Radiation Hormesis, Or, Could All That Radiation Be Good for Us?
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SPECIAL CONTRIBUTIONS Radiation Hormesis, or, Could All That Radiation Be Good for Us? Jennifer L. Prekeges, MS, CNMT Virginia Mason Medical Center, Seattle, Washington emerge from the information presented here: that public Objective: Nuclear medicine technologists work under sig- perception drives the enactment of regulation as much as nificant radiation protection constraints. These constraints does science and that, although the science of radiation are based on the linear no-threshold (LNT) radiation para- biology has advanced, regulations affecting occupational digm, which was developed in the 1960s and was based radiation exposure have not. largely on the deleterious effects of radiation as they were understood at the time. More recently, the theory of radia- tion hormesis, or a beneficial effect of low-level exposure to HISTORY OF PERCEPTIONS ABOUT RADIATION radiation, has gained recognition. This article reviews the Radiation has always been present in our environment. history of attitudes toward radiation, describes the radiation hormesis hypothesis, examines some of the evidence that However, mankind was not directly aware of its existence supports it, and suggests ways that radiation protection until the end of the 19th century, when a flurry of scientific regulations might change if the hypothesis were to become discoveries were made. In 1895, Wilhelm Roentgen discov- accepted. ered x-rays. In 1896, Henri Becquerel discovered the spon- Key Words: radiation hormesis; radiobiology; effects of ra- taneous emission of radiation from uranium, a phenomenon diation he called “radioactivity.” And, in 1898, Marie Curie dis- J Nucl Med Technol 2003; 31:11–17 covered radium, which is luminescent as well as having radioactive isotopes (1). Beyond the revolution they caused in basic physics, these discoveries were put to immediate practical use. The first Nuclear medicine is governed by regulations that are diagnostic x-ray was produced in January 1896, only a few based on an understanding of the harmful effects of radia- months after Roentgen made his discovery. More than 1,000 tion that was current in the early 1960s. However, the articles on x-rays were published that year. The field of question of whether low levels of radiation can cause harm nuclear medicine had its origins in 1923, when Georg de remains controversial. Several recent studies suggest that Hevesy proposed using radioactive tracers in biomedical radiation exposure, under some circumstances, can be ben- research. Today, the field of diagnostic radiology with its eficial. This new theory of radiation hormesis is especially various modalities affects the great majority of people in the pertinent to nuclear medicine technologists, who are ex- developed world. posed in the low-dose, low dose-rate fashion that seems to But the new rays were put to use in more mundane tools carry beneficial effects. as well (2). Thomas Edison introduced a home fluoroscopy This article will introduce radiation hormesis to the nu- unit in 1896. In the 1920s, x-ray units were used in beauty clear medicine technologist community by first reviewing parlors to remove unwanted facial and body hair. Even into the history of our perceptions of radiation and then contrast- the 1950s, fluoroscopes were used to measure the fit of ing the current radiation paradigm with a radiation hormesis children’s shoes. paradigm. Epidemiological and experimental evidence sup- The ability of radiation to treat disease was also explored porting the radiation hormesis paradigm will be reviewed. soon after its discovery. The first recorded radiation treat- Finally, several ways will be suggested in which the practice ment was performed in 1896. Radiation’s benefits for treat- of nuclear medicine and the utilization of radioactive ma- ment of malignancy are well documented and widely used. terials in general might be made easier by the acceptance of More recently, the use of radionuclides to treat certain the radiation hormesis hypothesis. Two specific points will illnesses, both malignant and nonmalignant, has become established. Radiation also has been used at various times to treat several nonmalignant conditions, including ankylosing For correspondence or reprints contact: Jennifer L. Prekeges, MS, spondylitis, postpartum breast tenderness, and scalp ring- CNMT, Nuclear Medicine, C5-NM, Virginia Mason Medical Center, P.O. Box 900, Seattle, WA 98111-0900. worm (3). It was even used for a brief period in efforts to E-mail address: [email protected] increase fertility (3). These uses have been discontinued. VOLUME 31, NUMBER 1, MARCH 2003 11 Various forms of radium were put to more esoteric uses (2). The Radium Eclipse Sprayer purported to be a combi- nation insecticide and furniture polish. Radithor tonic con- tained 0.076 MBq (2 Ci) radium per bottle and was touted for its health benefits. Radium-containing beverages were called “liquid sunshine cocktails.” One could even play “radium roulette” (the wheel, balls, and chips were painted with radium) or purchase a glowing radium-painted cruci- fix. Radium also produced some of the early harmful conse- quences of radiation. In the 1920s, women who painted watch dials with radium were diagnosed with osteosarco- mas and osteonecrosis. Even before that, radiation injuries had been reported. Becquerel left a vial of radioactive FIGURE 1. Three hypotheses of radiation dose–response rela- material in his coat breast pocket, resulting in erythema and tionship, as proposed by the United Nations Scientific Committee skin ulceration, the first recorded radiation injury. The first on the Effects of Atomic Radiation in 1958. (Reprinted with permis- known casualty resulting from radiation exposure was Clar- sion of (3).) ence Dally, Thomas Edison’s assistant. Dally was involved in Edison’s early work with x-rays, all of which was per- formed without benefit of shielding. Dally’s death was to accept this model as the basis for recommendations for horrific: his flesh became ulcerated, his hair fell out in radiation exposure limits. Because it was presumed to afford clumps, and he underwent multiple amputations of both the greatest protection, the LNT hypothesis became the arms in an effort to stem the progression of radiation dam- basis of the accepted model, or paradigm, for radiation’s age. ability to cause harm. The event that truly caught the public’s attention, how- A paradigm is an interlocking set of assumptions about ever, was the dropping of 2 atomic bombs in World War II. the operation of a complex system (4). It is a model of how The combination of immediate devastation, acute radiation the system works. Once accepted by the scientific commu- injuries, and increased leukemia incidence among survivors nity, a paradigm tends to channel attention and research cemented in the general consciousness the idea that radia- funding into “acceptable” directions. Observations that fail tion is harmful. Further experiments, such as the Mega- to fit the paradigm may be ignored or suppressed. This is not mouse genetic work at Oak Ridge National Laboratory in a conspiracy but, instead, a reflection of human nature. the 1950s, added to our understanding of radiation’s risks. When we believe something to be true, we discount alter- More recent incidents, such as the Chernobyl explosion, native statements that contradict the “truth” as we perceive have only reinforced these perceptions. it. In general, a paradigm must be conclusively disproved In the same time frame, scientific experiments using before a new paradigm can be accepted. tissue culture illuminated the effects of radiation on a cel- The LNT hypothesis assumes that the passage of a single lular level. Irradiation of cells was found to cause DNA charged particle through a single cell could cause damage to damage, division delay (longer than normal time to the next DNA that could lead to a genetic defect or a cancer. Thus division cycle), reproductive failure (inability to maintain the radiation paradigm based on the LNT hypothesis has the cell division over a long period of time), and interphase following tenets: death (cell death before the next cell cycle). These experi- ● Radiation exposure is harmful; ments solidified the understanding (widely held at that time) ● Radiation exposure is harmful at all exposure levels; that radiation is harmful. ● Each increment of exposure adds to the overall risk; and TWO RADIATION PARADIGMS ● The rate of accumulation of radiation exposure has no bearing on risk. The bureaucratic response to this knowledge of radia- tion’s dangers was embodied in the linear no-threshold These tenets reflect the mechanistic assumption that each (LNT) hypothesis. The United Nations Scientific Commit- particle of ionizing radiation (␣, ,or␥) can cause a DNA tee on the Effects of Atomic Radiation (UNSCEAR) in mutation, which, in turn, can potentially lead to a cancer. 1958 proposed 3 relationships of risk-versus-radiation dose Further, the proportional relationship of radiation expo- (Fig. 1). Of the 3 relationships, the linear model is the most sure to DNA damage to fatal illness allows the same prin- conservative, because it predicts the greatest amount of ciples to be applied on a population basis. The risk to a harm at low levels of radiation. In 1960, the International population in a radiation incident is directly proportional to Commission on Radiation Protection (ICRP) and its U.S. the aggregate radiation exposure of that population. This counterpart, the National Council on Radiation Protection implies that individually