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Health effects of radiation exposure Tilman A Ruff Nossal Institute for Global Health, University of Melbourne Advisor: Australian Red Cross, AusAID/UNICEF Consultant: GSK Biologicals, Novartis Vaccines Medical Association for Prevention of War International Campaign to Abolish Nuclear Weapons Hunter’s Hill Inquiry, Sydney 4 July 2008
Overview ,[object Object],[object Object],[object Object]
A Quiz… ,[object Object],[object Object],[object Object],[object Object]
Radiation Basics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ionising radiation
Introduction ,[object Object],[object Object],[object Object]
Ionizing vs Non-ionizing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radiation types
DNA injury …  somatic and germ-line effects
Radioactivity Basics ,[object Object],[object Object],[object Object],[object Object]
Sources of radiation ,[object Object],[object Object]
Ionizing Radiation Sources ,[object Object]
Ionizing Radiation Sources
Evironmental Radiation Sources ,[object Object],[object Object],[object Object],[object Object],[object Object]
Multiple exposure pathways ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radiation Basics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Radiation Quantities and Units ,[object Object],[object Object],[object Object],[object Object],[object Object]
Production of Ionizing Radiation ,[object Object],[object Object]
Production of Ionizing Radiation ,[object Object],5730 yrs T 1/2 20 s
Production of Ionizing Radiation ,[object Object]
U-238 radioactive decay
tissue injury: alpha-particle track …  lung cells
Radon ,[object Object],[object Object],[object Object]
Radon ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radon  risk per 1000 of lung cancer by age 75 y WHO Factsheet 291 June 2005 160 7 400 Bq/m 3 120 5 100 Bq/m 3 100 4 0 Bq/m 3 Smoker Non-smoker
Production of Ionizing Radiation ,[object Object]
Production of Ionizing Radiation ,[object Object]
Production of Ionizing Radiation ,[object Object]
Cell Sensitivity ,[object Object],[object Object],[object Object]
Varying tissue sensitivities
 
Health Effects of Radiation
Ionising radiation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biological Effects of Radiaton ,[object Object],[object Object],[object Object],[object Object]
Biological Effects of Radiaton ,[object Object],[object Object],[object Object],[object Object],[object Object]
What Radiation Affects ,[object Object],[object Object]
Possible Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Category of Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Somatic Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More Acute Somatic ,[object Object],[object Object],[object Object],[object Object]
Delayed Somatic Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More Delayed Somatic Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cancer Risks ,[object Object],[object Object],[object Object],[object Object],[object Object]
Latency Period
Cancer Risks ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cancer in Australia: an overview 2006, AIHW
Cancer Risks ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cancer risks vary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Low Dose Risk ,[object Object],[object Object],[object Object]
Possible Extrapolations
Threshold ,[object Object],[object Object],[object Object]
Linear-Quadratic ,[object Object]
Linear - No Threshold ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fetal radiation risk ,[object Object],[object Object],Less Least Most risk
Radiation-induced malformations ,[object Object],[object Object],[object Object]
Central nervous system effects ,[object Object],[object Object],[object Object]
Leukaemia and cancer… ,[object Object],[object Object]
Leukaemia and cancer ,[object Object],[object Object]
Probability of bearing healthy children as a function of radiation dose 5 Higher  Possible >100 99.1 97 100 99.4 97 50 99.6 97 10 99.7 97 99.7 97 1 99.7 97 0 Probability of  no  cancer (0-19 years) Probability of  no  malformation Dose to conceptus (mSv) above natural background
Pre-conception irradiation ,[object Object]
Pre-conception irradiation ,[object Object],[object Object]
The Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries.BMJ. 2005 Jul 9;331(7508):77. Epub 2005 Jun 29
The Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Evidence ,[object Object],[object Object],[object Object],[object Object]
Comparative Risks ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is ‘Safe’? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Years  of Life Lost
Days  of Life Lost
Hours  of Life Lost
Medical Radiation Exposure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Radiation Exposure ,[object Object]
Medical Radiation Exposure ,[object Object]
Medical Radiation Exposure ,[object Object]
Medical Radiation Exposure ,[object Object]
Medical Radiation Exposure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Berrington de González A, Darby S. Risk of cancer from diagnostic x-rays:estimates for the UK and 14 other countries.  Lancet  2004; 363: 345-351.
Medical Radiation Exposure 1:2800 440 669 220 4.4 Nuclear bone scan 1:1000 1200 1825 600 12 Nuclear myocardial perfusion study 1:125000 10 15 5 0.1 mammography 1:1400 870 1323 435 8.7 Ba enema 1:4200 300 456 150 3-11 Conventional coronary angio 1:1250 1000 1521 500 10 CT coronary angio 1:1100 1100 1673 550 11 CT abdo/pelvis 1:1600 800 1217 400 8 CT chest 1:4200 300 456 150 3 CT brain 1:625,000 2 3 1 0.02 Chest x-ray (PA) Probability of fatal cancer Equivalent aircraft flight hours EBR (days) Equivalent CXR Effective dose (mSv) Procedure
Medical Radiation Exposure ,[object Object]
Medical Radiation Exposure ,[object Object],Per capita dose due to diagnostic radiation has increased 600% since 1980
Worldwide diagnostic radiation cancer risks United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation. New York: United Nations, 2000.
CT Scanners
CT Scanners
CT Scanners
CT Scanners
Cancer Risks-how good are  we ? Radiology 2004; 231:393-398
A Quiz… The Answers ,[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object]
Nuclear industry workers 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nuclear industry workers 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nuclear industry workers vs Japanese bomb survivors* 3 0.26 – 4.01 1.86 Lung cancer *Men aged 20-60 at time of exposure ^Assuming linear dose response with no threshold  “  Assuming linear-quadratic response 0.03 - 1.88 0.01 – 0.50 0.87 0.32 Solid cancer,  4770 3246 <0 – 8.47  1.58 – 5.67^  -1.14 – 5.33” 1.93 3.15^  1.54” Leukemia excl CLL, 196 83 0.14 -1.97 0.97 All cancers excl leukemia,  5024 95% CI Excess relative risk per Sv Cause of death , N Workers  Survivors
Nuclear industry workers  4 ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
‘Routine’ radiation releases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
‘Routine’ radiation releases ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object]
[object Object]
Radioactivity of plutonium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BEIR VII 2005: Update on the risks of “low-level” radiation  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Linear No-Threshold (LNT) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risk Factors currently in use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Heritable effects (BEIR VII, p. 20) ,[object Object],[object Object],[object Object]

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Health Effects Of Radiation Exposure

  • 1. Health effects of radiation exposure Tilman A Ruff Nossal Institute for Global Health, University of Melbourne Advisor: Australian Red Cross, AusAID/UNICEF Consultant: GSK Biologicals, Novartis Vaccines Medical Association for Prevention of War International Campaign to Abolish Nuclear Weapons Hunter’s Hill Inquiry, Sydney 4 July 2008
  • 2.
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  • 9. DNA injury … somatic and germ-line effects
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  • 22. tissue injury: alpha-particle track … lung cells
  • 23.
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  • 25. Radon risk per 1000 of lung cancer by age 75 y WHO Factsheet 291 June 2005 160 7 400 Bq/m 3 120 5 100 Bq/m 3 100 4 0 Bq/m 3 Smoker Non-smoker
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  • 31.  
  • 32. Health Effects of Radiation
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  • 58. Probability of bearing healthy children as a function of radiation dose 5 Higher Possible >100 99.1 97 100 99.4 97 50 99.6 97 10 99.7 97 99.7 97 1 99.7 97 0 Probability of no cancer (0-19 years) Probability of no malformation Dose to conceptus (mSv) above natural background
  • 59.
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  • 66.
  • 67. Years of Life Lost
  • 68. Days of Life Lost
  • 69. Hours of Life Lost
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  • 73.
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  • 75.
  • 76. Medical Radiation Exposure 1:2800 440 669 220 4.4 Nuclear bone scan 1:1000 1200 1825 600 12 Nuclear myocardial perfusion study 1:125000 10 15 5 0.1 mammography 1:1400 870 1323 435 8.7 Ba enema 1:4200 300 456 150 3-11 Conventional coronary angio 1:1250 1000 1521 500 10 CT coronary angio 1:1100 1100 1673 550 11 CT abdo/pelvis 1:1600 800 1217 400 8 CT chest 1:4200 300 456 150 3 CT brain 1:625,000 2 3 1 0.02 Chest x-ray (PA) Probability of fatal cancer Equivalent aircraft flight hours EBR (days) Equivalent CXR Effective dose (mSv) Procedure
  • 77.
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  • 79. Worldwide diagnostic radiation cancer risks United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation. New York: United Nations, 2000.
  • 84. Cancer Risks-how good are we ? Radiology 2004; 231:393-398
  • 85.
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  • 89. Nuclear industry workers vs Japanese bomb survivors* 3 0.26 – 4.01 1.86 Lung cancer *Men aged 20-60 at time of exposure ^Assuming linear dose response with no threshold “ Assuming linear-quadratic response 0.03 - 1.88 0.01 – 0.50 0.87 0.32 Solid cancer, 4770 3246 <0 – 8.47 1.58 – 5.67^ -1.14 – 5.33” 1.93 3.15^ 1.54” Leukemia excl CLL, 196 83 0.14 -1.97 0.97 All cancers excl leukemia, 5024 95% CI Excess relative risk per Sv Cause of death , N Workers Survivors
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