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Dose Fractionation Concept in Radiation Protection to Standardize Epidemiology Studies Risk/Dose Limits and Epidemiology Studies

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Dose Fractionation Concept in Radiation Protection to Standardize Epidemiology Studies Risk/Dose Limits and Epidemiology Studies ISSN 2471-8211 SciO p Forschene n HUB for Sc i e n t i f i c R e s e a r c h Journal of Epidemiology and Public Health Reviews Editorial Volume: 2.4 Open Access Received date: 01 Aug 2017; Accepted date: 01 Dose Fractionation Concept in Radiation Sep 2017; Published date: 08 Sep 2017. Protection to Standardize Risk/Dose Limits and Citation: Sohrabi M (2017) Dose Fractionation Concept in Radiation Protection to Standardize Epidemiology Studies Risk/Dose Limits and Epidemiology Studies. J Epidemiol Public Health Rev 2(4): doi http://dx.doi. Mehdi Sohrabi* org/10.16966/2471-8211.e103 Department of Energy Engineering and Physics, Health Physics and Dosimetry Research Laboratory, Copyright: © 2017 Sohrabi M. This is an open- Amirkabir University of Technology, Tehran, Iran access article distributed under the terms of the Creative Commons Attribution License, *Corresponding author: Mehdi Sohrabi, Department of Energy Engineering and Physics, Health which permits unrestricted use, distribution, and Physics and Dosimetry Research Laboratory, Amirkabir University of Technology, Tehran, Iran, reproduction in any medium, provided the original Tel: 09121097485; E-mail: [email protected] author and source are credited. Ionizing radiation, either originated from natural background (NBG) As a known principle in experimental radiobiology, as the radiation radiation sources (primordial radioactive materials in the earth crust dose delivered to cells increases, the number of cells survived or the and cosmic rays) or from man-made sources (reactors, accelerators, survival fraction decreases. The shape of the survival curves depends on diagnostic and radiotherapy equipment, industrial sources, etc.) expose the radiation type and energy, LET, dose and dose rate (dose per unit time), the public and workers (as members of public) which may cause chemical state of fractionation of doses, oxygenation, temperature, etc. In fact, for and biological changes in the human body cells and may damage them the cell killing, a prescribed dose is required to be delivered with a known temporarily or permanently [1]. Some cells may die (apoptosis), some dose rate within a certain period of time. When the same prescribed dose become abnormal either temporarily or permanently, or some have is divided into several fractions, the total dose given in order to observe damages in the DNA as a genetic material which may cause cancer. The the same effects, for example for cell killings, should be increased. This is cell may also make self-repair depending on the severity of the damage due to the self-repair mechanisms that occur in a damaged cell within few and continue survival like a normal cell. The extent of the damage to the hours post irradiation depending on the factors as discussed above. cells depends on many radiation exposure factors such as the radiation type and its energy, LET, dose and dose rate, type of cell at risk and its In radiation therapy, dividing a prescribed radiation dose to a tumor to sensitivity, cell oxygenation, environmental conditions, and whether or kill the cancerous cells into multiple smaller dose fractions is commonly not the dose delivered to the cells is continuous or “fractionated” over referred to as “dose fractionation” [10]. The “dose fractionation” is applied time, a concept which has not been considered in the field of “radiation in order to maximize the positive effects of radiation by destroying the protection” so far. cancerous cells to be killed and to protect the normal cells by minimizing any negative effects. In fact, at the cellular level and at doses concerned Over the past few decades, major efforts have been in progress in radiation therapy, five important biologic processes occur after each worldwide on applying low dose/low dose rate ionizing radiation exposures to epidemiological studies of public and in particular radiation radiation treatment, which produces the benefit of fractionated dose workers to estimate radiation health risks per unit dose to either further in radiation therapy. These biological processes include repair of the support the “linear no-threshold (LNT) model” being presently practiced sublethal DNA damage by normal cells; repopulation of normal healthy or the “hormesis model” or any other acceptable models [2-5]. In fact, this cells, reassortment of tumor cells into more radiosensitive phases of the is one of the main challenging issues in the present radiation protection cell cycle; reoxygenation of tumor cells and radiosensitivity [10]. While philosophy of the workers, public, and environment in ionizing radiation such processes have been relatively well studied at high doses and dose applications to have scientifically acceptable radiation health risks per unit rates used in radiation therapy, it seems data on such effects occurring at dose of ionizing radiation to set standardized “dose limits” [6]. Presently, very low doses and dose rates (e.g. 10 µSv.h-1) encountered in radiation the dose limitation system and epidemiology studies of workers are based protection need to be developed. At such low doses and dose rates in on considering only the highly “fractionated” occupational exposure particular for low-LET radiation such as gamma rays, the interactions of with no consideration of any other doses received from sources such radiation with the DNA molecule in a cell are expected to cause single- as chronic “unfractionated” NBG radiation in daily living indoors and strand breaks which are more susceptible to be repaired as can be well outdoors, from which public and workers (as members of the public) noted on the shoulder of the gamma survival curves. While in radiation are continuously exposed to [1,7-9]. In this context, it is the purpose of therapy at high doses, double-strand DNA breaks are expected to be this “Editorial” to highlight and emphasize three important concepts in common making the cells more probable to be killed rather than repaired. order to have “conservation of cause and effect” in radiation protection Therefore, self-repair of cells at very low doses and dose rates common in [7-9]; (i) integrate occupational doses with other radiation doses a worker radiation protection can effectively occur, as is observed on the shoulder receives also as a member of public, (ii) emphasize further the role of of the survival curves. doses other than occupational exposure such as the NBG radiation in estimation of radiation risks and setting dose limits, and in particular While the level of doses and dose rates has been highly important in (iii) introduce and demonstrate the role of “fractionation” of doses observing radiobiological effects, the “fractionation of doses” at such received by radiation workers in the calculation of the integrated doses; levels has not yet been noted in order to equalize and standardize radiation concepts which have not yet been of concern in the present radiation effects and risks per unit dose for setting dose limits and in particular for protection system [6]. epidemiology studies of workers. However, it should be noted that the Copyright: © 2017 Sohrabi M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. SciForschenOpen HUB for Scientific Research Open Access w -1 doses of an individual member of public from environmental radiation in Iaid(mSv.y ) = EoxFo+ EnbgxFnbg+ EpesxFpes+EpoxFpo (1) particular from NBG radiation are usually chronic and “unfractionated”, Where; while those of the occupational exposure of workers are unavoidably wI = Annual integrated dose of a worker (mSv.y-1), highly “fractionated” for which relevant corrections should be applied. aid -1 This “dose fractionation concept” has been recently introduced in radiation Eo=Annual occupational dose (mSv.y ), protection by a new “Universal Radiation Protection System (URPS) Fo = Fractionation factor for occupational dose, Hypothesis” proposed by this author [1,7-9]. The“URPS Hypothesis”, E =Annual national mean NBG dose (mSv.y-1), based on 3 main principles, given below [1]: nbg F =Fractionation factorfor NBG dose, 1. Assigns equal radiation health risks to an individual (either a member nbg of public or a worker also as a member of public) per unit radiation Epes=Annual dose from planned exposure situation as a member of dose either from NBG radiation or from man-made sources, public (mSv.y-1), 2. Applies a “Standardized Integrated Dose System” (SIDS) to any Fpes=Fractionation factor for planned exposure situation effective dose, dose limits, reference levels, etc. based on integrating all doses an Epo =Annual public other dose, and individual receives from the existing exposure (e.g. NBG radiation), F =Fractionation factor of other doses. planned exposure, and emergency exposure situations in order to po w -1 standardize the integral doses an individual, in particular, a worker Therefore, the annual integrated dose of a worker Iaid (mSv.y ) can be receives for setting dose limits and for estimating health risk in given as a general equation (2): epidemiological studies, and w Iaid= ∑iEi. Fi (2) 3. Takes into account any factors affecting the effects of an individual Where; dose, in particular, the dose “fractionation factor” in setting integral wI = Worker’s annual integrated dose (mSv.y-1), health risk-based dose limits and reference levels in radiation aid -1 protection in general and in
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