Harnessing Nuclear Energy: Health Risks Amit Bhasin*, Aparna Ahuja**
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INDIAN JOURNAL OF MEDICAL SPECIALITIES 2011;2(1):46-53 Review Article Harnessing nuclear energy: health risks Amit Bhasin*, Aparna Ahuja** Abstract With increasing use of nuclear energy for various purposes all over the world, there is a growing debate over its ill-effects. Biological effects of radiation are dependent on the dose of radiation to which a person is exposed, dose rate of exposure, distance from radiation source, shielding and type of radiation and also type of cells and tissues being exposed with the most critically affected tissues in adults being the spermatocytes in the testis, haematopoietic precursor cells in the bone marrow and crypt cells in the intestines. Radiation injury can manifest early after the exposure, known as Acute Radiation Syndrome (ARS) or after a latent period of many months to years. Classic clinical syndromes associated with ARS include the Haematopoietic, Gastrointestinal, and Cerebrovascular (formerly known as cardiovascular and central nervous) syndromes with local radiation injury presenting as Cutaneous Syndrome (CS). Four phases may be identified in ARS- Prodromal Phase, Latent Phase, Stage of Manifest Illness and Death or Recovery Phase. Long term effects of exposure include cancers, genetic damage and cataracts. As controlled experiments regarding radiation exposure are neither feasible nor ethical, sources of information are the various disasters as the atomic bomb detonations in Japan (in the second world war), Chernobyl reactor explosion, Fukushima disaster (post-tsunami & following earthquake) in Japan and Mayapuri (Delhi, India) cobalt leak being some of them. Key words: Radiation injuries; health hazards; nuclear energy; radiation protection. Introduction Energy Agency (IAEA), contend that nuclear power is a sustainable energy source that reduces carbon With increasing use of nuclear energy for generating emissions. Opponents, such as Greenpeace power, therapeutic medical purposes and also for International and NIRS, believe that nuclear power nuclear terrorism, there has been also an increase in poses many threats to people and the environment radiation accidents and hence there is need for [3,4]. These threats include the problems of adequate medical knowledge and response. The processing, transport and storage of radioactive nuclear debate is growing in importance as nuclear waste, the risk of nuclear weapons governments everywhere are looking for ways to proliferation and terrorism, as well as health risks maintain economic growth and reduce the effects of and environmental damage from uranium mining. global warming. But it now seems like the They also contend that reactors themselves are disadvantages are just too great. Nuclear power enormously complex machines where many things provides about 6% of the world's energy and 13–14% can and do go wrong, and there have been serious of the world's electricity, with the U.S., France and nuclear accidents [5,6] Japan together accounting for about 50% of nuclear generated electricity [1,2]. Nuclear power is Determinants of radiation injury- The amount of controversial and there is an ongoing debate about radiation (i.e. radiation dose) absorbed by the the use of nuclear energy. Proponents, such as the patient's tissues is highly predictive of its biological World Nuclear Association and International Atomic effects. Such doses are defined as the amount of *Department of Medicine, Lady Hardinge Medical College, New Delhi **Department of Radiodiagnosis, Lok Nayak Hospital, New Delhi Corresponding Author: Dr. Amit Bhasin, Lady Hardinge Medical College, New Delhi-110001. India Email: [email protected] Received : 05-05-2011 | Accepted : 12-05-2011 | Published Online : 17-05-2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Conflict of interest: None declared Source of funding: Nil 46 Indian Journal of Medical Specialities, Vol. 2, No.1, Jan - Jun 2011 Harnessing nuclear energy: health risks energy of ionising radiation deposited per unit of proliferation’. Rapidly dividing cells are more tissue mass at a specific point. Some amount of profoundly affected. Radiosensitivity varies directly exposure naturally occurs during certain medical with the ‘number of future divisions’. Long-lived imaging such as: a standard chest x-ray delivers a gonadal and haematopoietic stem cells fall into this dose of 6 to 11 mrem (0.06 to 0.11 mSv, 0.06 to 0.11 category. Radiosensitivity varies indirectly with the mGy). Interventional cardiologists working in a high- ‘degree of morphologic and functional volume catheterisation laboratory may have collar differentiation’. As an example, cells at the growth badge exposures exceeding 600 mrem (6 mSv) per plate in bone, which have not yet developed into year. A barium enema with 10 spot images delivers a bone or cartilage, are more sensitive than those of dose of approximately 0.7 rem (700 mrem, 7 mSv, 7 the diaphysis. Accordingly, growth arrest of bone is mGy). Similar doses (7-8 mSv) are delivered from a commonly seen after radiation exposure to the CT scan of the chest or a PET scan, while a combined growth plate in children, as may occur in the PET/CT scan is estimated to deliver a dose of 25 mSv treatment of malignancy. Variation in sensitivity to [7-9]. But these exposures are not hazardous. The radiation is an inherited genetic trait, although lowest radiation dose resulting in an observable candidate gene studies have been largely effect in man on bone marrow depression, with a unsuccessful in identifying the genetic variants resultant decrease in blood cell counts, is in the underlying most phenotypes [13,14]. While all range of 10-50 rem (100 to 500 mSv, 0.1 to 0.5 Gy). tissues composed of short-lived cells are directly The lowest total body dose at which the first deaths and indirectly affected by radiation, the most may be seen following exposure to ionising radiation critically affected tissues in adults include the is in the range of 1.0 to 2.0 Gy. Depending upon the following: spermatocytes in the testis, type of support given, 50 percent of people exposed haematopoietic precursor cells in the bone marrow to a dose of 3 to 4 Gy will be expected to die of and crypt cells in the intestines. radiation-induced injury. There is virtually no Dose-dependent effects on various organs have also chance of survival following a total body exposure in been identified. They are of two types, excess of 10 to 12 Gy.The term “Lethal dose of deterministic and stochastic: A ‘deterministic’ radiation” has thus been defined — which is the dose effect is one in which the severity is determined by associated with death in 50 percent of those the dose (e.g. depression of blood counts). A dose similarly exposed (i.e., the LD 50). Depending on the threshold (i.e. a dose below which an effect is not incident, estimates for the LD 50 have ranged from seen) is characteristic of this effect. As an example, 1.4 Gy among atomic bomb survivors in Japan to 4.5 the threshold absorbed dose for a "deterministic Gy following uniform total-body exposure to effect" on bone marrow (0.5 Gy) is lower than that external photons [10,11]. for all other organs, except for the testis (0.15 Gy). A Several factors determine the lethality of ionising ‘stochastic’ effect represents an outcome for which radiation. These include: ‘Dose rate’ (doses the probability of occurrence (rather than severity) received over a shorter period of time cause more is determined by the dose. An example is radiation- damage), ‘Distance from the source’ (For point induced carcinogenesis, which occurs after a sources of radiation, the dose rate decreases as the prolonged and variable delay (latency) after square of the distance from the source {inverse exposure. These effects do not have an apparent square law}), ‘Shielding’ (Shielding can reduce threshold dose. The mechanisms underlying exposure, depending upon the type of radiation and deterministic and stochastic effects remain the material used, ‘Type of radiation’ (alpha unknown. Studies showing the impact of radiation particles can be stopped by a sheet of paper or a on gene function may shed light in this area. layer of skin, beta particles by a layer of clothing or less than one inch of a substance such as plastic, and Radiation injury gamma rays by inches to feet of concrete or less The damage caused by radiation exposure can be than one inch of lead) [12]. categorised according to whether the symptoms and Radiation exposure causes different degree of signs develop immediately or are delayed by months damage to various body structures depending upon or years. The ensuing damage results from the certain inherent properties of cells. Radiosensitivity sensitivity of cells to radiation, with the most varies directly with the ‘rate of cellular rapidly dividing cells being the most sensitive to the Indian Journal of Medical Specialities, Vol. 2, No.1, Jan - Jun 2011 47 Amit Bhasin and Aparna Ahuja acute effects of radiation. The inherent sensitivity victims of the Chernobyl accident, and was the main of these cells results in a constellation of clinical cause of death in more than half of lethal cases [15]. syndromes that occur within a predictable range of doses after a whole-body or significant partial-body There are four main phases to the ARS [16]- exposure. Symptoms arising from such exposures The Prodromal Phase usually occurs in the first 48 are referred to as radiation sickness or acute hours following exposure, but may develop up to six radiation syndrome (ARS). Classically, the threshold days after exposure. dose for ARS is a whole-body or significant partial- body irradiation of greater than 1 Gy delivered at a The Latent Phase is a short period characterised by relatively high dose rate. improvement of symptoms.