The use of dose quantities in radiological protection: ICRP publication 147 Ann ICRP 50(1) 2021.

The International Commission on Radiological Protection has recently published a report (ICRP Publication 147;Ann. ICRP50, 2021) on the use of dose quantities in radiological protection, under the same authorship as this Memorandum. Here, we present a brief summary of the main elements of the report. ICRP Publication 147 consolidates and clarifies the explanations provided in the 2007 ICRP Recommendations (Publication 103) but reaches conclusions that go beyond those presented in Publication 103. Further guidance is provided on the scientific basis for the control of radiation risks using dose quantities in occupational, public and medical applications. It is emphasised that best estimates of risk to individuals will use organ/tissue absorbed doses, appropriate relative biological effectiveness factors and dose-risk models for specific health effects. However, bearing in mind uncertainties including those associated with risk projection to low doses or low dose rates, it is concluded that in the context of radiological protection, effective dose may be considered as an approximate indicator of possible risk of stochastic health effects following low-level exposure to ionising radiation. In this respect, it should also be recognised that lifetime cancer risks vary with age at exposure, sex and population group. The ICRP report also concludes that equivalent dose is not needed as a protection quantity. Dose limits for the avoidance of tissue reactions for the skin, hands and feet, and lens of the eye will be more appropriately set in terms of absorbed dose rather than equivalent dose.

Harmonisation of standards for permissible radionuclide activity concentrations in foodstuffs in the long term after the Chernobyl accident.

The article critically examines the practice of post-Chernobyl standardisation of radionuclide concentrations (mainly 137Cs and 90Sr) in food products (FPs) in the USSR and the successor countries of Belarus, Russia and Ukraine. Recommendations are given on potential harmonisation of these standards of radionuclide concentrations in FPs among the three countries, taking into account substantial international experience. We propose to reduce the number of product groups for standardisation purposes from the current amount of several dozens to three to five groups to optimise radiation control and increase the transparency of the process. We recommend five product groups for the standardisation of 137Cs and three groups for 90Sr in food in radiocontaminated areas. The values of standards for individual product groups are recommended to be set proportionally to the measured specific activity in each of these groups, which will reduce unreasonable food rejection. The standards might be set for the entire country, and could be also used to control imports from other countries as well as exports to other countries. The developed recommendations were transferred in 2015-2016 to the regulatory authorities of the three countries.

Patient doses from medical examinations in Russia: 2009-2015.

The aim of this study was to evaluate adult patient doses in Russia in the context of patient protection. Effective doses from x-ray and nuclear medicine examinations were assessed using two approaches. The first was based on data collection performed by the authors in hospitals in St. Petersburg and other 17 Russian regions. The second approach was to assess mean doses through the collective dose estimated annually within the federal data bank ESKID. In 2015, 203 million examinations were conducted in Russia, i.e. 1.4 examinations per capita. The number of examinations has increased by 35% over the last 10 years. Patient doses from x-ray examinations are strongly dependent on the imaging modality. Mean dose increases by an order of magnitude with each x-ray modality from dental examinations (0.01-0.1 mSv) to radiography (0.1-1 mSv), fluoroscopy and CT (1-10 mSv) and to interventional examinations (more than 10 mSv). Mean doses for x-ray examinations are comparable with that of foreign countries. Scintigraphy examinations with 99mTc are associated with mean doses of 1-5 mSv. Mean doses from PET/CT whole body examinations are 15-25 mSv with similar contributions from CT and radiopharmaceuticals. In nuclear medicine, patient doses are lower compared to other countries. According to ESKID data the collective dose from medical exposure in Russia has decreased from 140 000 man-Sv in 2000 to 77 000 man-Sv in 2015. Medical exposure contributes about 13% into a total collective dose. The maximum contribution was from CT examinations, i.e. 45% in 2015. A range of mean doses between different hospitals was up to two orders of magnitude for radiography and one order of magnitude for CT. In interventional studies, the scatter of individual doses was significant. Significant variations in doses between hospitals and some regions indicate the potential for optimization with the focus on interventional examinations, CT and nuclear medicine examinations combined with CT.

Optimisation of environmental remediation: how to select and use the reference levels.

A number of past industrial activities and accidents have resulted in the radioactive contamination of large areas at many sites around the world, giving rise to a need for remediation. According to the International Commission on Radiological Protection (ICRP) and International Atomic Energy Agency (IAEA), such situations should be managed as existing exposure situations (ExESs). Control of exposure to the public in ExESs is based on the application of appropriate reference levels (RLs) for residual doses. The implementation of this potentially fruitful concept for the optimisation of remediation in various regions is hampered by a lack of practical experience and relevant guidance. This paper suggests a generic methodology for the selection of numeric values of relevant RLs both in terms of residual annual effective dose and derived RLs (DRLs) based on an appropriate dose assessment. The value for an RL should be selected in the range of the annual residual effective dose of 1-20 mSv, depending on the prevailing circumstances for the exposure under consideration. Within this range, RL values should be chosen by the following assessment steps: (a) assessment of the projected dose, i.e. the dose to a representative person without remedial actions by means of a realistic model as opposed to a conservative model; (b) modelling of the residual dose to a representative person following application of feasible remedial actions; and (c) selection of an RL value between the projected and residual doses, taking account of the prevailing social and economic conditions. This paper also contains some recommendations for practical implementation of the selected RLs for the optimisation of public protection. The suggested methodology used for the selection of RLs (in terms of dose) and the calculation of DRLs (in terms of activity concentration in food, ambient dose rate, etc) has been illustrated by a retrospective analysis of post-Chernobyl monitoring and modelling data from the Bryansk region, Russia, 2001. From this example, it follows that analysis of real data leads to the selection of an RL from a relatively narrow annual dose range (in this case, about 2-3 mSv), from which relevant DRLs can be calculated and directly used for optimisation of the remediation programme.

On protecting the inexperienced reader from Chernobyl myths.

The health and environmental consequences of the Chernobyl accident continue to attract the attention of experts, decision-makers and the general public, and now these consequences have been given added relevance by the similar accident in 2011 at the Fukushima-1 nuclear power plant (NPP) in Japan. Expert analysis of radiation levels and effects has been conducted by international bodies--UNSCEAR in 2008 and the Chernobyl Forum during 2003-5. At the same time, three Russian and Belarusian scientists, Yablokov, Nesterenko and Nesterenko (2009 Chernobyl. Consequences of the Catastrophe for People and the Environment (New York: Annals of the New York Academy of Sciences)) published both in Russian and English a substantial review of the consequences of Chernobyl based mostly on Russian-language papers. In this book, they suggested a departure from analytical epidemiological studies in favour of ecological ones. This erroneous approach resulted in the overestimation of the number of accident victims by more than 800 000 deaths during 1987-2004. This paper investigates the mistakes in methodology made by Yablokov et al and concludes that these errors led to a clear exaggeration of radiation-induced health effects. Should similar mistakes be made following the 2011 accident at Fukushima-1 NPP this could lead quite unnecessarily to a panic reaction by the public about possible health effects and to erroneous decisions by the authorities in Japan.

The Chernobyl Forum: major findings and recommendations.

The accident at the Chernobyl NPP in 1986 was the most severe in the history of the nuclear industry, causing a huge release of radionuclides over large areas of Europe. The recently completed Chernobyl Forum concluded that after a number of years, along with reduction of radiation levels and accumulation of humanitarian consequences, severe social and economic depression of the affected regions and associated psychological problems of the general public and the workers had become the most significant problem to be addressed by the authorities. The majority of the affected land is now safe for life and economic activities. However, in the Chernobyl Exclusion Zone and in some limited areas of Belarus, Russia and Ukraine some restrictions on land-use should be retained for decades to come. Most of the 600,000 emergency and recovery operation workers and five million residents of the contaminated areas in Belarus, Russia and Ukraine received relatively minor radiation doses which are comparable with the natural background levels. Apart from the dramatic increase in thyroid cancer incidence among those exposed at a young age and some increase of leukaemia and solid cancer in most exposed workers, there is no clearly demonstrated increase in the somatic diseases due to radiation.

Contribution of internal exposures to the radiological consequences of the Chernobyl accident.

The main pathways leading to exposure of members of the general public due to the Chernobyl accident were external exposure from radionuclides deposited on the ground and ingestion of contaminated terrestrial food products. The collective dose to the thyroid was nearly 1.5 million man Gy in Belarus, Russia and Ukraine with nearly half received by children and adolescents. The collective effective dose received in 1986-2005 by approximately five million residents living in the affected areas of the three countries was approximately 50,000 man Sv with approximately 40% from ingestion. That contribution might have been larger if countermeasures had not been applied. The main radionuclide contributing to both external and internal effective dose is 137Cs with smaller contributions of 134Cs and 90Sr and negligible contribution of transuranic elements. The major demonstrated radiation-caused health effect of the Chernobyl accident has been an elevated incidence of thyroid cancer in children.

PROPOSALS FOR THE ESTABLISHMENT OF NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR RADIOGRAPHY FOR ADULT PATIENTS BASED ON REGIONAL DOSE SURVEYS IN RUSSIAN FEDERATION.

In 2009-2014, dose surveys aimed to collect adult patient data and parameters of most common radiographic examinations were performed in six Russian regions. Typical patient doses were estimated for the selected examinations both in entrance surface dose and in effective dose. 75%-percentiles of typical patient effective dose distributions were proposed as preliminary regional diagnostic reference levels (DRLs) for radiography. Differences between the 75%-percentiles of regional typical patient dose distributions did not exceed 30-50% for the examinations with standardized clinical protocols (skull, chest and thoracic spine) and a factor of 1.5 for other examinations. Two different approaches for establishing national DRLs were evaluated: as a 75%-percentile of a pooled regional sample of patient typical doses (pooled method) and as a median of 75%-percentiles of regional typical patient dose distributions (median method). Differences between pooled and median methods for effective dose did not exceed 20%. It was proposed to establish Russian national DRLs in effective dose using a pooled method. In addition, the local authorities were granted an opportunity to establish regional DRLs if the local radiological practice and typical patient dose distributions are significantly different.

Soil-dependent uptake of 137Cs by mushrooms: experimental study in the Chernobyl accident areas.

The influence of agrochemical properties of forest soils and growth conditions on 137Cs aggregated transfer factors from soil to different species of forest mushrooms have been analysed. Statistically significant correlations between 137Cs soil to mushroom aggregated transfer factors and agrochemical soil properties have been revealed. The experimental data show that 137Cs aggregated transfer factors depend on the mushroom's trophic group, biological family, genus and species. They also strongly depend on forest soil properties and their values can be estimated with the use of multiple regression equations constructed from agrochemical soil parameters which most closely correlate with the 137Cs transfer parameters for particular mushroom groups.

Use of effective dose.

International Commission on Radiological Protection (ICRP) Publication 103 provided a detailed explanation of the purpose and use of effective dose and equivalent dose to individual organs and tissues. Effective dose has proven to be a valuable and robust quantity for use in the implementation of protection principles. However, questions have arisen regarding practical applications, and a Task Group has been set up to consider issues of concern. This paper focusses on two key proposals developed by the Task Group that are under consideration by ICRP: (1) confusion will be avoided if equivalent dose is no longer used as a protection quantity, but regarded as an intermediate step in the calculation of effective dose. It would be more appropriate for limits for the avoidance of deterministic effects to the hands and feet, lens of the eye, and skin, to be set in terms of the quantity, absorbed dose (Gy) rather than equivalent dose (Sv). (2) Effective dose is in widespread use in medical practice as a measure of risk, thereby going beyond its intended purpose. While doses incurred at low levels of exposure may be measured or assessed with reasonable reliability, health effects have not been demonstrated reliably at such levels but are inferred. However, bearing in mind the uncertainties associated with risk projection to low doses or low dose rates, it may be considered reasonable to use effective dose as a rough indicator of possible risk, with the additional consideration of variation in risk with age, sex and population group.

Model testing using data on 137Cs from Chernobyl fallout in the Iput River catchment area of Russia.

Data collected for 10 years following the Chernobyl accident in 1986 have provided a unique opportunity to test the reliability of computer models for contamination of terrestrial and aquatic environments. The Iput River scenario was used by the Dose Reconstruction Working Group of the BIOMASS (Biosphere Modelling and Assessment Methods) programme. The test area was one of the most highly contaminated areas in Russia following the accident, with an average contamination density of 137Cs of 800,000 Bq m-2 and localized contamination up to 1,500,000 Bq m-2, and a variety of countermeasures that were implemented in the test area had to be considered in the modelling exercise. Difficulties encountered during the exercise included averaging of data to account for uneven contamination of the test area, simulating the downward migration and changes in bioavailability of 137Cs in soil, and modelling the effectiveness of countermeasures. The accuracy of model predictions is dependent at least in part on the experience and judgment of the participant in interpretation of input information, selection of parameter values, and treatment of uncertainties.

Nuclear medicine examinations of children in Russia.

The number and specification of radionuclide examinations, administrated activity and effective doses were collected during 2011-13 for 4944 paediatric patients from 10 nuclear medicine (NM) departments of some Russian regions. The kidney examinations account for about 70 % of paediatric NM examinations in general hospitals. Diagnostics of all other organs contribute from 2 to 8 % each in the total number of paediatric examinations. Administrated activities of radiopharmaceuticals are approximately proportional to the child's age, and variations between different hospitals usually are within the factor of 3-4 and for some types of examination up to 10. The range of the effective dose due to paediatric NM examinations is roughly estimated as 2-6 mSv per examination, approximately the same as in adults. Some examinations (heart, thyroid, whole body) result in doses of younger children that are 2-3 times higher than the doses of adults. Effective doses in paediatric positron emission tomography (PET) diagnostics are in the range of 4-10 mSv per examination and are higher compared with the dose of adult patients. The application of combined radiodiagnostic technologies (single photon emission computer tomography with roentghen computer tomography [SPECT/CT] or PET with roetghen computer tomography [PET/CT]) increases the effective dose of patients by the factor of 1.5-2 for the skeleton or whole body examinations.

Russian practical guidance on radiological support for justification of X-ray and nuclear medicine examinations.

An important part of the justification process is assessment of the radiation risks caused by exposure of a patient during examination. The authors developed official national methodology both for medical doctors and sanitary inspectors called 'assessment of radiation risks of patients undergoing diagnostic examinations with the use of ionizing radiation'. The document addresses patients of various age groups and a wide spectrum of modern X-ray and nuclear medicine examinations. International scale of risk categorisation was implemented by the use of effective dose with account for age dependence of radiation risk. The survey of effective doses in radiology, including CT, mammography, and intervention radiology, and nuclear medicine, including single-photon emission tomography and positron emission tomography, for patients of various age groups from several regions of Russia was used for the risk assessment. The output of the methodology is a series of tables for each diagnostic technology with lists of examinations for three age groups (children/adolescents, adults and seniors) corresponding to various radiation risk categories.

Environmental radioactivity, population exposure and related health risks in the east Baltic region.

The paper considers radioactive contamination of the east Baltic region, population exposures, and the risk of damage to human health. Principal sources include global fallout, the Chernobyl accident, and marine transport of radionuclides. A mean annual exposure of 2-3 mSv comes from environmental radioactivity. Main contributors are primarily radon and its decay products. The Chernobyl accident brought an additional dose of about 0.5 mSv in southern Finland and 1.4 mSv in the most contaminated districts of the Leningrad region, Russia. Both external and internal exposure via contaminated food contributed. Currently, significant long-term radiological consequences of the Chernobyl accident include persistent radioactive contamination of natural terrestrial (forest) and freshwater (oligotrophic lakes) ecosystems and food products. Radiation health risks are lung cancer among the general population from indoor exposure to radon, acute radiation syndrome from occupational exposure, thyroid cancer among children in heavily contaminated non-Baltic areas, and mutations among offspring of exposed parents.

Fluxes of radiocaesium in selected rural study sites in Russia and Ukraine.

Food production and food harvesting systems common in the areas contaminated by the Chernobyl accident in Russia and Ukraine can be grouped into three major categories: collective farm produce, private farming produce and foods collected from natural ecosystems. The contribution of each of these sources to radiocaesium intake by people living in rural settlements in the mid 1990s has been estimated at two major study sites, one in each country. The collective farm system provided the smallest contribution (7-14%) to the intake of radiocaesium at both sites. Natural food was the major contributor to intake at the Russian site (83%). Whereas private farm produce was the major contributor (68%) at the Ukrainian study site. The difference between the two sites was mainly because private milk production was stopped at the Russian site due to the contamination in 1986. A retrospective assessment of the situation 1 year after the accident shows that collective farming could have been a minor contributor to radiocaesium intake (8%), whilst private farming would have been the major contributor wherever private milk production and consumption continued. The extent to which inhabitants consume natural foods from forests has a considerable effect on their radiocaesium intake. The comparative importance of food products from natural ecosystems increases with time due to the long effective ecological half-lives of radiocaesium in unimproved pastures and forests. Estimation of the fluxes of radiocaesium from the different production and harvesting systems showed that the contribution from private farming and food harvesting from natural ecosystems may be significant, contributing 14-30% to the total fluxes of radiocaesium from an area even if the quantity of food produced in these systems is small. However, the major contributor to the flux exported from an area was the collective farming system, accounting for about 70-86% of the total.

The metabolism of 3H compounds and limits for intakes by workers.

A wide variety of 3H compounds with different physico-chemical and radiotoxic properties are produced and used throughout the world. For the purpose of worker radiation safety, 3H compounds have been divided into five classes: oxide, gaseous, insoluble, soluble organic substances and precursors of nucleic acids. Based on recent radiobiological and dosimetric data the quality factor for 3H has been suggested (QF = 2). Standards for oxide and gaseous 3H, reduced by a factor of 3-10, as compared with International Commission on Radiological Protection (ICRP) recommendations, have been suggested. New standards, 2-30 times lower than those for 3H oxide, have been worked out for the other three classes of 3H compounds. A limit for removable surface contamination from nonvolatile forms of 3H has been proposed (LSC = 1 kBq cm-2).

Model validation for external doses due to environmental contaminations by the Chernobyl accident.

The objective of the present paper is to validate the deterministic JSP5 model for external exposures to population groups living in the areas contaminated with radionuclides after the Chernobyl accident. For this purpose inhabitants of contaminated areas wore TL-dosimeters for about 1 mo in the spring/summer periods of the years 1989 to 1994. External doses due to the Chernobyl accident were determined from the dosimeter readings by subtracting the natural background. 2,342 results for rural inhabitants and 420 results for inhabitants of the town Novozybkov passed reliability checks. These data show that the average dose in inhabitants of a rural settlement predicted by the model is in the range 0.69-1.55 of the measured values with a confidence level of 95%. Differences are attributed to settlement specific location factors, which are supported by the very good agreement of model and measurements in Novozybkov. In this case location factors of the model were obtained from Novozybkov directly.

Tritium radiobiological effects in mammals: review of experiments of the last decade in Russia.

This review briefly describes techniques and basic results of experimental investigations in mice and rats on metabolism, dosimetry, and radiobiological effects of tritium oxide and some tritiated biogenic compounds (glucose, amino acids, and nucleosides) during the last 10 to 15 years in Russia. The content of water in tissue cells of mammals is shown to be 15 to 40% less than in whole tissue. The kinetics of tritium incorporation from oxide (HTO) and its retention in DNA of hemopoietic tissues were studied. The contribution of bound tritium to dose strongly depends on the chemical form of tritium and reaches 90% when labeled L-lysine is injected. Specific features of the action of HTO on hemopoietic tissue were investigated in tests of damage and repair of DNA, induction of chromosome aberrations in cells, content of nucleic acids, kinetics of cell populations, immunity parameters, carcinogenesis, decrease of life span, induction of dominant lethal mutations in germ cells in male mice, and reciprocal translocations in mouse spermatogonia. According to these tests, the radiobiological effects of tritium beta radiation in the form of oxide is 2 to 6 times higher than for gamma radiation of 137Cs. The frequency of dominant lethal mutations induced by labeled lysine, thymidine, and deoxycytidine is 3 to 12 times higher than those induced by equal HTO activity. The results of these investigations are used to standardize HTO and the various biogenic compounds of tritium, improve techniques of indirect dosimetry, provide medical aid to personnel, and estimate population risk.

Assessment of current exposure levels in different population groups of the Kola Peninsula.

Activity concentrations of 137Cs and 90Sr in samples of vegetation and natural food products collected in the Kola Peninsula in 1998 and 1999 indicate a very slow decrease in contamination levels during the last decade, mainly due to the physical decay of the radionuclides. The activity concentrations of 137Cs in reindeer meat decreased with a half-life of about 9 years. 137Cs in lichen, moss and fungi is significantly higher than in natural vegetation (grasses) and agricultural plants (potatoes). The activity concentrations of 137Cs in reindeer meat were two orders of magnitude higher than those in locally produced beef and pork. Consumption of reindeer meat, fish, mushrooms and berries constituted the main contribution to the internal dose from 137Cs and 90Sr for reindeer-breeders in the Lovozero area. The estimated committed doses due to 137Cs intake in this group were about 10 microSv per month in summer 1998 and 15 microSv per month in winter, 1999. There was good agreement between internal dose estimates based on intake assessment and whole body measurements. The population of Umba settlement, which is not involved in reindeer breeding, received individual committed doses due to 137Cs intake of about 0.5 microSv per month, about a factor of 20 less than the reindeer-breeders in Lovozero. In this case, the main contribution to the internal dose of the general population came from consumption the of 137Cs in mushrooms and forest berries. The contribution of 90Sr to the internal dose varied from 1% to 5% in the different population groups studied.