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.

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.

Doses from radiation exposure.

Practical implementation of the International Commission on Radiological Protection's (ICRP) system of protection requires the availability of appropriate methods and data. The work of Committee 2 is concerned with the development of reference data and methods for the assessment of internal and external radiation exposure of workers and members of the public. This involves the development of reference biokinetic and dosimetric models, reference anatomical models of the human body, and reference anatomical and physiological data. Following ICRP's 2007 Recommendations, Committee 2 has focused on the provision of new reference dose coefficients for external and internal exposure. As well as specifying changes to the radiation and tissue weighting factors used in the calculation of protection quantities, the 2007 Recommendations introduced the use of reference anatomical phantoms based on medical imaging data, requiring explicit sex averaging of male and female organ-equivalent doses in the calculation of effective dose. In preparation for the calculation of new dose coefficients, Committee 2 and its task groups have provided updated nuclear decay data (ICRP Publication 107) and adult reference computational phantoms (ICRP Publication 110). New dose coefficients for external exposures of workers are complete (ICRP Publication 116), and work is in progress on a series of reports on internal dose coefficients to workers from inhaled and ingested radionuclides. Reference phantoms for children will also be provided and used in the calculation of dose coefficients for public exposures. Committee 2 also has task groups on exposures to radiation in space and on the use of effective dose.

Effective dose: a radiation protection quantity.

Modern radiation protection is based on the principles of justification, limitation, and optimisation. Assessment of radiation risks for individuals or groups of individuals is, however, not a primary objective of radiological protection. The implementation of the principles of limitation and optimisation requires an appropriate quantification of radiation exposure. The International Commission on Radiological Protection (ICRP) has introduced effective dose as the principal radiological protection quantity to be used for setting and controlling dose limits for stochastic effects in the regulatory context, and for the practical implementation of the optimisation principle. Effective dose is the tissue weighted sum of radiation weighted organ and tissue doses of a reference person from exposure to external irradiations and internal emitters. The specific normalised values of tissue weighting factors are defined by ICRP for individual tissues, and used as an approximate age- and sex-averaged representation of the relative contribution of each tissue to the radiation detriment of stochastic effects from whole-body low-linear energy transfer irradiations. The rounded values of tissue and radiation weighting factors are chosen by ICRP on the basis of available scientific data from radiation epidemiology and radiation biology, and they are therefore subject to adjustment as new scientific information becomes available. Effective dose is a single, risk-related dosimetric quantity, used prospectively for planning and optimisation purposes, and retrospectively for demonstrating compliance with dose limits and constraints. In practical radiation protection, it has proven to be extremely useful.

ICRP Publication 119: Compendium of dose coefficients based on ICRP Publication 60.

This report is a compilation of dose coefficients for intakes of radionuclides by workers and members of the public, and conversion coefficients for use in occupational radiological protection against external radiation from Publications 68, 72, and 74 (ICRP, 1994b, 1996a,b). It serves as a comprehensive reference for dose coefficients based on the primary radiation protection guidance given in the Publication 60 recommendations (ICRP, 1991). The coefficients tabulated in this publication will be superseded in due course by values based on the Publication 103 recommendations (ICRP, 2007).

Isoeffective dose: a concept for biological weighting of absorbed dose in proton and heavier-ion therapies.

When reporting radiation therapy procedures, International Commission on Radiation Units and Measurements (ICRU) recommends specifying absorbed dose at/in all clinically relevant points and/or volumes. In addition, treatment conditions should be reported as completely as possible in order to allow full understanding and interpretation of the treatment prescription. However, the clinical outcome does not only depend on absorbed dose but also on a number of other factors such as dose per fraction, overall treatment time and radiation quality radiation biology effectiveness (RBE). Therefore, weighting factors have to be applied when different types of treatments are to be compared or to be combined. This had led to the concept of 'isoeffective absorbed dose', introduced by ICRU and International Atomic Energy Agency (IAEA). The isoeffective dose D(IsoE) is the dose of a treatment carried out under reference conditions producing the same clinical effects on the target volume as those of the actual treatment. It is the product of the total absorbed dose (in gray) used and a weighting factor W(IsoE) (dimensionless): D(IsoE)=D×W(IsoE). In fractionated photon-beam therapy, the dose per fraction and the overall treatment time (in days) are the two main parameters that the radiation oncologist has the freedom to adjust. The weighting factor for an alteration of the dose per fraction is commonly evaluated using the linear-quadratic (α/ß) model. For therapy with protons and heavier ions, radiation quality has to be taken into account. A 'generic proton RBE' of 1.1 for clinical applications is recommended in a joint ICRU-IAEA Report [ICRU (International Commission on Radiation Units and Measurements) and IAEA (International Atomic Energy Agency). Prescribing, recording and reporting proton-beam therapy. ICRU Report 78, jointly with the IAEA, JICRU, 7(2) Oxford University Press (2007)]. For heavier ions (e.g. carbon ions), the situation is more complex as the RBE values vary markedly with particle type, energy and depth in tissue.

Response of neutron detectors to high-energy mixed radiation fields.

Radiation protection around CERN's high-energy accelerators represents a major challenge due to the presence of complex, mixed radiation fields. Behind thick shielding neutrons dominate and their energy ranges from fractions of eV to about 1 GeV. In this work the response of various portable detectors sensitive to neutrons was studied at CERN's High-Energy Reference Field Facility (CERF). The measurements were carried out with conventional rem counters, which usually cover neutron energies up to 20 MeV, the Thermo WENDI-2, which is specified to measure neutrons up to several GeV, and a tissue-equivalent proportional counter. The experimentally determined neutron dose equivalent results were compared with Monte Carlo (MC) simulations. Based on these studies field calibration factors can be determined, which result in a more reliable estimate of H*(10) in an unknown, but presumably similar high-energy field around an accelerator than a calibration factor determined in a radiation field of a reference neutron source.

The ICRU (International Commission on Radiation Units and Measurements): its contribution to dosimetry in diagnostic and interventional radiology.

The ICRU (International Commission on Radiation Units and Measurements was created to develop a coherent system of quantities and units, universally accepted in all fields where ionizing radiation is used. Although the accuracy of dose or kerma may be low for most radiological applications, the quantity which is measured must be clearly specified. Radiological dosimetry instruments are generally calibrated free-in-air in terms of air kerma. However, to estimate the probability of harm at low dose, the mean absorbed dose for organs is used. In contrast, at high doses, the likelihood of harm is related to the absorbed dose at the site receiving the highest dose. Therefore, to assess the risk of deterministic and stochastic effects, a detailed knowledge of absorbed dose distribution, organ doses, patient age and gender is required. For interventional radiology, where the avoidance of deterministic effects becomes important, dose conversion coefficients are generally not yet developed.

Dose quantities in radiation protection and their limitations.

For more than 50 years the quantity absorbed dose has been the basic physical quantity in the medical applications of ionising radiation as well as radiological protection against harm from ionising radiation. In radiotherapy relatively high doses are applied (to a part of the human body) within a short period and the absorbed dose is mainly correlated with deterministic effects such as cell killing and tissue damage. In contrast, in radiological protection one is dealing with low doses and low dose rates and long-term stochastic effects in tissue such as cancer induction. The dose quantity (absorbed dose) is considered to be correlated with the probability of cancer incidence and thus risk induced by exposure. ICRP has developed specific dosimetric quantities for radiological protection that allow the extent of exposure to ionising radiation from whole and partial body external radiation as well as from intakes of radionuclides to be taken into account by one quantity. Moreover, radiological protection quantities are designed to provide a correlation with risk of radiation induced cancer. In addition, operational dose quantities have been defined for use in measurements of external radiation exposure and practical applications. The paper describes the concept and considerations underlying the actual system of dose quantities, and discusses the advantage as well as the limitations of applicability of such a system. For example, absorbed dose is a non-stochastic quantity defined at any point in matter. All dose quantities in use are based on an averaging procedure. Stochastic effects and microscopic biological and energy deposition structures are not considered in the definition. Absorbed dose is correlated to the initial very short phase of the radiation interaction with tissue while the radiation induced biological reactions of the tissue may last for minutes or hours or even longer. There are many parameters other than absorbed dose that influence the process of cancer induction, which may influence the consideration of cells and/or tissues at risk which are most important for radiological protection.

Dose equivalent measurements in a strongly pulsed high-energy radiation field.

The stray radiation field outside the shielding of high-energy accelerators comprises neutrons, photons and charged particles with a wide range of energies. Often, accelerators operate by accelerating and ejecting short pulses of particles, creating an analogue, pulsed radiation field. The pulses can be as short as 10 micros with high instantaneous fluence rates and dose rates. Measurements of average dose equivalent (rate) for radiation protection purposes in these fields present a challenge for instrumentation. The performance of three instruments (i.e. a recombination chamber, the Sievert Instrument and a HANDI-TEPC) measuring total dose equivalent is compared in a high-energy reference radiation field (CERF) and a strongly pulsed, high-energy radiation field at the CERN proton synchrotron (PS).

Biological weighting of absorbed dose in radiation therapy.

Absorbed dose is a quantity which is scientifically rigorously defined and used to quantify the exposure of biological objects, including humans, to ionising radiation. There is, however, no unique relationship between absorbed dose and induced biological effects. The effects induced by a given absorbed dose to a given biological object depend also on radiation quality and temporal distribution of the irradiation. In radiation therapy, empirical approaches are still used today to account for these dependencies in practice. In hadron therapy (neutrons, protons, ions), radiation quality is accounted for with a diversity of (almost hospital specific) methods. The necessity to account for temporal aspects is well known in external beam therapy and in high dose rate brachytherapy. The paper reviews the approaches for weighting the absorbed dose in radiation therapy, and focusses on the clinical aspects of these approaches, in particular the accuracy requirements.

European measurements of aircraft crew exposure to cosmic radiation.

For more than 5 y, the European Commission has supported research into scientific and technical aspects of cosmic-ray dosimetry at flight altitudes in civil radiation. This has been in response to legislation to regard exposure of aircraft crew as occupational, following the recommendations of the International Commission on Radiological Protection in Publication 60. The response to increased public interest and concern, and in anticipation of European and national current work, within a total of three multi-national, multi-partner research contracts, is based on a comprehensive approach including measurements with dosimetric and spectrometric instruments during flights, at high-mountain altitudes, and in a high-energy radiation reference field at CERN, as well as cosmic-ray transport calculations. The work involves scientists in the fields of neutron physics, cosmic-ray physics, and general dosimetry. A detailed set of measurements has been obtained by employing a wide range of detectors on several routes, both on subsonic and supersonic aircraft. Many of the measurements were made simultaneously by several instruments allowing the intercomparison of results. This paper presents a brief overview of results obtained. It demonstrates that the knowledge about radiation fields and on exposure data has been substantially consolidated and that the available data provide an adequate basis for dose assessments of aircraft crew, which will be legally required in the European Union after 13 May 2000.

Risk assessment for cancer induction after low- and high-LET therapeutic irradiation.

The risk of induction of a second primary cancer after a therapeutic irradiation with conventional photon beams is well recognized and documented. However, in general, it is totally overwhelmed by the benefit of the treatment. The same is true to a large extent for the combinations of radiation and drug therapy. After fast neutron therapy, the risk of induction of a second cancer is greater than after photon therapy. Neutron RBE increases with decreasing dose and there is a wide evidence that neutron RBE is greater for cancer induction (and for other late effects relevant in radiation protection) than for cell killing. Animal data on RBE for tumor induction are reviewed, as well as other biological effects such as life shortening, malignant cell transformation in vitro, chromosome aberrations, genetic effects. These effects can be related, directly or indirectly, to cancer induction to the extent that they express a "genomic" lesion. Almost no reliable human epidemiological data are available so far. For fission neutrons a RBE for cancer induction of about 20 relative to photons seems to be a reasonable assumption. For fast neutrons, due to the difference in energy spectrum, a RBE of 10 can be assumed. After proton beam therapy (low-LET radiation), the risk of secondary cancer induction, relative to photons, can be divided by a factor of 3, due to the reduction of integral dose (as an average). The RBE of heavy-ions for cancer induction can be assumed to be similar to fission neutrons, i.e. about 20 relative to photons. However, after heavy-ion beam therapy, the risk should be divided by 3, as after proton therapy due to the excellent physical selectivity of the irradiation. Therefore a risk 5 to 10 times higher than photons could be assumed. This range is probably a pessimistic estimate for carbon ions since most of the normal tissues, at the level of the initial plateau, are irradiated with low-LET radiation.