Keeping the ICRP Recommendations Fit for Purpose

The science behind radiological protection is complex. It starts with the physical interaction between ionising radiations and the material that composes the human body (and other biota), then considers the potential changes induced by these interactions, including the response of different issues within the body and the whole body implications of those local responses, and tries to quantify the harm that might be done (detriment). It then considers the acceptability of this harm in terms of the tolerability of risks and by putting them into perspective with other risks.  It also considers how different groups and individuals might respond if exposed, recognising workers, the public and patients as different groups with different potential gains and losses and planned, existing and emergency exposure situations. The field thus encompasses physics, biology, sociology, ethics and politics.

The International Commission on Radiological Protection was “established to advance for the public benefit the science of radiological protection, in particular by providing recommendations and guidance on all aspects of protection against ionising radiation. The Main Commission is the governing body, setting policy and giving general direction” (Ref).  The recommendations of the ICRP form the basis of radiological protection around the globe. A useful review of the effects of this last major restatement of the recommendations can be found in a PHE paper “Application of the 2007 Recommendations of the ICRP to the UK”. (Ref)

ICRP have now pre-released a major discussion document as an early step in the consultation process for the next round of recommendations. Christopher Clement et al 2021 J. Radiol. Prot. in press. On line (updated version) available at https://iopscience.iop.org/article/10.1088/1361-6498/ac1611. This article is based on the accepted manuscript 20 July 2021.

In this we are reminded that the objective of the system of radiological protection described in ICRP-103 is “to contribute to an appropriate level of protection for people and the environment against the detrimental effects of radiation exposure without unduly limiting the desirable human actions that may be associated with such exposure”. The review that preceded this document started 20 years ago and took 10 years. “While it is safe to conclude that the System is robust and has performed well in relation to the protection objectives, the System must adapt to address changes in science and society to remain fit for purpose.

It is suggested that the ICRP-103 objective to prevent tissue reactions (deterministic effects to us oldies) should be modified to recognise that there are medial situations, emergency situations (and space exploration) where tissue reactions may be tolerated to achieve the desirable benefit of a particular activity. This seems sensible but is going to add, rather than remove, complexity.

A review of the lifetime risk estimates imbedded in the concept of detriment is due a review to reflect the evolution of scientific knowledge of risks and expert judgement. “In addition, explicit recognition of differences in detriment with age at exposure and between males and females could improve the clarity of application of the System, showing, in particular, that risks to young children are greater than risks to adults, and that risks to older individuals are low.” This could be useful, for example, in removing the perceived need to evacuate elderly people from their homes during a radiological or nuclear emergency to avert radiation doses of as little as 30 mSv which are of no real threat to them.

The discussion paper points out that the current system “principally deals with health effects resulting directly from exposure to radiation” which is not entirely in line with the WHO definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Including mental and social wellbeing in the system can only make it much more complicated, situation dependent and subjective (but pretty much removes the need to worry about the physics of the fundamental interactions).

There is a section (Section 2.3) on the protection of the environment and non-human biota. I have always considered this a job creation scheme for radiobiologists and mathematical modellers (of which I used to be one) and of little practical value in the real world of radiation safety. I realise that this view sees me ejected from the moral high ground.

In Section 2.5 the paper reports that “There have been many requests for more guidance on how to balance societal, economic, and other factors in the optimisation of protection and safety, requiring input from many fields of expertise” and summarises the work that ICRP have published in this general area. This includes ICRP Task Group 114 which seems to suggest that there are occasions where the lowest exposures or risks are sought when a better balance could be achieved to advantage.

Also in this section is a discussion of a more holistic approach in safety assessments of medical facilities. Again, this seems to be running the risk of making the system more complex and maybe asking too much of one stream of work.

Section 2.6 discusses dose limitation and worries that, since it only applies to planned exposure situations, it fails the “ethical obligation to protect individual people under all circumstances”. This seems to me to be a bit like worrying that the seat belt and airbags in my car don’t provide me with any protection when I am walking around a shopping centre.

The report suggests a broader principle which would apply in all situations and encompass the concepts of limits, constraints and reference levels, possibly combining the latter two concepts into one. This is an interesting thought, worth thinking about provided the ICRP are willing to back peddle if it does not work out as hoped.

Dose constraint

A prospective and source-related restriction on the individual dose from a source, which provides a basic level of protection for the most highly exposed individuals from a source and serves as an upper bound on the dose in optimisation of protection for that source. For occupational exposures, the dose constraint is a value of individual dose used to limit the range of options considered in the process of optimisation. For public exposure, the dose constraint is an upper bound on the annual doses that members of the public should receive from the planned operation of any controlled source.

Reference level

In emergency or existing controllable exposure situations, this represents the level of dose or risk, above which it is judged to be inappropriate to plan to allow exposures to occur, and below which optimisation of protection should be implemented. The chosen value for a reference level will depend upon the prevailing circumstances of the exposure under consideration.

ICRP-103

The report states that “defining a fundamental principle to protect the individual would result in a System where all three fundamental principles apply under all circumstances regardless of the exposure situation or category. This change would require the re-examination and clarification of the distinctions between limits, constraints, and reference levels”. (I’m not sure how you can put a useful dose limit on an accident or malicious use of radiation).

Section 2.7 suggests that the experience of using the three exposure situations introduced by ICRP-103 has led to the opportunity to update, clarify and expand the guidance. This seems reasonable and the application to space travel interesting.

ICRP identify ethics, communications and stakeholder involvement and education and training as important overarching considerations and briefing discuss each in turn in Section 3.

It is proposed to use absorbed dose (in gray) for the control of doses to individual organs and tissues for the avoidance or minimisation of tissue reactions leaving equivalent dose (in sievert) as an intermediate step in the calculation of effective dose. “Radiation weighting could then be considered separately for tissue reactions and stochastic effects for the calculation of radiation-weighted absorbed dose in Gy and effective dose in Sv, respectively.” This is intended to “apply scientific knowledge more appropriately and simplify radiological protection, with a clearer distinction between organ/tissue doses in absorbed dose in Gy and effective dose in Sv”. This does seem more transparent than the switch we currently make from seiverts to grey at (an arbitrary) high dose as at low dose you are concerned about stochastic effects and high doses with tissue reaction.

The paper reports discussions with ICRU with the intention that “the measured quantities for the estimation of effective dose would be related directly to effective dose in the reference phantoms, renamed as ‘dose quantities’ (ambient and personal dose) rather than ‘dose equivalent quantities’. Operational quantities for the measurement of doses to the skin and lens of the eye will become ‘absorbed dose quantities’”. Another episode where those of us who work around radiological protection are required to forget the hard learned jargon we work with and replace it with a different set.

In Section 4.2, discussing effective dose, the paper discusses the increased use of more accurate and differentiated anthropomorphic phantoms leading to more accurate and transparent values of detriment and relative detriment separately for males and females of different age groups. The report suggests that “Revisions to the methodology of calculation of effective dose could improve its suitability for the assessment of risk. Best estimates of health risk should be calculated using estimates of absorbed doses to organs/tissues and age- and sex-specific risk models for individual types of cancer, but risk estimates at low doses will still be subject to the uncertainties inherent in risk projection models”. The question this raise in my mind is “are the age and sex differences larger than the uncertainties in the estimates?”

It is suggested in Section 4.4 that the revision of dose per unit intake values in the light of the new recommendations should be more rapid than previous experiences due to preparatory work and experience gained. This seems to be a reasonable hope.

Section 5 suggests a review of the classification of radiation effects as either stochastic effects or harmful tissue reactions to ensure that it remains fir for purpose, suggesting that “For example, for protection purposes, it may be useful to distinguish between severe and other tissue reactions, or between short-term and long-term health effects”. This seems reasonable. There are occasions where the gain from a process may be worth suffering a mild or temporary tissue effect.

Since the last recommendation were made there has been considerable research and epidemiological study of the impacts of low exposures to ionising radiation. A Task Group is currently reviewing the linear no threshold assumption in the light of this work. It looks likely to survive.

It is almost certain that different people have different susceptibility to harm from ionising radiation but likely that there is insufficient information to include this in a system to protect workers and the public. “However, there are already efforts to individualise radiological protection of patients which should be considered in the review of the System, taking into account scientific, ethical, and practical aspects”.

Similarly, there is now more information on heritable effects that should be considered.

Likewise, there is more data on relative biological effectiveness and it is likely that a more sophisticated approach may now be appropriate.

The idea that “detriment could be calculated separately for males and females and at different ages at exposure, and the corresponding values of relative detriment could be used directly in the calculation of effective dose, rather than the current use of simplified age- and sex-averaged tissue weighting factors” sounds good. As does “explicit treatment of detriment from irradiation in utero could also be re-evaluated”.

There will also be a conversation about the replacing detriment with other proposed measures of harm such as fatality or disability-adjusted life years.

The discussion paper concludes that “The last review of the System of Radiological Protection was initiated 23 years ago, and the current General Recommendations (ICRP, 2007) were published 14 years ago. The System has performed well and remains robust, and there are significant practical benefits to stability in the System. Nonetheless, it must progress to remain fit for purpose as society evolves, scientific understanding advances, and new uses of ionising radiation emerge”.

The ICRP and others continue to research the effects of ionising radiation on people, biota and the environment. A time comes when the strengths and weaknesses of the current system should be discussed and new knowledge should be systematically reviewed incorporated into a revised international system of radiological protection. It appears that that time is approaching. This paper is one step in the consultation process. An ICRP Digital Workshop on 19 – 20th October is another step (Ref).

I shall watch this process develop with interest and get involved if I deem it good use of my time.

 

 

 

 

 

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