Population Monitoring After Radiation Emergencies
- What is Population Monitoring?
- Summary Information
- Manpower for Population Monitoring
- Estimate of Lifetime Excess Risk of Fatal Cancer Due to Short-term Radiation
- BEIR VII: Health Risks from Exposure to Low Levels of Ionizing Radiation
- Estimates of Cancer Following Radiation Exposure
- Use of Biodosimetry in Long Term Surveillance Studies After Radiation Exposure
- Mitigation of Delayed Effects of Acute Radiation Exposure
What is Population Monitoring?
- Population monitoring is a process that begins soon after a radiation incident is reported and continues until all potentially affected people have been monitored and evaluated for
- Needed medical treatment
- The presence of radioactive contamination on the body or clothing
- The intake of radioactive materials into the body
- The removal of external or internal contamination (decontamination)
- The radiation dose received and the resulting health risk from the exposure
- Long-term health effects
- Adapted from Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners, Second Edition, April 2014. (PDF - 13 MB) (HHS/CDC)
- Additional key documents:
- Long-Term Health Monitoring of Populations Following a Nuclear or Radiologic Incident in the United States: Proceedings of a Workshop (NASEM, 2019)
- Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident, (NCRP Report No. 166), National Council on Radiation Protection and Measurements, Bethesda, MD, 2011.
- An Introduction to the Estimation of Risks Arising from Exposure to Low Doses of Ionizing Radiation (HPA-RPD-055) (Public Health England [PHE], formerly Health Protection Agency [HPA], June 2009)
Summary Information
- Persons potentially or actually exposed to radiation during an emergency event should be registered for long-term monitoring and tracking.
- Individuals to be tracked include
- Actual victims documented to have been exposed or contaminated
- Individuals who think they may have been exposed or contaminated
- All responders
- Tracking and surveillance guidelines are directed
by
- Isotopes responsible for the contamination
- Dose from exposure received by each victim
- Host factors that may modify expected outcomes
- Individuals to be tracked should be entered into the global database generated for each event.
- Tracking and surveillance may be required for many years, as radiation late effects may not appear for decades.
- Even those who survive Acute Radiation Syndrome effects may be at risk for delayed effects of acute radiation exposure.
- Within HHS, CDC has been given the responsibility for population monitoring after a mass casualty event. Their documents provide comprehensive guidance.
- Radiation Epidemiology for Public Health Decision Making (course available until December 23, 2021, with continuing education credits)
- Miller CW, Ansari A, Martin C, Chang A, Buzzell J, Whitcomb RC Jr. Use of epidemiological data and direct bioassay for prioritization of affected populations in a large-scale radiation emergency. Health Phys. 2011 Aug;101(2):209-15. [PubMed Citation]
- Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners, Second Edition, April 2014. (PDF - 13 MB) (HHS/CDC)
- CDC's Roles in the Event of a Nuclear or Radiological Terrorist Attack (HHS/CDC, May 2006)
- Population Monitoring After a Release of Radioactive Material (HHS/CDC, May 2006)
- Population Monitoring After a Release of Radioactive Material (PDF - 79 KB) (HHS/CDC, January 2005)
- Roundtable on Population Monitoring Following a Nuclear/Radiological Incident (PDF - 334 KB) (HHS/CDC, January 2005)
- Prototype for basic tracking information to be collected from each individual (responder, victim, citizen) associated with a radiological/nuclear event (PDF - 31 KB) (HHS/CDC)
- Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident, (NCRP Report No. 166)
- Detailed guidance about the development of radiological response plans for emergency responders and medical centers for
- Efficient screening of a population for internally-deposited radionuclides, including detection procedures/equipment, and levels of concern
- Decontamination procedures for populations
- Treatment with decorporation therapy: details
- Use of Clinical Decision Guides for specific radionuclides of concern for adults, pregnant women and children
- Scaling up response capacity and operating procedures to match the size of the event
- Detailed guidance about the development of radiological response plans for emergency responders and medical centers for
- Other useful references about dose reconstruction
- NCI Radiation Epidemiology and Dosimetry Course from 2015 (2015)
See selected videos and pdfs available online.
(HHS/National Cancer Institute/Division of Cancer Epidemiology and Genetics) - Douple EB, Mabuchi K, Cullings HM, Preston DL, Kodama K, Shimizu Y, Fujiwara S, Shore RE. Long-term radiation-related health effects in a unique human population: lessons learned from the atomic bomb survivors of Hiroshima and Nagasaki. Disaster Med Public Health Prep. 2011 Mar;5 Suppl 1:S122-33. [PubMed Citation]
- Simon SL, Bailiff I, Bouville A, Fattibene P, Kleinerman RA, Lloyd DC, McKeever SWS, Romanyukha A, Sevan'kaev AV, Tucker JD, Wieser A. BiodosEPR-2006 consensus committee report on biodosimetric methods to evaluate radiation doses at long times after exposure. Radiation Measurements. 2007 Jul;42(6):948-71.
- Radiation Health Effects (Radiation Effects Research Foundation, 2007)
- Radiation Dosimetry Monograph: "Applications of Dosimetry in Radiation Epidemiology" (Radiation Research, July 2006, Volume 166, Number 1. Special Supplement, pages 125-318) (HHS/National Cancer Institute/Division of Cancer Epidemiology and Genetics)
- NCI Radiation Epidemiology and Dosimetry Course from 2015 (2015)
- UNSCEAR reports on late effects of radiation: cancer and other effects
- Effects of ionizing radiation: UNSCEAR 2006 Report
- Volume I
- Main text of the 2006 report to the General Assembly ( A/61/46 + Corr.1)
- Annex A - Epidemiological studies of radiation and cancer; and
- Annex B - Epidemiological evaluation of cardiovascular disease and other non-cancer diseases following radiation exposure.
- Volume II
- Annex C: Non-targeted and delayed effects of exposure to ionizing radiation
- Annex D: Effects of ionizing radiation on the immune system
- Annex E: Sources-to-effects assessment for radon in homes and workplaces
- Volume I
- Hereditary effects of ionizing radiation: UNSCEAR 2001 Report
- Introduction
- I: The Human Genome
- II: Mendelian Diseases
- III: Multifactorial Diseases
- IV: The Mutation Component for Genetic Diseases
- V: Cancer Predisposition, Radiosensitivity, and the Risk of Radiation-Induced Cancers
- VI: Other Relevant Studies
- VII: Concepts, Data and Analysis Used for the Estimation of Genetic Risks
- VIII: Risk Estimates
- Summary and Conclusions
- Report to the General Assembly (PDF - 119 KB)
- Hereditary effects of radiation (PDF - 2.12 MB) (156 pages)
- Sources and effects of ionizing radiation: UNSCEAR 2000 Report
- Report to the General Assembly (PDF - 192 KB)
- Scientific Annexes:
- Annex A: Dose assessment methodologies (PDF - 769 KB) (63 pages)
- Annex B: Exposures from natural radiation sources (PDF - 922 KB) (74 pages)
- Annex C: Exposures from man-made sources of radiation (PDF - 1.80 MB) (134 pages)
- Annex D: Medical radiation exposures (PDF - 2.07 MB) (203 pages)
- Annex E: Occupational radiation exposures (PDF - 2.09 MB) (158 pages)
- Effects of ionizing radiation: UNSCEAR 2006 Report
Manpower for Population Monitoring
Estimate of Lifetime Excess Risk of Fatal Cancer Due to Short-term Radiation
| Short-term Whole-body Dose [rad (Gy)] |
Excess Lifetime Risk of Fatal Cancer due to Short-term Radiation Exposure (%) |
|---|---|
| 10 (0.1) | 0.8 |
| 100 (1) | 8 |
| 200 (2) | 16 |
| 300 (3) | 24 |
| 600 (6) | >40 |
| 1,000 (10) | >50 |
b Lifetime risk to fatal cancer without radiation exposure is approximately 24%.
Most cancers are not likely to occur until several decades after exposure; although leukemia has a shorter latency period (>5 y).
c Applies to those individuals that survive the acute radiation syndrome.
Adapted from Key Elements of Preparing Emergency Responders for Nuclear and Radiological Terrorism (NCRP Commentary No. 19), National Council on Radiation Protection and Measurements, Bethesda, MD, December 2005, page 29. Purchase required.
BEIR VII: Health Risks from Exposure to Low Levels of Ionizing Radiation
Estimated Risk of Cancer in 100 People from a Single Exposure of 100 mSv of Radiation
In a lifetime, approximately 42 (solid circles) of 100 people will be diagnosed with cancer from causes unrelated to radiation. The calculations in this report suggest approximately one cancer (star) in 100 people could result from a single exposure 100 mSv of low linear energy transfer (low-LET) radiation.
Adapted from BEIR VII: Health Risks from Exposure to Low Levels of Ionizing Radiation, (The National Academies, 2005, purchase required). See short summary of the report (PDF - 288 KB) (free).
BEIR VII's Best Estimates of the Lifetime Attributable Risk (LAR) of Incidence and Mortality for All Solid Cancer and Leukemia per 100,000 Persons Exposed to 100 mSv
| All solid cancer | Leukemia | |||
|---|---|---|---|---|
Excess cases (including non-fatal cases) from exposure to 100 mSv |
Males | Females | Males | Females |
| 800 (400-1600) | 1300 (690-2500) |
100 (30-300) | 79 (20-250) |
|
| Number of cases in the absence of exposure | 45,500 | 36,900 | 830 | 590 |
| Excess deaths from exposure to 100 mSv | 410 (200-830) | 610 (300-1200) |
70 (20-220) | 50 (10-190) |
| Number of deaths in the absence of exposure | 22,100 | 17,500 | 710 | 530 |
- The Table shows the estimated number of cancer cases and deaths expected to result in 100,000 persons (with an age distribution similar to that of the entire U.S. population) exposed to 100 mSv.
- The estimates are accompanied by 95% subjective confidence intervals shown in parentheses that reflect the most important uncertainty sources including statistical variation, uncertainty in adjusting risk for exposure at low doses and dose rates, and uncertainty in the method of transporting data from a Japanese to a U.S. population.
- For comparison, the number of expected cases and deaths in the absence of exposure is listed.
Adapted from BEIR VII: Health Risks from Exposure to Low Levels of Ionizing Radiation, (The National Academies, 2005)
Estimates of Cancer Following Radiation Exposure
- Linear No-threshold Model of Carcinogenic Radiation Effects at Very Low Doses (PDF - 141 KB) (Brief overview by Dr. John Boice) (NCRP)
- Preston RJ, Boice JD Jr, Brill AB, Chakraborty R, Conolly R, Hoffman FO, Hornung RW, Kocher DC, Land CE, Shore RE, Woloschak GE. Uncertainties in estimating health risks associated with exposure to ionising radiation. J Radiol Prot. 2013 Sep;33(3):573-88. [PubMed Citation]
- Salomaa S, Prise KM, Atkinson MJ, et al. State of the art in research into the risk of low dose radiation exposure-findings of the fourth MELODI workshop. J Radiol Protection 2013;33(3):589-603. [PubMed Citation]
- Preconception and Prenatal Radiation Exposure: Health Effects and Protective Guidance, (NCRP Report No. 174), Bethesda, MD, 2013.
- Uncertainties in the Estimation of Radiation Risks and Probability of Disease Causation, (NCRP Report No. 171), National Council on Radiation Protection and Measurements, Bethesda, MD, 2012.
- Wakeford R. Cancer risk modelling and radiological protection. J Radiol Prot. 2012 Mar;32(1):N89-93. Epub 2012 Mar 6. [PubMed Citation]
- de Gonzalez AB, Iulian Apostoaei A, Veiga LH, Rajaraman P, Thomas BA, Owen Hoffman F, Gilbert E, Land C. RadRAT: a radiation risk assessment tool for lifetime cancer risk projection. J Radiol Prot. 2012 Jul 19;32(3):205-222. [PubMed Citation]
- Linet MS, Slovis TL, Miller DL, Kleinerman R, Lee C, Rajaraman P, Berrington de Gonzalez A. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin. 2012 Feb 3. doi: 10.3322/caac.21132. [Epub ahead of print] [PubMed Citation]
- Risk of Solid Cancer Following Radiation Exposure, Estimates for the UK population, see especially pages 198-211 (Public Health England [PHE], formerly Health Protection Agency [HPA], August 2011)
- Risk of Leukaemia and Related Malignancies following Radiation Exposure: Estimates for the UK Population (Public Health England [PHE], formerly Health Protection Agency [HPA], 2003)
Use of Biodosimetry in Long Term Surveillance Studies After Radiation Exposure
- Simon SL, Bouville A, Kleinerman R. Current use and future needs of biodosimetry in studies of long-term health risk following radiation exposure. Health Phys 2010 Feb; 98(2): 109-17. [PubMed Citation]
- NCI Radiation Epidemiology and Dosimetry Course from 2015 (2015)
See selected videos and pdfs available online.
(HHS/National Cancer Institute/Division of Cancer Epidemiology and Genetics)
Mitigation of Delayed Effects of Acute Radiation Exposure
- Yoo SS, Jorgensen TJ, Kennedy AR, Boice Jr JD, Shapiro A, Hu TC, Moyer BR, Grace MB, Kelloff GJ, Fenech M, Prasanna PG, Coleman CN. Mitigating the risk of radiation-induced cancers: limitations and paradigms in drug development. J Radiol Prot. 2014 Apr 14;34(2):R25-R52. [PubMed Citation]
References
- Moulder JE. Report on an interagency workshop on the radiobiology of nuclear terrorism. Molecular and cellular biology dose (1-10 Sv) radiation and potential mechanisms of radiation protection (Bethesda, Maryland, December 17-18, 2001). Radiat Res. 2002 Jul;158(1):118-24. [PubMed Citation]
- Moulder JE. Post-irradiation approaches to treatment of radiation injuries in the context of radiological terrorism and radiation accidents: a review. Int J Radiat Biol. 2004 Jan;80(1):3-10. [PubMed Citation]
- Follow-up of delayed health consequences of acute accidental radiation exposure: Lessons to be learned from their medical management (IAEA-TECDOC-1300, Sponsored by IAEA and WHO, July 2002) (PDF - 1.46 MB)