Consensus Study Report
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Leveraging Advances in Modern Science to Revitalize Low-Dose Radiation Research in the United States. Washington, DC: The National Academies Press. https://doi.org/10.17226/26434.
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COMMITTEE ON DEVELOPING A LONG-TERM STRATEGY FOR LOW-DOSE RADIATION RESEARCH IN THE UNITED STATES
JOE W. GRAY (NAM) (Chair), Oregon Health & Science University (emeritus), Portland
SIMON D. BOUFFLER, UK Health Security Agency, Chilton, United Kingdom
SHAHEEN A. DEWJI, Georgia Institute of Technology, Atlanta
ANDREW P. FEINBERG (NAM), Johns Hopkins University School of Medicine, Baltimore, Maryland
BENJAMIN FRENCH, Vanderbilt University, Nashville, Tennessee
BERNARD D. GOLDSTEIN (NAM), University of Pittsburgh (retired), Pennsylvania
JOHN D. GRAHAM, Indiana University, Bloomington
ELIZABETH M. JAFFEE (NAM), Johns Hopkins University, Baltimore, Maryland
EVAGELIA C. LAIAKIS, Georgetown University, Washington, District of Columbia
LINDSAY M. MORTON, National Cancer Institute, Bethesda, Maryland
DAVID B. RICHARDSON, University of California, Irvine
DÖRTHE SCHAUE, University of California, Los Angeles
RASHID A. SHAIKH, Health Effects Institute (retired), Cambridge, Massachusetts
RICHARD L. WAHL (NAM),1 Washington University School of Medicine in St. Louis, Missouri
GAYLE E. WOLOSCHAK, Northwestern University, Evanston, Illinois
Staff
OURANIA KOSTI, Study Director
LAURA D. LLANOS, Finance Business Partner
DARLENE GROS, Senior Program Assistant
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1 Resigned from the committee effective September 2, 2021.
NUCLEAR AND RADIATION STUDIES BOARD
WILLIAM H. TOBEY (Chair), Los Alamos National Laboratory, Los Alamos, New Mexico
JAMES A. BRINK (Vice Chair), Massachusetts General Hospital, Boston
SALLY A. AMUNDSON, Columbia University, New York, New York
STEVEN M. BECKER, Old Dominion University, Norfolk, Virginia
AMY BERRINGTON DE GONZÁLEZ, National Cancer Institute, Bethesda, Maryland
MADELYN R. CREEDON, The George Washington University, Washington, District of Columbia
SHAHEEN A. DEWJI, Georgia Institute of Technology, Atlanta
PAUL T. DICKMAN, Argonne National Laboratory, Washington, District of Columbia
ALLISON M. MacFARLANE, The University of British Columbia, Canada
ELEANOR MELAMED, National Nuclear Security Administration (retired)
PER F. PETERSON (NAE), University of California, Berkeley
R. JULIAN PRESTON, Environmental Protection Agency, Chapel Hill, North Carolina
MONICA C. REGALBUTO, Idaho National Laboratory, Idaho Falls
HENRY D. ROYAL, Washington University School of Medicine in St. Louis, Missouri
Staff
CHARLES D. FERGUSON, Senior Board Director
JENNIFER HEIMBERG, Senior Program Officer
MICHAEL T. JANICKE, Senior Program Officer
OURANIA KOSTI, Senior Program Officer
LAURA D. LLANOS, Finance Business Partner
DARLENE GROS, Senior Program Assistant
LESLIE BEAUCHAMP, Program Assistant
Acknowledgments
A number of people and organizations contributed to the successful completion of this report. The committee wishes to thank the following individuals:
Dr. Todd Anderson (Office of Biological and Environmental Research, Biological Systems Science Division, Department of Energy [DOE]) sponsored the study and provided information on activities related to low-dose radiation research. Dr. Anderson also served ably as the sponsor liaison to the committee and was effective in coordinating several information requests for the committee including on funding of DOE’s national laboratories to carry out low-dose radiation research and their capabilities. Dr. Steve Binkley (Office of Science, DOE) provided views on DOE’s potential role in the government-wide effort to coordinate low-dose radiation research in the United States.
The speakers are too numerous to name here; all gave high-quality presentations during the public meetings listed in Appendix C, and many of them responded to follow-up questions from the committee.
Dr. Guy Garty (Columbia University), Colonel (Dr.) Mohammad Naeem (Armed Forces Radiobiology Research Institute), Dr. Guy Savard (Argonne National Laboratory), Dr. Marcelo Vazquez (Loma Linda University Medical Center), Dr. Jason Weeks (National Aeronautics and Space Administration’s Johnson Space Center), and Dr. Michael Weil (Colorado State University) responded to the committee’s request for information on the characteristics and capabilities of the radiation facilities in their institutions. The committee found the responses comprehensive and a valuable asset to the radiation community and has included these responses in Appendix E.
Ms. Lilly Adams (Union of Concerned Scientists) assisted National Academies’ staff with identifying individuals from the communities impacted by nuclear weapons production and testing and moderated the presentations and discussion during the committee’s October 28, 2021, meeting. Ms. Adams also coordinated follow-on communications with the impacted communities and advocacy groups.
Ms. Lisa Meissner (Hobbs Straus Dean & Walker, LLP) coordinated with the Navajo Nation Office of the President and the Department of Health for presentations to the committee by Navajo President Jonathan Nez and Health Administrator Dr. Jill Jim.
Ms. Lisa Robinson (Harvard T.H. Chan School of Public Health) assisted the committee with retrieving information on current and historic government processes for cost-benefit analyses and rulemaking.
Mr. Armond Cohen (Clean Air Task Force) proposed several speakers for the committee’s meeting focused on risk communication and public engagement and provided comments in writing.
Ms. Virgini Donaldson (CANDU Owners Group [COG]) facilitated the presentation on the COG-supported low-dose radiation program and access to its report.
Dr. Kimberly Applegate (University of Kentucky, retired), Professor Perry Charley (Diné College), Ms. Barbara Hamrick (University of California, Irvine, Medical Center), Dr. Kathy Held (National Council on Radiation Protection and Measurements), Dr. Arjun Makhijani (Institute for Energy and Environmental Research), Dr. Noelle Metting (DOE, retired), Mr. John Tappert (U.S. Nuclear Regulatory Commission), and Colonel (Dr.) Alvin Young (U.S. Air Force, retired) provided comments in writing.
Several members of impacted communities and advocacy groups provided detailed commentaries with recommendations for the committee’s consideration. Those members are as follows (in the order they signed the commentaries): Dr. Bemnet Alemayehu (Natural Resources Defense Council), Terrie Barrie (Alliance of Nuclear Worker Advocacy Groups), Mary Dickson (Utah Downwinders), Daniel Hirsch (Committee to Bridge the Gap), Keith Kiefer (National Association of Atomic Veterans), Trisha Pritikin (Author, The Hanford Plaintiffs), Benetick Kabua Maddison (Youth, Climate, and Nuclear Issues), Dr. April L. Brown (Marshallese Educational Initiative), Beata Tsosie and Belin Marcus (Breath of My Heart Birthplace), Robert Alvarez (Consequences of Radiation Exposure), Jeff Carter (Physicians for Social Responsibility), Tina Cordova (Tularosa Basin Downwinders Consortium), Diane D’Arrigo (Nuclear Information and Resource Service), Dr. Thomas De Pree (Rensselaer Polytechnic Institute), Denise Duffield (Physicians for Social Responsibility–Los Angeles), Cindy Folkers (Beyond Nuclear), Susan Gordon (Multicultural Alliance for a Safe Environment), Dr. Robert M. Gould (San Francisco Bay Physicians for
Social Responsibility), Wenonah Hauter (Food & Water Watch and Food & Water Action), Dennis Nelson (Support and Education for Radiation Victims), Mary Olson (Gender and Radiation Impact Project), Dr. Linda Marie Richards (Corvallis, Oregon), Anna Marie Rondon (New Mexico Social Justice and Equity Institute, Indigenous Lifeway, Inc.), Lukas Ross (Friends of the Earth), Adrian Shelley (Public Citizen, Texas), Chris Shuey (Southwest Research and Information Center), Tyson Slocum (Public Citizen), and Dr. Sasha Stiles (Atomic Workers Advocacy).
The committee also thanks other individuals who provided comments in writing or during the committee’s public meetings.
The committee is grateful to the staff of the Nuclear and Radiation Studies Board of the National Academies of Sciences, Engineering, and Medicine (the National Academies) for organizing and facilitating this study. Study director Dr. Ourania Kosti organized the committee meetings and assisted the committee with collecting the information it needed to write its report. Ms. Darlene Gros managed the logistics of the meetings, report review, and publication. Additional National Academies’ staff assisted with report production: Eric Edkin, Division on Earth and Life Studies, assisted with figure design, and Christopher Lao-Scott, National Academies’ Research Library, assisted with report production.
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Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by MARYELLEN GIGER, University of Chicago, and BARBARA HAMRICK, University of California, Irvine, Medical Center. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Preface
It has been an honor and privilege to chair the committee tasked with developing a strategy for low-dose radiation research in the United States. Throughout my career as a biomedical scientist, I have led large biomedical programs that have been at the forefront of scientific innovation in translational research with the goal of improving human health. Chairing this committee allowed me an opportunity to gain an appreciation of how scientific research can influence and guide policy decisions that impact the lives of the U.S. population.
Ionizing radiation occurs in a wide range of medical, industrial, military, and commercial settings and the number of individuals exposed or potentially exposed to radiation in these settings is increasing. While these exposures may yield individual or societal benefit, they may also adversely affect human health. Past and present environmental exposures are especially concerning to some communities which are typically exposed involuntarily and may not receive or even agree with the presumed societal benefit. These include Indigenous communities; atomic veterans; nuclear workers; uranium miners, millers, transporters, and their families; and those individuals or communities impacted by radioactive contamination or nuclear fallout due to nuclear weapons testing, offsite radiation releases from nuclear weapons production sites, and nuclear waste cleanup activities. Disparities in infrastructure, social and behavioral risk factors for disease, and complex environmental stressors exacerbate risks for disease to some community members and raise important health questions as to whether these communities are also at higher risk of developing disease from low-dose radiation exposures. These disparities also raise social questions regarding
environmental injustice. It is imperative that risks to all exposed populations be known as well as is scientifically possible and that risk mitigation efforts be guided by that knowledge.
Much of what we know about risk from low doses of radiation comes from epidemiological studies of exposed populations including the Japanese atomic bombing survivors, and occupationally and medically exposed individuals. These studies give most attention to cancer as the adverse health effect, but there is increasing evidence that low-dose radiation exposure may be associated with non-cancer health outcomes such as cardiovascular disease, neurological disorders, immune dysfunction, and cataracts. The present study focuses on developing a low-dose and low-dose-rate research strategy for the United States and is built on the concept that recent advances in epidemiology, biological understanding of disease occurrence, and computational and analytical technologies can be leveraged by a revitalized low-dose radiation research program to improve assessment and understanding of the risks of adverse health effects that result from the radiation exposures received by the U.S. population. Other fields embrace these advancements. Radiation research must do the same.
During its seven public meetings, the committee received more than 80 presentations including from representatives of government and Congress, nongovernmental agencies, the national and international radiation research community, managers of the previous low-dose radiation program and collaborators, the U.S. biomedical research community, and, importantly, from impacted communities. The committee also received solicited and unsolicited information in writing. The presentations and recordings of the public meetings are posted on the National Academies’ study webpage1 and the written comments are available to the public upon request through the study’s public access file.2
The committee and I clearly heard the concerns raised by some of the presenters about possible bias on the part of some of the committee members including myself as a result of my past work in the Department of Energy (DOE)-supported national laboratories and publications on aspects of low-dose radiation effects. We discussed these concerns at length and were mindful of them during our deliberations. It was our intent to develop a strategic research plan that was neutral in terms of the impact of the proposed research on assessment of radiation health risk and consequently its potential impact on radiation protection policy and practice in the United
___________________
1 See https://www.nationalacademies.org/our-work/developing-a-long-term-strategy-for-low-dose-radiation-research-in-the-united-states.
2 Inquiries and requests for the list of the public access file materials can be made to the National Academies’ Public Access Records Office (see https://www8.nationalacademies.org/pa/managerequest.aspx?key=DELS-NRSB-21-02).
States. I believe that we succeeded in defining a research program that will provide the best possible information on risk so that risk mitigation efforts can be as scientifically well-grounded as possible. The committee also gave special attention to discovery or better quantification of health effects other than cancer that might be caused by low-dose radiation exposures. The essence of the proposed plan is captured in a list of nine findings and two recommendations.
The committee recognized that, while DOE has been the historical research home for radiation research in the United States, other federal agencies in the United States and programs in other countries carry out or support low-dose radiation research. The committee identified eight essential elements of a low-dose radiation research program that should be considered during the development of a revitalized low-dose radiation research program in the United States. Coordination with other research efforts in low-dose radiation is an important one.
I hope the audience of this report finds that this is an unbiased and forward-looking document that builds a strong case that a revitalized, focused, and comprehensive multidisciplinary low-dose radiation program that leverages advances in biotechnology and research infrastructure can provide evidence on risks at low doses of radiation for different health outcomes, thereby alleviating the need to rely on risk estimates derived from higher doses.
Joe W. Gray, Chair
Committee on Developing a Long-Term Strategy for Low-Dose Radiation Research in the United States
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Contents
COMMON ACRONYMS AND ABBREVIATIONS
1.1 Low-Dose Radiation Exposures to the U.S. Population
1.2 Low-Dose Radiation Research in the United States
2 LOW-DOSE RADIATION EXPOSURES AND HEALTH EFFECTS
2.1 Low-Dose Radiation Sources and Exposures
2.1.4 Nuclear Power Operations
2.1.5 Nuclear or Radiological Incidents
2.1.7 Nuclear Waste Management
2.2 Current Epidemiological Evidence on Low-Dose Radiation Health Effects
2.2.6 Heritable Genetic Effects
2.3 Chapter Summary and Finding
3 SCIENTIFIC BASIS FOR RADIATION PROTECTION
3.1 The Radiation Protection Framework
3.2 Agencies with Radiation Protection Responsibilities in the United States
3.3 Science Behind Radiation Protection
3.3.1 The Regulatory Development Process
3.3.2 Decision-Making Frameworks for Radiation Protection
3.3.3 Characterization of Risk in the Regulatory Development Process
3.4 Potential Economic Impacts of the Low-Dose Radiation Research Program
3.5 Chapter Summary and Findings
4 STATUS OF LOW-DOSE RADIATION RESEARCH
4.1 Low-Dose Radiation Research in the U.S. Government
4.1.2 National Aeronautics and Space Administration
4.1.3 National Institutes of Health
4.1.4 Centers for Disease Control and Prevention
4.1.6 National Science and Technology Council
4.1.7 Intelligence Advanced Research Projects Activity
4.2 Low-Dose Radiation Research in National Laboratories
4.3 Low-Dose Radiation Research in Universities
4.4 Support for Low-Dose Radiation Research by Other U.S. Entities
4.4.1 National Council on Radiation Protection and Measurements
4.4.2 Electric Power Research Institute
4.4.4 American Nuclear Society
4.5 Support for Low-Dose Radiation Research Internationally
4.5.3 United Nations Scientific Committee on the Effects of Atomic Radiation
4.5.4 Nuclear Energy Agency/Organisation for Economic Co-operation and Development
4.5.5 Support for Low-Dose Radiation Research in Canada
4.5.6 Support for Low-Dose Radiation Research in Japan
5.1 Low-Dose Radiation Research Challenges and Overview of Research Priorities
5.2 Epidemiological Research Priorities
5.2.1 Develop and Deploy Analytical Tools for Radiation Epidemiology (Priority E1)
5.3 Biological Research Priorities
5.3.2 Develop Biomarkers for Radiation-Induced Adverse Health Outcomes (Priority B2)
5.3.3 Define Health-Effect Dose-Response Relationships Around 10 mGy or 5 mGy/h (Priority B3)
5.4 Research Infrastructure Priorities
5.4.2 Harmonized Databases to Support Biological and Epidemiological Studies (Priority I2)
5.4.3 Dosimetry for Low-Dose and Low-Dose-Rate Exposures (Priority I3)
5.4.4 Facilities for Low-Dose and Low-Dose-Rate Exposures (Priority I4)
5.5 Estimated Timeline and Costs
5.6 Comparison of the Committee-Recommended Research Agenda to Those of Other Entities
5.7 Chapter Summary, Findings, and Recommendation
6 ESSENTIAL COMPONENTS OF THE LOW-DOSE RADIATION PROGRAM
6.2 Independent Advice and Evaluation
6.4 A Prioritized Strategic Research Agenda
6.5 Research-Sponsorship Mechanisms
6.5.1 Development of Research Solicitation
6.5.5 Data Management and Sharing
6.5.6 Dissemination of Scientific Results
6.7 Engagement and Communications with Stakeholders
6.8.1 Mechanisms for Coordination
6.9 Department of Energy and Management of the Low-Dose Program
6.9.3 Views of Members of the Scientific Community
6.9.4 Views of Members of the Impacted Communities
6.10 Chapter Summary, Findings, and Recommendation
A Consolidated Appropriations Act
B Committee and Staff Biographies
Common Acronyms and Abbreviations
| ABCC | Atomic Bomb Casualty Commission |
| ABM | agent-based model |
| ACERER | Advisory Committee for Energy-Related Epidemiologic Research |
| AEC | Atomic Energy Commission |
| AFRRI | Armed Forces Radiobiology Research Institute |
| AI | artificial intelligence |
| ALARA | as low as reasonably achievable |
| ALSDA | Ames Life Sciences Data Archive |
| ANL | Argonne National Laboratory |
| ANS | American Nuclear Society |
| AOP | adverse outcome pathway |
| ATLAS | Argonne (National Laboratory) Tandem Linac Accelerator System |
| BEIR | Biological Effects of Ionizing Radiation |
| BER | Biological and Environmental Research |
| BEST | Biomarkers, Endpoints and other Tools |
| BMI | body mass index |
| BNL | Brookhaven National Laboratory |
| CANDLE | CANcer Distributed Learning Environment |
| CANDU | CANada Deuterium Uranium |
| CDC | Centers for Disease Control and Prevention |
| CERCLA | Comprehensive Environmental Response, Compensation, and Liability Act |
| CIF | Community Involvement Fund |
| CIRRPC | Committee on Interagency Radiation Research and Policy Coordination |
| CNSC | Canadian Nuclear Safety Commission |
| COG | CANDU Owners Group |
| COHERE | Canadian Organization on Health Effects from Radiation Exposure |
| CRESP | Consortium for Risk Evaluation with Stakeholder Participation |
| CT | computed tomography |
| DoD | Department of Defense |
| DOE | Department of Energy |
| DOE-BER | Department of Energy’s Biological and Environmental Research |
| DOE-EM | Department of Energy’s Office of Environmental Management |
| DTRA | Defense Threat Reduction Agency |
| EMR | electronic medical record |
| EPA | Environmental Protection Agency |
| ERR | excess relative risk |
| FAIR | findable, accessible, interoperable, and reusable |
| GAO | Government Accountability Office |
| GPU | graphics processing unit |
| HHS | Department of Health and Human Services |
| HLG-LDR | high-level group in low-dose radiation |
| HPS | Health Physics Society |
| HRP | Human Research Program |
| HTAN | Human Tumor Atlas Network |
| HuBMAP | Human BioMolecular Atlas Program |
| ICGC | International Cancer Genome Consortium |
| ICRP | International Commission on Radiological Protection |
| IES | Institute for Environmental Sciences |
| IND | improvised nuclear device |
| INWORKS | International Nuclear Workers Study |
| IoMT | Internet of Medical Things |
| IoT | Internet of Things |
| ISCORS | Interagency Steering Committee on Radiation Standards |
| LANL | Los Alamos National Laboratory |
| LBNL | Lawrence Berkeley National Laboratory |
| LET | linear energy transfer |
| LLNL | Lawrence Livermore National Laboratory |
| LNT | linear no-threshold |
| LSS | Life Span Study |
| MD | molecular dynamic |
| MEI | maximally exposed individual |
| MELODI | Multidisciplinary European Low-Dose Initiative |
| ML | machine learning |
| MOU | memorandum of understanding |
| MRI | magnetic resonance imaging |
| MTA | Monitoring and Technical Assistance |
| NASA | National Aeronautics and Space Administration |
| NCI | National Cancer Institute |
| NCRP | National Council on Radiation Protection and Measurements |
| NEA/OECD | Nuclear Energy Agency/Organisation for Economic Co-operation and Development |
| NIAID | National Institute of Allergy and Infectious Diseases |
| NIEHS | National Institute of Environmental Health Sciences |
| NIH | National Institutes of Health |
| NIOSH | National Institute for Occupational Safety and Health |
| NORM | naturally occurring radioactive material |
| NSF | National Science Foundation |
| NSTC | National Science and Technology Council |
| OMB | Office of Management and Budget |
| ORNL | Oak Ridge National Laboratory |
| OSHA | Occupational Safety and Health Administration |
| PAG | Protective Action Guide |
| PDE | partial differential equation |
| PET | positron emission tomography |
| PNNL | Pacific Northwest National Laboratory |
| PSC | posterior subcapsular |
| PTM | post-translational modification |
| PUMA | Pooled Uranium Miner Analysis |
| QALY | quality-adjusted life year |
| QST | National Institutes for Quantum and Radiological Science and Technology |
| RadBio-AI | radiation biology research using artificial intelligence and machine learning |
| RDD | radiological dispersal device |
| REAC/TS | Radiation Emergency Assistance Center/Training Site |
| REB | Radiation Epidemiology Branch |
| RECA | Radiation Exposure Compensation Act |
| REE | rare earth element |
| RERF | Radiation Effects Research Foundation |
| REVCA | Radiation-Exposed Veterans Compensation Act |
| RNCP | Radiation and Nuclear Countermeasures Program |
| SPEERA | Secretarial Panel for the Evaluation of Epidemiological Research Activities |
| TCGA | The Cancer Genome Atlas |
| TCR | T-cell receptor |
| TEI-REX | Targeted Evaluation of Ionizing Radiation Exposure |
| TENORM | technologically enhanced naturally occurring radioactive material |
| UNSCEAR | United Nations Scientific Committee on the Effects of Atomic Radiation |
| U.S. NRC | United States Nuclear Regulatory Commission |
| USCG | United States Coast Guard |
| VSL | value of a statistical life |
| WMD | weapon of mass destruction |
