Paper
FALLOUT FROM NUCLEAR WEAPONS TESTS: ENVIRONMENTAL, HEALTH,
POLITICAL, AND SOCIOLOGICAL CONSIDERATIONS
André Bouville1
Abstract—The process of nuclear fission, which was discovered in
1938, opened the door to the production of nuclear weapons,
Downloaded from http://journals.lww.com/health-physics by BhDMf5ePHKbH4TTImqenVEHVxlGnW95Upr9actFw1oE9PoDF7+T2eXT6rK9wKbhc on 03/03/2020
which were used in 1945 by the United States against Japan in
World War II, and to the detonation of >500 nuclear weapons
tests in the atmosphere by the United States, the former Soviet
Union, the United Kingdom, China, and France from 1946–1980.
Hundreds of radionuclides, most of them short-lived, were pro-
duced in the atmospheric tests. The radioactive clouds produced
by the explosions were usually partitioned between the troposphere
and the stratosphere: the activity that remained in the troposphere
resulted in local and regional fallout, consisting mainly of short-
lived radionuclides and in relatively high doses for the populations
residing in the vicinity of the test site, whereas the activity that
reached the stratosphere returned to the ground with a half-life of
~1 y and was composed of long-lived radionuclides that contami-
nated all uncovered materials on Earth to a small extent and led
to low-level irradiation of the world population for decades or more.
The health effects resulting from exposure to radioactive fallout
constitute, in most cases, small excesses over baseline rates for thy-
roid cancer and leukemia. An extra 49,000 cases of thyroid cancer
would be expected to occur among the US population from expo-
sure to radioactive fallout from the atmospheric nuclear weapons
tests that were conducted at the Nevada Test Site in the 1950s. In
addition, there could be as many as 11,000 deaths from non-
thyroid cancers related to fallout from all atmospheric tests that
were conducted at all sites in the world, with leukemia making up
10% of the total. Public concern arose in part from the secrecy that
surrounded the nuclear testing programs and, for a long time, the
poor communication regarding the consequences of the tests, both
in terms of radiation doses and of health effects. Sociological and
political pressures contributed to the establishment of programs
of compensation for radiation exposures and evidence of
radiation-induced diseases in countries that incurred significant
fallout from nuclear weapons testing.
Health Phys. 118(4):360–381; 2020
Key words: National Council on Radiation Protection and Mea-
surements; fallout; health effects; nuclear weapons tests
1 of the local and regional populations, although environmen-
National Cancer Institute, National Institutes of Health, Bethesda,
MD (retired).
The authors declare no conflicts of interest.
For correspondence contact: A. Bouville, 5450 Whitley Park Terrace,
Apt #502, Bethesda, MD 20814, or email at ABouville@aol.com.
0017-9078/20/0
Copyright © 2020 Health Physics Society
DOI: 10.1097/HP.0000000000001237
360
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INTRODUCTION
THE FIRST occurrence of radioactive debris falling from the
atmosphere (known as “fallout”) from a manmade event
took place in New Mexico in July of 1945 with the
culmination of the Manhattan Project and the detonation
of the Trinity device. Only 3 wk later, it was followed by
the bombing of Hiroshima and Nagasaki, which became
one of the most significant events of the 20th century. The
bombing of Japan was, in turn, followed by ~500
atmospheric nuclear weapons tests, mainly by the United
States and the former Soviet Union, creating conditions
that are now understood to have blanketed much of Earth
with radioactive fallout debris.
Fallout was extensive and widespread: it contaminated
the environment on the global scale, so that air, foods, water,
and even nonliving materials (like film or building mate-
rials) contain fallout to some extent. People in all walks of
life, whatever their age, ethnicity, and location, have been
exposed to fallout via external irradiation, inhalation, and
ingestion. The long-lived radionuclides in fallout (mainly
90
Sr, 137Cs, 241Am, and 239+240Pu) are ubiquitous and will
stay with us for a long time, so that they are now considered
to be part of the background radiation environment. On the
other hand, fallout-related studies helped certain areas of sci-
ence to grow, like instrumentation, atmospheric transport
(particles, gases), bioassay, environmental surveillance (e.g.,
milk monitoring), radioecology, internal dosimetry, etc.
Atmospheric nuclear weapons tests were conducted, as
a rule, in areas with very small populations in the vicinity of
the test sites, in order to reduce the number of persons with
relatively high exposures to radiation in case of mishap.
From the 1950s until the early 1970s, limited information
was available on the radiation exposures and health effects
tal radiation levels both near and far away from the test sites
were monitored and reported in many countries (UNSCEAR
1962, 1966, 1972). The situation changed in the 1970s and
early 1980s, when major studies were initiated or conducted
in the United States to reconstruct the doses and estimate the
related health effects to the populations affected by the tests
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 Fallout from nuclear weapons tests c A. BOUVILLE
that had been conducted at the Nevada Test Site (NTS)
(Lyon et al. 1979; Church et al. 1990; Wachholz 1990).
More recently, doses and health effects have also been esti-
mated for local and regional populations near other test sites
around the world (Simon and Bouville 2002; Simon et al.
2010a; Land et al. 2015).
Because of the devastating effects of nuclear weapons,
constant efforts have been made by most governments to
limit the number of countries with nuclear weapons, there-
fore keeping the topic of potential nuclear weapons fallout
as a concern in the public and political arena. Public concern
regarding past exposures also is still prevalent among the
populations near the previous test sites, and monetary com-
pensation programs have been established in some countries
to compensate persons suffering from radiation-induced
cancer attributable to nuclear testing.
This paper will review and discuss available information
on the doses and health effects resulting from the nuclear
weapons tests that were conducted in the atmosphere. Even
though a substantial number of workers and military personnel
were involved in the preparation of the tests, in the radiation
measurements, and in the decontamination of the nuclear test
sites, only the members of the public will be considered in this
lecture. Political and sociological considerations regarding
these exposures also will be examined including the mecha-
nisms and rationales of current compensation programs.
HISTORY OF NUCLEAR WEAPONS TESTING
The process of nuclear fission was first reported by
Hahn and Strassman (1939), but Lise Meitner is recognized
as being the person who analyzed and interpreted the results
of Hahn’s experiments (Meitner and Frisch 1939; Rhodes
Fig. 1. Location of the main test sites.
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361
1986). This discovery triggered research into the possibility
of manufacturing nuclear weapons in order to obtain a sub-
stantial military edge during World War II. The United
States was the first to achieve that goal: the first test of a nu-
clear device, code-named Trinity, took place in New Mexico
on 16 July 1945. Three weeks after the Trinity test, nuclear
bombs were dropped over Hiroshima and Nagasaki and
resulted in the end of the war.
The United States had a monopoly on nuclear weapons
until 1949, when the former Soviet Union conducted its first
atmospheric test in Semipalatinsk, which is now part of
Kazakhstan (UNSCEAR 2000). Atmospheric testing by the
two countries, as well as by the United Kingdom that joined
the nuclear club in 1953, took place on a relatively large scale
until March 1958, when the former Soviet Union announced
that they were unilaterally halting nuclear tests. A few months
later, the United States and the United Kingdom announced
that they would do the same. This voluntary moratorium
was in effect until September 1961, when the former So-
viet Union, followed soon after by the United States, de-
clared that they would resume nuclear testing.
An extensive series of atmospheric testing then took
place at the end of 1961 and throughout 1962 until negotia-
tions between the United States and the former Soviet
Union led to the signature on 5 August 1963 of the Limited
Test Ban Treaty prohibiting all test detonations of nuclear
weapons except for those conducted underground, which
cause little or no leakage of radioactivity into the atmo-
sphere and are not considered in this paper. However, at-
mospheric nuclear weapons testing continued until 1980
by France and China, which had not signed the Limited
Test Ban Treaty and had started testing in the atmosphere
in 1960 and 1964, respectively. In addition, India,
362 Health Physics April 2020, Volume 118, Number 4

Table 1. Number a and yields of atmospheric weapons tests con- example, the activities of 131I, 137Cs, and 90Sr that were re-
ducted by each country (UNSCEAR 2000; Bennett 2002; Bouville leased by all atmospheric nuclear weapons tests were greater
et al. 2002).
than those released during the Chernobyl accident by factors
Yield (MT)
Number of 400, 10, and 60, respectively. In Table 3, the 131I activities
Country of tests Years Fission Fusion Total released during atmospheric nuclear testing are compared to
United States 195 1945 – 1962 82 72 154 those from nuclear reactor accidents.
Former Soviet Union 219 1949 – 1962 85 162 247 Depending on the yield of the explosion and its loca-
United Kingdom 21 1953 – 1957 4 4 8 tion (altitude and latitude), the radioactive fallout resulting
France 45 1960 – 1974 6 4 10 from the nuclear weapons test was partitioned among the lo-
China 22 1964 – 1980 12 9 21 cal, regional, and global environments to various degrees.
Totals 502 1945 – 1980 189 251 440 Portions of the radioactive fallout were deposited within a
a
Excluding the two combat explosions and 39 safety tests. few hundred kilometers from the site of the test (local fall-
out), regionally up to several thousand kilometers downwind
(regional fallout), while the remainder (global fallout) was
Pakistan, and North Korea recently joined the nuclear dispersed throughout the world (Bennett 2002). The general
club, although they did not conduct any tests of their nu- features of air flow patterns at the global scale are shown in
clear weapons in the atmosphere. It is worth noting that a Fig. 2. In short, the activity that reached the stratosphere
Comprehensive Test Ban Treaty, banning the conduct of diffused mainly over the latitude band in which it was
any nuclear test in any environment, was adopted by the injected, with some interhemispheric transfer, and gradually
United Nations General Assembly in September 1996 descended to Earth’s surface in a matter of months or years.
but has not entered into force because eight specific coun- In contrast, the activity that did not reach the stratosphere,
tries have not ratified the treaty. and therefore remained in the troposphere, was carried by
Altogether, from 1945–1980, over 500 nuclear devices the prevailing winds, circled Earth within 2–3 wk, and did
were exploded at 13 primary testing sites (Fig. 1), yielding the not cross the equatorial barrier. The fraction of the activity
equivalent explosive power of 440 MT of TNT (Table 1). The injected into the stratosphere depends on the total yield and
radiation exposure of the public varied widely according to the
characteristics of the detonation (yield ranging from 1 kT–50
MT; height above ground level ranging from 0–2.5 km), to Table 2. Activities of selected radionuclides released in the atmo-
the meteorological conditions at the time of the detonation, sphere from all nuclear weapons tests and activities deposited on
to the climatic conditions (arctic, temperate, or tropical), and Earth’s surface (based on Bouville et al. 2002).
to the dietary and lifestyle habits of the populations exposed, Activity Activity
among other factors. Extensive information on the charac- Main mode released deposited Deposition/
Radionuclide of production Half-life (PBq) (PBq) release
teristics of each detonation can be found in the 2000 United
131
Nations Scientific Committee on the Effects of Atomic Ra- I Fission 8d 675,000 5,300 0.008
140
diation (UNSCEAR) Report to the General Assembly Ba Fission 13 d 759,000 9,900 0.013
141
Ce Fission 33 d 263,000 7,900 0.030
(UNSCEAR 2000). 103
Ru Fission 39 d 247,000 9,900 0.040
89
Sr Fission 51 d 117,000 5,600 0.048
BASIC INFORMATION ON FALLOUT 91
Y Fission 59 d 120,000 7,900 0.066
95
Zr Fission 64 d 148,000 9,900 0.067
Following an atmospheric nuclear weapons test, about 144
Ce Fission 280 d 30,700 11,500 0.37
150 fission products contribute to radioactive fallout (Hicks 54
Mn Activation 310 d 3,980 1,300 0.33
1981). Other radionuclides are produced by activation of the 106
Ru Fission 370 d 12,200 5,900 0.48
bomb constituents and surrounding materials, the testing 55
Fe Activation 2.7 y 1,500 910 0.59
platform, and constituents in the soil and air. In addition, 125
Sb Fission 2.8 y 740 540 0.73
plutonium isotopes and tritium were used as a fuel and/or 3
H Fuel 12 y 186,000 —a —
were produced by activation of 238U and by fusion reactions 241
Pu Fuel 14 y 140 140b 1b
in thermonuclear devices (Beck and Bennett 2002). The 90
Sr Fission 29 y 622 612 0.98
137
main modes of production of selected radionuclides, as well Cs Fission 30 y 948 919 0.97
as their activities released into the atmosphere from all nu- 14
C Activation 5,700 y 213 —a —
240
clear weapons tests, are presented in Table 2. As a rule, Pu Fuel 6,600 y 4.35 4.35b 1b
239
the activities released from nuclear weapons tests were Pu Fuel 24,000 y 6.52 6.52b 1b
much higher than those resulting from reactor accidents a
Not applicable because the deposited activity is recycled into the environment.
such as the one that occurred at Chernobyl in 1986. For b
The deposited activity is assumed to be equal to the activity released.

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 Fallout from nuclear weapons tests c A. BOUVILLE 363

Table 3. Ranking of nuclear events in terms of 131I releases from the Chernobyl accident: atmospheric nuclear testing com-
pared to nuclear reactor accidents.
131
I release (relative to Chernobyl) Geographic location Year(s)

150 Marshall Islands, Pacific Ocean 1946 – 1958

20 Semipalatinsk Nuclear Test Site, Kazakhstan 1949 – 1962
3 Nevada Test Site, United States 1951 – 1962
1 Chernobyl Reactor accident, Ukraine 1986
0.1 Fukushima Daiichi Reactor accident, Japan 2011
0.03 Hiroshima and Nagasaki, Japan (atomic bombs) 1945
0.0004 Windscale Reactor accident, United Kingdom 1957

on the height of the troposphere, which is lower at the poles
than at the equator. For a 1-MT total yield at a polar site, al-
most all of the activity produced in an atmospheric test is
injected into the stratosphere, whereas that fraction is <40%
for a test conducted at an equatorial site (Beck and Bennett
2002). Because of the relatively long residence time of the
radioactive debris in the stratosphere, the activity of global
fallout deposited on Earth’s surface is depleted in short-
lived radionuclides. This is illustrated in Table 2, where it
is shown that <1% of the 131I activity produced in all nuclear
weapons tests was deposited on Earth’s surface while that
fraction is close to 100% for 137Cs (Bouville et al. 2002).
Wet processes (rain, snow, etc.) are much more efficient than
dry processes (sedimentation, impaction, or diffusion) to
clean the atmosphere so that the deposition density of global
fallout over a month or longer is approximately proportional
to the amount of precipitation during that time period.
Global fallout, which was mainly produced by the
high-yield tests detonated by the United States and the for-
mer Soviet Union in the 1950s and early 1960s, was exten-
sively monitored all over the world. The major monitoring
programs of measurement of global fallout are described
in Beck and Bennett (2002) and summarized in Table 4. Be-
cause, for global fallout, the amounts of radionuclides depos-
ited per unit area of ground and per unit of precipitation are
relatively constant in a given latitude band, it is justified as
a first approximation to use measurements performed any-
where in that latitude band but far away from the nuclear test
sites to derive doses as a function of latitude. Doses from
global fallout, based on the measurements of radionuclides
in precipitation, were reviewed every few years between
1958 and 2000 by UNSCEAR (2000). The annual effective
dose, averaged over the population of the entire world, is
crudely estimated to have peaked at ~0.1 mSv in 1963 and
to have decreased to ~0.02 mSv in 1980 (UNSCEAR 1982).
Because there has been no atmospheric test since 1980, doses
from fallout are currently lower than those in 1980.
The magnitude of the local and regional fallout, which
was due to the radioactive debris that did not reach the
stratosphere, depended on a number of factors: the height
of the detonation, the total yield and fission yield, the winds
in the troposphere at various heights above the ground, the
location of the test site, the presence or absence of precipi-
tation, and the fractionation of volatile compounds from

Fig. 2. Features of air flow patterns in the atmosphere (Bennett 2002).

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364 Health Physics
Table 4. Major global fallout monitoring programs (based on Beck and Bennett 2002).
Program Dates
HASL gummed-film 1951 – 1958
HASL precipitation 1954 – 1991
United Kingdom precipitation 1956 – 1994
AEC/USDAa soil 1953 – 1967
NRLb/HASL surface air 1957 – 1999
AEC high altitude air 1956 – 1983
WMOc precipitation 1961 – 1964
a
US Department of Agriculture.
b
US Naval Research Laboratory.
c
World Meteorological Organization.
refractory compounds. Fractionation occurs mainly after ex-
plosions relatively close to ground level, which cause large
soil particles to be sucked up into the stem of the fireball.
As the fireball cools, the refractory radionuclides that were
produced by the explosion solidify more rapidly than the
volatile radionuclides and are incorporated into the large
soil particles that fall rapidly onto the ground. The volatile
radionuclides condense more slowly and subsequently de-
posit onto the surface of smaller particles. Because the
surface-to-volume ratio is larger for smaller particles, the
volatile radionuclides tend to be concentrated on smaller
particles that settle less rapidly and therefore take longer
to deposit (i.e., further away from the detonation site than
the refractory radionuclides) (Beck and Bennett 2002). En-
vironmental monitoring of local fallout mainly consisted of
measurements of exposure rates, which were conducted af-
ter each test. Doses were assessed from the measured expo-
sure rates, information on the radionuclide composition of
fallout, and models. Doses from local and regional fallout
were reviewed by Bouville et al. (2000) and by Simon and
Bouville (2002). As a rule, atmospheric nuclear weapons
tests were carried out in areas with very small populations
in the vicinity of the test sites in order to reduce the number
of persons with relatively high exposures to radiation in
case of mishap (Simon et al. 2006b; Simon and Bouville
2015). Detailed information on the most important studies,
including those conducted since the early 2000s, is provided
in the next sections.
DOSES TO THE US POPULATION
FROM FALLOUT
In the United States, doses resulting from nuclear
weapons tests are mainly due to local and regional fallout
from the atmospheric tests that were conducted at NTS from
January 1951–July 1962. It is interesting to note that, even
though radioactive dust from Trinity in 1945 had spoiled
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April 2020, Volume 118, Number 4
Measurement Number of sites Sampling frequency
Beta activity ≈60 – 200 Daily
89
Sr, 90Sr ≈60 – 150 Monthly 1954 – 1976,
quarterly composites
1976 – 1991
90
Sr 29 3 mo
90
Sr ≈50 – 100 ≈Biannual
Total beta activity, 21 – 33 Daily, weekly,
selected radionuclides monthly composites
Total beta activity, 6 – 27 km at ≈Weekly
selected radionuclides several latitudes
3
H 100 Monthly
film produced by the Eastman Kodak Company hundreds
of miles from the site of the explosion (Webb 1949), virtu-
ally no monitoring of regional fallout was conducted by
the US Atomic Energy Commission for the tests of early
1951 (Eisenbud 1994). It is, at least partly, because the East-
man Kodak Company reported again in 1951 that radioac-
tive dust was accumulating on the air intake filters at their
Rochester film manufacturing plant and requested that the
Atomic Energy Commission warn them in advance of radio-
active clouds from weapons tests moving in the direction of
one of their manufacturing facilities, that the Health and Safety
Laboratory (HASL) was assigned the responsibility to extend
the monitoring area from 300–800 km around the site and to
establish a network of fixed stations throughout the world
(Eisenbud 1994). From that point on, radioactive fallout from
the tests conducted at the NTS was extensively monitored.
Public concern arose in 1953 when several detonations
led to considerable fallout to the north and east of NTS (nu-
merous sheep died following winter feeding in that area of
Nevada) and continued to build during the late 1950s and
early 1960s (Church et al. 1990). Congressional hearings
were held in 1957, 1959, and 1963 to evaluate the impact
on the public from fallout from nuclear explosions. Al-
though estimated doses to local populations were low
(Dunning 1959), they did not include the internal doses
due to inhalation of contaminated air and ingestion of con-
taminated foodstuffs. Public action groups were formed to
seek federal relief for “fallout victims,” and congressional
representatives from the states of Utah and Nevada began
proposing legislative relief for persons suffering from
cancers allegedly caused by radiation. A particular epidemio-
logic study (Lyon et al. 1979) implied a causal relationship be-
tween radioactive fallout and childhood leukemia. These events
and concerns prompted the need for a thorough reevaluation of
radiation exposures to the public resulting from fallout produced
by nuclear detonations at the NTS (Church et al. 1990). In the
1980s, four major dose-reconstruction studies related to
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 Fallout from nuclear weapons tests c A. BOUVILLE
atmospheric testing at the NTS were undertaken, followed by
a fifth one in the 1990s. They will be described in turn.
Off-Site Radiation Exposure Review Program study
The first major comprehensive dose-reconstruction
study for NTS fallout was the Off-Site Radiation Exposure
Review Program (ORERP), which was established by the
US Department of Energy in 1979 to: “(1) collect and orga-
nize at one central location all relevant documents and data
pertaining to fallout in the off-site area and make these doc-
uments available to the public, and (2) produce a dosimetric
reevaluation of the offsite area characterized by region,
community/locale, and age/occupation” (Church et al. 1990).
A unique methodology was developed by ORERP to
reconstruct doses from all exposure pathways (mainly external
irradiation from activities deposited on the ground, inhalation
during the passage of the radioactive cloud, and ingestion of
contaminated water and foodstuffs) for either specific individ-
uals involved in a class action lawsuit against the US govern-
ment or for unspecified representative persons in a number of
western states (Beck et al. 2006). Parts of the developed
methodology, as well as the associated databases, were used
in all subsequent fallout-related dose reconstruction studies.
A key development was the determination of the mix-
ture of radionuclides in fallout from each test conducted at
the NTS (Hicks 1981, 1982). Using data on fission yields
and on the concentrations of various radionuclides mea-
sured in the debris cloud immediately after the test, the ac-
tivity of each radionuclide deposited on the ground was
determined as a function of time after the test. The calcula-
tions, which took fractionation into account and were nor-
malized to unit exposure rate at H + 12 h using conversion
factors developed by Beck (1980), allowed one to relate
measurements of exposure rates at various times to deposi-
tion densities of specific radionuclides in fallout from that
test (Church et al. 1990; Beck et al. 2006). Using this meth-
odology, the exposure rate can also be determined if the de-
position density of one or more radionuclides is measured.
In areas far from the NTS where exposure rates after each
test were not measured, the 137Cs deposition density could
not be directly measured, but it could be inferred from con-
temporary measurements of the total (NTS + global) 137Cs
and total 239,240Pu in soils, using a technique developed by
Beck and Krey (1983). The estimation of the NTS 137Cs
deposition density, supplemented by meteorological data
calculations of fallout patterns and other relevant data,
led to the determination of the exposure rates and of the
radionuclide mix in those areas for each of the most im-
portant tests (Beck et al. 2006). The doses from external
irradiation could then be readily derived from the variation
with time of the exposure rates. The effective doses from ex-
ternal irradiation were estimated to exceed 3 mSv in 20% of
the 180,000 people residing in the ORERP Phase I Study
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365
area, including Clark, Lincoln, and Nye counties in Nevada,
and Washington county in Utah. The highest external doses were
in the range from 60–90 mSv. Most of the dose resulted from
short-lived gamma emitters (half-lives shorter than 100 d) and
from relatively few tests, the most important being HARRY
on 19 May 1953, BEE on 22 March 1955, and SMOKYon
31 August 1957 (UNSCEAR 2000; Beck et al. 2006).
With respect to the estimation of the internal doses
from ingestion, ORERP developed a dynamic model relating
the deposition density on the ground to concentrations of
specific radionuclides in vegetation and subsequent transfer
to foodstuffs (Whicker and Kirchner 1987). This model
was the first of its type to include the capability to conduct
comprehensive stochastic uncertainty analyses (Breshears
et al. 1989). Absorbed doses from internal irradiation were
estimated to be less than those from external irradiation, with
the exception of the thyroid, in which 131I from ingestion of
milk contributed relatively higher doses.
Utah Leukemia Case-Control Study
The University of Utah, under contract to the NCI, con-
ducted a study designed to evaluate the association, if any,
between exposure to NTS fallout and the incidence of leu-
kemia in Utah (Wachholz 1990; Bouville 1996). One of
its purposes was to test earlier observations (Lyon et al.
1979; Machado et al. 1987) that seemed to indicate an ex-
cess of childhood leukemia in southern Utah, but that did
not account for residential moves and did not include esti-
mates of doses to individuals. These deficiencies were dealt
with in the Utah Leukemia Case-Control Study, which in-
cluded 1,177 cases who had died of leukemia and 5,330
controls who had died of other causes (Lloyd et al. 1990;
Stevens et al. 1990; Simon et al. 1995; Gilbert et al. 2002).
The tissue of interest for leukemia is the red bone mar-
row. The most important dose contribution to the red mar-
row was found to be, by far, external irradiation from
radionuclides deposited on the ground (Beck and Krey
1983). Therefore, red marrow doses from external irradia-
tion were calculated for each of the 6,507 subjects included
in the study. The information necessary to perform these
calculations included:
• the residence history of all subjects considered, which
was for the most part extracted from the records of the
Church of Jesus Christ of Latter-Day Saints but necessi-
tated additional information that was found using local
and regional telephone directories;
• the temporal variation of the exposure rate at each location
where the subjects resided during the exposure period,
which was mainly based on two ORERP databases but
also required the preparation of another database;
• the relationship between exposure rate and red bone-
marrow dose as a function of age, which was based on
information from the scientific literature; and
366 Health Physics April 2020, Volume 118, Number 4

Table 5. Utah Case-Control Leukemia Study: summary of red leafy vegetables, could also contribute significantly to the
marrow doses (mGy) for the 6,507 study subjects (based on Simon thyroid dose (Bouville 1996). In addition, minor contribu-
et al. 1995).
tions were due to: (1) the consumption of foodstuffs con-
Cases Controls Overall taminated with 133I, (2) external irradiation from fallout
Number of subjects 1,177 5,330 6,507 activity deposited on the ground, and (3) inhalation of air
Mean dose (mGy) 2.9 2.7 2.8 contaminated with both 131I and 133I. Because of the smaller
Median dose (mGy) 3.2 3.1 3.2 mass of their thyroid gland, children receive higher doses
Mode (mGy) 3.4 3.4 3.4 than adults for a given intake of 131I.
Minimum (mGy) 0 0 0 The information needed to calculate the thyroid doses
Maximum (mGy) 26 29 29 received from ingestion by all study subjects included:

• the deposition densities of 131I and 133I, which were es-

• shielding factors, also obtained from the literature, ac-
counting for the fact that people spend most of their time
indoors where exposure rates are lower than outdoors.
A summary of the red bone-marrow doses (mGy) for
the 6,507 subjects is presented in Table 5.
Utah Thyroid Cohort Study
The Utah Thyroid Cohort Study, also funded by NCI
and carried out by the University of Utah, was an extension
and amplification of a study conducted by the US Public
Health Service in 1965–1970 (Wachholz 1990). In that
study, the exposed group consisted of children living in
Washington County, Utah, and Lincoln County, Nevada,
which were examined for the presence of thyroid abnormal-
ities, while children of Graham County, Arizona, were used
as a control group (Rallison et al. 1974). The major weak-
nesses of the Public Health Service study were the lack of
information on the individual thyroid doses received by
the study subjects and the short following time interval
since exposure. The objectives of the Utah Thyroid Cohort
Study were to locate and reexamine the original cohort and
estimate thyroid dose and uncertainty for each of the sub-
jects. Altogether, 4,180 subjects were relocated, 3,122 were
reexamined, and thyroid doses were assigned for 3,545 (Till
et al. 1995).
Thyroid doses resulted mainly from the consumption
of foodstuffs contaminated with 131I. Intake of fresh cow’s
or goat’s milk usually accounted for most of the thyroid
dose because milk was consumed regularly and in relatively
large amounts. Other foodstuffs with short shelf life, such as
Table 6. Utah thyroid cohort study: summary of thyroid doses (milligray) for the 3,545 study subjects, based on subject residence in
1965 (based on Till et al. 1995).
Washington county, Utah
sentially derived from ORERP databases;
• the transfer coefficients that relate the deposition densi-
ties to the radionuclide concentration in fresh cow’s milk
and other important foodstuffs, which involved the de-
velopment of an appropriate methodology and a detailed
determination of pasture practices and milk distribution
in Utah (Simon et al. 1990; Ward and Whicker 1990);
• the dietary and lifestyle habits of all study subjects,
which were obtained with the use of a questionnaire; and
• the thyroid doses per unit intake, which were taken from
the literature (ICRP 1989).
The estimated thyroid doses ranged from 0–4,600 mGy,
while most of their uncertainties, expressed in terms of geo-
metric standard deviations, ranged from 2.0–4.0 (Till et al.
1995). A summary of the thyroid doses (milligray) for the
6,507 subjects of the Utah Thyroid Cohort Study, as reported
in Till et al. (1995), is presented in Table 6.
Health risks estimates using these thyroid doses were
reported by Kerber et al. (1993). However, a few years later,
mistakes were discovered in the estimated thyroid doses due
to computer problems and human errors. From 2001
through 2004, the dosimetry system was restored and
corrected, and all doses were recalculated. Although the
overall mean thyroid dose did not change, individual doses
to many study subjects changed by more than an order of
magnitude (Simon et al. 2006a).
NCI Fallout Study
The NCI Fallout Study was carried out in response to
Public Law 97-414, Section 7(a), which set forth, among
other things, the requirement to “conduct scientific research
Graham county, Arizona Lincoln county, Nevada Overall

Number of subjects 1,896 1,369 280 3,545

Mean dose (mGy) 170 13 50 98
Median dose 72 3.6 28 25
Minimum 0 0 0 0
Maximum 4,600 450 840 4,600
Mean geometric standard deviation 2.7 3.0 2.7 2.8

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 Fallout from nuclear weapons tests c A. BOUVILLE
and prepare analyses necessary to develop valid and credi-
ble assessments of the exposure to iodine-131 that the
American people received from the Nevada atmospheric
nuclear bomb tests.” Following the recommendations of
the advisory committee that was established to assist the
NCI in addressing its task, thyroid doses from intakes of
131
I were estimated for representative individuals in each
of the nearly 3,100 counties of the contiguous United
States for each test that resulted in substantial fallout (NCI
1997). The main focus of the study was on the estimation
of the thyroid doses resulting from the pasture-cow-milk ex-
posure pathway, but the thyroid doses due to inhalation of
131
I-contaminated air and ingestion of foodstuffs other than
fresh cows’ milk also were crudely estimated. In the assess-
ment of the thyroid doses from the pasture-cow-milk food
chain, estimates were made of:
• the activities of 131I deposited on soil and vegetation;
• the amounts of 131I consumed by dairy cows and the
resulting concentrations of 131I in cows’ milk;
• the amounts of 131I ingested by people; and
• the absorbed doses from 131I in the thyroids of represen-
tative individuals in each county after each test (Bouville
et al. 1990; Bouville 1996).
Conceptually, the methodology used in this study is
very similar to that used in the ORERP Study (as far as
the estimation of thyroid doses from intakes of 131I is con-
cerned) and to the dose-reconstruction effort related to the
Utah Thyroid Cohort Study. The main differences among
the studies are that: (1) in the NCI Fallout Study, the popu-
lations across the contiguous United States are taken into
account, whereas the other two studies only consider the
people residing in a few states in the vicinity of NTS, and
(2) most of the thyroid doses in the ORERP Study and all
doses in the NCI Fallout Study are assessed for representa-
tive unspecified individuals, whereas thyroid doses to iden-
tified study subjects are estimated in the Utah Thyroid
Cohort Study.
Special efforts were made to reconstruct the deposition
of 131I across the United States for each significant test at
Table 7. Example calculations showing the variation of the thyroid dose (milligray) according to the date of birth and place of
residence (NCI 1997).
Father, born Mother, born
Place of residence 9/15/1927 10/10/1929
Los Angeles, California 0.3 0.3
Salt Lake City, Utah 13 14
Denver, Colorado 11 11
Chicago, Illinois 7 7
Tampa, Florida 3 3
New York, New York 5 6
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367
NTS. Between the latter part of 1951 and 1958, fallout
was collected daily by the HASL, renamed the Environmental
Measurements Laboratory in 1977, at sites throughout the
country (Beck 1984). The passive collectors, consisting of
30 cm  30 cm squares of material resembling adhesive
tape (called “gummed-film”) were exposed to fallout for
24 h periods at the time during which atmospheric weapons
tests were carried out; the number of monitoring sites
throughout the contiguous United States varied from year-
to-year and ranged from 40–95 (Beck 1984). The collected
fallout, which had been analyzed in the 1950s in terms of
total beta activity, was reevaluated by Beck (1984) in or-
der to derive estimates of daily depositions of 131I at the
monitoring sites (Beck et al. 1990). Deposition of 131I be-
tween monitoring sites was estimated by interpolation
using precipitation data and appropriate techniques, espe-
cially kriging (Gogolak et al. 1988). For those tests during
which the gummed-film network was not in place (i.e.,
during the Ranger series at the beginning of 1951 and
for tests carried out after 1958), an atmospheric disper-
sion and deposition model was developed by the National
Oceanic and Atmospheric Administration to provide esti-
mates of 131I during those tests in the areas of the United
States where rainfall coincided with the passage of the
fallout cloud (Hoecker and Machta 1990). In addition,
for locations close to NTS, the ORERP estimates were
used (NCI 1997).
Detailed information also was needed on the pasture
practices, milk distribution, and consumption in the conti-
nental United States in the 1950s. For that purpose, special
surveys of agricultural and milk marketing agents, supple-
mented with extensive literature searches, were performed
(Dreicer et al. 1990).
Thyroid doses were estimated for each test and for the
population of each county according to age, gender, and
source and quantity of milk consumed. For example, the
changes in thyroid dose according to age for the residents
of several cities are shown in Table 7, and the variation,
from county-to-county, of the average thyroid dose from
all tests conducted at the NTS is presented as a map in
Fig. 3. The overall average thyroid dose to the ~160 million
Thyroid dose estimate (mGy)
Child, born Child, born Child, born Child, born
10/1/1951 9/15/1952 11/28/1956 9/5/1958
3 0.6 0.2 0.02
100 89 55 1
100 89 55 2
66 58 29 0.4
17 8 22 0.03
50 38 22 0.1
368 Health Physics
Fig. 3. Per capita thyroid doses (milligray) resulting from 131I intakes from all NTS tests (based on NCI 1997).
people in the continental United States in the 1950s was es-
timated to be 20 mGy.
US Department of Health and Human Services
Countrywide Study
Soon after the publication of the report of the NCI Fall-
out Study (NCI 1997), the US Congress “provided funding
for the US Department of Health and Human Services
(DHHS) to study the health impact on American peoples
of radioactive fallout” (US Senate 1998). More specifically,
the Department should “conduct an initial assessment of the
feasibility and public health implications of such a study”
(US DHHS 2005). In response to that mandate, DHHS
made crude estimates of doses and health risks from expo-
sure to radioactive fallout from nuclear weapons tests con-
ducted from 1951–1962 at NTS, as well as at other sites
throughout the world (“global” tests) (US DHHS 2005).
The preparation of the report was a joint effort of the Cen-
ters for Disease Control and Prevention (CDC) and NCI.
The scope of the project was much broader than that of
any other study previously conducted: (1) with respect to
NTS, the geographic domain to be considered was the entire
country, county-by-county, like in the NCI Fallout Study,
but the doses were to be calculated for all organs and tissues
of the body, from all pathways of exposure and from all im-
portant fallout radionuclides, as had been done by ORERP
just for states in the vicinity of NTS; and (2) with respect
to global fallout, it was essentially a new project, because
UNSCEAR only estimated average doses to populations
in 10-degree-wide latitude bands around the world.
In the time allowed to deliver the feasibility report, it
was not possible to develop new tools or to gather all data
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April 2020, Volume 118, Number 4
needed to complete an extensive assessment of the doses
from fallout that were received throughout the United
States. Instead, crude dose estimates were made based on a
detailed review of relevant reports and using available dose
assessment models. Consequently, the doses calculated are
fraught with large uncertainties, particularly for the estimates
concerning the exposures resulting from the intake of
shorter-lived radionuclides (e.g., 131I) in global fallout.
The estimated doses to the thyroid gland and to the red
bone marrow, averaged over all adults in the conterminous
United States, are presented in Table 8, in which external
and internal exposures are considered separately. The com-
parison of the doses from NTS and global fallout indicates
that: (1) the doses from external irradiation are similar for
NTS and for global fallout, (2) the total doses from internal
irradiation from global fallout are much smaller for the thy-
roid but larger for the red bone marrow than those from
NTS fallout, and (3) the contributions of specific radionu-
clides to the internal doses were notably different for NTS
and global fallout. As shown in Fig. 4 for 137Cs, the geo-
graphic distributions of fallout from NTS and from global
fallout differ substantially. For the nuclear weapons tests con-
ducted at the NTS, fallout occurred predominantly in the
western states surrounding the NTS, and the highest
doses to Americans were due to short-lived radionuclides,
especially 131I. In contrast, global fallout exposures were
higher in areas with high precipitation rates, such as the
eastern states where long-lived radionuclides, such as
137
Cs and 90Sr, were in much greater abundance than in
NTS fallout.
As indicated in the Abstract of the report (US DHHS
2005): “The estimated doses and risks, while rudimentary
 Fallout from nuclear weapons tests c A. BOUVILLE 369

Table 8. Summary of average thyroid and red bone marrow doses (milligray) from NTS and global fallout received as a result
of exposure to the most important radionuclides (based on US DHHS 2005). The values are for adults at the time of the tests.
Blank spaces reflect negligible values of dose.
NTS fallout Global fallout
Internal Internal Internal
Radionuclide Half-life External dosea thyroid dose RBMb dose External dosea Internal thyroid dose RBMb dose
3
H 12.3 y 0.07 0.07
14
C 5,730 y 0.1 0.1
54
Mn 313 d 0.04
89
Sr 52 d 0.001 0.03
90
Sr 28.5 y 0.02 0.0009 0.2c
95
Zr-Nb 64 d 0.08 0.2
97
Zr-Nb 17 h 0.02
103
Ru 39 d 0.03 0.02
106
Ru 368 d 0.001 0.002 0.04
125
Sb 2.7 y 0.03
131
I 8d 0.02 5d 0.001 0.4d
132
Te-I 3.3 d 0.1 0.06 0.001
133
I 0.9 d 0.02 0.04
136
Cs 13 d 0.002 0.002
137
Cs 30 y 0.01 0.009 0.009 0.3 0.1 0.1
140
Ba-La 13 d 0.2 0.006 0.05
144
Ce 284 d 0.02
239
Np 2.4 d 0.02
Rounded totals 0.5 5d 0.1 0.7 0.7d 0.6c
a
The external dose is approximately equal for all organs of the body.
b
RBM stands for red bone marrow.
c
For children born on 1 January 1951, the internal thyroid doses would be 30 and 5 mGy for NTS and global fallout, respectively.
d
For children born on 1 January 1951, the internal RBM doses from global fallout would be 0.5 mGy for 90Sr intakes and 0.9 mGy for
the total dose.

in nature, demonstrate that it is feasible to conduct a more
detailed study of the health impact on American people as
a result of exposure to radioactive fallout from the testing
of nuclear weapons in the United States and abroad. How-
ever, significant resources would be required to implement
such a study, and careful consideration should be given to
public health priorities before embarking on that path. To
assist in the process of making a decision about conducting
future fallout-related research, five different options were
developed for consideration and were subsequently reviewed
by the National Academy of Sciences. Those options were:
Option 1: Conduct no additional fallout-related work.
Option 2: Retrieve and archive only the historic documenta-
tion related to radioactive fallout from nuclear weapons test-
ing conducted by the United States and other nations.
Option 3: Conduct a more detailed dose reconstruction of
radioactive fallout from global nuclear weapons testing

Fig. 4. Cs deposition density (Bq m−2) due to all NTS tests (map on the right) and to global fallout (map on the left) (US DHHS 2005).
137

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370 Health Physics
for 131I, the most significant radionuclide identified in
this study.
Option 4: Conduct a more detailed dose reconstruction for
multiple radionuclides in radioactive fallout from both
Nevada Test Site and global nuclear weapons testing.
Option 5: Conduct a detailed study of the health effects of
nuclear weapons testing fallout including, in a single pro-
ject, dose estimation, risk analysis, and communication of
the results to interested parties.
The National Academies’ Committee on Assessment
of CDC Radiation Studies, in its review of the first complete
draft of the feasibility study, recommended that Options 2
and 3 should be further considered by CDC and NCI
(NA/NRC 2003). Consequently, NCI (1) retrieved the avail-
able “historic documentation related to radioactive fallout
from nuclear weapons testing conducted by the United
States and other nations” (US DHHS 2005); and (2) spon-
sored research to calculate more accurate individual doses
from both global and NTS fallout, in particular doses from
131
I, and developed a website allowing any individual to ob-
tain credible estimates of his or her thyroid dose resulting
from both NTS and global fallout from atmospheric
weapons tests, given information on date of birth, residen-
tial history, and dietary and lifestyle habits (NCI 2017).
Trinity Study
The Trinity Nuclear Test was the culmination of the
Manhattan Project that began in 1942 to develop the atomic
bomb. The nuclear device that became known as Trinity
was designed and fabricated at the Los Alamos Scientific
Laboratory in northern New Mexico and tested in south-
central New Mexico at the Alamogordo Bombing and
Gunnery Range at 05:30 am on 16 July 1945. Trinity was
the first test of a nuclear fission device ever and resulted
in the first nuclear explosion. However, information on the
radiation doses received by the population of New Mexico
as a result of that test did not become available until 2008,
in response to a request from Senator Bingaman, New
Mexico, when NCI prepared crude estimates of thyroid
and bone-marrow doses for representative individuals of
the 19 counties of New Mexico that were the most
exposed to the radioactive fallout from Trinity but did not
complete other organ dose estimates, consider all important
radionuclides, diet and lifestyle differences of ethnic groups.2,3
Key findings from the 2008 report were:
2 OTHER DOSE STUDIES
Trinity Nuclear Weapon Test: estimates of radiation doses to the residents
of New Mexico, executive summary. Prepared by the National Cancer
Institute for Senate Committee on Energy and Natural Resources.
Bethesda, MD: National Cancer Institute; unpublished 2008.
3
Trinity Nuclear Weapon Test: estimates of radiation doses to the residents
of New Mexico, a technical report. Bethesda, MD: National Cancer
Institute; unpublished 2008.
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• The estimated doses from external irradiation (to thyroid
and bone marrow) for people living in wooden houses
ranged from <0.1 mGy in Rio Arriba, Union, Sandoval,
and Los Alamos counties to >10 mGy in Torrance,
Guadalupe, and Socorro counties. External radiation
doses for people living in adobe houses were estimated
to be about half of those for wooden houses due to the
additional shielding properties of the thick mud walls.
Based on the variation in exposure rates in some counties
and house types, there could be up to 10-fold variations
in the doses from external irradiation;
• For all the 19 affected counties together, the population-
weighted mean estimated dose from external irradiation
(for thyroid and bone marrow) was ~1.3 mGy for resi-
dents of wooden houses and ~0.7 mGy for residents of
adobe houses;
• The estimated thyroid doses from internal irradiation were,
in general, greater for people who were young at the time of
the detonation and were the largest for those who were 1 y
of age. Compared with people who were adults at the time
of the test, the thyroid doses were estimated to be ~30 times
greater for those exposed at 1 y of age;
• For those who were exposed at 1 y of age, the estimated
mean thyroid doses from internal sources were estimated
to have ranged from <1 mGy in Rio Arriba, Harding, and
Quay Counties to >600 mGy in Torrance and Guadalupe
Counties. As with the external dose estimates, the thy-
roid dose estimates from internal irradiation can vary
up to 10-fold within individual counties due to differ-
ences in fallout deposition and individual habits; and
• The estimates provided contain no allowances for differ-
ences in diet and lifestyle of Native Americans and
Hispanic/Latino population groups, though both diet
and lifestyle (particularly home construction materials
and time spent in- and outdoors) may result in significant
differences in actual doses received.
In 2013, a comprehensive dose assessment of the radi-
ation doses to New Mexico residents resulting from the
detonation of the Trinity Test was undertaken by NCI. The
dose assessment has been completed to a large degree:
several articles presenting the results of the study are
under review prior to submission for publication in a peer-
reviewed scientific journal. A risk projection study, based
on the newly estimated doses, also has been prepared and
awaits publication.
Major dose reconstruction studies related to local and
regional fallout from tests conducted outside the United
States were carried out in recent years with involvement of
NCI scientists. The nuclear test sites that were considered
 Fallout from nuclear weapons tests c A. BOUVILLE 371

in those studies are: (1) Bikini and Enewetak Atolls in the
Republic of the Marshall Islands, (2) Semipalatinsk in the
Republic of Kazakhstan, and (3) Mururoa and Fangataufa
Atolls in French Polynesia.
Marshall Islands Study
Sixty-six nuclear weapons tests were conducted by the
United States in or near the Marshall Islands between 1946
and 1958 (Fig. 5). The total explosive yield of the 66 tests
was ~100 MT, corresponding to ~100 times the total yield
of the atmospheric tests conducted at NTS. The largest test
conducted in the Marshall Islands, with an explosive yield
of 15 MT, was Castle Bravo, detonated on 1 March 1954.
Because of unexpected wind-shear conditions, heavy fallout
from Castle Bravo occurred on atolls east of the Bikini Atoll
Test Site and resulted in high radiation doses to the popu-
lations of nearby atolls. Within ~2 d following the test, the
resident populations of the most exposed atolls were evac-
uated to avert continued exposure, to be decontaminated,
and to receive immediate medical care for conditions of
acute doses.
In the early 2000s, a thorough and systematic recon-
struction of radiation doses to the resident population of
the present-day Republic of the Marshall Islands, by year,
age at exposure, and atoll of residence was carried out by
NCI. The main results of this dose-reconstruction effort,
which were presented in detail in a special issue of Health
Physics (August 2010), including Beck et al. (2010), Bouville
et al. (2010), Ibrahim et al. (2010), Harris et al. (2010), Moroz
et al. (2010), and Simon et al. (2010a, 2010b), are:
• the determination that 20 of the 66 nuclear tests con-
ducted in or near the Marshall Islands led to measurable
fallout deposition on at least one of the 32 inhabited
atolls or islands of the Marshall Islands;
• the estimation, for each of those 20 tests, of deposition
densities (kBq m−2) of all important dose-contributing
radionuclides at each inhabited atoll or island;
• the estimation of age-dependent doses from external irra-
diation resulting from each test and aggregated on an an-
nual basis; and
• the estimation of age-dependent doses from internal irra-
diation to the red bone marrow, thyroid gland, stomach
wall, and colon wall of representative individuals of the
inhabited atolls and islands.
The dose estimates were based on the available radia-
tion measurement data (concentrations of 131I in urine,
whole-body measurements, concentrations of 137Cs in soil,

Fig. 5. Atolls and islands of the Republic of the Marshall Islands and locations of nuclear test sites and of evacuated populations (Simon et al. 2010a).
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372 Health Physics April 2020, Volume 118, Number 4

exposure rates, etc.) supplemented with a variety of
models and assumptions. It was found (Simon et al.
2010a): “…that the total deposition of 137Cs, external
dose, internal organ doses, and cancer risks followed the
same geographic pattern with the large population of the
southern atolls receiving the lowest doses. Permanent res-
idents of the southern atolls who were of adult age at the
beginning of the testing period received external doses
ranging from 5 to 12 mGy on average; the external doses
to adults at the mid-latitude atolls ranged from 22 to
59 mGy on average, while the residents of the northern
atolls received external doses in the hundreds to over
1,000 mGy. Internal doses varied significantly by age at
exposure, location, and organ.” The thyroid doses are
estimated to have been as high as ~20,000 mGy for young
children exposed on Rongelap as a result of the Castle
Bravo test of 1 March 1954.
Kazakhstan Study
The former Soviet Union’s Semipalatinsk Nuclear Test
Site [SNTS (also known as the Polygon)], is located in
northeast Kazakhstan in Central Asia ~200 km east of the
city of Semipalatinsk and the same distance southwest of
the border with the Altai region of Russia (Fig. 6). The
SNTS became operational ~3 y after the United States be-
gan testing in the Pacific (June 1946) but before the first test
in Nevada took place (January 1951). The first Soviet test at
the SNTS was in August 1949, and the last atmospheric

Fig. 6. The SNTS and its environs. The lines represent the centerline trajectories of the 11 tests that were considered in the study. The solid circles
represent the eight villages of residence of the 2,994 study subjects (Land et al. 2008).
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 Fallout from nuclear weapons tests c A. BOUVILLE 373

Table 9. Average cumulative thyroid dose from all tests by age at time subjects who resided predominantly in villages of either
of main test for village of residence (Land et al. 2008). Russian or Kazakh ethnicity located within 200 km of the
Age at time Number of
Average thyroid dose (mGy) detonation sites (Land et al. 2008). The dose reconstruction
of main test subjects External Internal Total study was a collaborative effort of NCI, the Russian Institute
Preconception 113 2 5.8 6
of Biophysics (Moscow), the Semipalatinsk State Medical
In utero 68 27 104 131 Academy, and the Kazakhstan National Research Institute
0–4y 788 41 681 722 for Radiation and Medical Ecology. Though the strategy de-
5–9y 622 40 198 238 scribed here for estimating doses to individuals is similar to
10 – 14 y 815 42 199 241 that in other US studies, the specific algorithms used in the
15+ 7 588 58 140 198 study were developed at the Russian Institute of Biophysics
Total 2,994 42 307 349 (Gordeev et al., 2006a, b). The estimated average thyroid
doses received by the study subjects are presented in
tests were conducted in December 1962; altogether, there Table 9: the overall averages are 42 mGy for the doses from
were 86 atmospheric tests and 25 surface tests. The total en- external irradiation and 307 mGy for the doses from internal
ergy yield of the atmospheric nuclear explosions at the irradiation. The internal doses, which were predominantly
SNTS was ~6.6 MT, larger than in Nevada (1 MT) but con- due to intakes of 131I, were found to be greater than the exter-
siderably smaller than in the Marshall Islands (110 MT) and nal doses for each age category. The high thyroid doses re-
at the northern Soviet test site at Novaya Zemlya (240 MT). ceived in some villages were primarily a result of the close
Within the framework of an epidemiologic study of proximity of those villages to the test site, their significant de-
thyroid nodules, thyroid doses were reconstructed for 2,994 pendence on food products derived from grazing animals,

Fig. 7. Atolls and islands of French Polynesia, location of the test sites (solid squares) and numbers of study subjects (in parentheses) (Drozdovitch
et al. 2008).
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374
and adverse weather conditions—in particular, high winds
and precipitation at the time of some of the tests. Doses re-
ceived by individual subjects depended on individual dietary
habits that usually varied with age and ethnicity.
The dose estimates reported by Land et al. (2008) were
not reported with uncertainties. In a subsequent effort, un-
certainties were evaluated using a two-dimensional Monte
Carlo procedure that has the capability of maintaining the
separation between shared and unshared errors (Land et al.
2015; Simon et al. 2015).
French Polynesia Study
Forty-one atmospheric nuclear weapons tests (plus five
safety tests) were conducted in French Polynesia between
1966 and 1974. The tests took place at Mururoa and
Fangataufa, which are two atolls located in the southeastern
part of the Tuamotu-Gambier Archipelago (Fig. 7). During
the tests and afterwards, no civilian population lived in the
two atolls, and fewer than 500 people resided within 500
km, among a total of ~70,000 inhabitants in French Polyne-
sia during the period of atmospheric testing. In the early
2000s, a dosimetry study was undertaken as a component
of an epidemiologic study of thyroid cancer related to expo-
sure to fallout from the French atmospheric tests. The epide-
miologic study, which was conducted by the Institut National
de la Santé et de la Recherche Médicale (INSERM), included
602 subjects, either cases or controls, all aged <40 y old at the
end of nuclear weapons testing in 1974. For each atmospheric
nuclear weapons test that contributed substantially to fall-
out, the thyroid dose from 131I intake was estimated,
along with less important pathways including the intake
of short-lived radioiodines (132I, 133I, 135I) and 132Te, ex-
ternal irradiation from gamma-emitting radionuclides de-
posited on the ground and ingestion of long-lived 137Cs
(Drozdovitch et al. 2008). Given the limited number of avail-
able radiation data, the dose estimates were deemed to be
fraught with large uncertainties. The mean thyroid dose
among the study subjects was assessed to be ~3 mGy, while
the highest dose was estimated to be ~40 mGy. The contribu-
tions of the various exposure pathways to the thyroid dose are
presented in Table 10.
Table 10. Thyroid doses reconstructed for the study subjects from
different exposure pathways (Drozdovitch et al. 2008).
Thyroid dose (mGy)
Exposure pathway Minimum Mean Maximum
131
Intake of I 0.003 2.0
Intake of short-lived 132I, 133I, 135I, and 132Te 0.0008 0.4
External irradiation 0.004 0.2
134,137
Cs ingestion 0.0006 0.1
All exposure pathways 0.03 2.7
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Health Physics April 2020, Volume 118, Number 4
In 2013–2015, INSERM extended the epidemiological
study of thyroid cancer and included 348 additional sub-
jects, which resulted in a total of 950 subjects who resided
in 49 islands and atolls in French Polynesia in 1966–1974.
In 2013, the French Ministry of Defense also declassified
a large number of reports providing detailed information
on the results of environmental radiation monitoring in
French Polynesia during the atmospheric testing period.
Consequently, it was decided to revise the thyroid dose esti-
mates using the newly available radiation data and including
an extensive survey of the dietary and lifestyle habits of the
French Polynesia population in the various archipelagoes.
The revised dose assessment has been completed: three ar-
ticles presenting the results of the study are under review
prior to submission for publication in peer-reviewed scien-
tific journals.
HEALTH EFFECTS DUE TO FALLOUT
Risk assessment
On the basis of the crude doses estimated in the NCI
(1997) countrywide study and the DHHS (2005) study,
estimates of the average risk to the United States popula-
tion have been made for thyroid cancer, leukemia, and
all cancers. “With the exception of thyroid cancer, the
risk estimates were developed using simple approaches,
and only provide an approximate estimate of the poten-
tial impact of fallout radiation on the American popula-
tion” (US DHHS 2005).
In the NCI (1997) country wide study, thyroid doses
from intakes of 131I were crudely estimated for all counties
of the contiguous United States and for all tests that were
conducted at the NTS in the 1950s. The number of thyroid
cancers resulting from those exposures was predicted to
be 49,000, with a range of uncertainty from 11,300 to
212,000 (IOM/NRC 1999). In addition, global fallout
was expected to increase those estimates by ~15% (US
DHHS 2005), with an uncertainty that would be even larger
than that associated to the number of thyroid cancers due to
NTS fallout.
The number of fatal cancers resulting from the average
external dose of ~1.2 mGy (Table 8) from both NTS and
global fallout was reported (US DHHS 2005) to be less than
1,000 among the 3.8 million people born in the United States
in 1951, corresponding to a lifetime risk of <0.03% or ~1 in
3,800. This number may be compared with the ~760,000 fa-
tal cancers that would be predicted in the absence of fallout.
Among the population of the United States alive at any time
28
during the years 1951 to 2000, about 11,000 extra cancer
10
deaths from all cancers, including leukemia, would be pre-
2.6
dicted to occur as a result of external irradiation from NTS
0.8
37
and global fallout (US DHHS 2005). It is also expected that
the largest number of excess cancer deaths would occur in the
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 Fallout from nuclear weapons tests c A. BOUVILLE
group of persons born in 1951, because on average, this
group received higher doses at younger ages than groups
born earlier or later (US DHHS 2005).
Leukemia, which has been strongly linked with radia-
tion in many epidemiologic studies, was given special con-
sideration. About 10% or 1,100 of the 11,000 cancer deaths
predicted from exposure to fallout from NTS and global
tests would be expected to result from leukemia (US
DHHS 2005). In addition, internal doses to the red bone
marrow could result in 550 cases of leukemia among the
population of the United States who were alive at any time
during the years 1951–2000 and in 17 cases among the
~3.8 million persons born in 1951, corresponding to a risk
of 1 in 220,000 (US DHHS 2005).
Cancers to other sites were not assessed because of
their lower doses and of the smaller amount of information
available about radiation-associated health effects. For such
sites, the risk estimates would be smaller than those for thy-
roid cancer and leukemia, and the uncertainties would be
very large (US DHHS 2005).
The comprehensive study of radiation doses received
by the population of the Marshall Islands as a result of the
nuclear weapons testing conducted at Bikini and Enewetak
Atolls during 1946–1958 also was used to estimate cancer
risks among that population (Land et al. 2010; Simon
et al. 2010a). About 170 excess cancer cases, including 50
thyroid cancers and seven leukemias, were projected to oc-
cur among >25,000 Marshallese, half of whom were born
before 1948. The 170 excess cancer cases are in comparison
to ~10,600 cancers that would spontaneously arise, unre-
lated to radioactive fallout, among that population.
Risk comparison
The lifetime risk of thyroid cancer from exposure to
131
I in NTS fallout was compared to other radiation risks
in at least two studies:
• Hoffman et al. (2011) compared the lifetime risk of thy-
roid cancer in female children born in 1952 from expo-
sure to 131I in NTS fallout at an average thyroid dose of
100 mGy with (1) the excess lifetime risk of cancer from
a lifetime exposure to radon decay products at an average
indoor concentration of 46 Bq m−3 and (2) the lifetime
risk of cancer (excluding skin cancer) to 50 y old females
who receive a single abdominal computed tomography
scan: they estimated that the risk from childhood expo-
sure to 131I in NTS fallout (thyroid dose of 100 mGy)
was similar to that resulting from a single abdominal
computed tomography scan for a 50 y old female and in-
termediate between the risks from indoor radon for
smokers and nonsmokers; and
• Reed et al. (2003) compared the risks for representative
maximally and typically exposed individuals in dose
reconstructions related to federal facilities (Fernald,
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375
Hanford, Oak Ridge, Rocky Flats, and NTS). The ex-
cess risk of cancer incidence due to NTS releases was
found to be the highest for a typically exposed individ-
ual, and the second highest, under Hanford, for the
maximally exposed individual.
Public concern
People living in the vicinity of nuclear test sites have
raised complaints and concerns that are, to some extent,
rooted in the legacy of government secrecy surrounding the
development and testing of nuclear weapons, distrust of gov-
ernment sources of information about radiation exposures
and health risks, and the imposition of past exposures without
informed consent (Hoffman et al. 2002). The fact that radia-
tion cannot be seen or smelled and that it may induce cancer
a very long time after exposure also contributes to public con-
cern. The decisions by the US government to mandate com-
prehensive studies on radiation doses and health effects
resulting from the atmospheric tests that took place at
the NTS likely led to the discussion of the possibility
of establishing compensation programs for fallout expo-
sure, not only in the United States but also in other countries
where atmospheric tests had been carried out.
FALLOUT EXPOSURE
COMPENSATION PROGRAMS
Compensation programs have been established in
countries involved in nuclear weapons testing. The following
examples illustrate the variety of the mechanisms that have
been used:
• In the United States, the Radiation Exposure Compensa-
tion Act (RECA), passed by the US Congress on 6
October 1990 (RECA 2012), provides monetary com-
pensation ($50,000) to individuals who lived downwind
of NTS and contracted certain cancers and other serious
diseases following the exposure to radiation released dur-
ing the atmospheric nuclear tests. In order to obtain such
compensation, the claimant must establish (1) physical
presence in the downwinder area (Fig. 8) for 2 y begin-
ning on 21 June 1951 and ending on 31 October 1958,
or for the entire period beginning on 30 June 1962 and
ending on 31 July 1962, and (2) a subsequent diagno-
sis of a specified compensable disease (i.e., leukemia,
multiple myeloma, non-Hodgkin lymphoma, or primary
cancer of the thyroid, male or female breast, esophagus,
stomach, pharynx, small intestine, pancreas, bile ducts,
gall bladder, salivary gland, urinary bladder, brain, colon,
ovary, liver, or lung). RECA does not require claimants
to establish causation of the contracted disease by the ra-
diation exposure.
376 Health Physics
Fig. 8. Downwinder area, as defined by RECA.
It is worth noting that, in 2019, amendments to RECA
are still under consideration by Congress regarding expan-
sion of the downwinder area to other counties of Nevada,
Utah, and Arizona, as well as to other states. Also, compen-
sation to downwinders in New Mexico, resulting from
radiation exposure from Trinity or from tests conducted at
NTS, is not covered by RECA or any other applicable
law at the time of this writing (TDBC 2017);
• In the Republic of the Marshall Islands, which became
an independent nation in 1986, compensation for nuclear
testing damages was provided by the United States
through international agreements (Library of Congress
2005, Appendix A). From 1991–2003, the Republic of
the Marshall Islands Nuclear Claims Tribunal awarded
over $2 billion for personal injury, property loss, and
class-action claims. Monetary compensation was some-
times used to offset displacements, lifestyle changes,
and individual burdens, as well as the occurrence of
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April 2020, Volume 118, Number 4
specific cancers. However, the claims awarded exceeded
the settlement amount, and payments from the Tribunal
ceased in 2009 after having disbursed all existing funds;
• In the Russian Federation, members of the public ex-
posed to fallout resulting from nuclear testing at SNTS
are eligible for a monthly cash payment (Russian Federa-
tion 2002). The monthly cash payment is set at (1) 1,236
rubles (about $20) for those with an accumulated effective
dose of >250 mSv; and (2) 387 rubles (about $6) for those
with an accumulated effective dose in the range of 50–250
mSv, as well as for children <18 y of age suffering from a
disease due to radiation exposure of their parents or grand-
parents, if any of the parents or grandparents received an ac-
cumulated effective dose >50 mSv. In addition, members of
the public that were exposed to fallout receive benefits re-
garding medical care, travel by public transportation, and
payment of housing and communal services;
• In the Republic of Kazakhstan, the territories exposed to
fallout from tests conducted at the SNTS were classified
 Fallout from nuclear weapons tests c A. BOUVILLE
in five zones (Republic of Kazakhstan 1992): (1) zone of
emergency radiation risk, where the total effective dose
to the public from all tests conducted at the SNTS during
1949–1990 was >1,000 mSv: members of the public re-
siding and living in this zone received a one-time mone-
tary compensation of 5.23 monthly calculation index for
each year of residence from 1949 – 1965 and of 1.05
monthly calculation index for each year of residence
from 1966–1990. Members of the public residing in this
zone who retired before 1 January 1998, have a right for
a pension supplement (on a monthly basis) of 2.09
monthly calculation index. Members of the public cur-
rently living in this zone have a right for a salary supple-
ment (on a monthly basis) of two monthly calculation
index and for an additional paid vacation of 14 d per year.
The value of the monthly calculation index, which is de-
termined by the Government of the Republic of
Kazakhstan, increased from 550 Kazakhstani Tenge on
1 January 1997 to 2,525 Kazakhstani Tenge on 1
January 2019. On 10 July 2019, the value of 1,000
Kazakhstani Tenge was 2.6 US dollars; (2) zone of maxi-
mum radiation risk (total effective dose to the public from
all tests in the range from 350–1,000 mSv): monetary com-
pensation of 2.62 monthly calculation index for each year
of residence from 1949 – 1965 and of 1.05 monthly calcu-
lation index for each year of residence from 1966–1990.
Members of the public residing in this zone who retired be-
fore 1 January 1998 have a right for a pension supplement
(on a monthly basis) of 1.83 monthly calculation index.
Members of the public currently living in this zone have a
right for a salary supplement (on a monthly basis) of 1.75
monthly calculation index and for an additional paid vaca-
tion of 12 d per year; (3) zone of increased radiation risk
(total effective dose to the public from all tests in the range
from 70–350 mSv): monetary compensation of 1.57
monthly calculation index for each year of residence from
1949–1965 and of 0.79 monthly calculation index for each
year of residence from 1966–1990. Members of the public
currently living in this zone have a right for a salary supple-
ment (on a monthly basis) of 1.5 monthly calculation index
and annual additional paid vacation of 10 d; (4) zone of
minimum radiation risk (total effective dose to the public
from all tests in the range from 1–70 mSv): monetary com-
pensation of 1.05 monthly calculation index for each year
of residence from 1949–1965 and of 0.52 monthly calcu-
lation index for each year of residence from
1966–1990. Members of the public currently living in this
zone have a right for a salary supplement (on a monthly
basis) of 1.25 monthly calculation index and for an addi-
tional paid vacation of 7 d per year; (5) territory with a
favorable socioeconomic status (total effective dose to
the public from all tests of <1 mSv, but members of the
public suffer from emotional stress associated with living
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377
near radiation hazardous areas): monetary compen-
sation of 0.26 monthly calculation index for each year
of residence from 1949–1990. Members of the public
currently living in this zone have a right for a salary
supplement (on a monthly basis) of one monthly calcu-
lation index and for an additional paid vacation of 5 d
per year;
• In Australia, where 1,200 aboriginal people were ex-
posed to radiation from the tests conducted by the
United Kingdom, the government made, in 1991–1992,
a payment of $618,000 to aboriginal groups around
Maralinga for land contamination (Korff 2018). This
was followed in 1995 by a payment of $13.5 million
for the loss of the land and as compensation for the
contamination, and a payment of $6 million to main-
tain the township. Compensation for exposure to radi-
ation seems to be difficult to obtain. As of 2018, only
five people had been paid a total of $200,000 for com-
pensation; and
• In French Polynesia, any person suffering from a
radiation-induced disease caused by exposure to radiation
from the French nuclear weapons tests may obtain full
compensation, commensurate to the health damage, if that
person spent time in French Polynesia between 2 July
1966 and 31 December 1998 (France 2019). Claims
must be submitted to the Comité d’Indemnisation des
Victimes des Essais Nucléaires Français (CIVEN). If
the person is deceased, the claim must be submitted
by his or her heirs. CIVEN has to provide its decision,
with explanation, within 8 mo following submission of
the claim.
SCIENTIFIC FALLOUT
Fallout was harmful for the health of humanity, but it
created an opportunity for scientific progress (Harley 1976):
• In the physical sciences, meteorological concepts could
be tested (Bennett 2002; Machta 2002), oceanographic
current movements could be monitored (Livingston and
Povinec 2002), and instrumentation developments in
low-level counting, spectrometry and external gamma
exposure measurements were numerous (Miller and
Larsen 2002);
• On the biological side, information on the metabolism of
strontium, cesium, and even potassium and calcium be-
came available (Harley 2002), and the whole field of ra-
dioecology blossomed (Anspaugh et al. 2002; Whicker
and Pinder 2002); and
• These were responses to a need, for the most part, but were
made possible through the radioactivity introduced in the
environment. Thus, although fallout was not a “good
thing,” it was possible to take advantage of its existence.
378 Health Physics
SUMMARY
• The process of nuclear fission, which was discovered in
1938, opened the door to the possibility to produce nu-
clear weapons that would be much more destructive than
the chemical weapons that were used at that time;
• The use of nuclear weapons in 1945 by the United States
in Japan in order to end World Word II was one of the
most important events of the twentieth century;
• Proliferation of nuclear weapons ensued, as well as the
detonation of >500 nuclear weapons tests in the atmo-
sphere by the United States, the former Soviet Union, the
United Kingdom, China, and France from 1946–1980;
• Hundreds of radionuclides, most of them short-lived,
such as 131I, with a half-life of 8 d, were produced in
the atmospheric tests. However, a few radionuclides, like
137
Cs and 90Sr, with long half-lives of ~30 y, were pro-
duced as well;
• The radioactive clouds generated by the explosions
rose to high altitudes and were usually partitioned be-
tween the troposphere and the stratosphere. The activ-
ity that remained in the troposphere resulted in local
and regional fallout that consisted mainly of short-
lived radionuclides and in relatively high doses for
the populations residing in the vicinity of the test site,
although atmospheric nuclear weapons tests were con-
ducted, as a rule, in areas with very small populations
in order to reduce the number of persons with rela-
tively high exposures to radiation in case of mishap.
The highest doses resulted from the Castle Bravo Test
of 1 March 1954 with estimated external doses in the
hundreds to >1,000 mGy and internal thyroid doses
as high as ~20,000 mGy to regional populations in
the Marshall Islands;
• The activity that reached the stratosphere returned to the
ground with a half-life of ~1 y as global fallout and was
composed of long-lived radionuclides that contaminated
all uncovered materials on Earth to a small extent in a rel-
atively homogeneous manner and led to low-level irradi-
ation of the world population for decades or more. The
annual effective dose, averaged over the population of
the entire world, is crudely estimated to have peaked at
~0.1 mSv in 1963 and to have decreased to ~0.02 mSv
in 1980. Because there been no atmospheric test since
1980, doses from fallout are currently lower than those
in 1980;
• The health effects of exposure to radiation from radioac-
tive fallout can, for the most part, be primarily described
as small excesses over baseline rates for thyroid cancer
and leukemia. An extra 49,000 cases of thyroid cancer
would be expected to occur among the US population
from exposure to radioactive fallout from the atmo-
spheric nuclear weapons tests that were conducted at
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April 2020, Volume 118, Number 4
NTS in the 1950s. In addition, there could be as many
as 11,000 deaths from non-thyroid cancers related to
fallout from all atmospheric tests that were conducted
at all sites in the world, with leukemia making up
10% of the total;
• People living in the vicinity of nuclear test sites have
raised complaints and concerns that are, to some extent,
rooted in the legacy of government secrecy surrounding
the development and testing of nuclear weapons, distrust
of government sources of information about radiation
exposures and health risks, and the imposition of past ex-
posures without informed consent. The fact that radia-
tion cannot be seen or smelled and that it may induce
cancer a very long time after exposure also contributes
to public concern;
• Sociological and political pressures contributed to
the establishment of programs of compensation for
radiation exposures and evidence of radiation-
induced diseases in countries involved in nuclear
weapons testing;
• Radioactive fallout from nuclear weapons tests was
harmful for the health of humanity, but it also created
an opportunity for scientific progress in physical and bi-
ological sciences, which was a response to a need for the
most part, but was made possible through the radioac-
tivity introduced in the environment. Thus, although
fallout was not a “good thing,” it was possible for
the scientific community to take advantage of its ex-
istence; and
• Knowledge gained from decades of studies on radioac-
tive fallout and human exposure can be useful to the fu-
ture generations in preparing for either accidental or
intentional releases of radioactive materials to the atmo-
sphere and environment.
Acknowledgments—I wish to extend my sincere gratitude to my friends and col-
leagues of many years who have shared my passion for fallout studies, with
whom I have collaborated, and who have contributed to the improvement of this
manuscript. These colleagues are, in alphabetical order, Lynn Anspaugh (Uni-
versity of Utah, retired), Harold Beck (US Department of Energy, retired), Bur-
ton Bennett (UNSCEAR, retired), Vladimir Drozdovitch (NCI), Florent de
Vathaire (INSERM, France), Owen Hoffman (ORRISK, retired), Sergey
Shinkarev (Burnasyan Federal Medical Biophysics Center, Russia), and Steve
Simon (NCI).
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