Strontium biokinetic model for the pregnant woman and fetus: application to Techa River studies.

A biokinetic model for strontium (Sr) for the pregnant woman and fetus (Sr-PWF model) has been developed for use in the quantification of doses from internal radiation exposures following maternal ingestion of Sr radioisotopes before or during pregnancy. The model relates in particular to the population of the Techa River villages exposed to significant amounts of ingested Sr radioisotopes as a result of releases of liquid radioactive wastes from the Mayak plutonium production facility (Russia) in the early 1950s. The biokinetic model for Sr metabolism in the pregnant woman was based on a biokinetic model for the adult female modified to account for changes in mineral metabolism during pregnancy. The model for non-pregnant females of all ages was developed earlier with the use of extensive data on (90)Sr-body measurements in the Techa Riverside residents. To determine changes in model parameter values to take account of changing mineral metabolism during pregnancy, data from longitudinal studies of calcium homeostasis during human pregnancy were analysed and applied. Exchanges between maternal and fetal circulations and retention in fetal skeleton and soft tissues were modelled as adaptations of previously published models, taking account of data on Sr and calcium (Ca) metabolism obtained in Russia (Southern Urals and Moscow) relating to dietary calcium intakes, calcium contents in maternal and fetal skeletons and strontium transfer to the fetus. The model was validated using independent data on (90)Sr in the fetal skeleton from global fallout as well as unique data on (90)Sr-body burden in mothers and their still-born children for Techa River residents. While the Sr-PWF model has been developed specifically for ingestion of Sr isotopes by Techa River residents, it is also more widely applicable to maternal ingestion of Sr radioisotopes at different times before and during pregnancy and different ages of pregnant women in a general population.

Strontium biokinetic model for the lactating woman and transfer to breast milk: application to Techa River studies.

This paper presents a biokinetic model for strontium metabolism in the lactating woman and transfer to breast milk for members of Techa River communities exposed as a result of discharges of liquid radioactive wastes from the Mayak plutonium production facility (Russia) in the early 1950s. This model was based on that developed for the International Commission for Radiological Protection with modifications to account for population specific features of breastfeeding and maternal bone mineral metabolism. The model is based on a biokinetic model for the adult female with allowances made for changes in mineral metabolism during periods of exclusive and partial breast-feeding. The model for females of all ages was developed earlier from extensive data on (90)Sr-body measurements for Techa Riverside residents. Measurements of (90)Sr concentrations in the maternal skeleton and breast milk obtained in the1960s during monitoring of global fallout in the Southern Urals region were used for evaluation of strontium transfer to breast and breast milk. The model was validated with independent data from studies of global fallout in Canada and measurements of (90)Sr body-burden in women living in the Techa River villages who were breastfeeding during maximum (90)Sr-dietary intakes. The model will be used in evaluations of the intake of strontium radioisotopes in breast milk by children born in Techa River villages during the radioactive releases and quantification of (90)Sr retention in the maternal skeleton.

Doses to the red bone marrow of young people and adults from radiation of natural origin.

Natural radiation sources comprise cosmic rays, terrestrial gamma rays, radionuclides in food and inhaled isotopes of radon with their decay products. These deliver doses to all organs and tissues including red bone marrow (RBM), the tissue in which leukaemia is thought to originate. In this paper we calculate the age-dependent annual RBM doses from natural radiation sources to young people and to adults at average levels of exposure in the UK. The contributions to dose are generally less complex than in the case of doses to foetuses and young children where it is necessary to take into account transfer of radionuclides across the placenta, intakes in mother's milk and changes in gut uptake in young infants. However, there is high uptake of alkaline earths and of similar elements in the developing skeleton and this significantly affects the doses from radioisotopes of these elements, not just in the teens and twenties but through into the fifth decade of life. The total equivalent dose to the RBM from all natural sources of radiation at age 15 years is calculated to be about 1200  µSv a year at average UK levels, falling to rather less than 1100  µSv per year in later life; the gentle fall from the late teens onwards reflects the diminishing effect of the high uptakes of radioisotopes of the alkaline earths and of lead in this period. About 60% of the equivalent dose is contributed by the low linear energy transfer (LET) component. Radionuclides in food make the largest contribution to equivalent doses to RBM and much the largest contribution to the absorbed dose from high LET radiation (mainly alpha particles).

ICRP Publication 141: Occupational Intakes of Radionuclides: Part 4.

The 2007 Recommendations (ICRP, 2007) introduced changes that affect the calculation of effective dose, and implied a revision of the dose coefficients for internal exposure, published previously in the Publication 30 series (ICRP, 1979a,b, 1980a, 1981, 1988) and Publication 68 (ICRP, 1994b). In addition, new data are now available that support an update of the radionuclide-specific information given in Publications 54 and 78 (ICRP, 1989a, 1997) for the design of monitoring programmes and retrospective assessment of occupational internal doses. Provision of new biokinetic models, dose coefficients, monitoring methods, and bioassay data was performed by Committee 2 and its task groups. A new series, the Occupational Intakes of Radionuclides (OIR) series, will replace the Publication 30 series and Publications 54, 68, and 78. OIR Part 1 (ICRP, 2015) describes the assessment of internal occupational exposure to radionuclides, biokinetic and dosimetric models, methods of individual and workplace monitoring, and general aspects of retrospective dose assessment. OIR Part 2 (ICRP, 2016), OIR Part 3 (ICRP, 2017), this current publication, and the final publication in the OIR series (OIR Part 5) provide data on individual elements and their radioisotopes, including information on chemical forms encountered in the workplace; a list of principal radioisotopes and their physical half-lives and decay modes; the parameter values of the reference biokinetic models; and data on monitoring techniques for the radioisotopes most commonly encountered in workplaces. Reviews of data on inhalation, ingestion, and systemic biokinetics are also provided for most of the elements. Dosimetric data provided in the printed publications of the OIR series include tables of committed effective dose per intake (Sv per Bq intake) for inhalation and ingestion, tables of committed effective dose per content (Sv per Bq measurement) for inhalation, and graphs of retention and excretion data per Bq intake for inhalation. These data are provided for all absorption types and for the most common isotope(s) of each element. The online electronic files that accompany the OIR series of publications contains a comprehensive set of committed effective and equivalent dose coefficients, committed effective dose per content functions, and reference bioassay functions. Data are provided for inhalation, ingestion, and direct input to blood. This fourth publication in the OIR series provides the above data for the following elements: lanthanum (La), cerium (Ce), praseodymium (Pr), neodymium (Nd), promethium (Pm), samarium (Sm), europium (Eu), gadolinium (Gd), terbium (Tb), dysprosium (Dy), holmium (Ho), erbium (Er), thulium (Tm), ytterbium (Yb), lutetium (Lu), actinium (Ac), protactinium (Pa), neptunium (Np), plutonium (Pu), americium (Am), curium (Cm), berkelium (Bk), californium (Cf), einsteinium (Es), and fermium (Fm).

The computation of ICRP dose coefficients for intakes of radionuclides with PLEIADES: biokinetic aspects.

The ICRP has published dose coefficients for the ingestion or inhalation of radionuclides in a series of reports covering intakes by workers and members of the public including children and pregnant or lactating women. The calculation of these coefficients conveniently divides into two distinct parts--the biokinetic and dosimetric. This paper gives a brief summary of the methods used to solve the biokinetic problem in the generation of dose coefficients on behalf of the ICRP, as implemented in the Health Protection Agency's internal dosimetry code PLEIADES.

The internal dosimetry code PLEIADES.

The International Commission on Radiological Protection (ICRP) has published dose coefficients for the ingestion or inhalation of radionuclides in a series of reports covering intakes by workers and members of the public, including children and pregnant or lactating women. The calculation of these coefficients divides naturally into two distinct parts-the biokinetic and dosimetric. This paper describes in detail the methods used to solve the biokinetic problem in the generation of dose coefficients on behalf of the ICRP, as implemented in the Health Protection Agency's internal dosimetry code PLEIADES. A summary of the dosimetric treatment is included.

Dose coefficients calculated using the new ICRP model for the human alimentary tract.

Publication 100 of the International Commission on Radiological Protection (ICRP) provides a Human Alimentary Tract Model (HATM) to replace the gastrointestinal (GI) model described in Publication 30. The HATM will be used for future calculations of dose coefficients and bioassay predictions, first in a series of publications on occupational intakes of radionuclides, and subsequently in revision of dose coefficients for public exposures. This paper compares dose coefficients calculated using the new model with current values calculated using the GI model for a range of radionuclides. Colon doses are lower using the HATM in all cases considered, in some cases by significant factors. Stomach doses tend to be lower, but are in some cases higher under HATM. The extent to which these changes in doses to gut tissues impacts upon the effective dose varies among nuclides, but there is a tendency for lower effective doses. Special-case applications of the HATM are also described, considering retention on teeth or in the walls of the small intestine. Although the effect of such retention on the regional tissue dose can be large, the effective dose is not greatly changed.

In utero and postnatal haemopoietic tissue doses resulting from maternal ingestion of strontium isotopes from the Techa River.

Reliable estimates of tissue doses to individuals exposed as a result of radioactive releases to the Techa River are essential prerequisites for epidemiological analyses. This paper describes progress made in collaborative studies, sponsored by the European Union, between the Urals Research Center for Radiation Medicine and the UK Health Protection Agency to provide dose estimates to Techa River populations following in utero exposures and infant exposures resulting from breast-feeding. Studies have concentrated on the assessment of internal doses from 90Sr as the main contributor to internal doses to the Techa River populations.

ICRP Publication 137: Occupational Intakes of Radionuclides: Part 3.

Abstract ­: The 2007 Recommendations of the International Commission on Radiological Protection (ICRP, 2007) introduced changes that affect the calculation of effective dose, and implied a revision of the dose coefficients for internal exposure, published previously in the Publication 30 series (ICRP, 1979, 1980, 1981, 1988) and Publication 68 (ICRP, 1994). In addition, new data are now available that support an update of the radionuclide-specific information given in Publications 54 and 78 (ICRP, 1988a, 1997b) for the design of monitoring programmes and retrospective assessment of occupational internal doses. Provision of new biokinetic models, dose coefficients, monitoring methods, and bioassay data was performed by Committee 2, Task Group 21 on Internal Dosimetry, and Task Group 4 on Dose Calculations. A new series, the Occupational Intakes of Radionuclides (OIR) series, will replace the Publication 30 series and Publications 54, 68, and 78. OIR Part 1 has been issued (ICRP, 2015), and describes the assessment of internal occupational exposure to radionuclides, biokinetic and dosimetric models, methods of individual and workplace monitoring, and general aspects of retrospective dose assessment. OIR Part 2 (ICRP, 2016), this current publication and upcoming publications in the OIR series (Parts 4 and 5) provide data on individual elements and their radioisotopes, including information on chemical forms encountered in the workplace; a list of principal radioisotopes and their physical half-lives and decay modes; the parameter values of the reference biokinetic model; and data on monitoring techniques for the radioisotopes encountered most commonly in workplaces. Reviews of data on inhalation, ingestion, and systemic biokinetics are also provided for most of the elements. Dosimetric data provided in the printed publications of the OIR series include tables of committed effective dose per intake (Sv Bq−1 intake) for inhalation and ingestion, tables of committed effective dose per content (Sv Bq−1 measurement) for inhalation, and graphs of retention and excretion data per Bq intake for inhalation. These data are provided for all absorption types and for the most common isotope(s) of each element. The electronic annex that accompanies the OIR series of publications contains a comprehensive set of committed effective and equivalent dose coefficients, committed effective dose per content functions, and reference bioassay functions. Data are provided for inhalation, ingestion, and direct input to blood. This third publication in the series provides the above data for the following elements: ruthenium (Ru), antimony (Sb), tellurium (Te), iodine (I), caesium (Cs), barium (Ba), iridium (Ir), lead (Pb), bismuth (Bi), polonium (Po), radon (Rn), radium (Ra), thorium (Th), and uranium (U).

ICRP Publication 134: Occupational Intakes of Radionuclides: Part 2.

Abstract ­: The 2007 Recommendations of the International Commission on Radiological Protection (ICRP, 2007) introduced changes that affect the calculation of effective dose, and implied a revision of the dose coefficients for internal exposure, published previously in the Publication 30 series (ICRP, 1979, 1980, 1981, 1988b) and Publication 68 (ICRP, 1994b). In addition, new data are available that support an update of the radionuclide-specific information given in Publications 54 and 78 (ICRP, 1988a, 1997b) for the design of monitoring programmes and retrospective assessment of occupational internal doses. Provision of new biokinetic models, dose coefficients, monitoring methods, and bioassay data was performed by Committee 2, Task Group 21 on Internal Dosimetry, and Task Group 4 on Dose Calculations. A new series, the Occupational Intakes of Radionuclides (OIR) series, will replace the Publication 30 series and Publications 54, 68, and 78. Part 1 of the OIR series has been issued (ICRP, 2015), and describes the assessment of internal occupational exposure to radionuclides, biokinetic and dosimetric models, methods of individual and workplace monitoring, and general aspects of retrospective dose assessment. The following publications in the OIR series (Parts 2­5) will provide data on individual elements and their radioisotopes, including information on chemical forms encountered in the workplace; a list of principal radioisotopes and their physical half-lives and decay modes; the parameter values of the reference biokinetic model; and data on monitoring techniques for the radioisotopes encountered most commonly in workplaces. Reviews of data on inhalation, ingestion, and systemic biokinetics are also provided for most of the elements. Dosimetric data provided in the printed publications of the OIR series include tables of committed effective dose per intake (Sv per Bq intake) for inhalation and ingestion, tables of committed effective dose per content (Sv per Bq measurement) for inhalation, and graphs of retention and excretion data per Bq intake for inhalation. These data are provided for all absorption types and for the most common isotope(s) of each element. The electronic annex that accompanies the OIR series of reports contains a comprehensive set of committed effective and equivalent dose coefficients, committed effective dose per content functions, and reference bioassay functions. Data are provided for inhalation, ingestion, and direct input to blood. The present publication provides the above data for the following elements: hydrogen (H), carbon (C), phosphorus (P), sulphur (S), calcium (Ca), iron (Fe), cobalt (Co), zinc (Zn), strontium (Sr), yttrium (Y), zirconium (Zr), niobium (Nb), molybdenum (Mo), and technetium (Tc).

Completeness of follow up in a cohort study of mortality using the United Kingdom National Health Service Central Registers and records held by the Department of Social Security.

STUDY OBJECTIVE: The aim was to evaluate and improve the completeness of follow up in a cohort study of mortality carried out using the UK National Health Service (NHS) Central Registers. SETTING: This was a follow up study of UK servicemen who served abroad in the 1950s and 1960s, including those who participated in the UK atmospheric nuclear weapon tests and experimental programmes. DESIGN: Details of men for whom follow up achieved using the NHS Central Registers was unsatisfactory were submitted to the Department of Social Security (DSS) for tracing, as were details of men born before 1916 and reported by the NHS Central Registers as currently registered with a general practitioner, and a 1% sample of remaining men born in or after 1916. MEASUREMENTS AND MAIN RESULTS: The additional follow up increased the number of deaths fully identified in the cohort by 6.5%. Mortality among those untraced on the NHS Central Registers was substantially greater than in the cohort as a whole (10.2% v 6.9%). Among those reported by the NHS Central Registers as not currently registered with a general practitioner, 2.7% were found to have died, as were 1.1% of men born before 1916 and currently reported to be registered with a general practitioner. As expected there was clear evidence that information about emigrations supplied by both the NHS Central Registers and DSS is far from complete. CONCLUSION: Standardised mortality ratios based on follow up via the NHS Central Registers alone are likely to be somewhat low, and this should be borne in mind when interpreting the data.

Simplified organ retention functions for physiologically based recycling biokinetic models.

Recent ICRP Publications on biokinetic models show a movement from simple schematic models to more complex, physiologically-based models. Such models require considerably greater computing resources to implement than their predecessors, effectively making them inaccessible to many users. Fortunately, retention in most of the compartments of these large recycling models can be adequately approximated by the sum of a few exponential functions compatible with the simple catenary models used almost exclusively in ICRP Publication 30. An eigenvalue method is used to solve the plutonium model of ICRP Publication 67 for intakes by inhalation, ingestion, and injection. The organ retention expressions so obtained are reduced by least squares minimization to functions consisting of the sum of a few exponential terms only. These simplified functions give committed doses accurate to within 5% and activities to within 10%. A similar treatment is used to obtain simplified expressions for daily excretion rates of plutonium.

The risk of leukemia in Seascale from radiation exposure.

An excess of leukemias in children has been observed between 1950 and 1980 in the village of Seascale (population about 3,000) which is situated approximately 3 km to the south of Sellafield nuclear fuel reprocessing plant in West Cumbria, England. Radiation doses from all the main sources of radiation exposure of the population and risks of radiation-induced leukemia have been calculated for children born and living in Seascale during the period of operation of the plant. For the Seascale study population of 1225 children and young persons, followed to age 20 y, or followed until 1980 for those born after 1960, 0.016 radiation-induced leukemias are predicted from the Sellafield discharges. This corresponds to an average risk to children in the population of about one in 75,000. For the four fatal leukemias observed in the study population (0.5 expected from United Kingdom statistics) to be attributed to the operations at Sellafield, the average risk would have to be increased by a factor of about 250, to one in 300. Although there is some uncertainty about the releases from the plant and concentrations of radionuclides in environmental materials in the Sellafield area, particularly for the early years of its operation, the possibility that the doses calculated and the risk coefficients used for radiation-induced leukemia could be so substantially wrong is very unlikely. The number of radiation-induced leukemias from all radiation sources is calculated to be 0.1, which corresponds to a risk of about one in 12,250 for the average child in the study population. About two-thirds of the risk is from natural radiation, 16% from the Sellafield discharges, and nuclear weapons fallout and medical exposure each contribute about 9%. The models used for calculating radiation doses from intakes of radionuclides were based upon those recommended by the International Commission on Radiological Protection (ICRP). This presented a number of difficulties in the assessment, which included the lack of any generally accepted age-related dosimetric models, particularly for bone-seeking radionuclides; limited information on gut transfer factors for radionuclides incorporated in foodstuffs; and no dosimetric models for the fetus. These and other problems identified in the analysis that require more information are discussed.

A model for the transfer of alkaline earth elements to the fetus.

A biokinetic model has been developed for the transfer of calcium, strontium, barium and radium to the human fetus. For the mother, ICRP models were adapted for pregnancy to include increases in gastrointestinal absorption, urinary excretion and bone turnover rates. The fetus was modelled with blood, soft tissue and bone compartments. Fetal requirements for Ca were determined by skeletal calcification, and recyling between fetal and maternal blood was inlcluded. Daily transfer of Sr, Ba and Ra to the fetus was taken to be lower than for Ca by factors of 0.6 for Sr and 0.4 for Ba and Ra. For acute intakes in late pregnancy at 35 weeks after conception, when maximum transfer occurs, the model predicts whole-body fetus:mother concentration ratios (C(F):C(M)) of 18 for Ca, 8 for Sr and 2 for Ba and Ra, respectively. Estimates of committed equivalent doses to the red bone marrow of offspring, including in utero and postnatal dose, after maternal ingestion in late pregnancy, were greater than corresponding doses in adults by factors of 20-31 for 45Ca, 2-3 for 90Sr and 3-4 for 226Ra but slightly lower (0.8-1.9) for 133Ba.

Doses and risks from the ingestion of Dounreay fuel fragments.

The radiological implications of ingestion of nuclear fuel fragments present in the marine environment around Dounreay have been reassessed by using the Monte Carlo code MCNP to obtain improved estimates of the doses to target cells in the walls of the lower large intestine resulting from the passage of a fragment. The approach takes account of the reduction in dose due to attenuation within the intestinal wall and self-absorption of radiation in the fuel fragment itself. In addition, dose is calculated on the basis of a realistic estimate of the anatomical volume of the lumen, rather than being based on the average mass of the contents, as in the current ICRP model. Our best estimates of doses from the ingestion of the largest Dounreay particles are at least a factor of 30 lower than those predicted using the current ICRP model. The new ICRP model will address the issues raised here and provide improved estimates of dose.

Transfer of alkaline earth elements in mothers' milk and doses from 45Ca, 90Sr and 226Ra.

An international programme of work is currently under way to develop methods for calculating doses to infants from ingestion of radionuclides present in mothers' milk. This paper considers the special case of the alkaline earth elements. Models have been developed for 45Ca, 90Sr and 226Ra and the sensitivity of results to various changes in parameter values is discussed. A complication when calculating doses from intakes of radium is that the International Commission on Radiological Protection has previously recommended that doses from decay products of radium should be calculated using element-specific biokinetic models (so-called independent biokinetics). An extension of this method to the models for breastfeeding is proposed. Preliminary estimates of the doses received by the infant for a number of maternal intake scenarios show that doses to the infant can exceed the corresponding adult dose, such as for 45Ca (ratio = 3.1) while, in other cases such as 90Sr, the infant dose can be a significant fraction of the adult dose.

Some aspects of the fetal doses given in ICRP Publication 88.

The International Commission on Radiological Protection (ICRP) has recently published dose coefficients (dose per unit intake, Sv Bq(-1)) for the offspring of women exposed to radionuclides during or before pregnancy. These dose estimates include in utero doses to the embryo and fetus and doses delivered postnatally to the newborn child from radionuclides retained at birth. This paper considers the effect on doses of the time of radionuclide intake and examines the proportion of dose delivered in utero and postnatally for different radionuclides. Methods used to calculate doses to the fetal skeleton are compared. For many radionuclides, doses are greatest for intakes early in pregnancy but important exceptions, for which doses are greatest for intakes later in pregnancy, are iodine isotopes and isotopes of the alkaline earth elements, including strontium. While radionuclides such as 131I deliver dose largely in utero, even for intakes late in pregnancy, others such as 239Pu deliver dose largely postnatally, even for intakes early during pregnancy. For alpha emitters deposited in the skeleton, the assumption made is of uniform distribution of the radionuclide and of target cells for leukaemia and bone cancer in utero; that is, the developing bone structure is not considered. However, for beta emitters, the bone structure was considered. Both approaches can be regarded as reasonably conservative, given uncertainties in particular in the location of the target cells and the rapid growth and remodelling of the skeleton at this stage of development.

Dose coefficients for the embryo and fetus following intakes of radionuclides by the mother.

The International Commission on Radiological Protection has recently issued Publication 88, giving dose coefficients for the embryo, fetus and newborn child from intakes of selected radionuclides of 31 elements by the mother, either before or during pregnancy. The biokinetic models used for calculating these doses were based upon the available human data and the results of animal experiments. This paper summarises the approach used for the development of biokinetic and dosimetric models. It also compares the estimates of dose received by the offspring with those received by the reference adult. The main findings are that, in general, doses to the offspring are similar to or lower than those to the reference adult. For a few radionuclides, however, the dose to the offspring can exceed that to the adult. The reasons for these variations in comparative doses are examined.

Further follow up of mortality and incidence of cancer in men from the United Kingdom who participated in the United Kingdom's atmospheric nuclear weapon tests and experimental programmes.

OBJECTIVES: To study the long term effects of participation in the United Kingdom's atmospheric nuclear weapon tests and experimental programmes and to test hypotheses generated by an earlier report, including the possibility that participation in tests caused small hazards of leukaemia and multiple myeloma. DESIGN: Follow up study of mortality and cancer incidence. SUBJECTS: 21,358 servicemen and civilians from the United Kingdom who participated in the tests and a control group of 22,333 non-participants. MAIN OUTCOME MEASURES: Numbers of deaths; standardised mortality ratios; relative risks of mortality from all causes and 27 types of cancer. RESULTS: During seven further years of follow up the numbers of deaths observed in participants were fewer than expected from national rates for all causes, all neoplasms, leukaemia, and multiple myeloma (standardised mortality ratios 0.86, 0.85, 0.57, and 0.46); death rates were lower than in controls (relative risks 0.99, 0.96, 0.57, and 0.57; 90% confidence intervals all included 1.00). In the period more than 10 years after the initial participation in tests the relative risk of death in participants compared with controls was near unity for all causes (relative risk 0.99 (0.95 to 1.04) and all neoplasms (0.95 (0.87 to 1.04)); it was raised for bladder cancer (2.69 (1.42 to 5.20)) and reduced for cancers of the mouth, tongue, and pharynx (0.45 (0.22 to 0.93)) and for lung cancer (0.85 (0.73 to 0.99)). For leukaemia mortality was equal to that expected from national rates but greater than in controls for both the whole follow up period (1.75 (1.01 to 3.06)) and the period 2-25 years after the tests (3.38 (1.45 to 8.25)). CONCLUSION: Participation in nuclear weapon tests had no detectable effect on expectation of life or on subsequent risk of developing cancer or other fatal diseases. The excess of leukaemia in participants compared with controls seems to be principally due to a chance deficit in the controls, but the possibility that participation in the tests may have caused a small risk of leukaemia in the early years afterwards cannot be ruled out.

Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers.

OBJECTIVE: To study cause specific mortality of radiation workers with particular reference to associations between fatal neoplasms and level of exposure to radiation. DESIGN: Cohort study. SETTING: United Kingdom. SUBJECTS: 95,217 radiation workers at major sites of the nuclear industry. MAIN OUTCOME MEASURE: Cause of death. RESULTS: Most standardised mortality ratios were below 100: 83 unlagged, 85 with a 10 year lag for all causes; 84 unlagged, 86 lagged for all cancers; and 80 for all known other causes, indicating a "healthy worker effect." The deficit of lung cancer (75 unlagged, 76 lagged) was significant at the 0.1% level. Standardised mortality ratios were significantly raised (214 unlagged, 303 lagged) for thyroid cancer, but there was no evidence for any trend with external recorded radiation dose. Dose of external radiation and mortality from all cancers were weakly correlated (p = 0.10), and multiple myeloma was more strongly correlated (p = 0.06); for leukaemia, excluding chronic lymphatic, the trend was significant (p = 0.03; all tests one tailed). The central estimates of lifetime risk derived from these data were 10.0% per Sv (90% confidence interval less than 0 to 24%) for all cancers and 0.76% per Sv (0.07 to 2.4%) for leukaemia (excluding chronic lymphatic leukaemia). These are, respectively, 2.5 times and 1.9 times the risk estimates recommended by the International Commission on Radiological Protection, but 90% confidence intervals are large and the commission's risk factors fall well within the range. The positive trend with dose for all cancers, from which the risk estimate was derived, was not significant. The positive association between leukaemia (except chronic lymphatic leukaemia) was significant and robust in subsidiary analyses. This study showed no association between radiation exposure and prostatic cancer. CONCLUSION: There is evidence for an association between radiation exposure and mortality from cancer, in particular leukaemia (excluding chronic lymphatic leukaemia) and multiple myeloma, although mortality from these diseases in the study population overall was below that in the general population. The central estimates of risk from this study lie above the most recent estimates of the International Commission on Radiological Protection for leukaemia (excluding chronic lymphatic leukaemia) and for all malignancies. However, the commission's risk estimates are well within the 90% confidence intervals from this study. Analysis of combined cohorts of radiation workers in the United States indicated lower risk estimates than the commission recommends, and when the American data are combined with our analysis the overall risks are close to those estimated by the commission. This first analysis of the National Registry for Radiation Workers does not provide sufficient evidence to justify a revision in risk estimates for radiological protection purposes.