Miner studies and radiological protection against radon.

Fundamental estimates of radon-associated health risk have been provided by epidemiological studies of miners. In total, approximately 15 studies have been conducted worldwide since the 1960s. These results have contributed directly to radiological protection against radon. The present article summarises the main results, with a focus on analyses of miners exposed more recently, estimates of radon lifetime attributable risk, and interaction between radon and smoking. The potential for the upcoming Pooled Uranium Miner Analysis project to further improve our knowledge is discussed.

ICRP recommendations on radon.

The International Commission on Radiological Protection (ICRP) publishes guidance on protection from radon in homes and workplaces, and dose coefficients for use in assessments of exposure for protection purposes. ICRP Publication 126 recommends an upper reference level for exposures in homes and workplaces of 300 Bq m-3. In general, protection can be optimised using measurements of air concentrations directly, without considering radiation doses. However, dose estimates are required for workers when radon is considered as an occupational exposure (e.g. in mines), and for higher exposures in other workplaces (e.g. offices) when the reference level is exceeded persistently. ICRP Publication 137 recommends a dose coefficient of 3 mSv per mJ h m-3 (approximately 10 mSv per working level month) for most circumstances of exposure in workplaces, equivalent to 6.7 nSv per Bq h m-3 using an equilibrium factor of 0.4. Using this dose coefficient, annual exposure of workers to 300 Bq m-3 corresponds to 4 mSv. For comparison, using the same coefficient for exposures in homes, 300 Bq m-3 corresponds to 14 mSv. If circumstances of occupational exposure warrant more detailed consideration and reliable alternative data are available, site-specific doses can be assessed using methodology provided in ICRP Publication 137.

The Mayak Worker Dosimetry System (MWDS-2013): How to Weight the Absorbed Dose to Different Lung Regions in the Calculation of Lung Dose.

In the Mayak Worker Dosimetry System-2013, lung dose is calculated as an average of the three absorbed doses to the bronchial, the bronchiolar and the alveolar regions. Previous epidemiological studies involving Mayak Workers have used a lung dose calculated as the total energy deposited in the lungs divided by the mass. These two definitions lead to very different estimates of lung dose, especially for radon dosimetry. This paper uses the results of recent epidemiological studies to justify the use of a regionally weighted lung dose (wi = 1/3, I = 1, 3) over the use of an 'average lung' dose.

TECHNICAL RECOMMENDATIONS FOR MONITORING INDIVIDUALS FOR OCCUPATIONAL INTAKES OF RADIONUCLIDES.

The TECHREC project, funded by the European Commission, will provide Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides It is expected that the document will be published by the European Commission as a report in its Radiation Protection Series during 2016. The project is coordinated by the European Radiation Dosimetry Group (EURADOS) and is being carried out by members of EURADOS Working Group 7 (Internal Dosimetry). This paper describes the aims and purpose of the Technical Recommendations, and explains how the project is organised.

EURADOS-IDEAS GUIDELINES (VERSION 2) FOR THE ESTIMATION OF COMMITTED DOSES FROM INCORPORATION MONITORING DATA.

Dose assessment after intakes of radionuclides requires application of biokinetic and dosimetric models and assumptions about factors influencing the final result. In 2006, a document giving guidance for such assessment was published, commonly referred to as the IDEAS Guidelines. Following its publication, a working group within the European networks CONRAD and EURADOS was established to improve and update the IDEAS Guidelines. This work resulted in Version 2 of the IDEAS Guidelines, which was published in 2013 in the form of a EURADOS report. The general structure of the original document was maintained; however, new procedures were included, e.g. the direct dose assessment method for (3)H or special procedure for wound cases applying the NCRP wound model. In addition, information was updated and expanded, e.g. data on dietary excretion of U, Th, Ra and Po for urine and faeces or typical and achievable values for detection limits for different bioassay measurement techniques.

Liver preservation with machine perfusion and a newly developed cell-free oxygen carrier solution under subnormothermic conditions.

We describe a new preservation modality combining machine perfusion (MP) at subnormothermic conditions(21 °C) with a new hemoglobin-based oxygen carrier (HBOC) solution. MP (n=6) was compared to cold static preservation (CSP; n=6) in porcine orthotopic liver transplants after 9 h of cold ischemia and 5-day follow-up. Recipients' peripheral blood, serial liver biopsies, preservation solutions and bile specimens were collected before, during and after liver preservation. Clinical laboratorial and histological analyses were performed in addition to mitochondrial functional assays, transcriptomic, metabolomic and inflammatory inflammatory mediator analyses. Compared with CSP, MP animals had: (1) significantly higher survival (100%vs. 33%; p<0.05); (2) superior graft function (p<0.05);(3) eight times higher hepatic O2 delivery than O2 consumption (0.78 mL O2/g/h vs. 0.096 mL O2/g/h) during MP; and (4) significantly greater bile production (MP=378.5 ± 179.7; CS=151.6 ± 116.85). MP downregulated interferon (IFN)-α and IFN-γ in liver tissue. MP allografts cleared lactate, produced urea, sustained gluconeogenesis and produced hydrophilic bile after reperfusion. Enhanced oxygenation under subnormothermic conditions triggers regenerative and cell protective responses resulting in improved allograft function. MP at 21 °C with the HBOC solution significantly improves liver preservation compared to CSP.

Mortality from internal and external radiation exposure in a cohort of male German uranium millers, 1946-2008.

PURPOSE: To examine exposure-response relationships between ionizing radiation and several mortality outcomes in a subgroup of 4,054 men of the German uranium miner cohort study, who worked between 1946 and 1989 in milling facilities, but never underground or in open pit mines. METHODS: Mortality follow-up was from 1946 to 2008, accumulating 158,383 person-years at risk. Cumulative exposure to radon progeny in working level months (WLM) (mean = 8, max = 127), long-lived radionuclides from uranium ore dust in kBqh/m(3) (mean = 3.9, max = 132), external gamma radiation in mSv (mean = 26, max = 667) and silica dust was estimated by a comprehensive job-exposure matrix. Internal Poisson regression models were applied to estimate the linear excess relative risk (ERR) per unit of cumulative exposure. RESULTS: Overall, a total of 457, 717 and 111 deaths occurred from malignant cancer, cardiovascular diseases and non-malignant respiratory diseases, respectively. Uranium ore dust and silica dust were not associated with mortality from any of these disease groups. A statistically significant relationship between cumulative radon exposure and mortality from all cancers (ERR/100 WLM = 1.71; p = 0.02), primarily due to lung cancer (n = 159; ERR/100 WLM = 3.39; p = 0.05), was found. With respect to cumulative external gamma radiation, an excess of mortality of solid cancers (n = 434; ERR/Sv = 1.86; p = 0.06), primarily due to stomach cancer (n = 49, ERR/Sv = 10.0; p = 0.12), was present. CONCLUSION: The present findings show an excess mortality from lung cancer due to radon exposure and from solid cancers due to external gamma radiation in uranium millers that was not statistically significant. Exposure to uranium was not associated with any cause of death, but absorbed organ doses were estimated to be low.

A review of lung-to-blood absorption rates for radon progeny.

The International Commission on Radiological Protection (ICRP) Publication 66 Human Respiratory Tract Model (HRTM) treats clearance of materials from the respiratory tract as a competitive process between absorption into blood and particle transport to the alimentary tract and lymphatics. The ICRP recommended default absorption rates for lead and polonium (Type M) in ICRP Publication 71 but stated that the values were not appropriate for short-lived radon progeny. This paper reviews and evaluates published data from volunteer and laboratory animal experiments to estimate the HRTM absorption parameter values for short-lived radon progeny. Animal studies showed that lead ions have two phases of absorption: ∼10 % absorbed with a half-time of ∼15 min, the rest with a half-time of ∼10 h. The studies also indicated that some of the lead ions were bound to respiratory tract components. Bound fractions, f(b), for lead were estimated from volunteer and animal studies and ranged from 0.2 to 0.8. Based on the evaluations of published data, the following HRTM absorption parameter values were derived for lead as a decay product of radon: f(r) = 0.1, s(r) = 100 d(-1), s(s) = 1.7 d(-1), f(b) = 0.5 and s(b) = 1.7 d(-1). Effective doses calculated assuming these absorption parameter values instead of a single absorption half-time of 10 h with no binding (as has generally been assumed) are only a few per cent higher. However, as there is some conflicting evidence on the absorption kinetics for radon progeny, dose calculations have been carried out for different sets of absorption parameter values derived from different studies. The results of these calculations are discussed.

Note on the autocorrelation coefficient as a test statistic for assessment of the goodness-of-fit of biokinetic models to multiple bioassay data sets.

The European Commission project IDEAS has produced guidelines for internal dose assessments from monitoring data. A key stage in the guidelines requires assessment of the goodness-of-fit of biokinetic models to bioassay data. The present note extends the use of an autocorrelation coefficient to assess the fits of multiple types of bioassay quantity simultaneously.

Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique.

Laparoscopic liver resections are being performed with increasing frequency, with several groups having reported minimally invasive approaches for major anatomic hepatic resections. Some surgeons favor a pure laparoscopic approach, while others prefer a hand-assisted approach for major laparoscopic liver resections. There are clear advantages and disadvantages to a hand-assisted technique. The purpose of this study is to summarize the literature comparing pure laparoscopic and hand-assisted approaches for minimally invasive hepatic resection, and to describe our approach in 432 laparoscopic liver resections.

Effective dose from inhaled radon and its progeny.

Currently, the International Commission on Radiological Protection (ICRP) uses the dose conversion convention to calculate effective dose per unit exposure to radon and its progeny. In a recent statement, ICRP indicated the intention that, in future, the same approach will be applied to intakes of radon and its progeny as is applied to all other radionuclides, calculating effective dose using reference biokinetic and dosimetric models, and radiation and tissue weighting factors. Effective dose coefficients will be given for reference conditions of exposure. In this paper, preliminary results of dose calculations for Rn-222 progeny are presented and compared with values obtained using the dose conversion convention. Implications for the setting of reference levels are also discussed.

Dosimetric calculations for uranium miners for epidemiological studies.

Epidemiological studies on uranium miners are being carried out to quantify the risk of cancer based on organ dose calculations. Mathematical models have been applied to calculate the annual absorbed doses to regions of the lung, red bone marrow, liver, kidney and stomach for each individual miner arising from exposure to radon gas, radon progeny and long-lived radionuclides (LLR) present in the uranium ore dust and to external gamma radiation. The methodology and dosimetric models used to calculate these organ doses are described and the resulting doses for unit exposure to each source (radon gas, radon progeny and LLR) are presented. The results of dosimetric calculations for a typical German miner are also given. For this miner, the absorbed dose to the central regions of the lung is dominated by the dose arising from exposure to radon progeny, whereas the absorbed dose to the red bone marrow is dominated by the external gamma dose. The uncertainties in the absorbed dose to regions of the lung arising from unit exposure to radon progeny are also discussed. These dose estimates are being used in epidemiological studies of cancer in uranium miners.

Occupational dust and radiation exposure and mortality from stomach cancer among German uranium miners, 1946-2003.

OBJECTIVES: 'Dusty occupations' and exposure to low-dose radiation have been suggested as potential risk factors for stomach cancer. Data from the German uranium miner cohort study are used to further evaluate this topic. METHODS: The cohort includes 58 677 miners with complete information on occupational exposure to dust, arsenic and radiation dose based on a detailed job-exposure matrix. A total of 592 stomach cancer deaths occurred in the follow-up period from 1946 to 2003. A Poisson regression model stratified by age and calendar year was used to calculate the excess relative risk (ERR) per unit of cumulative exposure to fine dust or from cumulative absorbed dose to stomach from α or low-LET (low linear energy transfer) radiation. For arsenic exposure, a binary quadratic model was applied. RESULTS: After adjustment for each of the three other variables, a statistically non-significant linear relationship was observed for absorbed dose from low-LET radiation (ERR/Gy=0.30, 95% CI -1.26 to 1.87), α radiation (ERR/Gy=22.5, 95% CI -26.5 to 71.5) and fine dust (ERR/dust-year=0.0012, 95% CI -0.0020 to 0.0043). The relationship between stomach cancer and arsenic exposure was non-linear with a 2.1-fold higher RR (95% CI 0.9 to 3.3) in the exposure category above 500 compared with 0 dust-years. CONCLUSION: Positive statistically non-significant relationships between stomach cancer and arsenic dust, fine dust and absorbed dose from α and low-LET radiation were found. Overall, low statistical power due to low doses from radiation and dust are of concern.

Particle clearance in the alveolar-interstitial region of the human lungs: model validation.

New information on particle retention of inhaled insoluble material indicates that the ICRP Human Respiratory Tract Model (HRTM) significantly underestimates long-term retention in the lungs. In a previous paper, the information from three studies was reviewed, and a model developed to predict particle retention in the lungs of coal miners was adapted in order to obtain parameter values for general use to predict particle retention in the alveolar-interstitial (AI) region. The model is physiologically based and simpler than the HRTM, requiring two instead of three compartments to model the AI region. The main difference from the HRTM AI model is that a significant fraction, about 35 %, of the AI deposit of insoluble material remains sequestered in the interstitium. The new model is here applied to the analysis of two well-known contamination cases with several years of follow-up data.

Safety of liver resection in the elderly: how important is age?

BACKGROUND: With the aging population, more elderly patients are being considered for hepatic resection. We investigated whether advanced age was associated with higher rate and severity of postoperative complications. METHODS: A total of 75 patients aged ≥70 years (group E) were matched with 75 patients aged <70 years (group Y) by the extent of liver resection and by operative indications. Primary outcome measures were rates and severity of complications. Secondary outcome measures were length of hospital stay and discharge destination. Univariate analysis was also performed to identify variables associated with higher surgical risk. RESULTS: Male-to-female ratio was 43:32 in both groups. Overall complication rates were 44 and 33.3% in group E and Y, respectively (P = 0.241; odds ratio = 1.57; 95% confidence interval [95% CI], 0.81-3.05). There was no mortality in both groups. The only postoperative age-related morbidity was confusion in the elderly. There was no difference in the rates of severe complications (grade ≥3) between group E and group Y (16 vs. 14.7%; P = 0.744; odds ratio = 1.11; 95% CI, 0.46-2.70). Median length of hospital stay were 7 and 6 days, respectively (P = 0.01). Nineteen percent and 1% of patients in group E and group Y were discharge to rehabilitation facilities, respectively (P = 0.001). Univariate analysis showed that preoperative systemic chemotherapy and longer operative time were associated with higher morbidity in the elderly. CONCLUSIONS: Liver resection can be performed in patients aged ≥70 years as safely as in younger patients. Duration and timing of systemic chemotherapy before liver resection should be optimized to minimize postoperative morbidity.

Results of an internal dose assessment intercomparison exercise after a EURADOS/IAEA training course.

A training course named 'European Radiation Dosimetry Group/International Atomic Energy Agency Advanced Training Course on Internal Dose Assessment' was held in Czech Technical University in Prague from 2 to 6 February 2009. The course, jointly organised by the two organisations, had the aim of providing guidance on the application of IDEAS guidelines and of disseminating the results of EC CONRAD Project in relation to internal dosimetry (Work Package 5). At the end of the course a dose assessment exercise was proposed to participants. Four artificial cases, named exercises left to participants, were used to check the capabilities of application of the IDEAS guidelines, gained by participants during the event. The participants had to use both hand calculations and dedicated software, in limited time (7 h). Forty per cent of participants had solved all four cases in the allotted time. The results of the dose assessment were analysed to gain experience in types of errors assessors may make during the evaluations. The result of this intercomparison exercise was promising: half of the results in each case were equal to the 'reference evaluation estimate', which was obtained by applying the guidelines correctly.

EURADOS coordinated action on research, quality assurance and training of internal dose assessments.

EURADOS working group on 'Internal Dosimetry (WG7)' represents a frame to develop activities in the field of internal exposures as coordinated actions on quality assurance (QA), research and training. The main tasks to carry out are the update of the IDEAS Guidelines as a reference document for the internal dosimetry community, the implementation and QA of new ICRP biokinetic models, the assessment of uncertainties related to internal dosimetry models and their application, the development of physiology-based models for biokinetics of radionuclides, stable isotope studies, biokinetic modelling of diethylene triamine pentaacetic acid decorporation therapy and Monte-Carlo applications to in vivo assessment of intakes. The working group is entirely supported by EURADOS; links are established with institutions such as IAEA, US Transuranium and Uranium Registries (USA) and CEA (France) for joint collaboration actions.

Modelling particle retention in the alveolar-interstitial region of the human lungs.

Better information is available now on long-term particle retention in the human lungs than there was in 1994, when the human respiratory tract model (HRTM) was adopted by the International Commission on Radiological Protection (ICRP). Three recent studies are especially useful because they provide such information for groups of people who inhaled very similar aerosols. For all three the HRTM significantly underestimates lung retention of insoluble material. The purpose of this work was to improve the modelling of long-term retention in the deep lung. A simple physiologically based model developed to predict lung and lymph node particle retention in coal miners was found to represent lung retention in these studies adequately. Instead of the three alveolar-interstitial (AI) compartments in the HRTM, it has an alveolar compartment which clears to the bronchial tree and to a second compartment, representing the interstitium, which clears only to lymph nodes. The main difference from the HRTM AI model is that a significant fraction of the AI deposit is sequestered in the interstitium. To obtain default parameter values for general use, the model was fitted to data from the three recent studies, and also the experimental data used in development of the HRTM to define particle transport from the AI region for the first year after intake. The result of the analysis is that about 40% of the AI deposit of insoluble particles is sequestered in the interstitium and the remaining fraction is cleared to the ciliated airways with a half-time of about 300 days. For some long-lived radionuclides in relatively insoluble form (type S), this increased retention increases the lung dose per unit intake by 50-100% compared to the HRTM value.

ICRP Publication 115. Lung cancer risk from radon and progeny and statement on radon.

Recent epidemiological studies of the association between lung cancer and exposure to radon and its decay products are reviewed. Particular emphasis is given to pooled case-control studies of residential exposures, and to cohorts of underground miners exposed to relatively low levels of radon. The residential and miner epidemiological studies provide consistent estimates of the risk of lung cancer, with significant associations observed at average annual concentrations of approximately 200 Bq/m³ and cumulative occupational levels of approximately 50 working level months (WLM), respectively. Based on recent results from combined analyses of epidemiological studies of miners, a lifetime excess absolute risk of 5 × 10⁻4 per WLM [14 × 10⁻5 per (mJh/m³)] should now be used as the nominal probability coefficient for radon- and radon-progeny-induced lung cancer, replacing the previous Publication 65 (ICRP, 1993) value of 2.8 × 10⁻4 per WLM [8 × 10⁻5 per (mJh/m³)]. Current knowledge of radon-associated risks for organs other than the lungs does not justify the selection of a detriment coefficient different from the fatality coefficient for radon-induced lung cancer. Publication 65 (ICRP, 2003) recommended that doses from radon and its progeny should be calculated using a dose conversion convention based on epidemiological data. It is now concluded that radon and its progeny should be treated in the same way as other radionuclides within the ICRP system of protection; that is, doses from radon and its progeny should be calculated using ICRP biokinetic and dosimetric models. ICRP will provide dose coefficients per unit exposure to radon and its progeny for different reference conditions of domestic and occupational exposure, with specified equilibrium factors and aerosol characteristics.