IOP PUBLISHING PHYSICS IN MEDICINE AND BIOLOGY

Phys. Med. Biol. 53 (2008) R41–R60 doi:10.1088/0031-9155/53/8/R01

TOPICAL REVIEW

New recommendations from the International

Commission on Radiological Protection—a review

A D Wrixon
Castellezgasse 25/2/6, 1020 Vienna, Austria

E-mail: anthony.wrixon@chello.at

Received , in final form 18 September 2007

Published 26 March 2008
Online at stacks.iop.org/PMB/53/R41

Abstract
For almost half a century, the International Commission on Radiological
Protection (ICRP) has revised its recommendations on radiological protection
with an average frequency of about 10 years, building on the experience gained
in their implementation. This has ensured that the recommendations remain
up to date and fit for purpose and it is this that has led in turn to their wide
acceptance internationally. Indeed, the 1990 version of the recommendations
forms the basis of the international radiological protection standards and
the systems of control of exposure to ionizing radiation in many countries
throughout the world. This version introduced new concepts and a more
holistic approach to radiological protection but marrying the different exposure
situations into one coherent framework has proved not to be straightforward
and further reflection seemed necessary in order to satisfy both those who are
responsible for the development of the control systems as well as a broader
audience. Review of the 1990 recommendations started around 1998 and, since
then, many ideas have been explored and avenues followed. Eventually, new
recommendations were agreed by the Commission at its meeting in Essen in
March 2007. This paper provides a review of these new recommendations and
their possible implications.

1. Introduction

Radiological protection is concerned with the protection of people and the environment from
the detrimental effects of exposure to ionizing radiation, while at the same time not unduly
limiting the beneficial uses. It is based on scientific knowledge of radiation effects, but
science alone is not sufficient. Societal and economic judgements are essential. Indeed, all
those involved in radiological protection need to make such value judgements, whether this is
explicitly recognized or not.
0031-9155/08/080041+20$30.00 © 2008 Institute of Physics and Engineering in Medicine Printed in the UK R41
R42 Topical Review

The euphoria associated with the medical benefits of the use of x-rays and radium
that must have existed at the beginning of the last century was soon tempered by the
growing realization of the consequential dangers. This realization led, in 1928, to the
establishment by the International Congress of Radiology of the International X-Ray and
Radium Protection Committee. In 1950, this Committee was renamed the International
Commission on Radiological Protection (ICRP). Since then, the interests of ICRP have
extended far beyond medical applications in order to take account of the availability and
wider applications of artificially-produced radionuclides and the increasingly wide uses of
radiation and radioactive material. As time progressed, ICRP also saw the need to turn its
attention to the exposures from natural sources, some of which are eminently controllable.
In spite of the value judgements that have inevitably had to be made with regard to all of
these exposure situations, it is much to the credit of the organization that, for more than half a
century now, its recommendations on radiological protection have been accepted throughout
the world.
There is however nothing sacrosanct about this arrangement. Alternative ways of making
the necessary basic judgements could be found. The important thing is that it has worked
very successfully over many years. But success carries responsibilities. The recommendations
must remain up to date and appropriately address the needs of the wider radiological protection
community, in particular, those who have the responsibility for turning them into international
standards and national regulations. It is therefore entirely reasonable that ICRP should keep its
recommendations under review and revise them as necessary. Even here, though, judgement
is necessary regarding the timing for issuing new recommendations. On the one hand, ICRP
needs to retain its position as the central point of reference internationally on radiological
protection and therefore to update its recommendations from time to time; on the other
hand, change, if done too frequently, can result in reduction in confidence or unnecessary
expenditure, which may, in turn, lead to rejection.
Since the late 1950s, ICRP has in fact issued revised recommendations on five occasions
(ICRP 1959, 1964, 1966, 1977, 1991). Each set of new recommendations precipitated
a substantial amount of work by the international organizations, notably the International
Atomic Energy Agency (IAEA) and the European Commission (EC), leading, in general,
to new international requirements—the current versions of these are IAEA (1996) and the
Council of the European Union (1996)—and, in turn, in many countries, to new national
regulations. Thus, with this precedent, it is almost inevitable that any new recommendations
that are produced by ICRP will be comprehensively scrutinized by the IAEA, EC and national
regulatory authorities, and there will be pressure for revision of the international requirements
and national regulations.
The process of reviewing the 1990 recommendations started around 1998 (Clarke 1999). It
was motivated by a desire to reduce the complexity that had arisen as a consequence of the way
in which the focus of radiological protection had evolved over the years, from exposures from
x-rays and extracted radionuclides of natural origin (primarily radium), through exposures
from radioactive sources of artificial origin, including those from the production of nuclear
energy, to exposures from radiation of natural origin, which may, in some circumstances,
warrant control. The objective of the review was to establish a more holistic approach covering
exposures from radiation sources of both natural and artificial origin, normal and potential
exposures, and exposures as a consequence of accidents and past activities. In this respect,
ICRP was only too conscious of the need to be able to communicate its recommendations to
decision makers at the political level, to those professionally involved in protection as well
as to a broader constituency of interested parties. This is perhaps more important now than
previously due to the renewed interest in using nuclear energy, which clearly is going to have a
Topical Review R43

significant role to play as the world gets to grips with the problem of energy supply and global
warming. ICRP was also very conscious of the need for much more transparency than hitherto
during the development of its recommendations. As a consequence, technical discussions were
held with professionals at two major gatherings—the meetings of the International Radiation
Protection Association (IRPA) in Hiroshima in 2000 and Madrid in 2004—and two progress
reports were prepared during the process of development (ICRP 2001a, 2003a). In addition,
proposed new recommendations were made available on the web for full consultation on two
separate occasions—in 2004 and 2006. The interest in them was intense as evidenced by the
fact that, on each occasion, they solicited a substantial number of comments.
At its meeting in Essen, in March 2007, ICRP eventually approved its new
recommendations (ICRP 2007). These new recommendations take account of the latest
biological and physical information and trends in the setting of radiation safety standards. This
paper provides a review of those recommendations and their implications, with a particular
emphasis on any changes that have been introduced.

2. Biological basis

Radiological protection has, for many years, been firmly grounded in the latest understanding
of the biological effects induced by exposure to radiation. In the early days, concern centred on
the prevention of what were referred to in the 1990 ICRP recommendations as ‘deterministic
effects’ (ICRP 1991). These are the effects that inevitably and only occur above thresholds of
dose. It was the prevention of such effects that was the primary basis for setting dose limits in
those early days. Nowadays, doses of whatever magnitude are assumed by ICRP to be able
to induce what are referred to as ‘stochastic effects’ (i.e. cancers and hereditary disorders),
the probability of such effects increasing with the magnitude of the dose, the so-called linear
non-threshold model. This assumption reflects a general principle that safety is seldom, if
ever, absolute and, through comparative risk assessment, has, for several decades, been used
as the primary basis in the development of radiological protection standards. It has however
been the focus of much debate1 .

2.1. Deterministic effects

Like much of what is in the new recommendations, the ICRP has sought better words to
clarify its meanings. In the context of the biological effects of radiation exposure, the ICRP
feels that the term ‘deterministic effects’ was ‘not always familiar to those outside the field
of radiological protection’. Furthermore, some extraneous factors can modify the amount of
damage and perhaps the threshold dose level, so strictly speaking, the term is not entirely
accurate. So, while retaining the phrase because it has ‘a firmly embedded use in its system
of protection’, the ICRP now regards the term ‘tissue reactions’ as more precise. An earlier
proposal made during the development of the new recommendations to drop the use of the
term ‘deterministic effects’ altogether was not however warmly received by all those involved
in protection for the reason given by the ICRP.
The ICRP reviewed the biological and clinical data on deterministic effects. It notes that
‘in the absorbed dose range up to around 100 mGy (low LET or high LET2 ) no tissues are
1 The health effects of radiation exposure are kept under review by the United Nations Scientific Committee on the

Effects of Atomic Radiation (UNSCEAR) and its reports should be consulted for further information on the validity
of this assumption, see, in particular, UNSCEAR (2000).
2 LET stands for linear energy transfer, which is the average linear rate of energy loss of charged particle radiation

in a medium; the radiation energy lost per unit length of path through a material.
R44 Topical Review

judged to express clinically relevant functional impairment. This judgement applies to both
single acute doses and to situations where these low doses are experienced in a protracted
form as repeated annual exposures’.
It also reviewed the growing amount of evidence about other radiation-associated
health consequences—heart disease, stroke, digestive disorders and respiratory disease.
The strongest evidence for these effects comes from the most recent mortality analysis of
the survivors of the Japanese atomic bombing (Preston et al 2003). Additional evidence
comes from radiotherapy patients. These consequences however are not yet sufficiently
well understood to assign them to one or other of the categories of effects, deterministic or
stochastic, and ICRP concludes that ‘the data available do not allow for their inclusion in
the estimation of detriment following low radiation doses, less than about 100 mSv. This
agrees with the conclusion of the United Nations Scientific Committee on the Effects of
Atomic Radiation (UNSCEAR 2006) which found little evidence of any excess risk below
0.5 Sv’.

2.2. Stochastic effects

As far as cancer induction is concerned, ICRP has reviewed the data accumulated since
1990. The cellular and animal data have ‘strengthened the view that DNA damage response
processes in single cells are of critical importance to the development of the cancer after
radiation exposure’. ICRP concludes that ‘although there are recognized exceptions, for the
purposes of radiological protection the Commission judges that the weight of evidence on
fundamental cellular processes coupled with dose–response data supports the view that in the
low dose range, below about 100 mSv, it is scientifically plausible to assume that the incidence
of cancer or heritable effects will rise in direct proportion to an increase in the equivalent
dose in the relevant organs and tissues’. This view accords with that given by UNSCEAR
(2000).
ICRP considered possible challenges to its linear non-threshold model. Some have
continued to argue in support of a practical threshold for radiation cancer risk (see, for example,
Tubiana and Aurengo (2005)). However, while the idea that there might be a threshold holds,
at first sight, some attraction for the purpose of setting standards and communicating the
effect of low doses to the public if the doses remain below that threshold, it seems entirely
appropriate that ICRP should continue to adhere to its basic assumption of linearity, without
threshold. Not only is this supported by the work of UNSCEAR (2000) which is the UN body
specifically tasked with keeping the levels and effects of radiation exposure under review,
but it is a prudent assumption that is appropriate for the practical purposes of radiological
protection, i.e. the management of the risks from low-dose radiation exposure3 . Furthermore,
there would be practical difficulties in applying the concept of a threshold in view of the
magnitude and variability of exposure to natural sources of radiation and the fact that the
doses from man-made sources are in addition to these exposures.
In recent years, there has also been considerable discussion on such things as cellular
adaptive responses, genomic instability and bystander signalling (ICRP 2005a). However, the
ICRP notes that ‘since the estimation of nominal cancer risk coefficients is based upon direct
human epidemiological data, any contribution from these biological mechanisms would be
included in that estimate’.
3 Because of the uncertainties surrounding the risks of health effects at low doses, the ICRP stresses that the

assumption of linearity of dose and effect without threshold should not be used to calculate the hypothetical number
of cancers or cases of heritable disease that might be associated with very small radiation doses received by a large
number of people (see section 3.4).
Topical Review R45

Table 1. Detriment-adjusted nominal risk coefficients for stochastic effects after exposure to
radiation at low dose rate (10−2 Sv−1).

Cancer Heritable effects Total detriment

Exposed
population 2007 1990 2007 1990 2007 1990
Whole 5.5 6.0 0.2 1.3 5.7 7.3
Adult 4.1 4.8 0.1 0.8 4.2 5.6

2.3. Nominal risk coefficients

Most of the information on radiation risks comes from the follow-up of the survivors of
the atomic bombings in Japan in 1945, the data for which now covers a 47-year period.
The overall conclusion reached by the ICRP is that the cancer risk estimates derived from
the epidemiological studies of the Japanese survivors has not greatly changed since 1990,
although, with emphasis on cancer incidence rather than mortality, the data have provided a
firmer foundation for the modelling of risk.
In its 1990 recommendations, the ICRP applied a dose and dose-rate effectiveness factor
(DDREF) of 2 to the risk data obtained from high doses and high dose rates (such as were
received by the survivors of the atomic bombings) in order to derive the risks that would occur
at low doses and low dose rates. Support for this comes from epidemiological, animal and
cellular data (UNSCEAR 2000) but the information available does not allow a precise estimate
to be made of DDREF. The ICRP states in its new recommendations that ‘the Commission
finds no compelling reason to change its 1990 recommendations of a DDREF of 2. However,
the Commission emphasizes that this continues to be a broad whole number judgement for the
practical purposes of radiological protection which embodies elements of uncertainty’. Thus,
ICRP used this factor to derive nominal risk coefficients for all the cancers that it considered,
although it recognized that in reality different factors may well apply to different organs or
tissues.
One significant development since 1990 is that direct information on the lung-cancer
risk from exposure to radon in dwellings is now available. This risk arises primarily from
the deposition of the short-lived decay products of radon in the lung. Previously, the risk
of lung cancer had been derived from the epidemiological studies of miners exposed to high
levels of radon. However, now, the results of several residential epidemiological studies have
become available (see, for example, Darby (2006) and UNSCEAR (2006)) and the ICRP
considered that the results are sufficiently robust for them to be used to provide a direct
method of estimating risks to people at home without the need to use the data from the miner
studies.
There is no direct evidence that the radiation exposure of persons leads to heritable disease
in their offspring. Nevertheless, the ICRP continues to judge that there is strong evidence
that radiation causes such effects since they are clearly demonstrable in experimental animals.
However, a review of the relevant information by UNSCEAR (2001) led to the conclusion that
the risk of heritable diseases had been overestimated in the past and this has caused the ICRP
to lower its risk coefficient for such effects.
The nominal risk coefficients for stochastic effects—cancer and heritable effects—derived
by the ICRP are given in table 1. The values given in the ICRP’s 1990 recommendations are
shown for comparison. All values are nominal in that, the new values were based upon data
on cancer incidence weighted for lethality and life impairment, whereas the 1990 values were
based upon fatal cancer risk weighted for non-fatal cancer, relative life years lost for fatal
cancers and life impairment for non-fatal cancer. The decimal places in the table are not
intended to indicate a high level of precision; they are simply the outcome of the calculations.
R46 Topical Review

Thus, overall, there is no significant change in the risk coefficients: if anything, the total
detriments are somewhat lower now than the values given in the 1990 ICRP recommendations,
reflecting largely the reduction in the risk of serious heritable effects. The values can also
be compared with those used as the basis for the 1977 ICRP recommendations (ICRP 1977),
which were 1 × 10−2 Sv−1 for the mortality risk factor for radiation-induced cancers (averaged
over both sexes and all ages) and 0.4 × 10−2 Sv−1 for hereditary effects as expressed in the
first two generations and about twice this in total.
In fact, it was in the 1977 recommendations that the ICRP first quantified the risks of
stochastic effects of radiation and used the risk factors as the basis for justifying its dose
limits. It was the increase in risk per sievert that led to the reduction in the annual dose limit
of 50 mSv for workers to 20 mSv, averaged over 5 years, in the 1990 recommendations. The
annual dose limit for members of the public had already been reduced from 5 mSv to 1 mSv
on average in an earlier statement from ICRP (1985) and in its 1990 recommendations (ICRP
1991) ICRP gave this dose limit as 1 mSv in a year with the possibility of averaging over 5
years ‘in special circumstances’.

2.4. Risk to embryo and fetus

Some mention should be made of the radiation effects in the embryo and fetus, since this
is a matter that has been of interest in both radiology and occupational exposure. ICRP’s
review of the available data has essentially confirmed the position that it took in its 1990
recommendations, which is that at doses under 100 mGy lethal effects in the pre-implantation
period of embryonic developments will be very infrequent. As far as the induction of
malformations is concerned, ICRP judges that there is a true dose threshold of around
100 mGy and therefore ‘risks of malformations after in-utero exposure to doses well below
100 mGy are not expected’. As far as severe mental retardation is concerned, ICRP supports
a dose threshold of at least 300 mGy during the most sensitive pre-natal period (8–15 weeks
post-conception). It also concludes that any effects on IQ following in-utero exposure to less
than 100 mGy would be of no practical significance. ICRP also judges that the lifetime cancer
risk following in-utero exposure will be similar to that following irradiation in early childhood,
i.e. at most about three times that of the population as a whole.
On this basis, ICRP concludes that ‘prenatal doses from most correctly performed
diagnostic procedures present no measurably increased risk of prenatal or postnatal death,
developmental damage including malformation or impairment of mental development over
the background incidence of these entities. . . . [However] higher doses such as those involved
in therapeutic procedures have the potential to result in developmental harm’.

2.5. Overall impact of the review of the biological effects

Overall, therefore, it can be concluded that contrary to the situation prior to the establishment
of the 1990 recommendations, where the risk of fatal cancer was estimated to be about three
times higher than previously assumed, there has been no significant change in the risk factors
that are used for radiological protection purposes.

3. Quantities for radiological protection

3.1. Radiation weighting factors and equivalent dose

The quantities used in radiological protection have changed over the years. It is now accepted
that the fundamental dosimetric quantity is the absorbed dose, which is the energy absorbed
Topical Review R47

Table 2. Recommended radiation weighting factors.

Radiation type Radiation weighting factor, wR

Photons 1
Electrons and muons 1
Protons and charged pions 2
Alpha particles, fission fragments, heavy ions 20
Neutrons A continuous function of neutron energy

per unit mass and its unit is the joule per kilogram, which is given the special name gray (Gy).
For radiological protection purposes, the dose is averaged over the tissue or organ that has
been exposed. This is only valid for the radiation detriment from stochastic effects resulting
from low doses. It may well need to change in the future depending on developments, but this
averaging is just one of a number of judgements that ICRP has made. The quantity absorbed
dose, however, is not sufficient to reflect the biological damage caused by radiation of different
types and energies. Over the years, different names have been given to the absorbed dose
weighted by a number to take account of the radiation quality. In its 1990 recommendations,
ICRP (1991) introduced radiation weighting factors, which were selected based on the relative
biological effectiveness (RBE) of the radiation in inducing stochastic effects at low doses—
primarily cancer and heritable disease. The equivalent dose was then derived by weighting the
mean absorbed dose in an organ or tissue by the radiation weighting factor (wR ). This approach
has been maintained in the new recommendations, but there has been some adjustment to the
values used.
The wR values for photons, electrons, muons and alpha particles selected by ICRP have
remained as in its 1990 recommendations. The value for protons has been reduced from 5 to
2; charged pions, which were not previously considered, have also been assigned a value of 2.
Pions have been added since these particles contribute to exposures from cosmic rays in aircraft,
a matter that has been given more significance since publication of the 1990 recommendations.
They also contribute to occupational exposure from high-energy particle accelerators. The
values for neutrons remain dependent on energy and are given as a continuous function;
previously, the values were given as a step function with respect to ranges of neutron energy.
As ICRP points out, this does not imply a higher precision of the basic data; it is based on the
practical consideration that most neutron exposures involve a range of energies. The revised
wR values are given in table 2.

3.2. Tissue weighting factors and effective dose

The quantity, effective dose, was introduced in the 1990 recommendations of ICRP (1991)
and was defined as the sum of the equivalent doses in the principal tissues and organs of the
body (i.e. those that are considered to be sensitive to the induction of stochastic effects), each
weighted by a tissue weighting factor (wT ). The purpose of introducing this quantity was so
that a single value of dose could be derived that reflects the harm caused by the induction of
stochastic effects, irrespective of the dose distribution throughout the body. In other words,
the effective dose from a given dose distribution within the body is the single dose value that
corresponds to a uniform whole body dose that would cause the same total detriment. Thus,
the weighting factor took account of the probability of fatal cancer, the probability of non-fatal
cancer, weighted for severity, and the average length of life lost due to an induced cancer. It
also included a contribution for severe hereditary disorders.
R48 Topical Review

Table 3. Recommended tissue weighting factors.

Tissue weighting Sum of

Tissue factor, wT wT values
Bone marrow (red), colon, lung, stomach, 0.12 0.72
breast, remainder tissuesa
Gonads 0.08 0.08

Bladder, oesophagus, liver, thyroid 0.04 0.16

Bone surface, brain, salivary glands, skin 0.01 0.04

Total 1.00
aRemainder tissues: adrenals, extrathoracic (ET) region, gall bladder, heart, kidneys, lymphatic
nodes, muscle, oral mucosa, pancreas, prostate ( ), small intestine, spleen, thymus and
uterus/cervix ( ).

The revised values of wT given in the new recommendations and reproduced in table 3
were derived from epidemiological studies on cancer induction in exposed populations and
assessments of the risk of heritable effects. They represent mean values for humans averaged
over both sexes and all ages and thus they do not relate to the characteristics of particular
individuals. Two changes from the values given in the previous recommendations are noted.
First, more tissues have been included (12 in the 1990 recommendations, 14 in the new
recommendations, the additional two being brain and salivary glands). Second, the wT value
assigned to gonads has been reduced reflecting the reduced significance of hereditary disorders
(the 1990 value was 0.20); that for breast has been increased (the 1990 value was 0.05).

3.3. Determination of equivalent and effective dose

The unit of both the equivalent dose and effective dose is joules per kilogram (J kg−1)
which, for these quantities, has been given the special name sievert (Sv). Neither though
is measurable and their values are generally determined using coefficients relating them to
measurable quantities. For the calculation of conversion coefficients for external exposure,
computational phantoms were used for dose assessment in various radiation fields (ICRP
1996a). For the calculation of dose coefficients from intakes of radionuclides, biokinetic
models for radionuclides, reference physiological data, and computational phantoms were
used (ICRP 1994a, 1996b). In the new recommendations, ICRP has again used reference
computational phantoms of the adult Reference Male and adult Reference Female for the
calculation of equivalent doses to organs and tissues but these phantoms were based on
medical tomographic images. The three-dimensional volume pixels (voxels) that make up
defined organs have been adjusted to approximate the organ masses assigned to the Reference
Male and Reference Female (ICRP 2002). These models are to be used to compute the mean
absorbed dose in an organ or tissue from reference radiation fields external to the body and
from decay of radionuclides after incorporation. They are also to be used for calculations of
dose conversion coefficients for external radiation fields and dose coefficients for the intake
of radionuclides. These organ and tissues doses are then to be multiplied with the radiation
weighting factor to yield the equivalent doses in the tissues and organs of the Reference Male
and the Reference Female. For radiological protection purposes, the doses to the Reference
Male and Reference Female are to be averaged and the sum over all relevant organs of the
products of these equivalent doses and the tissue weighting factors, which are themselves
averaged over both sexes, gives the effective dose.
Topical Review R49

For radiation fields outside the body, the measurable quantities are called operational
quantities and these have been recommended by the International Commission on Radiation
Units and Measurements (ICRU 1985). The operational quantities for area monitoring are
the ambient dose equivalent, H∗(10) and the directional dose equivalent, H (0.07,
). The
operational quantity for individual monitoring is the personal dose equivalent, HP(d), which is
the dose equivalent in ICRU (soft) tissue at an appropriate depth, d, below a specified point on
the human body. The specified point is normally taken to be where the individual dosemeter
is worn. For the assessment of effective dose, HP(10) with a depth of d = 10 mm is chosen
and for the assessment of the dose to the skin and to the hands and feet, the personal dose
equivalent, HP(0.07) with a depth d = 0.07 mm is used. In routine monitoring, the values of
these operational quantities are taken as sufficiently precise assessments of the effective dose
and the equivalent dose to the skin, respectively, in particular, if their values are below the
protection limits.
The equivalent or effective dose from the intake of radioactive material is calculated using
dose coefficients (doses per unit intake, Sv Bq−1). The intake can be estimated from direct
measurements (e.g. external monitoring of the whole body or of specific organs), indirect
measurements (e.g. of urine or faeces), or measurements on environmental samples, and
the application of biokinetic models. Dose coefficients have previously been calculated for
members of the public of various ages and for adults who are occupationally exposed to
radiation (ICRP 1994a, 1996a). The changes in models and tissue weighting factors will
however necessitate the calculation of new dose coefficients to replace these values, which
have been reproduced in the international requirements (IAEA 1996, Council of the European
Union 1996). However, in view of the uncertainties involved in the assessment of equivalent
and effective dose, it is doubtful whether these changes in weighting factors and models
will have a significant effect on radiological protection and ICRP does not recommend that
the doses that have already been assessed should be re-computed using the new models and
parameters.
For occupational exposure, ICRP has recommended that the value of HP(10) given by an
individual dosemeter should be used to assess the effective dose under the assumption that the
body has been uniformly exposed. Internal exposure (committed effective dose to 50 years) is
generally determined from assessments of intakes and the appropriate dose coefficients. The
commitment period of 50 years is taken as representative of the possible period over which a
worker will accumulate dose following intake. It is however only relevant for radionuclides
with long half lives and long retention times in the body. The external and internal doses can
be summed to give the total effective dose, which is needed for demonstrating compliance
with the relevant dose limit.
A similar approach is used for estimating the effective doses to members of the public.
However, such doses are not normally assessed directly but rather are determined by effluent
and environmental measurements, habit data and the use of appropriate models of exposure
pathways.
Regarding the exposure of patients undergoing medical diagnosis, ICRP notes that the
‘use of effective dose for assessing the exposure of patients has severe limitations that must
be considered when quantifying medical exposure’, although it may be useful for ‘comparing
doses from different diagnostic procedures and for comparing the use of similar technologies
and procedures in different hospitals and countries as well as the use of different technologies
for the same medical examination’. For planning the exposure of patients and for risk–
benefit assessments, ICRP recommends the use of the equivalent dose or the absorbed dose to
irradiated tissues.
R50 Topical Review

3.4. Use of effective dose and collective dose

The effective dose provides a measure of radiation detriment for protection purposes. It can be
used for planning purposes; it is also one of the quantities in which dose limits are expressed
(the other is the equivalent dose), but it needs to be used with care and, as a consequence,
ICRP gives some warnings over its use. It does not, for example, provide an individual-specific
dose but rather a dose to a Reference Person under a given exposure situation. In particular,
it should not be used for epidemiological evaluations nor for detailed specific retrospective
investigations of individual exposure; specific estimates of the doses to organs or tissues are
needed for assessing the probability of cancer induction. In addition, effective dose (and
equivalent dose, for that matter) is inappropriate for assessing deterministic effects (tissue
reactions); in such situations, it is necessary to estimate the absorbed dose and take into
account the appropriate RBE of the radiation.
In principle, if the risks of deleterious effects of radiation exposure increase linearly with
dose and there is no threshold, then the sum of the doses received by all of the people exposed
from a particular source should give a measure of the detriment associated with that source. It
is on that basis that ICRP, many years ago (ICRP 1977), established the concept of ‘collective
dose’. Thus, the collective effective dose, S, to a population can be defined as
S = i Ei Ni
where Ei is the average effective dose in the population subgroup i and Ni is the number of
individuals in this subgroup. The special unit of the collective effective dose is the man sievert
(man Sv).
The main use of collective effective dose is in the optimization of radiological protection
and is therefore for planning purposes. For example, the collective effective doses from
different options can be compared in order to select the most appropriate, taking account of
the other factors associated with each option. However, its use in this context comes with
a caution. ICRP states that ‘to avoid inappropriate aggregation of, e.g., very low individual
doses over extended time periods and wide geographical regions, limiting conditions need to
be set. The dose range and the time period should be stated’. This is particularly important
when consideration is being given to different waste management options. Furthermore, as
with effective dose, ICRP indicates that it is inappropriate to use collective effective dose in
epidemiological studies and in assessing actual risk. It should certainly not be used to calculate
the hypothetical number of cases of cancer or heritable disease that might be associated with
very small radiation doses received by large numbers of people over very long periods of time.

4. System of radiological protection

The systems of control—regulatory or otherwise—in most countries throughout the world are
currently based on the sub-division of activities into ‘practices’ and ‘intervention’ introduced
in the 1990 ICRP recommendations (ICRP 1991). A practice was defined as a human activity
that increases the overall exposure to radiation; intervention was defined as a human activity
that decreases the overall exposure. The introduction of any new source of radiation, such as
an x-ray set, would clearly fall under the definition of a practice; activities intended to reduce
exposure following an accidental release of radioactive material would clearly fall under the
definition of intervention. The three well-known principles of justification, optimization of
protection and dose limits applied to practices. Justification, in the sense of doing more good
than harm, and optimization of protection also applied to intervention, but dose limits did
not.
Topical Review R51

A number of problems arose with these two terms, although the reasons for the distinction
between them were generally clear to the professionals in the field. The first problem was
that ICRP had given a specific meaning to the term ‘practice’, which could cause confusion
with the much more general use of the word. Second, there were some situations, particularly
some involving exposure to natural sources of radiation, which did not readily fall into either
category. Flying in aircraft increases a person’s exposure to cosmic rays, so might be regarded
as a practice; living indoors generally causes an increase in a person’s exposure to radon decay
products, but all that can be done when the exposures are unreasonably high is to attempt
to reduce them (i.e. to intervene). These difficult cases could—perhaps, should—have been
solved by administrative decision and generally they have been.
The third problem was that the approach in some cases was not readily communicable to
members of the public. For example, people living in areas contaminated as a consequence of
the Chernobyl accident may not have understood why it was acceptable for them to receive
doses from that source in the long term that were higher than the actual dose limit for public
exposure. In ICRP’s words, ‘the distinction between practices and interventions may not have
been clearly understood in the wider radiological protection community. Additionally, there
were exposure situations which were difficult to categorize in this manner’.
Quite rightly, ICRP now states that ‘The Commission has aimed to make its
recommendations applicable as widely and as consistently as possible. In particular, the
Commission’s recommendations cover exposures to both natural and man-made sources. The
recommendations can apply in their entirety only to situations in which either the source of
exposure or the pathways leading to the doses received by individuals can be controlled by
some reasonable means. Sources in such situations are called controllable sources’. The terms,
practice and intervention, do in fact embody the concept of controllable sources. However,
while retaining the terms, practice and intervention, ICRP now defines three new types of
exposure situations to which its recommendations are to be applied, namely, planned exposure
situations which involve the deliberate introduction and operation of sources; emergency
exposure situations, which require urgent action in order to avoid or reduce undesirable
consequences; and existing exposure situations, which include prolonged exposure situations
after emergencies. Whether these terms do in fact reduce the confusion as well as assisting in
fulfilling the purpose of the ICRP recommendations, which is ‘to be of help to regulatory and
advisory agencies at national, regional and international levels, mainly by providing guidance
on the fundamental principles on which appropriate radiological protection can be based’,
will, no doubt, become clear over the next few years as the bodies concerned get to grips with
the new recommendations.
The principles of protection remain as previously: justification and optimization apply
to all three exposure situations; dose limits apply only to planned exposure situations, except
those involving medical exposure of patients. ICRP also concludes that the slight differences
in nominal detriment coefficients for both workers and the general public are of no practical
significance and therefore retains the dose limits given in its 1990 recommendations (ICRP
1991). The limits are reproduced in table 4.
The limits on effective dose relate to the sum of the relevant effective doses from external
exposure in the specified time period and the committed effective dose from intakes of
radionuclides in the same period. For adults, the committed dose is computed for a 50-year
period after intake, whereas for children it is computed for the period up to age 70 years. The
dose to skin is averaged over 1 cm2 regardless of the area exposed.
Additional restrictions apply to the occupational exposure of pregnant women. If a female
worker has declared that she is pregnant, ICRP has recommended that the level of protection
for the embryo/fetus should be broadly similar to that provided for members of the public.
R52 Topical Review

Table 4. Recommended dose limits in planned exposure situations.

Type of limit Occupational, mSv in a year Public, mSv in a year

Effective dose 20, averaged over 5 years, 1 (exceptionally, a higher value of effective dose
with no more than 50 mSv could be allowed in a year provided that the average over
in any 1 year 5 years does not exceed 1 mSv in a year)
Equivalent dose to 150 15
lens of the eye
Equivalent dose to skin 500 50
Equivalent dose to 500 –
hands and feet

4.1. Dose constraints and reference levels

Dose constraints and reference levels together probably represent the most significant
presentational change in the new recommendations, and it is the use of these two terms
that reflect above all else ICRP’s attempt to provide a system of radiological protection
that is both coherent and holistic. The term ‘dose constraint’4 was introduced in the 1990
recommendations. The stated function was ‘to limit the inequity likely to result from the
inherent economic and social judgements’ in the optimization of protection in practices. In
essence, therefore, the dose constraint restricts the range of options that should be considered
in the optimization process. In the case of public exposure, it provides for the possibility that
a member of the public could be exposed to be a number of separate sources and still remain
within the overall dose limit. The dose constraint might therefore be used by a regulatory
body as the basis for establishing authorized limits for the discharge of radioactive material
to the environment. In the case of occupational exposure, where workers (except mainly
itinerant workers) are normally exposed to only one significant source, such a restriction is not
necessary to ensure that the doses remain within the dose limit. However, the dose constraint
can be set taking account of experience in similar operations and is therefore useful in that it
helps to focus the attention on good management of the exposure of workers. It can therefore
be a useful tool in the design of facilities and in the planning of operations. These concepts
were further developed in subsequent ICRP publications, for example, Publication 75, which
deals with occupational protection (ICRP 1997), and Publication 77, which deals with waste
(ICRP 1998).
Although the ICRP in its 1990 recommendations used the term in the context of medical
exposure of patients, it was subsequently changed to guidance or diagnostic reference level
in the international requirements (IAEA 1996, Council of the European Union 1997, ICRP
1996c). While still being seen as part of the principle of optimization of protection, the
guidance or reference level was not intended to be used to limit the range of options available,
but rather to act as a benchmark figure against which doses from common diagnostic procedures
could be compared. Three statements illustrate the use of this level: ‘they should be applied
with flexibility to allow higher doses where indicated by sound clinical judgement’ (ICRP
1991); ‘in some circumstances, actions may need to be considered when the specified quantity
is substantially below the guidance level’ (IAEA 1996); ‘reviews [should] be considered if
4 The term ‘risk constraint’ was also introduced in the 1990 ICRP recommendations (1991). Thus dose constraints

relate to exposures normally or routinely received, while risk constraints relate to potential exposures (i.e. those that
are not expected to be delivered with certainty but may result from an accident or other event of a probabilistic nature).
The concept of risk constraint is not considered further in this review, although the new recommendations do also
deal with the concept.
Topical Review R53

doses or activities exceed the guidance levels as an input to ensuring optimized protection of
patients and maintaining appropriate levels of good practice’ (IAEA 1996).
During the developmental stage of the new recommendations, much discussion was given
to the use of the term ‘dose constraints’. There were those who saw the concept, in some
way or other, as underpinning radiological protection in all areas and therefore wished to
see the term used in protection in emergency and existing exposure situations. This however
was not universally welcomed because it was felt that it would have further broadened the
meaning of a term which already meant somewhat different things in the contexts of public
and occupational exposure. In the event, the ICRP, in its new recommendations, retains the
term only for planned exposure situations involving occupational or public exposure with the
same meanings as given to it previously.
For the medical exposure of patients, the ICRP now uses the term ‘diagnostic reference
levels’. Rather than having the function of limiting the range of options in the process of
optimization of protection, the term is to be used ‘to indicate whether, in routine conditions,
the levels of patient dose or administered activity from a specified imaging procedure are
unusually high or low for that procedure. If so, a local review should be initiated to determine
whether protection has been adequately optimized or whether corrective action is required’.
Too high a dose may result in an image of desired quality, but could mean that the patient had
received more dose than necessary; too low a dose could mean that the desired image quality
has not been obtained and therefore the benefit to the patient not maximized.
The ICRP uses the term ‘reference level’ in the context of emergency and existing exposure
situations ‘for the restriction on dose or risk, above which it is judged to be inappropriate
to plan to allow exposures to occur, and below which optimization of protection should
be implemented’. Defined in this way, it is clear why the ICRP wished to use the all-
encompassing term of dose constraint for all exposure situations—planned (except medical
exposure of patients), emergency and existing. In all these cases, options resulting in doses
greater in magnitude than the dose constraint or reference level should be rejected at the
planning stage.

4.2. Numerical values

As part of the development of the new recommendations, the ICRP undertook a review of the
numerical values that it had produced in the 1990 recommendations and subsequent reports.
It concluded that altogether some 30 different numerical values for restrictions on individual
dose had been introduced for differing circumstances. Furthermore, these numerical values
had been justified in many different ways (ICRP 2006). With the definitions given in the
new recommendations, these values would be regarded as dose constraints or reference levels
according to the circumstance. As a consequence of this review, the ICRP recommends that
all of these numbers could be rationalized in terms of three bands of dose constraints and
reference levels. These bands are given in summary form in table 5. The upper end of the top
band was set based on considerations of deterministic effects (harmful tissue reactions). The
upper ends of the other two bands are equivalent to the dose limits for workers and the public,
respectively.
The lower band relates to public exposure from planned exposure situations and is entirely
consistent with earlier guidance from ICRP. In particular, ICRP has previously recommended
a value for the dose constraint for members of the public from waste management operations
of no more than 0.3 mSv in a year (ICRP 1998). For situations of prolonged exposure, the
ICRP recommended a value of 0.1 mSv in a year (ICRP 1999).
R54 Topical Review

Table 5. Framework for dose constraints and reference levels.

Bands of effective dose,
mSv (acute or annual) Characteristics Requirements Examples
20–100 Controlled by action Consider reducing Reference level for
on exposure pathway doses radiological emergency

1–20 Controlled by action For planned exposure Constraints for

on source or situations, individual dose occupational
exposure pathway assessment and training exposure
Constraints for comforters and
carers of patients treated with
radiopharmaceuticals
Reference level for
radon in dwellings

<1 Controlled by Periodic checks Constraints for

action on on exposure public exposure in
source pathway planned situations

The middle band relates to all exposure situations—planned, emergency and existing—
and some care may be needed to avoid confusion. Dose constraints for occupational exposure
from planned exposure situations should be below the average dose limit of 20 mSv in a year
and based on well-designed or well-managed operations and this has already been established
in previous ICRP guidance (ICRP 1997). Similarly, dose constraints for those who comfort
and care for patients (not those occupationally exposed, but friends and members of the family)
recommended by the ICRP are of the order of a mSv or so up to 5 mSv per episode (ICRP
2004).
Previously, the ICRP has defined action levels for radon in dwellings (ICRP 1994b). It
recommended that remedial measures would almost always be justified above a continued
annual effective dose of 10 mSv. However, remedying high levels of radon in dwellings can
involve simple measures, and where this is the case ICRP recommended the use of a lower
level. It concluded that ‘the choice of action level for annual effective dose is thus limited
to the range of about 3–10 mSv’ and ‘that the action level should be set within this range by
the appropriate authorities’. It also noted that ‘the best choice of an action level may well
be that level which defines a significant, but not unmanageable, number of houses in need of
remedial work. It is then not to be expected that the same action level will be appropriate in all
countries’ (ICRP 1991). Thus, the range of action levels previously recommended fall within
the middle band.
The upper band relates to reference levels for emergency exposure situations. The
intervention levels given previously by ICRP for emergency exposure situations (ICRP 1993)
however relate to the dose to be averted by the countermeasure (averted dose is the dose
reduction that is to be achieved by the intervention) whereas the dose bands in the above table
relate to residual effective dose. The level at which sheltering would almost always be justified
was an effective dose of 50 mSv (ICRP 1993); that for iodine prophylaxis was an equivalent
dose to the thyroid of 500 mSv; and that for evacuation was an effective dose of 500 mSv or
an equivalent dose to the skin of 5 Sv. In all cases, the range of optimized values would not
be more than a factor of 10 lower.
During the consultation period, comments were made regarding the disparity in the
quantities used in the table compared with those used in earlier ICRP publications—acute or
Topical Review R55

annual projected or residual effective doses in the consultation version of the table, compared
with averted effective or equivalent doses in the previous guidance. The ICRP in its new
recommendations notes however that ‘during emergency response, the reference level would
act as a benchmark for evaluating the effectiveness of protective actions and as one input into
the need for establishing further actions’. Even so, it retains the concept of averted dose and
considers that this is ‘the concept for the optimization of the individual protective measures
. . . that will make up the overall protection strategy’. Reconciliation of this disparity is a
complicated matter and no doubt will be one of the matters that an ICRP Task Group now
working on emergency exposure situations will consider in due course. In particular, further
clarification on how reference levels for emergency response can be used practically will be
necessary.

5. Application to the medical field

The medical exposure of patients for diagnostic purposes has attracted considerable attention
by the radiological protection community in recent decades. It is, on average, by far the largest
contributor to human exposure from all artificial sources of radiation. Overall, it accounts
for about 14% of the total per caput effective dose, whereas all other sources account for less
than 1% of the total, the remaining 85% being due to natural sources (UNSCEAR 2000)5 .
The average percentage for medical exposure of patients however conceals the substantial
variations that exist between procedures and, more importantly from the point of view of
protection, the substantial variations within a given procedure between different countries and
different hospitals within a country. It has been realized for some time now that there is ample
scope for dose reduction in diagnostic radiology while ensuring that the required information
is obtained. ICRP has been particularly active in producing practical guidance for the medical
community, with the optimization of protection being the primary aim (ICRP 1996c, 2000a,
2001b, 2003c). In addition, guidance has also been provided on the prevention of accidents in
radiotherapy and interventional radiology (ICRP 2000b, 2000d, 2005b).
Medical exposure is actually a term that the ICRP uses to cover more than the exposure
of patients for diagnostic, interventional or therapeutic purposes. It includes exposure of the
embryo/fetus or infant during medical exposure of patients who are pregnant or breast-feeding,
exposure (other than occupational) incurred knowingly and willingly by individuals such as
family and close friends helping either in hospital or at home in the support and comfort of
patients undergoing diagnosis or treatment, and exposures incurred by volunteers as part of a
programme of biomedical research that provides no direct benefit to the volunteers. The focus
here is on the medical exposure of patients themselves.
The new recommendations retain much of what has been given previously, which placed
emphasis on the importance of justification and the optimization of protection. Limitation of
the dose to the individual patient is not however recommended because it may, by reducing
the effectiveness of the patient’s diagnosis or treatment, do more harm than good.
The ICRP considers that the justification principle operates on three levels—the
justification of the use of radiation in medicine in general; the justification of a specified
procedure with a specified objective and the justification for applying that procedure to an
individual patient. The first level of justification can now be taken for granted leaving it
necessary to discuss only the other two levels. The aim of the second level of justification is
5 The detriment associated with a given effective dose to patients, workers or the public in general will differ because

of differences in the characteristics (age, sex, health status) of the exposed populations. Thus, the comparison here
is only intended to provide a rough indication of the relative importance of medical exposure compared with other
sources of exposure.
R56 Topical Review

to judge whether the radiological procedure will usually improve the diagnosis or treatment or
will provide necessary information about the exposed individual. This is a matter for national
and international professional bodies, in conjunction with national health and radiological
protection authorities and the corresponding international organizations. The third level
involves consideration of whether the particular application should be judged to do more good
than harm to the individual patient. ICRP recommends that a check should first be made that
the required information is not already available and the proposed examination is the most
suitable method. This is particularly important with high-dose examinations. ICRP also notes
that ‘it will often be possible to speed up the procedure by defining referral criteria and patient
categories in advance’. The advice given by ICRP regarding the third level of justification
is eminently sensible, perhaps at first sight too obvious, but it needed to be stated because
experience shows that this third level of justification is not always done.
As far as optimization of protection is concerned, ICRP emphasizes the use of diagnostic
reference levels, as noted above. It recommends that values should be selected by professional
medical bodies in conjunction with national health and radiological protection authorities on
the basis of a percentile point on the observed distribution of doses to patients or to a reference
patient. It notes that they could be specific to a country or region but should be expressed in
readily measurable quantities related to patient dose for the specified procedure.
One issue highlighted in the new recommendations is the management of pregnant
patients. This is particularly important because there have been cases where a woman, on
discovering, after a diagnostic procedure, that she was pregnant has sought an abortion. The
IAEA in particular has established a web site, one of the purposes of which is make information
available to the medical profession and patients on the risks associated with fetal/embryo
irradiation (see http://rpop.iaea.org). ICRP stresses that it is important to determine whether
a female patient is pregnant before undertaking any procedure involving ionizing radiation.
It notes however that ‘prenatal doses from most correctly performed diagnostic procedures
present no measurably increased risk of prenatal or postnatal death, development damage . . .
or impairment of mental development . . . [however] higher doses such as those involved in
therapeutic procedures have the potential to result in developmental harm’. Detailed guidance
on the management of pregnant patients is given in an earlier ICRP publication (ICRP 2000c).
On the specific issue of termination of pregnancy, ICRP reiterates its previous guidance
(ICRP 2003b). In particular, it states that ‘absorbed doses below 100 mGy to the embryo/fetus
should not be considered a reason for terminating a pregnancy’. Above this level, ‘the pregnant
patient should receive sufficient information to be able to make informed decisions based upon
individual circumstances, including the magnitude of the estimated embryonic/fetal dose and
the consequent risks of serious harm to the developing embryo/fetus and risks of cancer in
later life’.
All of these matters—the justification of patient exposure, the optimization of protection
and the management of pregnant patients—require those involved in patient care to be
appropriately trained and, quite rightly, ICRP emphasizes this: ‘The physicians and other
health professionals involved in the procedures that irradiate patients should always be trained
in the principles of radiological protection, including the basis principles of physics and
biology. The final responsibility for the medical exposure of patients lies with the physician,
who therefore should be aware of the risk and benefits of the procedures involved’.

6. Protection of the environment

The protection of the environment is a difficult and, at times, an emotional issue. In its
previous recommendations, the ICRP stated ‘the Commission believes that the standard of
Topical Review R57

environmental control needed to protect man to the degree currently thought desirable will
ensure that other species are not put at risk. Occasionally, individual members of non-human
species might be harmed, but not to the extent of endangering whole species or creating
imbalance between species’. However, the interest in environmental protection has greatly
increased since those recommendations were produced and the ICRP now sees the need to
develop advice and guidance on the matter, even though there are no ‘new or specific concerns
about the effects of radiation on the environment’. There is also a need for more explicit
demonstration of the validity of the previously-made statement.
The new recommendations, rather than providing the needed advice and guidance, indicate
the ICRP’s intention in dealing with the matter. It intends to develop a clearer framework ‘in
order to assess the relationships between exposure and dose, and between dose and effect, and
the consequences of such effects, for non-human species, on a common scientific basis’. Its
initial thoughts were given in an earlier publication (ICRP 2003d). The framework will be
developed through the establishment of relevant data for a small set of reference animals and
plants that are typical of ‘the major environments’. At this stage, however, the ICRP does not
propose to set any form of ‘dose limits’ with respect to environmental protection.

7. Conclusions

The ICRP, after reviewing the available biological and epidemiological information on the
effects of exposure to ionizing radiation, has retained its basic assumption of linearity of dose
and effect for cancer induction and heritable effects. At low levels of dose, the combined
detriment from these effects has remained unchanged at around 5% per Sv. In addition,
the ICRP has maintained its three fundamental principles of radiological protection, namely
justification, optimization of protection and the application of dose limits. Because there has
been no change in the risk factor, the effective dose limits have remained unchanged. The
equivalent dose limits have also remained as previously. This is unlike the situation with the
1990 recommendations which were developed following a significant increase in the assessed
risk factor for stochastic effects.
The main changes that have been introduced in the new recommendations are of two
types, enumerated below. In addition, the new recommendations reinforce the principle of
optimization of protection and include an approach for developing a framework to demonstrate
radiological protection of the environment.
The first main change is in the factors and models used to calculate the protection
quantities, effective dose and equivalent dose. Thus, following a substantial review of
the biological and physical information on exposure to ionizing radiation, the ICRP has
made some adjustments to the values of radiation and tissue weighting factors, wR and wT .
The radiation weighting factors, wR , for photons, electrons, muons and alpha particles have
remained unchanged, but the values for neutrons are now given as a continuous curve rather
than the previous step function and a value for pions has been introduced. The tissue weighting
factor, wT , for breast has been increased while that for gonads has been decreased, the former
reflecting the increase in the risk factor for this tissue and the latter reflecting the fact that
the estimated risk of heritable effects is currently lower than before. In addition, the ICRP
now recommends the use of computational phantoms of the human body for the calculation
of external and internal dose. These changes will necessitate recalculation of the relevant
conversion coefficients, although the impact is unlikely to be substantial and the ICRP advises
against the recalculation of any doses received in the past.
The second main change is in the presentation of the approach to radiological protection,
the desire being to make the system of protection more communicable and streamlined. The
R58 Topical Review

ICRP’s recommendations and guidance have, for many years, been focused on those exposures
that can be regarded as reasonably controllable, rather than just those from sources that have
introduced by humans. In its 1990 recommendations, it used the concepts of ‘practice’
and ‘intervention’ to reflect this, a practice being a process (the introduction of a source)
whereby exposure is increased and intervention being the process for reducing exposures
when the benefits outweigh the harm. The ICRP now uses a ‘situation-based approach’ and
has replaced the previous categorization into practices and intervention by defining three
exposure situations, namely, planned, emergency and existing. But the objective remains—
to focus attention on those exposures that can reasonably be controlled. The principles of
justification and optimization of protection apply to all situations; dose limits only apply to
planned exposure situations, other than medical exposure of patients.
The principle of optimization of protection has been reinforced through the emphasis
given to the use of restrictions on doses to individuals in all three exposure situations—either
dose constraints for planned exposure situations (except medical exposure of patients) or
reference levels for emergency and existing exposure situations. These dose constraints and
reference levels have been grouped into three bands of effective dose and ICRP’s view is
that these bands accommodate the 30 or so values of dose restrictions given in the previous
recommendations and subsequent guidance.
The use of dose constraints in planned exposure situations is entirely consistent with
the previous recommendations, which used the concept in the optimization of protection in
practices. However, some difficulties arise in the introduction of the concept of reference
levels for emergency exposure situations. In earlier guidance, the ICRP gave ranges of
intervention levels for defined countermeasures in an emergency within which levels were
to be selected. These intervention levels however were defined in terms of the effective or
equivalent dose averted by the particular countermeasure. However, the reference levels in
the new recommendations are given in terms of residual effective dose. No doubt, this matter
will be addressed in subsequent guidance that the ICRP is currently developing.
In recent years, the ICRP has produced a great deal of much needed advice and guidance
in the medical field. The new recommendations have consolidated this rather than added to it.
Because of the scope for dose reduction in diagnosis without loss of diagnostic information
and for the prevention of injuries in interventional radiology and accidents in radiotherapy,
this remains a very important area of work and the emphasis given to the protection of the
patient in the new recommendations should therefore be welcomed.
The development of a policy on protection of the environment will not be straightforward,
although undoubtedly, there are many lessons that can be drawn from the system of protection
for humans. However, the ICRP has made a useful start by developing a framework to
demonstrate radiological protection of the environment.
Overall, these new recommendations are more a matter of consolidation of the previous
recommendations and subsequent guidance, any changes that have been introduced being more
second order in nature than fundamental. The fact that this is so should provide confidence
that the system of protection established in ostensibly its present form several decades ago
has reached a certain level of maturity and remains appropriate and therefore that no major
changes in the systems of control of radiation exposure that have been established throughout
the world would appear to be necessary. As the ICRP itself states it, ‘the Commission
anticipates that although the revised recommendations do not contain any fundamental changes
to the radiological protection policy, these recommendations will help to clarify application of
the system of protection in the plethora of exposure situations encountered, thereby improving
the already high standards of protection’ and ‘these revised recommendations should not imply
Topical Review R59

any substantial changes to radiological protection regulations that are based on its previous
recommendations and subsequent policy guidance’.
Whether changes will in fact be necessary to the international requirements and national
regulations will no doubt become clear over the next few years. If the main thrust of the new
ICRP recommendations has been more on producing a more streamlined presentation, the
question that will need to be asked is whether the current requirements and regulations are
already sufficiently clear and streamlined themselves. The new recommendations will however
provide an opportunity for those requirements and regulations to be reviewed more generally,
taking account of the experience gained in implementing them and other developments. After
all, all such requirements and regulations should be reviewed from time to time and revised as
appropriate. A careful judgement will be required in which there will need to be a balancing of
the need for stability in control systems and the costs and benefits involved in change. Particular
thought will need to be given to the interests of developing countries, many of which have
devoted considerable effort over the last 10 or more years to bringing their radiation safety
infrastructures up to date with the international requirements.

Acknowledgments

The author is grateful to Jack Valentin, Secretary of the ICRP, for providing him with a pre-
publication copy of the ICRP recommendations and to him and many other colleagues within
the ICRP family and in the Radiation, Transport and Waste Safety Division of the IAEA for
useful discussions during the development of the new recommendations and in the preparation
of this review. The views however are entirely those of the author.

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