nucleosides and The level of creatinuria has never been correlated with
amino acids, as well as their metabolites, increases. A dose. but i t may confirm the uniformity of irradiation.
dose-dependent increase of deoxycytidine from normal In accidents where a relatively large portion of the
low levels [I151 was observed in the urine of rats body has not been irradiated, such as the Lockport
during the first day after a whole-body irradiation accident in 1960, the level of creatinuria (creatine/
with 0.5-2.5 Gy [G30]. An enhanced excretion was creatinine ratio) scarcely increased. In accidents
also found in man after radiotherapy [B55. S39]. involving whole-body irradiation, such as occurred at
Similar effects were reported for the excretion of Oak Ridge (Y-12) in 1958 and at Mol in 1965, the level
thymine in rats [ZS]; however, this was not seen in was significant. with three conspicuous peaks in one
man [B55]. Thymine is n~etabolized to /&amino- instance (day 2, end of first week and end of second
isobutyric acid (BAIBA). The excretion of this sub- wcek) [J 141.
stance is considerably increased in mice, rats and man
after irradiation [S39]. After accidental human irra- 265. In recent years a number of new biochemical
diation, a n increase from 100-200 pmoles per litre of indicators of severe radiation damage have been
urine to 250-650 pmoles per litre was observed [G19, proposed. For example, a method has been suggested
J 141. for the quantitative evaluation of damage to the
membranes of erythrocytes in the peripheral blood does not differ significantly from that for irradiation
[M50, M51. M521. Inhibition of the incorporation of in vitro [C46], so that the aberration yield observed in
labelled precursors of the D N A in bone-marrow cells cells taken from an irradiated subject may be inrer-
has been used in a method worked out by Porschen et preted by reference to the appropriate calibration
al. [P31]; the authors used their method to monitor curve in vitro. In vitro curves have been established
irradiation even in small doses (some tenths of Gy). for a large range of radiation qualities, including all
There are also data on determining the total content those likely to be encountered in accidents [L75].
of desoxyribonucleotides in the blood and urine of Within any one laboratory, the calibration curves for
patients irradiated for therapeutic purposes [S46, dicentrics have proved t o be very reproducible, pro-
T 3 11. However, due to the paucity of such studies, it is vided that the cells are examined at their first post-
difficult to evaluate the value of these indicators. irradiation mitosis. This is now reliably achieved by
including bromodeoxyuridine in the culture medium
and staining the chromosomes by fluorescence plus
3. Dosimetry based on cytogenetic data Giemsa [S37].
266. The analysis of chromosome aberrations in the 270. For low-LET radiations, the yield of aberra-
circulating lymphocytes is widely used to assess the tions, Y. conforms well to the quadratic relationship
dose. Even in cases of partial-body exposure. the + +
Y = c u D /ID2 where c is the background incidence
chromosome changes are excellent indicators of the (about one dicentric in lo3 cells), D is the dose, a n d a
absorbed dose. The evidence to justify the technique is and ,4 are fitted coefficients. A dicentric aberration
well founded and covers various irradiated popula- requires the interaction of two breaks, each induced in
tions (in nuclear medicine, radiotherapy and accidents) separate G, or G , chromosomes. An explanation of
a n d very wide ranges of dose [B42, K13, L15. L161. the quadratic relationship may be that when both
The technique provides a reliable indication of the breaks are produced by the passage of a single
acute dose, since lymphocytes are widely dispersed in ionizing track, the yield is represented by the linear
the various tissues and organs, have a reproducible term aD. The PD2 term thus represents those dicentrics
radiosensitivity and a long life, and circulate rapidly in that are produced when the two breaks are caused by
the body [D 131. separate ionizing tracks. The latter term becomes
more important when the dose increases.
267. Many types of radiation-induced chromosomal
aberrations may appear in irradiated lymphocytes, but 271, In general, high-LET radiation, such as fission
the dicentric aberration is currently taken as providing spectrum neutrons and alpha particles, give a linear
the most valuable information on dose. This is dose response relationship. Y = c + nD (Figure XXVII).
because the dicentric aberration is almost unique to For these types of radiations the ionizing events are so
ionizing radiation and occurs rarely in persons exposed densely distributed along the track that there is a high
only to normal background radiation. Centric rings probability that one track will deposit energy in both
occur only 5-10'3 as frequently as dicentrics in control chromosomes. RBE values at low doses. calculated as
o r irradiated Lymphocytes and are thus roo infrequent the ratios of the aloha coefficients of two radiations of
to be used as a sole measure of dose. Some researchers different quality. may represent the relative hazards of
combine the centric and dicentric yields. Acentric the two radiations at loat routine occupational levels
fragments, by contrast. have a higher background [I2 I]. At higher doses, such as are likely to cause overt
frequency, which probably reflects their induction by symptoms of sickness, the values of RBE decrease
a large number of chemical mutagens. The confounding markedly [L36]. With neutrons, as their energy
effect of many environmental non-radiological insults increases the average LET decreases and the linear
reduces the acentric's value as a measure of dose. model requires a second (quadratic) term, e.g., with
although elevated acentric yields may qualitatively 7.6 MeV and 13.7 MeV neutrons. RBE values for
supporr dose estimates derived from the dicentric specific energies of neutrons have been proposed [B34,
incidence.. PlB].
268. Human T-lymphocytes have a long lifetime; a 272. Another feature of the dose-response curves for
small proportion of them survives for decades. The high- and low-LET radiation is the relative importance
rate of replacement is quite slow, so that in the few of the dose rate. For high-LET radiation with a linear
weeks after exposure the dicentric yield remains fairly dose response, this is unimportant. For low-LET
constant. After a partial or inhomogeneous acute radiation, the equation Y = c + aD A /IG(.v)D' can be
exposure, the lymphocytes that were in the irradiated used, where the number of inirial chromosome breaks
volume of [he body in both the vascular and extra- falls exponentially with time according to the facror
vascular pools are rapidly mixed with unirradiated G(s). In practice, the dose-squared term reduces until
cells. An equilibrium is reached by about 20 hours the response can be considered to be linear for x- o r
[T25]. and thereafter the dicentric yield in cells from a gamma-radiation doses of a few Gy, if delivered at a
sample of peripheral blood will provide an estimate of more or less uniform rate over 24 or more hours.
the average whole-body dose.
273. An important problem in assessing the dose to
269. The dose-response for dicentric aberrations in an appropriate degree of precision is the number of
the irradiated lymphocytes of normal individuals is metaphase cells that have to be examined. As a rule,
little affected by factors such as the donor's age o r sex. evaluation of 100-500 metaphases is sufficient to
The dose-response obtained for irradiation in vivo estimate a dose at irradiation levels of medical
DOSE (Gy)
303. In Hiroshima and Nagasaki, 50% of the deaths 307. Data on LD,,, for various species of large
after day 20 in a small documented sample occurred animals have been used to estimate the probable slope
of the dose-mortality curve for man. The average prodromal responses are somewhat alleviated by dose
coefficient of variation among species is about 0.24. protraction or fractionation; for example, small doses
and the ratio of LD,/LD,, is about 2. This suggests of 0.2 Gy can be delivered daily for several weeks
that the dose that would kill few healthy humans is without inducing nausea. Low-dose-rateor fractionated
about 3.0 Gy and the dose that would kill most is irradiation markedly reduces injury to the intestine in
about 6.0 Gy. all species, including man, but dose-mortality relation-
ships for man due to protracted intestinal irradiation
308. Based on experiments with animals, the LD,,,,, are unknown.
would be expected to be greater for unilateral than for
bilateral irradiation, by about 20%. This depends on 313. The relationship between the lowest concentra-
the penetration of the radiation used. Doses decrease tion of leukocytes and the total dose and exposure
faster with depth for low energy photon or electron time has been measured. There is less effect with
beams and for fission neutrons than for higher energy protraction of the dose. I t has also been found that
beams. In and near bone, there is a higher dose from marrotv recovery during irradiation is less in leukaemic
low energy photon irradiation and a lower dose from patients than in other patients with non-haemato-
neutrons. logical malignancies. The greater radiosensitivity of
lymphocytes, as compared to granulocytes. applies to
309. In large animals. the LD,,,,,, may be increased fractionated treatments as well as to single doses.
by up to about 1 Gy through conventional supportive Various types of quantitative formulae have been
medications and transfusions of blood elements. How- proposed to estimate changes in the LD,,,,,, as a
ever, such a small dose increment can increase markedly function of protracted irradiation. As the data base is
the survival rate because of the steepness of the dose- sparse, these are to be taken as very rough guidelines
response curve. Bone marrow grafts also increase for assessing the effects of changes in dose-time
survival. After a lethal dose in man. 2 10' bone relationships.
marrow cells per kilogram is needed to rescue 50% of
individuals, based on experiments with different animal
313. The tissue responses are also markedly depen-
species, and 3 10' cells per kilogram for 100%. rescue.
dent on the mode of delivery of the dose with respect
More allogeneic than isogeneic marrow cells are
to time. The responses of the bone marrow and the
required for rescue. The shielding of perhaps as little
skin to protracted and fractionated doses are fairly
as 10% of active marrow in man may reduce the
- mortality to zero after doses near the LD!,,,,. well known from radiotherapeutic experience. The
lung. too. is spared by protraction. In contrast with all
other tissues, protracted doses are more injurious to
310. It is concluded from the various groups of
the testis, owing to the progression of cells into
individuals discussed in this Annex that the LDwm for
sensitive phases. In women, a larger dose is generally
humans receiving no or little medical treatment after
required to cause infertility when fractionated doses
exposure is likely to be around 2.5 Gy marrow dose
are used, but an accurate assessment is not available.
and possibly higher. A similar value may pertain to
some groups of ill cancer patients receiving good
medical care. For healthy humans receiving good 3 15. Large amounts of internal emitters are required
supportive medical treatment after irradiation, the to produce early effects in man. Bone-marrow depres-
LD,,,,,, is likely to be approaching or equal to about sion is observed after large, single doses of iodine-131;
5 Gy. The LD,,,6,, can be further increased by success- 5 Gy is the maximum total dose that can safely be
ful marrow transplantation, probably up to around delivered to the blood. Radiocolloids have produced
9 Gy. After these higher doses, there may be some mild radiation sickness and haematological complica-
cases of pneumonitis occurring in the second month. tions, as have radiophosphorus and sulphur-35. Setrere
unless the lungs were shielded. After even higher doses acute intestinal injury in man from internal emitters
(> 10 Gy) acute gastrointestinal injury will become has not been reported, and lung injury has been rare.
more prevalent. Treatments for intake of radionuclides by ingestion
are based on reduced retention, enhanced excretion o r
31 1. Neutrons are more efficient in causing acute diminished translocation. Emetics, lavage and pre-
injury than low-LET radiations, by a factor of 2-3. cipitating agents may help prevent gut toxicity. Decal-
using single doses. However, because of the IOU, cification therapy and chelating agents continue to be
penetration of neutrons. values of LD,, for large studied.
animals can be apparently smaller for neutrons than
for low-LET radiation. There is little experience in 3 16. The radiation response of tissues can be modified
man of mortality after neutrons, except in a few by physical or chemical conditions or treatments, such
isolated accidents. The neutron component of the as the removal of oxygen, the use of protective or
doses to the Japanese survivors from the bombs is sensitizing chemicals. drug adjuvants or previous
now considered to be much smaller than had previously treatments with cytotoxic drugs that produce residual
been thought. probably less than 3% of the total dose tissue injury.
at distances where acute early effects were seen.
317. A small section of the population may be
312. In radiobiology. a protracted dose or a frac- particularly radiosensiti\~ebecause of inherited genetic
tionated dose is known to have less effect than the disorders, such as ataxia telangiectasia (AT). Children
same total dose given singly. The early effects of high with A T are more radiosensitive, and cultured skin
doses in man also follow this general rule. Thus, fibroblasts taken from them are similarly sensitive.
Estimates of the frequency of hereditary conditions of immature granulocytes and ery~liroblasthand the
that are likely to render individuals particularly appearance of reticulocytes are also indicative of
radiosensitive are of the order of one per cent in the irradiation but are not suitable for accurate dose
general population. assessments.
318. I t is difficult to establish a prognosis for 320. Tests of the proliferative abilitl of the marrobr.
individuals irradiated above the threshold doses for may also be regarded as useful dosimetric indicators. A
acute effects solel!. from an estimate of the dose, drop in the mitotic index, for example, is a sign of doses
because of the steepness and uncertainty in the dose- higher than I Gy. The migration of granulocytes into
response curves, including uncertainty of the value of the bloodstream after the injection of ethiocholanolon
the LD,,,, for man. Also, there are many confounding suggests the active production of granulocytes by the
factors, such as the presence of intercurrent disease. bone marrow. Cultures of mixed-cell colonies and
the effect of shielding and protraction and the quality granulocyte/macrophage colonies give some indica-
of the radiation. The type, severity and duration of the tion of the concentration of precursor cells in the
prodromal symptoms. including the presence and marrow, as a function of the dose. By contrast,
extent of erythema, may assist in the prognosis. erythrocytes are relatively radioresistant and long-
Haematological signs, particularly the lymphocyte lived. and hence their concentration in the blood is a
count, are good prognostic indicators. The lowest poor indicator of dose; however, marrow scans for
concentrations of the various blood cell types and the erythropoiesis may be used to estimate marrow doses.
time at which such concentrations are reached follow- Biochemical analyses of the urine are more indicative
ing irradiation are important inputs for the prognosis. of dose than similar analyses of the blood, but no test
as is the duration of marrow aplasia after high doses. provides a better estimate of the dose than haemato-
The appearance and persistence of immature cells in logical and cytogenetic measurements.
the blood is a sign of marrow regeneration and is a
favourable sign. Marrow scanning can give an indica- 32 1. Cytogenetic measurements of chromosomr di-
tion of erythropoiesis in different regions, but for centrics, rings, fragments and micronuclei provide the
estimating the likelihood of long-term recovery. it is most accurate assessment of the average dose. of
necessary to culture very immature cells in the importance for acute effects, over the body. The linear
marrow. Urine and bacteriological analysis may assist or linear-quadratic relationships are well established
in prognosis; sperm analysis is important for assessing for irradiation of lymphocytes in vitro, for many
the dose and subsequent likelihood of fertility. How- radiation qualities and dose rates. With neutrons.
ever, to be valid, a prognosis must be founded on linear relationships apply, and the relative efficiencies
many different data and constantly updated. of different energies of neutrons have been measured.
Protracted doses are, however, more difficult to
319. Biological dosimetry relies on many prognostic estimate.
indicators, as well as on laboratory tests, for which
correlations between effect and dose have been reason- 322. Changes in a number of neurophysicllogical
ably well established. Changes in lymphocytes that are parameters have been observed after irradiation. and
clearly related to dose include the appearance of these have good potential for development as dosi-
nuclear abnormalities, pycnosis. tritiated thymidine meters. The radiation-induced activation of biological
uptake and electrophoretic mobility. These measure- and other materials. as well as electron spin resonance
ments should be regarded, for dosimetric purposes, as measurements, are quantifiable signals at lethal or
only semi-quantitative. Leucocyte malformations. the sublethal doses, down to about 0.3 Gy, that could also
level of serum glycoproteins, the presence in the blood be used as dosimetric techniques.
T a b l e 1
Ixtra-
Cell t y p e Do polatlon Ref
( GY number
C o l o n l e s of g r a n u l o c y t e s and
m a c r o p h a g e s In d l f f u s l o n chambers
Erythrold colonles
C o l o n l e s of s t r m l c e l l s
1 - l y m p h o c y t e precursor c e l l s
Skln keratlnocytes
Skln flbroblasts
S k l n a n d lung flbroblasts
Mamnary flbroblasts
Uamnary eplthellum
Thyrold eplthellum
T a b l e 2
Small lntestlne
Cells per vlllus
Cells per crypt
-- 4000-8000
300- 500
Crypt cells In cycle < 300
Cell cycle tlme 36-60 h
Total number of crypts - 6 100
Total cells produced per day
Translt tlme (crypt to vlllus tlp)
- 1011
3- 4 d
T a b l e 4
0- 1
2- 3
4- 5
6- 7
8- 9
10-1 1
12-13
14-15
16-17
18-19
20-29
3 0 - 39
40-49
50-59
60-69
70-79
> 80
Unknown
Total 345 41 2
T a b l e 5
C e l l k l n e t l c d a t a f o r human e p l d e r m l s
[ P l l . P301
Number o f c e l l l a y e r s
Nucleated ( l n c l u d l n g basal)
Corneocytes
Transtt tlme
Basal t o g r a n u l a r 14 + 6 (SO)
Granular t o surface I 8 i 6 (SO)
Llfetlme surface c e l l s - 2
(20-30) l o 3
Basal c e l l s p e r mn2
Labelling lndex ( 1 8 - h average) - 4.7
H l t o t t c lndex ( 1 8 - h average) - 0.63
9 i 2 (SO)
L e n g t h o f S phase
Cell cycle duratlon 213 i 84 (SD)
C e l l s produced p e r h o u r
p e r 100 b a s a l c e l l s a/
&/ Assumlng g r o w t h f r a c t l o n = 1 . 0
T a b l e b
F l e l d s i z e (cm x cni)
Treatment
6 x 4 8 x 1 0 15x20 L/S
(Small) (Large) (x)
I P2l
S l n g l e dose 70.0 14.5 11 .OO 55
3 weeks 50.0 37.5 29 .O 58
5 weeks 58.0 43.5 33.5 58
F l e l d s l z e (cm x cm)
Treatment
7 x 5 8 x 1 0 15x20 L/S
(Small) (Large) iX)
[vai
S l n g l e dose 25.0 17.0
3 weeks 52.5 45.0 30.0 57
5 weeks 60.0 50.0 35.0 58
T a b l e 7
Doses t o a 1 cm c l r c l e o f p l g s k l n c a u s l n q d r y d e s ~ u a m t l o n
(modlfted from [ M Z l ) ]
Oose (Gy)
T a b l e 9
Ouratlon of Spermatlds
Spermato- Stages t r m
gonlal acrosome
types development Cell- Spermato- Number of Number of
cycle genesls stages types
(h) (dl
T a b l e 10
Cffect on
Oose
(GY)
Spermatogenes ls fertll\ty
Mldline or
Data source marrow dose Year Reference
(GY)
vlnca
V (dled) 2.14 1.33 0.89 4.3 0.68 (2.30-3.10) 3.28 4.53
2.73
M 2.09 1.30 0.81 4.26 0.66 (2.30-3.10) 3.20 4.32
2.61
0 1.92 1.36 0.91 4.19 0.69 (1.80-2.50) 3.14 4.05
2.11
G 1.89 1.35 0.90 4.14 0.68 (1.80-2.50) 3.09 3.99
2.16
H 1.58 0.99 0.6 3.24 0.50 ( 1 .lo-2.30) 2.42 3.21
2.01
E / Not stated.
Columns:
1 G a m - r a y e m l s s l o n by s o u r c e : leakage d o s e = first-colllslon dose.
Y-12: [H23]; vlnca: [H22].
2 G a m - r a y d o s e for neutron capture In t h e s u r f a c e o f t h e body.
Y-12: [H23]: Vlnca: [Ht?].
3 F l r s t - c o l l l s l o n charged-particle dose. Y-12: [H23]; Vlnca: [H22).
4 Total d o s e a s published (columns 1 t 2 t 3). 7-12: [H23]; Vlnca: [H??].
5 C a m - r a y d o s e f r o m neutron capture In 6 - c m annulus of 3 0 - c m cyllnder.
6 M a r r o w d o s e [Bl].
Y-12. flrst flgure: m a r r o w dose If exposed f r o m t h e f r o n t ;
Y-12. second flgure: If exposed f r o m t h e slde;
Vlnca: uncertalnty range ls i 15% of the mean.
7 M a r r o w d o s e [M28].
Values a r e for Y-12: 0.8 (column 1) 0.8 ( c o l u m n 3) + column 5:
For Vlnca: 0.8 (column 1 ) + c o l u m n 3 + c o l u m n 5.
8 A further r e v l s l o n of t h e dorlmetry o n t h e basls of lower body sodlurn
levels. results In increased estimates of d o s e uslng s o d l u m actlvatlon
by factors o f 1.06-1.20 at Y-12. and 1.29-1.41 a t Vlnca [MZb. WZl].
T a b l e 13
Total-body lrradlatlon In man: rchematlc clasrlflcatlon o f dose ranges: symptoms, therapv and outcome
If lnJury
. . ls fatal
Acute Inctdence Latency Syndrome Characterlstlc symptoms Crltlcal Therapy Prognosis ~ctha-
dose or organ perlod llty
lnvolved after Death Usual
(GY) exposure (X) wlthln cause of death
> 50 100 Mlnutes Neurological Cramps. tremor. atarla. 1-48 h Symptomatic Hopelesr 100 1-48 h Cerebral oednna
symdrome lethargy. lmpalred vlslon.
Co m
10-15 100 0.5 h lntestlnal Diarrhoea. fever, 3-14 d Palllatlve Ve-y poor 90-100 2 weeks fnterocolltls
syndrome electrolytic Imbalance shock
5-10 100 0.5-1 h Bone marrow Thrombopenla. leucopenla, 2-6 wrtkS Bone m a r r w transplan- Uncertrln 0-90 Ueets Infectlons and/
syndrome h a e m r r h a g e . lnfectlons. tatlon. transfusions depending or h a t m r r h a g e
epllatlon o f leukocytes and on success
platelets. optlmal of therapy
care (lsolatlon.
antlblotlcs, fluldr)
2-5 50-90 1-2 h Bone marrow Thrombopenla. leucopenla. 2-6 weeks Transfuslons of leuko- Uncertrln 0-90 Ueets lnfectlons and/
syndrome h a m r r h a g t . lnfcctlons. cytes and platelets. depending o r haelnorrhage
epllatlon optlmal care (lsola- on success
tlon. antlblotlcs. of therapy
flulds). bone mdrrou
transplantatlon
1-2 0-50 > 3 h Bone marrow Mlld leucopenla and 2-6 weeks Symptomatlc Excellent 0-10 Months Infections andl
thrombopenla o r haemorrhage
T a b l e 14
-30-70% mild-
ro rncwleratc
-20-50% mild-
lo rndcmle
Anorexia -50-903
D I J R ~ ~(crclnlph)"
J
-30-609 mild ------.--------------hlilJ----------------------
to modemre
-30-60% mild ---------------------hlil~----------------------
ro m d c r a r e
Hypolension
Dizziness
Disorlcn~auon
+,,+ -1Wr-
mild
-(I -1 -
Frvcr 10-508
Infccr~on mild 11)
n~trlcrarc
Fluid lasc/clccrrolyre
inlb~lsnce
lic~dachc
Fa~n~ing
Prosrra~lon
a/ References f o r t h l s group o f symptoms: A25. A26, A27, 817, 829. C10. C14.
CIS. C39. C42. C43. C44. E l l . 626, G28, G29. H39. H40, 32, L20, L24. n l 8 .
U42, M44. N10, N11. N13. 05. 06, P24, R23, 533, 534, 535, 536, 15. Vl8.
W19. W21. 24.
b/ 10% o f t h e H a r s h a l l e s e v \ c t l m s exposed t o 1.75 Gy e x p e r l e n c e d dlarrhea
d u r \ n g t h e f \ r r t day a f t e r I r r a d t a t l o n . a c c o r d l n g t o [ A 2 5 ] .
c/ R e f e r e n c e s f o r t h l s group o f symptoms: A27. H39. K21. N13. 06. P24. 533.
U8. U9.
d_/ References f o r t h l s group o f symptoms: A2b. A27. 816. 829. C10. C14. CIS.
5 5
e/ S l l g h t t o moderate d r o p I n p l a t e l e t s : f r o m 3 10 /ul t o 1.8-0.8 10 /ul.
3 3
f / S l l g h t t o moderate d r o p I n g r a n u l o c y t e s : f r o m b 1 0 - / u 1 t o 4.5-2.0 10 / u l .
3
f r o m 3 l ~ ~ / tu
q/ S l l g h t t o moderate d r o p l n lymphocytes: o l2.0-1.0 1 0 /ul
h/ References f o r t h l s event: A25. 816. L4. 06.
T a b l e 15
Postcxpusurc unic
- (c)- -------
lo-80%
Infeclion (1 - motitrate
Ulceration 3 0 5 + - . -----
(L) moderate
Fluid loss/elcc~rolytc
~rnbalancc
Headache
Fainling
Prosiraiion
Fcvcr
lniccrion
Flurd losr:clecrrt~lyrc
lrnbaI~nie'
Hcad~chc
a/ Reference's f o r t h l s group o f symptoms: A24. A25, A26, A27. 816. 817. 829,
C14. C39, C40. E l l . 625. G26. H39. H40. 120. JZ. J19, L20, U42, U43. N10.
N11. 05, 06. P24. R12. R23. 533. 534, T5. T23. W19. WZO, U9. 23. 24.
b/ R e f e r e n c e s f o r t h l s group o f symptoms: A24, A26, A27, 816. G27. H40. 120.
U18. 06, P24. 533, U9.
c/ R e f e r e n c e s f o r t h l s group o f symptoms: U43. R12.
d/ R e f e r e n c e s f o r t h l s group o f symptoms: A24, A26. A27. 816. 817, C14. C41.
~ 4 7 . 019, 111. ~ 1 9 . LO. LIO. LZO. ~ 2 2 , nio, n42, 1443, 06. ~ 2 4 . ~ 2 3 . 533.
534. U9. W19. W20. WZ1. 23. 24.
5 5
g/ Severe d r o p I n p l a t e l e t s : f r o m 3 10 / u 1 t o 0.1 10 - 0 / p 1 .
3 3
-f / Severe d r o p I n g r a n u l o c y t e s : f r o m 6 10 / u 1 t o 0.5 10 -0/ 1 .
3 5
Severe d r o p I n l y m p h o c y t e s : from 3 10 / u 1 t o 0 . 4 - 0 . 1 10 /ul.
i /
/
I/
Cpllatlon.
R e f e r e n c e s f o r t h l s group o f symptom%: A27. 816. L10. 06, R12. U9.
I/ U l l d I n t e s t l n a l damage.
K/ R e f e r e n c e s f o r t h l s e v e n t : A25. 816. 14, 06.
T a b l e 17
T a b l e 18
Humans
A c c l d e n t a l human t o t a l - b o d y p r o t r a c t e d e x p o s u r e s
g l v l n q marrow doses h l g h e r t h a n 1 Gy
Approximate
Exposure marrow
Accldent Person(s) duratlon dose Outcome Ref.
(days) (GY)
T a b l e 20
l n c l d e n c e o f D n e u m n l t l s l n man a f t e r F r a c t l o n a t e d l r r a d l a t m
L I438 I
lncldence of
Lung dose ( G y ) / Number o f pneumonltls Prlmary dlagnosls
number o f f r a c t l o n r patlents o f tumour
33 ~ung.
Hodgkln's d l s e a s e
42 Lung,
Hodgkln's d l s e a s e
67 Lung,
Hodgkin's dlsease.
Hemangloperlcytoma.
1h ymoma
90 Lung, B r e a s t .
Thymoma
86 Lung. B r e a s t ,
Sarcoma
T a b l e 21
C l l n l c a l course a f t e r doses
r e s u l t l n u l n t h e bone-marrow syndrome
Phase Approxlmate d u r a t l o n
Prodromal 1- 7 days
Latent 7-20 days
Crltlcal Second o r t h l r d week
to 7 weeks
Recovery 8-15 weeks
T a b l e 22
G a s t r o l n t e s t l n a l prodromal SYmptoms
a t 48 h o u r s I n Ill cancer ~ a t l e n t s
[LEI
Doses (Gy)
Symptoms
D 10% D 50%
a/ By s l x weeks.
T a b l e 23
S u m r y o f symptoms. t l m e c o u r s e and p r o g n o s l s
I n t h e bone marrow syndrome I n man
(adapted from [ 1 1 2 ] )
Approprlate
Dose tlme of Tlme of
range Prognosls delay for delay for Ma\n Time o f Tlme o f
nausea and crltlcal symptoms recovery death
(GY) vomlt l n g perlod
0-1 Excellent
1-2 Excellent 3 hours Moderate S e v e r a l weeks -
leucopenla
2-6 Uncertaln 2 hours 4-6 weeks Leucopenla. 6 - 8 ueeks < 2 months
haemorrhage 1 - 1 2 months
infectlon
6-10 Uncertaln 1 hour 4-6 weeks Leucopenla Prolonged < 2 months
10-15 Poor 0.5-1 h 5-14 days D l a r r h o e a . < 2 weeks
fever.
electrolyte
imbalance
> 60 Hopeless 0.5 hour 1-48 hours A t a x l a . < 2 days
lethargy
T a b l e 24
ED 50 (Gy) f o r p r o d r o m a l symptoms I n 1 1 1 c a n c e r p a t l e n t s
a f t e r whole-body a c u t e o r p r o t r a c t e d e x p o s u r e
[L91
Exposure p e r l o d
Symptom
1 day 7 days
(504 p a t l e n t s ) (103 p a t l e n t s )
T a b l e 25
1: Anorexia
Nausea
Voml t 1n g
Weakness, f a t l g u e
Prostratlon
2: Sweatlng, f e v e r
Purpura
Hemorrhage, e p l s t a x l s , g l n g l v a l b l e e d l n g ,
haematemesls, melaena, haemoptysls
Infectlon
3: Erythema. e p l l a t l o n . s c a l p p a l n
4: Abdomlnal p a i n
Abdominal d l s t e n t l o n
Olarrhoea
5: Ollgurla
Hyperaesthesla. paraesthesla
Ataxla
Dlsorlentatlon
Shock
coma
Death
T a b l e 26
Case Outcome
Dose 1 Dose 2 Cells/ Tlme Cells/ Tlme Cells/ Tlme
a/ b/ c/ ul (days) 111 (days) 111 (days)
favourable
Favourable
Death (day 12)
T a b l e 27
Case Dose
(Gy) y Cells/ TIme Cells/ TIme Cells/ Time
u1 (days! v1 (days) u1 (days)
a_/ !!I -b/ b/
Acute radiation effects in victims of the Chernobyl nuclear power plant accident
Figure A.I. Location of lung samples taken a1 the time of autopsy and distribution of the main
radionuclides in lung samples. The number above each sample group indicates the approximate
relative average value.
times) from the second day after the accident. These 13. The dose levels from external irradiation were
measurements showed that "'I accounted for 80 f 20% reconstructed from the indication of several measure-
of the total activity of all iodine isotopes, "31 for ments on the basis of previous experience. Sub-
15 i 10%. and the remaining isotopes ('231, '*'I, IZ6I, sequently. in three cases with a lethal outcome. these
and "'I) for not more than 2%. findings were refined using methods earlier proposed
by Kraytor for clothing fabrics [B31] and according to
8. The calculations for estimating intake quantities the electron spin resonance technique for dental
from the thyroid measurements were performed accord- enamel [T16]. These measurements agreed within
ing to the recommendations of the International + 20% with the dose estimates based on clinical and
Commission on Radiological Protection [I19]. On the biological criteria.
basis of the distribution of thyroid doses in exposed
individuals (Table A.I), it may be stated that in the 14. The total number of affected individuals among
overwhelming majority of cases the thyroid doses were the persons present at the reactor site in the early
below the levels likely to cause direct injury to that hours of 26 April 1986 was 203, as given in the report
organ (< 3.7 Sv) o r of significantly influencing the presented by Soviet representatives at the Post-
clinical picture during the onset of acute radiation Accident Review Meeting in August 1986 [I 181. Of
sickness. Low radioiodine dose levels were also these, 115 were treated, beginning on day 2, at the
suggested by the post-mortem nuclide measurements specialized treatment centre in Moscow; it was this
of the 28 persons who subsequently died. group that provided most of the scientific analytical
data discussed in this report. At other hospitals in Kiev
9. Internal dose values according to post-mortem there were only 12 patients with a clearly defined
measurements for 6 patients are shown in Table A.2. clinical pattern of second-degree acute radiation sick-
The maximum amount of "'Cs and 13'Cs incorporated ness and one person with fourth-degree acute radiation
activity was 7.4 MBq, except for two patients with sickness. a fact that cannot in any substantial way alter
extensive steam burns, which allowed intake of nuclides the overall assessment of the data for the entire group
through the wound. The post-mortem dosimetry gave of victims.
40 and 80 MBq of "'Cs plus '-"Cs. and 350 and 15. The increase in the total number of affected
1,100 MBq of "'I. for these two patients. respectively. individuals from 203 to 237, announced in November
The whole-body internal doses in these two individuals 1986. was due solely to persons suffering from first-
from these nuclides were estimated as approximately degree acute radiation sickness. There were 3 1 persons
1 Sv and 2 Sv during the two to three weeks before suffering from first-degree acute radiation sickness
they died, which are commensurable with their external at the special treatment centre in Moscow and
gamma doses. This fact was taken into account during 109 persons in Kiev. The task of establishing a diagnosis
the interpretation of clinical data. Internal doses for distinguishing between first-degree acute radiation
other patients did not exceed 1-3% of the external sickness and ordinary somatic diseases according to
irradiation doses. generally accepted criteria is a complex one, and one
that continued throughout 1986. On the whole, a
10. The transuranic elements (e.g., 239Pu)were studied critical analysis of the data shows a decrease in the
in urine specimens from 266 persons (635 analyses), number of persons suffering from first-degree acute
including. in some ofethe cases. analyses conducted radiation sickness in comparison with the number
before and after the administration of pentacine. The given originally. At the time of writing this report. up to
urine activity values and a negative finding after three quarters of these persons are for all practical
chelation treatment confirmed the absence of a signi- purposes healthy. Their clinical signs of reaction to the
ficant plutonium contamination of all the patients accident during the first three months were neither
observed. Post-n~orten~ tests by alpha spectrometry for individually significant nor typical of a reaction t o
transuranic elements showed their presence (74-300 Bq irradiation. Table A.3 shows the distribution of
per organ) only in the lungs; curium accounted for as patients with acute radiation sickness according to its
much as 90% of the specimen activity, and plutonium degree of severity [B31] in the group selected for
a n d americium for 10%. scientific analysis.
11. Gamma-spectrometric analysis of the first speci-
mens within 36-39 hours of the accident failed to A. INITIAL DIAGNOSIS O F ACUTE
reveal any sign of 22.24Naactivation, which confirmed RADIATION SICKNESS
that neutron irradiation of the victims was not
significant. 16. The medical unit sewing the plant was informed
of the accident within 10-15 minutes of its occurrence.
12. For most of the victims, the energy peaks of First aid to the affected individuals was provided by
more than 20 radionuclides were detectable in the middle-level medical personnel and emergency teams
spectrum of their whole-body gamma measurements; over a time period from 30-40 minutes to 3-6 hours
however, apart from the iodine and caesium isotopes after the accident. First aid consisted in the evacuation
pre~.iouslymentioned, the contribution to the overall of the victims from the industrial site, the simplest
dose from the others (q5Nb, j4'Ce, lJOLa etc.) was forms of medical attention, the administration of
negligible. These measurements, performed while the antiemetic and symptomatic (sedative, cardiotonic)
victims were still alive, were also confirmed through drugs, the distribution of potassium iodide a n d the
the analysis of autopsy specimens (approximately transportation of persons suffering from a pronounced
35 specimens from each deceased person) (Figure A.1). primary reaction to the medical unit. During the first
12-24 hours after the accident. other persons who were on the skin. Radionuclide ingestion was below the
in satisfactory condition were urged to go to the medical level likely to cause acute radiation injury. As already
unit for examination; a total of 132 persons were noted, two patients suffered from all three of these
hospitalized there during the first 12 hours. One person irradiation modalities, in combination with extensive
with severe thermal burns died during the first hour. steam burns.
Another, a reactor operator, could not be found; his
working station was located in the collapsed high- 22. The important diagnostic task during the first few
activity zone. days after the accident was the assessment of the degree
of severity of the bone marrow syndrome resulting from
17. Within 12 hours, a specialized emergency team the external gamma-irradiation dose. This was possible
arrived at the site and began work. Within 36 hours, through the use of previously devised methods, which
this team, together with the on-site medical unit, are based on the number of lymphocytes and on
examined more than 350 persons and carried out chronlosome aberrations in peripheral-blood lympho-
approximately 1.000 blood tests, each person under- cytes or on the incidence of chromosome aberrations
going two to three such tests. The treatment with in bone marrow cells [B31, B5O. G241. These data
potassium iodide was continued. were later transformed into a prognosis of the overall
dynamics of the blood picture. A subsequent re-
18. Within the first three days, 299 persons suspected
assessment of dose levels involving a larger sample of
of suffering from acute radiation sickness were sent to
cells scored revealed not more than 5-10% changes in
the specialized treatment centre in Moscow and to
the estimated doses.
hospitals in Kiev, and over the subsequent days some
200 additional persons were admitted for examination.
23. Dose-effect relationships for these indicators had
19. The primary diagnostic criteria for assessing the been derived earlier through the analysis of relatively
priority for hospitalization were the presence. time of uniform accidental or therapeutic irradiations of
onset and intensity of nausea and vomiting and of human subjects having normal initial haematological
primary erythema of the skin and mucosae, and a characteristics and exposed to well established doses
decrease of the lymphocyte count in the peripheral [P22]. Figure A.11 shows the curves (and analytical
blood to below 109/1 during the first days following expressions) for the relationships between the dose
irradiation. and the blood lymphocyte count for each of the first
nine days and the average lymphocyte count on days
20. The diagnosis of acute radiation sickness was 4-7 and days 1-8 after irradiation. The radiation dose
subsequently confirmed in 99 of the 128 persons received by each person was estimated according to
(firemen. Unit 4 operators, turbine-room duty officer the number of chromoson~eaberrations (dicentrics) in
and auxiliary personnel) admitted to the specialized a blood-lymphocyte culture, using a dose-effect curve
treatment centre in Moscow during the first two days for 100 first-mitosis cells that had been obtained after
and in six of the 74 victims hospitalized during the whole-body gamma-irradiation to treat acute leukaemia
following three days. This is an indication of the high patients during a period of full clinical and haemato-
specificity of the screening methods used. An addi- logical remission [P23].
tional 10 cases of minor acute radiation sickness were
diagnosed among persons present at the site at the 24. The formula for calculating of the dose is as
time of the accident, who were later admitted to the follows:
hospital facility for a variety of reasons. In the D = (-a + I/' a2 + 4by)/2b
reception area the patients were monitored again for This assumes that the yield of dicentrics shows a linear-
contamination and, if necessary, subjected to decon- quadratic dependence on dose:
tamination measures (washing under a shower with
ordinary soap and change of underwear). Blood and y = (a t 2.24)D + (b t 0.56)D2
urine samples were taken for a quick test of the where D is the average gamma-irradiation dose in the
presence of radionuclides; the patients also underwent body (Gy), y is the dicentric count per 100 cells;
measurements (repeated a further 4-6 times during the a = 8.36: b = 5.70.
first 6-10 days) of the radioactive iodine content in the
thyroid. Measuring devices consisting of a scintillation 25. Up to day 7 after the accident, the estimates of
detector or a semiconductor detection unit were used the average dose of total gamma-irradiation were
for the whole-body counting of radionuclide activity. refined, mostly on the basis of the peripheral-blood
lymphocyte counts but also, in the more severe cases
and to a lesser degree. on the chromosome aberration
B. THE BONE MARROW SYNDROME count. This made it possible to divide the patients into
AND ITS TREATMENT various prognostic groups [B31]. according to the
severity of the bone marrow syndrome as follows (see
21. Dosimetric data, together with an analysis of the Table A.3):
circumstances of the accident and the presence in a
considerable number of the victims of obvious primary (I) slight (1-2 GY)
reaction symptoms (nausea, vomiting. diarrhoea, hyper- (11) intermediate (2-4 Gy)
aemia of the mucosae and skin, lymphopenia), con- (111) severe (4-6 GY)
(IV) extremely severe (6 Gy and above)
firmed that the principal modes of irradiation had been:
(a) by external, relatively uniform gamma-radiation; It was also possible to separate those persons who
and (b) by deposition of beta/gamma-emitting nuclides received doses of less than I Gy.
I Dore = a - b log(1ymphocyte count)
0 2 4 6 8 1 0
CAMHA DOSE (Gy)
0.01 1010-.
0 2 4 6
0 2 4 6
MEAN BODY DOSE (Gy) rlEAri BODY DOSE (Gy)
Figure A.II. Estimation of the total gamma dose according to the blood lymphocyte counts. Upper
panel: Dose-effect relationships for lymphocyte counts at the days post irradiation shown on the
curves; analytical expression and coefficients of these relationships. Lower panels: Curves showing
the dependence of average lymphocyte counts on days 4-7 and the minimum lymphocyte count on
days 1-8 as a function of the irradiation dose.
26. Particular attention during the first days was
directed at identifying persons with a n extremely
severe and irreversible degree of myelodepression, for
whom a n urgent decision was required regarding a
bone marrow transplant. Additional signs providing
further evidence that a patient belonged to this group
were (a) vomiting during the first half-hour and of
diarrhoea during tne first 1-2 hours from the start of
irradiation; (b) a swelling of the parotid glands during
the first 24-36 hours: and (c) the ascertainment of an
irreversible degree of myelodepression using a dia-
gnostic table previously devised (Table A.4).
TIRE (days)
Figure A.V. Estimation of the total gamma dose according to two neutrophll counts: Left panel: time to the minimum of the second
phase of depletion; Right panel: time to the "500 neutrophll day" or lo the middle of the second depletion.
used prophylactically; experience has shown that this
should be the case with high-dose whole-body irradia-
tion. An ointment containing acyclovir proved effec-
tive in the treatment of skin lesions involving herpes
virus.
O
-
, 40-
g 39-
3
k
g 33-
0.
x
P 37
36 :~IIIIII~IIIII~IIIIIIII~II
INFECTION
Blood 0 0 0 0 e o o 0 0 0 0 0
Lungs
Intestine l e 0 . e m
Kidney 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Oral c a v i t y l l eee me l l l l l @ @ a e r n e
BURNS
Hands 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 32'2'2'2'2'2'2'2'2'2'1'1'1'1'1'1'r
Shins 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 3 3 3 3332'2't'2'2'1'1'1'1'1'1'1'1'
Buttocks 1 1 1 1 1 1 1 I 1 1 1 i 1 1 1 1 2 2 2 2 2 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' 1' I'
TREATtlEfIT
Isolation
Gut s t e r i l i z a t i o n Biseptol-480: 2880 ng d-' N i s t a t i n : 6 lo6 u n i t s d-'
ANTIBIOTICS
Cepari n (9)
Gentamycin (mg) 240.0
Carbenicillin (g) 20.0
0 1 2 3 4 5 6 7 8 9101111U1415161718!9;1021Z1U2ciX262728BD31R~%3536~~39~~~~lur1F,~Wla~~
DAY AFTER EXPOSURE
Figure A.VII. Clinical record of a patient (case 21) suffering from acute radiation sickness with bone marrow syndrome of an
average degree of severity; whole-body gamma dose of 3.9 Gy, estimated according to the chromosome aberrations i n blood
lymphocytes. The circles i n the infection section indicate the results of bacteriological tests of biological samples (blood, mucus.
faeces, etc.); empty circles indicate absence of growth; solid circles indicate the presence of bacteria or fungi. The numbers i n the
burn segment designate the three degrees of radiation-induced burns.
43. The indication for an allogeneic bone marrow C. OTHER INJURIES AND
transplantation or an embryonic liver cell transplanta- T H E I R TREATMENT
tion was the whole-body gamma-irradiation dose,
estimated according to the peripheral-blood lymphocyte 50. The extensive skin lesions caused by beta-radiation
count and the chromosome aberrations at about represented a distinctive feature of the injuries suffered
6.0 G y and above. At these dose levels the prognosis in this emergency situa~ion. Radiation-induced skin
expected was for irreversible or extremely protracted burns in firemen and personnel from the plant were
severe myelodepression. observed only in combination with radiation injury to
haemopoiesis and were therefore an integral part of
44. A total of 13 allogeneic bone marrow transplan- the general acute radiation sickness.
tations and six embryonic liver cell transplantations
were performed. The latter contains haemopoietic 51. This situation may be regarded as one in which
stem cells and a minimum of immunocompetent cells, there is an extremely non-uniform distribution of dose
which sharply lowers the risk of an acute secondan as a function of the depth of penetration within the
syndrome. body; the skin doses are estimated to be 10-20 times
greater than the bone marrow doses. There was a
definite correlation in the severity of the injuries in
45. Seven patients who received allogeneic bone
both tissues.
marrow transplant died between two and 19 days
(15-25 days after irradiation) from acute radiation
52. Table A.6 and Figure A.VIII show the distribu-
injuries to the skin, intestines and lungs.
tion of cases involving radiation-induced skin burns of
various degrees in patients with acute bone marrow
46. Of six patients who did not suffer fatal skin syndrome of different severity. Skin injuries were
burns and intestinal injuries and whose total doses observed in more than one half of the patients and in
had been estimated at between 4.4 and 10.2 Gy, two virtually every patient suffering from third- or fourth-
survived allogeneic bone marrow transplants (gamma- degree bone marrow syndrome.
ray doses of 5.6 and 8.7 Gy). Both had haplo-identical
female donors (sisters), rejected the partially function- 53. The aggravating contribution ofradiation-induced
ing transplant (at days 32 and 35) and experienced a skin injuries to the overall clinical picture arose not
restoration of their own myelopoiesis, beginning at only from their severity. but also from the duration of
day 28. the injuries, characterized as they are by recurrences
of the pathological process. As a rule. the burns
47. Four patients who received allogeneic bone occurred at different times on various parts of the
marrow transplantation died between 27 and 79 days body. The most frequent locations during the early
(34-91 days after irradiation) from mixed viral-bacterial period were the wrists, the face. the neck and the feet;
infections. Two of them had effectively functioning later, lesions appeared also on the chest and back, and
HLA-identical transplants (cases 6 and 28: total still later o n the knees, hips and buttocks. Exceptions
gamma-ray doses 5.2 Gy and 6.4 Gy, respectively), to this sequence were encountered in individual cases.
a n d two had early rejection (day 16 and 42) of
"haplo + 1" and haplo-identical transplants, but during 54. The development of the injury was similar to
times when their own myelopoiesis was restored (cases 5 that described by Cronkite et al. [C16], but in a more
and 16: gamma-ray doses 4.4 and 10.2 Gy). severe form. The diffuse hyperaemia in the first few
days (primary erythema) was followed after 3-4 days
by a period of latency. Secondary erythema in the
48. Similarly, all the patients who received embryonic more severe cases developed after 5-6 days and in the
liver cell transplants died from skin and intestinal majority of patients from day 8 t o day 21. Depending
injuries within a brief period (14-18 days after on the degree of the injury, it reached a level of dry
irradiation), with the exception of one woman of (first-degree radiation burn) o r moist desquamation
63 years (case 8, embryonic-liver cell transplant from
with the development of blisters (second-degree burn),
a n 18-week male donor), who lived 30 days, having or the formation of vesicular-ulcerated and ulcerated-
received a dose of 8-10 Gy. At death (17 days after necrotic dermatitis (third- to fourth-degree burn).
transplant), numerous mitoses were discovered, against
The re-epithelialization of the desquamated surfaces
a background of severe marrow pancytopenia, and all continued for two or three weeks from the occurrence
the cells had a female karyotype, i.e., regeneration of of the visible injury to the skin. In six patients, the
the host bone marrow had begun. healing of the burns over skin areas involving deep
necrosis did not begin until the end of the second
49. This experience confirms that in an emergency month. A characteristic feature in the time course of
situation like the one described, the group of persons the burns, and one which could be monitored through-
for whom bone marrow transplants would be indicated out in this group of victims, was the appearance of
with a reasonable prospect of success is extremely recurrent waves of erythema, beginning by the end of
limited. Seven of 13 patients died as a result of skin the fourth week a n d continuing up to days 45-60.
and intestinal injuries before bone marrow engraft- These changes were characterized by hyperaemia on
ment could be expected. In Table A.5 a comparison is the previously unaffected skin areas o r by the increase
given of survival or cause of death of patients in clinical signs of injury a t the foci of the primary
reiceiving bone marrow transplantations and of patients lesions then in the process of healing. For example.
in a control group. late secondary erythema appeared in the area of the
50 I I N T E R S T I T I A L PNEUMOliITIS
I ENTERITIS
d I !I IV
1-2 Gy 2-4 Gy 4-6 Gy 6 - 1 5 Gy
DEGREES OF BOliE IlARRO'nl 5YliDRO:IE AND DOSES TC THE BONC FIARROW
::i:r:eath non-haetnopoieti~)
p
J Non severe
( f o r death haenopoietic)
ankles and feet, or on the hips and buttocks. of those than 40% first developed a febrile-toxemic syndrome.
patients who during the first three weeks displayed followed by renal-hepatic insufficiency and encephalo-
"flowering" burns on their knees. By the time of pathic coma with cerebral oedema, resulting in death
appearance of this late erythema, the lesions that had at 1 3 3 8 days after irradiation. A causal link connecting
occurred earlier in many instances had already been the fatal renal-hepatic insufficiency and the encephalo-
repaired. As a rule. late erythema was accompanied by pathic coma to the skin injuries is confirmed by the fact
oedema of the subcutaneous tissues, which was that a similar development of such fatal syndromes
particularly noticeable when located on the knees: was observed in several patients who had neither
pain was experienced in walking; palpation of the skin severe bone marrow syndromes nor intestinal syn-
a n d underlying tissues (muscles. tendons) caused dromes. However. in the majority of cases. burns were
discomfort. The most severe cases involved fever and combined with an extremely severe bone marrow
a general worsening of the patient's condition. Late syndrome and severe acute enteritis. and in some cases
secondary erythema was successfully resolved within the burns may have been the primary cause of death.
two weeks by purely topical treatment, although in the
more severe cases it was necessary to resort to
additional therapeutic means. such as the prescription 1. Intestinal syndrome
of glucocorticoids, a form of treatment that fairly
rapidly eliminated all manifestations of epidermatitis 56. The intestinal syndrome was one of the more
a n d subcutaneous oedema, both general and local. threatening manifestations of acute radiation sickness.
In 10 patients, diarrhoea was observed from day 4 to
55. As may be seen in Table A.6. the burns suffered day 8. This suggested that these persons had received
by the patients with acute radiation sickness covered total gamma doses of about 10 Gy or above; all these
from 1% to 100% of the body surface. I t may be noted. patients died during the first three weeks following
in this connection, that if there were relatively early irradiation. The occurrence of diarrhoea after eight
(from day 5-6) second-.or third-degree burns over an days in seven other persons was an indication that
area of even 30-40% of the body. followed by the spread they had received lower doses. The presence of
of hyperaemia, these burns were life-threatening. In radiation-induced enteritis lasting from day 10 to
19 of the 56 patients suffering from burns, the burns days 18-25 in spite of intensive water-electrolyte-
proved fatal (Figure A.VII1). I t was found that patients protein supportive treatment suggests that the intestinal
with early secondary erythema over a body area ofmore syndrome was not the main cause of death.
2. Oropharyngeal reactions five cases skin injuries were the sole cause of death.
because there was neither radiation enteritis or irrever-
57. Acute radiation-induced inflammation of the oral sible myelodepression. Deaths were observed between
and pharyngeal mucosa was observed in 82 patients. Its 10 and 96 days after exposure. The clinical picture in
more benign manifestations (first and second degree all fatal cases was characterized as following a difficult
of severity) were characterized by desquamation an3 course. because in every case two or three radiation
oedema of the rnucosa in the area of the cheeks and syndromes had occurred with complex toxicity, infec-
tongue and by tenderness of the gums. These were tion and circulation disorders. A summary listing of
observed in 42 persons (dose range 1.7-4.0 Gy) from patient identification and causes of death is given in
days 8-9 to days 20-25. The basic signs of a more acute Table A.7.
oropharyngeal reaction were observed in 40 patients
with third and fourth degree acute radiation sickness 61. A detailed clinico-morphological analysis made
(dose range 4.5-16.0 ~ ~ ) , ; n dthese were erosions and it possible to identify the predominance, within
ulcers of the oral mucosa, sharp pain, and a large specified time periods, of particular lethal syndromes.
production of rubber-like mucus occasionally blocking Up to day 24, a total of 19 patients (65%) died. In one
the throat and causing breathing problems. The first half of these patients the competing causes of death
signs appeared as early as days -3-4, attained their were skin and intestinal reactions (cases 3, 4, 10, 14,
maximum intensity by day 10 and then subsided after 15, 17. 20, 23, 26. 2097: in all the cases the gamma-
days 18-20, when there was also granulocytopenia. The radiation dose in the bone marrow was estimated to
Drocess involved no selective localization. as is charac- be greater than 10 Gy). Four patients showed acute
teristic of the ulcerated lesions in the area of the radiation injury in the lung (cases 2, 9, 12 and 27; the
tonsils and gums when there are infectious complica- doses were, respectively. 9.2, 9.7, 9.3 and 8.3 Gy), and,
tions. However, in a significant number of cases, the of these, two (cases 2 and 9) suffered also severe
radiation-induced inflammation of the mucous mem- injuries to the skin. Two patients died of combined
branes was complicated by secondary microbial and thermo-radiation burns (cases 24 and 25: the gamma-
viral infection, which prolonged its course. radiation doses in the bone marrow were estimated to
be 3.7 and 5.7 Gy, respectively. in combination with
58. Another typical finding was the early (days 3-4) internal irradiation doses. Within this time-frame, one
appearance of herpes-like rashes forming massive patient (case 62, dose about 6 Gy) died almost
crusts on the lips and facial skin; this was observed in exclusively from severe radiation burns at a time when
nearly 30% of the patients with severe bone marrow haemopoiesis had begun to be restored. Three cases
syndrome. Within this group of patients, primarily (cases 17, 26, 62) had involvement of mycobacterial
those suffering from fourth-degree acute radiation sepsis. One patient (case 30, dose about 5.5 Gy) died
sickness, a pronounced radiation-induced parotitis of bleeding caused by mechanical injury to the sub-
was observed. coupled with an inability to salivate and clavicular vein during catheterization. and another
a high level of amylase in the blood from days 1-4. The (case 7. dose about 4.7 Gy), suffering from severe radia-
swelling of the parotid glands disappeared without tion injury to the skin, died of post-transfusion shock.
special treatment, whereas recovery of salivary gland Characteristics of the deaths on days 11-34were marked
secretion was slower. circulatory problems during the terminal period. This
was shown by the relatively high frequency of signs
indicating cerebral oedema and focal haemorrhaging
3. Lung reactions into the brain and spinal cord.
59. Lung reactions were observed in seven patients 62. Six patients died during the period from
suffering from third- and fourth-degree acute radia- days 25-48. All six cases were characterized by
tion sickness. Its characteristic signs were a rapidly extremely severe complications of a toxic or infectious
intensifying dyspnoea together with respiratory in- nature. Two patients (cases 31 and 34) involved sub-
sufficiency progressing over a period of two to three total skin injuries (bone marrow doses about 6.7 and
days culminating in death. Autopsies revealed large, 5.8 Gy, respectively, with death occurring on days 32
blue lungs with pronounced interstitial oedema, without and 48, respectively), coupled with practically restored
destruction of the mucous membranes of the trachea haemopoiesis. The immediate cause of death in these
and bronchi. As a rule, interstitial pneumonitis devel- cases was severe respiratory insufficiency and cerebral
oped several days before death, generally in combina- oederna. In one patient (case 28, dose about 6.4 Gy;
tion with extremely severe lesions of the skin and the death on day 48) the cause of death was severe, graft-
intestine. The times to death were 14-30 days after versus-host disease and fungal and viral infections.
irradiation. One additional patient (case 5. dose about 4.4 Gy)
died on day 34 of severe pulmonary and renal
4. Causes of death insufficiency, caused, most likely, by the transplanta-
tion of HLA-non-identical bone marrow and by post-
60. The frequency of non-haemopoietic injury in- transplant immunosuppression using cyclosporin and
creased as a function of total dose (Figure A.VII1). methotrexate. Two patients (cases 1 and 8. doses
Clinical observations indicated the essential role of about 6.6 and 8.3 Gy) died on days 25 and 30.
skin injuries in pathological processes prior to death. respectively, with symptoms of severe toxicity and
Among the patients that died, in two thirds of them pulmonary insufficiency. In nearly all six cases there
there was extensive and severe radiation and thermal were marked circulatory disorders in the lungs,
skin burns, which were considered life-threatening. In intestines, brain and myocardium.
63. At a relatively late stage. days 86-96. three did not show such an effect. At later times (days 35-55).
patients died. One patient (case 6, dose about 7.5 Gy) superficial radiation-induced keratitis was observed in
died on day 56 of graft-versus-host disease complicated patients suffering from second-. third- and fourth-
by cytomegalovirus (CMV) infection. Cytomegalovirus degree radiation sickness in 5%. 5257 and 100% of the
infection was also the cause of death for another cases. respectively. Also noted were focal defects on the
patient (case 16. dose about 10.1 Gy) on day 91. A superficial epithelium of the cornea; these defects, which
female patient (case 33. dose about 4.1 Gy) died on often merged. stained with fluorescein. The radiation
day 96 displaying marked disruptions of cerebral keratitis regressed over a period of 1- 1.5 months, leaving
blood circulation against a background of renal- no opacification of the cornea.
hepatic insufficiency and foci of mycococcal infection
(pneumonia). This patient suffered also skin injuries 69. Signs of disturbances in the haemodynamics of the
from beta-radiation which extended over one third of retina were related to the dose and the degree of setverity
her skin surface and underwent a severe recurrent of radiation sickness. From a few days after irradiation,
wave of erythema with oedema of the subcutaneous a reduction was observed in the level of diastolic
tissue. pressure in the central retinal artery. followed later by
signs of hypotonic angiopathy of the retina. Coinciding
in time with the peak of the sickness. other injuries
5. Eye damage appeared. e.g.. retinal oedema along the vessels and
increased permeability of the retinal vessels (plasma
64. Eye injuries were characterized by the early and discharge and haemorrhaging). The low diastolic
subsequent involvement of all eye tissues in the pressure in the central retinal artery persisted over the
pathological process (Table A.8). In this group of entire acute phase.
patients. damage to the skin and eyelid conjunctiva
was caused, to a considerable degree. by beta- 70. In one severely ill patient (case 29. dose about
radiation. 8.7 Gy) with fourth-degree acute radiation sickness.
who survived the acute phase. the symptoms of
65. At doses not exceeding 1 Gy there were no visible angioretinopathy with haemorrhaging and plasma
alterations in the structure of the eyes. In the case of discharge recurred within 4.5 months, accompanied by
patients suffering from first-degree acute radiation a persistently low diastolic pressure in the central
sickness, changes were noted only in the front segment retinal artery (up to 5-10 mm Hg).
of the eye: there was in individual cases a slight
erythema in eyelid skin during the first two to four days 71. In the acute period, the treatment consisted in
and an intensification of the vascular pattern in the lid the topical application of ointments to the scaling
and conjunctiva of the eyeball. In 40% and 100% of surface of the eyelid skin and the instillation of 20%
the patients suffering from second- and third-degree albucid, sophradex and vitamin solutions as eyedrops
acute radiation sickness, respectively. the eyelid skin into the conjunctival cavity.
showed a first wave of of erythema within 6-12 hours
of irradiation. and within 2-3 weeks there was a 72. Within observation periods of up to one year, no
second wave. These cutaneous alterations disappeared obvious radiation-induced alterations of the lens were
without trace, leaving'hyperpigmentation and scaling. noted.
In all patients suffering from fourth-degree acute
radiation sickness, the times to the appearance of the
first and second wave of erythema were 1-2 hours and 6. Treatment of radiation burns and other injuries
8- 10 days, respectively.
73. The treatment of radiation burns and other non-
66. Microscopy of the bulbar conjunctiva revealed a bone-marrow syndromes and their complications posed
number of alterations in the microcirculation: there complex and multifaceted problems [J18]. From day 2
was a dilation of the venules and capillaries (more through day 8. 15 haemosorption sessions (purification
rarely the arterioles), and an increase in the number of using activated charcoal) were conducted for 13 patients
functioning vessels coupled with a reduced blood flow. suffering from the most severe skin lesions. Three
patients who had been exposed to a total dose range
67. Two patients suffering from combined radiation of 2.0-4.6 Gy survived: they underwent haemosorption
and thermal second-degree lesions on the lid skin and on a single occasion at days 5-8. i-e.. considerably
conjunctiva experienced ulcerations on the skin around later than the time at which this might have affected
the eye that did not re-epithelialize for a long time. the treatment of the bone marrow syndrome. This
Epilation of the eyebrows was noted at days 15-17 in method of treatment did not change the outcome of
16% of the persons with second-degree acute radiation the illness by modifying the haemocytopenia.
sickness. and in 67% and 100% of those with third-
and fourth-degree acute radiation sickness, respectively. 74. During the haemosorption process, and parti-
The epilation was partial and transient. Hair growth cularly towards the end of the session. many patients
on the head was fully restored. All patients retained experienced a short-term improvement (lasting from a
their eyelashes. few hours to a single day), a reduction or dis-
appearance of the pain in the extremities, and also a
68. Corneal damage was manifested in an early decrease of the oedema in their tissues. In this
reduction in corneal sensitivity coinciding with the connection, contributory effects from the medication
first wave of erythema. although first-degree patients accompanying the procedurecannot be totally excluded.
75. A more widely used technique to combat the The danger, which has possibly not been fully
development of renal-hepatic insufficiency and fatal evaluated, is the probability that certain severely
encephalopathic coma was plasmapheresis. Lesions injured, comatose patients may enter a state of
induced by beta-irradiation over 30-40% and more of hyperosmolarity. Data on plasma osmolarity that
the body surface served as an indication for the would appear to be necessary in a programme of total
application of this procedure. Plasmapheresis sessions parenteral nutrition were not provided for all patients.
were conducted for 17 patients from days 18-37. For a
number of patients, daily sessions were conducted, up 80. For the majority of patients suffering from first-
to six times. and second-degree bone marrow syndrome, the period
of clinical convalescence was con~pletedby the third
76. The positive effect of repeated plasmapheresis or fourth month. A longer period of treatment was
was shown by a reduction of bilirubinemia and required by persons suffering from severe radiation
transaminasemia and a lowering of the nitrate level in burns and the sequelae of third- and fourth-degree
patients suffering from renal-hepatic insufficiency bone marrow syndrome. A1 the present time, the bulk
caused by skin burns. On occasion, the plasmapheresis of the patients have resumed work with the exclusion
sessions uere accompanied by reactions of minor of any contact with radiation sources.
severity such as chills and fever; there were no fatal
complications. Another method used to treat toxicosis 81. O w r the period from the fourth month t o one
due to skin injuries was the injection of 1,000 ml of year after the accident. the specialized treatment
freshly-frozen plasma, accompanied by round-the- centre was periodically visited by patients with skin
clock administration of heparin (1,000 active units/ lesions (dystrophic a n d ulcerated areas and also
hour) with a liquid load (2-6 litres/day) and forced oedema of the subcutaneous tissues, mainly o n the
diuresis adequate to the intake volume. A pre- knees and feet). These patients are being treated with
condition for this treatment was the presumption of agents designed t o improve local blood circulation
disseminated intravascular clotting (DIC) syndrome and tissue trophism. Five patients ~vith deep and
(no typical anomalies in respect of coagulation were extensive ulcers o n their arms and other areas of the
present) as a possible cause of encephalopathy and body underwent repeated plastic surgery. and a
renal-hepatic syndrome. In its most strictly applied number of them will require more extended treatment.
form, the heparin treatment method was used with
two patients over a period of 7-15 days. The impres- 82. Immunological examination data, acquired
sion was that these patients survived longer than did 0.5-1.5 years after the accident, haire shown that in the
patients whose condition was s ~ m i l a r in terms of peripheral blood of the patient groups with a history
severity and extent of their burns. Their renal-hepatic of acute radiation sickness of the second, third a n d
insufficiency was less pronounced; however, a death fourth degrees a decline was observed in the number
due to encephalopathic coma was not averted. of T-lymphocytes with helper activity along with an
increase in the number of T-lymphocytes with sup-
77. The topical treatment of the burns required the pressor activity. This led to a considerable reduction
involvement of a group of surgeons and nurses. A in the normal ratio between these immunoregulatory
broad range of preparations and agents having an lymphocyte sub-populations. At the same time, there
anti-inflammatory, bacteriostatic and regeneration- was no reduction in the general lymphocyte level o r in
stimulating effect was used. Good results were achieved their T- and B-sub-populations. As an average for the
with lioxanol aerosol, an anti-burn ointment based on groups, the level of class A, M and G immunoglobulins
hydrocortisone with locally acting antibiotics, as well in the patients' blood serum corresponded to the
as BALIZ-2 solution and collagenous coatings. In physiological norm. Similar changes ivere not observed
each individual case the treatment varied in accordance in the case of patients with a history of acute radiation
with the stage of the lesions. Experience gained in the sickness of the first degree. During this time they
use of bactericidal fabric, both as a dressing material experienced no severe o r life-threatening infections. In
a n d for supplementary bedding, for patients with a number of cases an effort \vas made at immuno-
extensive burns deserves a particularly favourable corrective therapy using T- and B-activin.
comment in this connection [Z2].
83. Within these same patient groups. an estimate of
78. Treatment of pain. as is typical of radiation the number of respiratory illnesses over the same
injuries, was rather ineffective. At present. there are period of time was conducted retrospectively. It was
clearly no suitably effective local anaesthetics. found that the incidence of illness in the group of
19 patients with a history of first-degree acute radiation
79. In patients suffering from severe radiation-induced sickness did not differ from the incidence of illness for
inflammation of the oral mucosa, and enteritis, total the group of persons for whom no acute radiation
parenteral nutrition had a positive effect: this was sickness diagnosis had been established, and that it
based on alvesin hydrolysate or an aminoacid mixture. averaged 0.3 cases per person per year. During the
aminone and a 40% glucose solution as the energy same period, this indicator approached I for 22 patients
material. The treatment was carried out according to who had experienced second-degree acute radiation
the principles and rules described by Dudrick et al. sickness, and 3 for 8 persons with a history of third- to
[D18]. This method was tested over a number of years fourth-degree acute radiation sickness.
with good results in patients receiving whole-body
therapeutic gamma-irradiation at a dose level of 84. This comparison underlines the importance of
10 Gy for allogeneic bone marrow transplantation. the immune system in maintaining anti-infection
resistance in radiation convalescents and raises the 88. The analysis provides a basis for describing the
question as to the usefulness of conducting supportive principal clinical syndrome, the bone marrow syndrome.
immunomodulating therapy courses, long after the with various degrees of severity in all 115 patients. In
incident, for persons who have undergone severe the case of some of them the bone marrow syndrome
forms of radiation sickness. was combined with intestinal and oropharyngeal
injuries and radiation damage to the skin, the fore-
85. The experience of the specialized treatment ward segment of the eye (keratitis), and the lungs.
centres in Moscow and Kiev in the organization of
medical care of persons exposed in this nuclear reactor 89. The treatment provided was in accordance with
accident has been described [N16]. For the surki vors. international practice and proved highly effective for
a plan of scheduled follow-up observation is in effect, the patient group exposed to doses of 2-3 Gy and for
a n d decisions as how best to arrange their living and two thirds of the patients who received doses of
working condirions are being taken. 4-6 Gy. In the group of patients receiving 6-16 Gy.
two patients who received doses of 8-9 Gy survived
past 60 days.
D. CONCLUSIONS 90. The average bone marrow dose and the prognosis
regarding the further course of the illness were
determined on the basis of biological criteria. During
86. The analytical data presented in this Appendix the early period, most information was obtained from
and derived from clinical observations of the victims the karyological analyses, the lymphocyte counts and
of the accident at the Chernobyl nuclear power plant the primary reaction periods; later, from the granulocyte
are in agreement with the data in Annex G . counts. The remaining indications were of an auxiliary
nature. In three cases, the dose value coincided with
87. However. the fact that such a large group of the electron spin resonance study of dental enamel
115 patients, who had all received uniform whole- after death.
body irradiation. was treated simultaneously for acute
radiation sickness of varying degrees of severity, 91. There is a need for further analysis of the time
represents a unique event that makes i t possible to course of the early effects for a more accurate
clarify numerous aspects of earl? effects in man. A understanding of the nature of lung and neurological
complicating factor was the presence of severe and injuries, and for more detailed data on the relevance
extensive beta-radiation skin injuries in 58 patients of biological dose indicators and the reasons for
which aggravated the course of the sickness in 19 of disparities between them. I t is hoped that these data
the 28 who died. Two more patients died during the will be of use in the preparedness to respond in the
first days as a result of severe combined injuries event of an accident of a similar type in the provision
(trauma plus thermal burns plus irradiation). of medical treatment.
T a b l e A.l
Range of Number
thyrold of
doses persons
(Sv)
T a b l e A.2
Ooses of vlctlrns recelvlnq hlqher Internal exDosures
T a b l e A.3
Slgn Olagnostlc
score a/
a/ The dlagnostlc slgns are used to determine the dlagnostlc Scores, uhlch are
-
then added together. A sum of +10 I s the basls for a prognosls of
lrreverslble myelodepresslon; a sum of -10 for a prognosls of no
lrreverslble myelodepresslon. If after the dlagnostlc coefflclents of all
the avallable slgns have been added no postttve value has been reached, the
answer i s lndetermlnate (the avatlable lnformatlon Is lnsufflclent for a
dlfferentlal dlagnosls, wlth an error probablllty of not more than t 10%).
T a b l e A.5
Total 13 7 4 2 14 8 6
T a b l e A.6
Total 115 56
T a b l e A.7
Patlent Identiflcatlon, estimated dose. cause and day of death
a/
- BHT = bone marrow transplantatlon; LC1 = llver cell transplantatlon.
T a b l e A.8
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