Program of the 2003 Annual Meeting, Radiation Protection at the Beginning of the 21st Century – A Look Forward

April 9-10, 2003

Summary of Current Radiation Principles in the United States and Internationally
John D. Boice, Jr., Session Chair

Radiation Protection Principles of the National Council on Radiation Protection and Measurements
Kenneth R. Kase, Stanford Linear Accelerator Center

The current recommendations of the National Council on Radiation Protection and Measurements (NCRP) relative to ionizing radiation are based on radiation protection principles that developed historically as information about radiation effects on human populations became available. Because the NCRP Charter states that the NCRP will cooperate with the International Commission on Radiological Protection (ICRP), the basic principles and recommendations for radiation protection of NCRP are closely coupled with those of ICRP. Thus, the fundamental principles of justification, optimization, and dose limitation as initially stated in ICRP Publication 26 (1977) have been adopted and applied by NCRP in its recommendations. ICRP and NCRP recommendations on dose limitation for the general public and for occupationally exposed individuals are based on the same analyses of radiation risk, and are very similar. In 1989, NCRP extended its guidance to address exposure to individuals engaged in space activities. Several reports have been issued, or are in preparation to provide recommendations on dose limitation and the development of radiation safety programs to apply radiation protection principles in space activities. The biological basis for these recommendations is provided in these and accompanying NCRP reports. Recommendations for the application of basic radiation protection principles have been made in many reports over the years. Those that are most current appear in approximately 50 NCRP reports published in the last 15 y. These address radiation safety practices in industrial and medical institutions, control of radionuclides in the environment, protection of the public, and assessment of radiation risk. Some aspects of these recommendations will be discussed.

Current recommendations related to radiation safety practice are based on the principles and dose limits specified in NCRP Report No. 116 (1993). The limits are based on estimates of the risk of fatal cancer and an assessment of the risk that should be tolerated by workers who are occupationally exposed, and by the general public. These levels of risk are related to other risks that individuals accept in their lives. Looking to the future, one might consider other directions that NCRP could take in developing radiation protection recommendations that are still based upon the stated principles, such as relating dose to loss of life expectancy instead of fatal cancer risk. It may also be that the principles of justification, optimization, and dose limitation should be reconsidered. For example, NCRP may make recommendations about the relationship of radiation dose to various biological effects or outcomes and the resulting estimates of risk, but not specify dose limits. This would relieve NCRP of the necessity to speculate about acceptable risks. One can also imagine that the principle of justification could be applied not only to the introduction of a new source of radiation, but also to the removal of an existing source of radiation, i.e., the idea of justifying decontamination efforts. It is clear that as we move into the 21st century there will be a continuing need for NCRP to identify the principles upon which radiation protection is to be based and to provide guidance on the application of those principles for the many beneficial uses of radiation and radioactive materials in society.

International Radiation Protection: Policies and Current Issues
Abel González, International Atomic Energy Agency

Internationally, protection against exposure to ionizing radiation (or radiation in short) rests on three foundations:

• the estimates of the health effects attributed to radiation exposure, which are assessed by the United Nations Committee on the Effects of Atomic Radiation (UNSCEAR) and periodically submitted to the United Nations (UN) General Assembly;
• the basic recommendations for radiation protection, which are provided by the International Commission on Radiological Protection (ICRP); and
• he international standards on radiation safety, which are established by the International Atomic Energy Agency (IAEA) on the basis of the UNSCEAR estimates and taking account of the ICRP recommendations.

This presentation briefly describes the current policies of UNSCEAR and ICRP and how these policies are converted into international standards by IAEA, which is the only organization within the UN with a statutory mandate not only to establish such standards but also to provide for their application. It also summarizes the current status of the established corpus of international radiation safety standards, and its foreseeable evolution, as well as of legally binding undertakings by countries around the world that are linked to these standards.

Moreover, this presentation also reviews some major current global issues related to the application of international standards, including the following:

• Strengthening of national infrastructures for radiation safety, including technical cooperation programmes for assisting developing countries.
• Occupational radiation protection challenges, including the protection of pregnant workers and their unborn children, dealing with working environments with high natural radiation levels, and occupational attributability of health effects (probability of occupational causation).
• Restricting discharges of radioactive substances into the environment: reviewing current international polices vis-à-vis the growing concern on the radiation protection of the “environment”
• Radiological protection of patients undergoing radiodiagnostic and radiotherapeutic procedures: the current International Action Plan.
• Safety and security of radiation sources: post-September 11th developments.
• Preparedness and response to radiation emergencies: enhancing the international network.
• Safe transport of radioactive materials: new apprehensions.
• Safety of radioactive waste management: concerns and connections with radiation protection.

Radioactive residues remaining after the termination of activities: radiation protection response to the forthcoming wave of decommissioning of installations with radioactive materials.

The ultimate aim of this presentation is to encourage fostering information exchange, cooperation and collaboration within the professional radiation protection community. In particular the presentation tries to facilitate the consolidation of the growing international regime on radiation safety, including the expansion of legally binding undertakings by countries, the strengthening of the current corpus of international radiation safety standards, and the development of international provisions for ensuring the proper worldwide application of these standards, such as a system of international appraisals by peer reviewing.

Improvements Needed and Being Undertaken with Current Radiation Protection Principles
John R. Frazier, Session Chair

Radiation Protection Challenges Facing the Federal Agencies
C. Rick Jones, U.S. Department of Energy

In the United States, federal agencies are responsible for setting national policy that establishes performance expectations for radiation protection programs. National policy creates a regulatory regime, under which society can realize the beneficial uses of radiation while at the same time protecting workers, the public, and environment from the potential hazards of radiation. The challenges facing the federal agencies continue to revolve around finding the right balance between benefit and adverse impact. Federal agencies are petitioned to support the research community to provide a sound scientific basis for informing the decision-making process related to radiation protection policy. The federal agencies are further challenged to consider the deliberations of the International Commission on Radiological Protection (ICRP) and the National Council on Radiation Protection and Measurements (NCRP). ICRP and NCRP bring together the best technical minds in the field to consider the latest scientific information and publish recommendations for establishing comprehensive and coherent radiation protection programs. The uncertainty inherent in research and the conservatism in products and models of ICRP and NCRP should be transparent and communicated. Determining the level of uncertainty and the degree of conservatism acceptable to society is a challenge for, and the responsibility of, the federal agencies in creating performance-based policies for public health and radiation protection. Another issue to be considered by the federal agencies, in partnership with industry, is the adequacy and qualifications of radiation protection professionals to implement these policies and programs. It is through the federal government’s open, inclusive and democratic processes where society strikes the balance that defines adequate radiation protection policy, builds public trust, and addresses the need for professionals to properly implement and manage that policy.

United States Nuclear Industry Perspective on Useful Improvements to Radiation Protection Principles
Ralph L. Andersen, Nuclear Energy Institute

In the United States, 104 nuclear power plants generate 20 percent of the nation’s electricity. Of currently available energy sources, nuclear energy is among those with the least impact on the environment, especially in terms of unit energy produced. For example, nuclear plants do not emit gases potentially harmful to the environment—including those that have been associated with ground-level ozone formation, smog, acid rain, and global warming. Nuclear energy is currently the lowest cost source of base load electrical generation in the United States.

In the view of the United States nuclear energy industry, the current radiation protection framework provides an adequate basis for protecting workers, the public, and the environment. Nevertheless, international and national radiation protection organizations are presently engaged in updating, clarifying and enhancing radiation protection principles, and appropriately so, given our culture of pursuing excellence in radiation protection through a process of continuous improvement. Accordingly, the nuclear energy industry appreciates the opportunity to provide its perspective on this effort. The nuclear energy industry’s perspective is shaped in several ways—as an operator, we carry out a primary responsibility for protecting human health and safety and the environment; as a licensee, we are responsible for complying with government regulations; and as an energy producer, we are responsible for the safe, reliable and economic generation of electricity for consumers. Our objective in regard to improving radiation protection principles is to help promote an outcome that has a clearly articulated basis in science, is flexible in regard to how it might be applied to a very wide range of current and future regulated activities, and is practical and cost-effective in terms of how it can be implemented and maintained.

Although this presentation deals primarily with the nuclear energy industry’s perspective on possible improvements to radiation protection, perspective from other segments of the nuclear industry are also included. There are over 20,000 radioactive material licenses in the United States, administered by the Nuclear Regulatory Commission and 32 Agreement States. In addition to the use of radioisotopes in medicine (covered in another presentation at this meeting), radioactive material is also used extensively in a wide range of industrial applications and consumer products. Radioactive sources and radiation are used in petroleum exploration, to ensure the strength, integrity, and quality of materials; to sterilize medical products and consumer goods; to improve food safety and abundance; to create fresh water supplies from sea water; and to provide power in diverse applications ranging from nanotechnologies to space exploration. Radioactive material is also used in consumer goods, such as smoke detectors, wrist watches, and exit signs. And, perhaps most fundamentally, the role of radionuclides is critical in the conduct of physical, chemical and biological research.

Among areas that will be discussed for possible improvements in radiation protection principles, the following three are highlighted:

• Although no radiation dose is below a level of concern, an improved approach is needed to ascertain levels (for different applications) that do not require further action.
• Practical guidance would be useful regarding effective and efficient uses of the concept of collective dose as a radiation protection tool, while constraining its misapplications, e.g., in estimating health effects among large populations receiving low average doses of radiation.
• Principles should be expanded to address development of risk-informed approaches for assuring the safety and security of radioactive sources.

In closing, our admonition is that useful changes should arise from the need to reflect new scientific developments, incorporate insights from the evaluation of experience and lessons learned, and solve identified and defined problems. New and revised principles should be directly related to an expectation of a substantial improvement of radiation protection without unnecessarily restricting societal access to the vast benefits of nuclear technology.

State Perspective on Ways to Improve Radiation Protection Principles
Cindy Cardwell, Conference of Radiation Control Program Directors, Inc.

State radiation regulators have a broad scope of regulatory authority. They are responsible for regulating both man-made and naturally occurring radioactive material, radiation-producing machines, and nonionizing sources of radiation. This broad-scope authority presents challenges to state radiation regulatory agencies that must implement and maintain a regulatory framework that incorporates radiation safety principles for all types of uses, without unduly hindering effective use of sources of radiation. The challenges include resource allocation, prioritization of risk in order to appropriately allocate resources, and the ability to effectively predict and respond to changing risk-informed priorities. Changes in radiation protection principles and policies must be accomplished through a partnership of stakeholders to be most effective and to meet these challenges.

Medical Perspective on Ways to Improve Radiation Protection Standards
Fred A. Mettler, Jr., University of New Mexico

Classical radiation protection seeks to minimize dose by a number of methodologies such as ALARA (as low as reasonably achievable). Medical radiation exposures have been recognized as different from occupational and public exposures in a number of ways. The most obvious is that the patient (who receives the absorbed dose) receives a direct-personal benefit.

Another facet is that minimal dose is not the point. The medical perspective is that too small a dose will not provide adequate information for diagnosis or will not be sufficient to cure a cancer. Thus the “correct” dose is what should be the goal.

Dose limits are not used in medicine. Clearly if a chest x ray is indicated in a life-threatening situation it should not be denied if the equipment is older and provides a higher than average dose. The use of “reference” values in medicine allows abnormally high doses to be identified and corrected or justified.

Ways to improve radiation protection in medicine are the topic of the current International Action Plan of the International Atomic Energy Agency, World Health Organization, and other organizations. This will be discussed in more detail.

Another differentiating point is that the patient in most circumstances gives consent to have the exposure. One can question the degree of informed consent but generally with high doses used in radiation therapy there is explicit written consent while with lower doses and lower risks the consent may be verbal and less explicit.

Finally, any radiation protection system in medicine must be integrated with radiation protection as a whole since the radiologists, technologists, etc. are experiencing occupational exposure as the patients are receiving their doses.

Stakeholder Perspectives on Radiation Protection
Lisa Ledwidge, Institute for Energy and Environmental Research
Lisa Crawford, Fernald Residents for Environmental Safety and Health
LeRoy Moore, Rocky Mountain Peace and Justice Center

Standards for permissible exposure to radiation and the way they are established must incorporate a set of principles that uphold both health and democracy. When the science is uncertain, the burden of proof that risk is not being imposed should be on the source, not on the public and workers. Scientific processes must be transparent to the public, address all relevant risk issues and endpoints (and not only cancer), and be inclusive of the actual experience and opinion of the people who are exposed to r adiation risks. Scientists are too often dismissive of public experience and interests, as for instance with worker illnesses or fallout, even though input from the public and workers have frequently proven to be valuable in the development of radiation protection principles. Incorporating the concerns, views and experiences of workers and the public in a respectful way while maintaining a high standard of scientific work must be an essential part of the standard setting process. Further, the clearly enunciated International Commission on Radiological Protection principle that the imposition of risk must be accompanied by a clear benefit needs to be a far more explicit part of standard-setting processes, which must also ensure that all known risks are disclosed and that suspected risks, such as synergisms between hormone-disrupting chemicals, are carefully considered. Finally, given the long-lived nature of risks from many radionuclides and the large uncertainties about future physical, social, economic, and other conditions, the issue of how the interests of future generations can be included in standard setting is a difficult but vital matter.

Radiation Protection Principles for the 21st Century
R. Julian Preston, Session Chair

Current Activities of the International Commission on Radiological Protection
Lars-Erik Holm, Swedish Radiation Protection Authority

The present recommendations of the International Commission on Radiological Protection (ICRP) were published in 1991 . ICRP’s advice is aimed principally at the regulators and operators that have responsibility for establishing protection standards. Since then, ICRP has provided additional recommendations in nine other publications. The system has thus become increasingly complex, and it has in some respects been difficult to explain the variations between different applications. ICRP has reviewed its system of protection and decided to try to simplify it and make it more coherent. ICRP will adopt a new set of recommendations in 2005, and this will include a stronger emphasis on the protection of individuals, broadening the concept of dose limits by adding a range of actions and levels above which action should be taken, a distinction between actions that can be applied to the source and those that can be applied to the pathways leading from the source to the doses in individuals, clarification of the dosimetric quantities, and a framework for protection of nonhuman organisms.

In the review of the current system of protection, many topics are being looked at and all ICRP committees are currently addressing issues of relevance for the 2005 recommendations. Committee 1 is, for example, looking at low dose response, linear nonthreshold, and dose-rate effects. The two types of weighting factors (radiation and tissue) may need some simplification and Committees 1 and 2 are addressing this issue. Committee 2 is also developing voxel phantoms and dosimetric models, such as for the human alimentary tract. Issues for Committee 3 are, among other things, to see how the ICRP’s new recommendations can be applied in medicine, training and authorization for users of radiation in medicine, and release of patients after therapy with permanently implanted sources. Committee 4 will address how to use the action levels proposed by ICRP and how to comply with the system. Other important tasks are to define what are an individual and a critical group.

ICRP’s system of protection has evolved over time as our understanding of underlying mechanisms has increased, and substantial revisions are made at intervals of about 10 to 15 y. ICRP wishes to see an ongoing debate over the next few years, and the ideas of the ongoing revision have already been published in international journals and promulgated through international organizations. In 2004, the proposal for the 2005 recommendations on radiological protection will be discussed at the 11th International Radiation Protection Association conference in Madrid. When ICRP adopts the new recommendations in 2005, this will be 15 y after the current recommendations were adopted.

Draft Recommendations from International Commission on Radiological Protection at the Start of the 21st Century
Roger H. Clarke, International Commission on Radiological Protection

The International Commission on Radiological Protection (ICRP) has been stimulating discussion, during the past three years, on the best way of expressing protection philosophy for the next publication of its recommendations, which it hopes will be by 2005. The presentations were initiated by Publication 60 in 1990 and have subsequently been complemented by additional publications over the last 12 y.

The 1990 system of protection was developed over some 30 y, during which the system became increasingly complex as ICRP sought to reflect the many situations to which the system applied. This complexity involved the justification of a practice, the optimization of protection, including the use of constraints, and the use of individual limits. It has also been necessary to deal separately with practices and intervention and to apply the recommendations in different ways to occupational, medical and public exposures. This complexity is logical, but in some respects, it has been difficult to explain the variations between different applications.

The concept of the constraint in optimization of protection from a source was introduced because of the need to restrict the inequity of any collective process for offsetting costs and benefits when this balancing is not the same for all the individuals affected by the source. This introduction of the constraint recognized the importance of restricting the optimization process with a requirement to provide a basic minimum standard of protection for the individual.

The principles for intervention set out in Publication 60 are expressed in terms of a level of dose or exposure where intervention is almost certainty warranted, which is followed by a requirement to maximize the benefit of the intervention. This is effectively an optimization process and therefore it may be seen in exactly the same terms as for practices, i.e., there is a restriction on the maximum individual dose and then the application of the optimization process, which is itself, expected to lead to lower doses to individuals.

Since the 1990 recommendations, there have been nine publications that have provided additional recommendations for what are to be regarded as “constraints” in the control of exposures from radiation sources. There exist nearly 30 different numerical values for these “constraints,” which are justified in some six different ways.

The new recommendations should be seen, therefore, as a consolidation of recommendations from Publication 60 and those published subsequently, to give a single unified set that can be simply and coherently expressed. The question to be addressed is whether, for the future, fewer constraints may be recommended, and whether they can be established on a more uniform and consistent basis.

Future Role of the National Council on Radiation Protection and Measurements in Radiation Protection
Thomas S. Tenforde, National Council on Radiation Protection and Measurements

The National Council on Radiation Protection and Measurements (NCRP) was founded in 1929, and in 1964 was formally chartered by the U.S. Congress as a national resource for scientific guidance on issues related to safe radiation protection practices. During the intervening 39 y, NCRP has published 111 reports, 15 commentaries, and 9 statements related to radiation policies and practices in industry, medicine, and other sources of public and occupational exposure to ionizing and nonionizing radiation.

Considerable progress has been made during this period toward understanding the mechanisms of interaction of radiation with living systems, as well as the consequences of radiation exposure to both human health and the vitality of natural ecosystems. Nevertheless, there are still many aspects of human disease and damage to the natural environment caused by radiation that are not adequately understood, especially at low dose levels typical of most environmental exposures experienced outside the workplace. In addition, a number of relatively new radiological methods are being used to an increasing extent in medicine, security screening, and for other purposes. These growing applications of radiation represent a source of increased exposure to the public, the health implications of which will require careful analysis. As a consequence, the role of NCRP in assisting with the interpretation of new scientific information on radiation damage to living systems, in providing guidance on acceptable levels of exposure, and in making recommendations of practical methods for mitigating radiation damage and managing radioactively contaminated environments, remains as important as ever.

There are three primary areas in which NCRP activities will be focused over the next several years:

• Working in close collaboration with the International Commission on Radiological Protection and other national and international organizations, NCRP will provide scientific insights and guidance to assist with the development of new recommendations for safe radiation policies and practices.
• NCRP will play a central coordination role in efforts to harmonize the several different sets of guidelines that currently exist in the United States for limiting radiation exposure of workers and members of the public.
• Several parallel efforts, some of which are already underway, will be expanded over the coming years to address special issues related to radiological safety. These efforts include (1) analysis of the health implications and methods for mitigation of the high doses received by patients in certain medical procedures; (2) development of rational strategies for the management of radioactive waste materials, including an analysis of the feasibility of clearing potentially valuable waste materials for beneficial reuse; (3) developing guidance on the cleanup and remediation of radiologically contaminated sites in a way that optimizes the protection of human health and natural ecosystems; (4) providing guidance to protect the health of individuals in occupations that pose the risk of high radiation exposures, for example, astronauts participating in interplanetary missions; and (5) analysis of appropriate federal, state and local responses to acts of radiological terrorism that could pose severe health risks to first responders and members of the general public.

Through a balanced set of activities, including both the preparation of timely new reports and the organization of symposia and annual meetings on specialized topics, NCRP will continue to play a key scientific role as a national resource for the development of safe radiological policies and practices.

Twenty-Seventh Lauriston S. Taylor Lecture on Radiation Protection and Measurements

Introduction of the Lecturer, S. James Adelstein

The Evolution of Radiation Protection: From Erythema to Genetic Risks to Risks of Cancer to ?, Charles B. Meinhold

Implementing Changes to Radiation Protection

Panel Discussion
Mary E. Clark, Moderator

• Roger H. Clarke, National Radiological Protection Board
• Greta Dicus, U.S. Nuclear Regulatory Commission
• Jill Lipoti, New Jersey Department of Environmental Protection
• Thomas S. Tenforde, National Council on Radiation Protection and Measurements

Meeting Summary
John E. Till, Risk Assessment Corporation

The Program Committee

John E. Till, Chair
John D. Boice, Jr.
Mary E. Clark
Roger H. Clarke
John R. Frazier
Jill Lipoti
R. Julian Preston