Radiation literature survey

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This is a human randomised crossover provocation study that investigated whether electromagnetic fields (EMF) exposure is associated with physiological changes and symptoms. The study recruited 58 participants with self-reported idiopathic environmental intolerance attributed to EMF (IEI-EMF) and 92 participants without IEI-EMF as a control group. In a double-blind controlled environment, participants were exposed to EMF signals mimicking those from a mobile phone base station and a sham exposure in a random sequence. Participants reported whether they could perceive EMF exposure and any symptoms they were experiencing while physiological parameters (heart rate, blood pressure etc.) were monitored. The IEI-EMF and control groups reported similar frequencies of symptoms during both the provocation and sham sessions. In both groups, physiological parameters were similar between the two sessions and no participant could accurately detect the presence of EMF. The results of this study indicate that radiofrequency EMF exposure from mobile phone base stations did not affect physiological parameters in people with or without IEI-EMF and that symptoms reported by participants were not related to EMF exposure.

Physiological changes and symptoms associated with short-term exposure to electromagnetic fields: a randomized crossover provocation study

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IEI-EMF, also referred to as electromagnetic hypersensitivity (EHS), has no clear diagnostic criteria and the science so far has not provided evidence that EMF exposure is the cause. The majority of scientific studies published to date, as well as this study, have found that under controlled laboratory conditions, EHS or IEI-EMF individuals cannot detect the presence of EMF sources any more accurately than non-EHS individuals. Several studies have indicated a nocebo effect (Van Moorselar et al. 2016; Verrender et al. 2018).  

Based on current scientific information, there is no established evidence that EHS symptoms are caused by exposure to EMF. However, ARPANSA acknowledges that the health symptoms experienced by the affected individuals are real and can be a disabling problem and advise those affected to seek medical advice from a qualified medical specialist. ARPANSA will continue to review the research into potential health effects of exposure to EMF to provide accurate and up-to-date advice.

More information on EHS is available in a factsheet by ARPANSA as well as the World Health Organization.
 

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This review describes the current progress in understanding radiofrequency (RF) heating effect and injuries, particularly burns, that have occurred in patients during magnetic resonance imaging (MRI) procedures. MRI scans are produced by applying a strong static magnetic field, a fast-varying magnetic field gradient, and a RF field. While MRI injuries remain rare, the frequency of accidents is increasing in parallel to the increasing application of high magnetic field strength. RF burn injuries constitute nearly half of all MRI related injuries and are increasing. RF burn injuries occur either due to skin to skin contact or skin contact with a wire/cable or a wire acting as an antenna that interacts with the RF field of the MRI machine. Considerable local heating occurs that is concentrated at the contact points of the wire or skin, however, the mechanism for some of the RF burn injuries occurring at contact points is not well understood. This poses challenges for the application of adequate safety or preventive measures for RF related burns in MRI procedures.

Progress in Understanding Radiofrequency Heating and Burn Injuries for Safer MR Imaging

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The review provides state-of-the-art knowledge on RF heating and burn injuries in medical MRI systems, including RF exposure limits. Internationally, the RF exposure limits for MRI procedures are guided by the recommendations of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). These RF exposure limits are given in terms of specific absorption rate (SAR in W/kg), which is essentially the amount of RF energy absorbed per unit mass of human tissue. SAR limits applicable for the use of passive implants (e.g., hip and knee prostheses) or active implantable medical devices (e.g., cardiac pacemakers or cochlear implants) have been documented in other standards such as ASTM-F2182 and ISO/TS 109474:2018, respectively. 

The review also recommends key preventive measures to avoid the likelihood of RF related burns in MRI procedures. The recommendations include the use of foam pads (1-2 cm thick) to insulate the patient from cables, the bore, and between limbs to prevent RF burn injuries, avoiding positioning the body near the RF transmit coil and considering the antenna effect for patients with large implants and tattoos. These recommendations are consistent with those provided by the Royal Australian and New Zealand College of Radiologists (RANZCR).

In conclusion, this review is a useful guide to understanding MRI related RF burn injuries in medical imaging settings. 
 

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This review aimed to investigate the possible link between exposure to electromagnetic fields (EMF) and adverse pregnancy outcomes and various other health effects. The authors state the review included all studies on the impacts of EMF from electronic devices on health outcomes among adults, pregnant women, and newborns or in non-human subjects or in vitro research published in the last 5 years. Based on this inclusion criteria the authors assessed 18 papers for the review. The authors concluded that EMF radiation is linked to various health effects and suggested women and children are at risk due to exposure during pregnancy.

Impacts of smartphone radiation on pregnancy: A systematic review

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There are a number of methodological issues with this review that indicate the authors have not fully assessed the evidence and may have omitted evidence contrary to their desired conclusions. Although the authors mention that they conducted a systematic review and describe in the methods how it was conducted, the results do not indicate a properly conducted systematic review. Although the studies are given a risk of bias (RoB) rating the full RoB analysis is not presented and it is noted that the authors rate poor quality studies as being high quality. Also, systematic reviews only include original research papers, but Al-Jarrah and Rababa include a meta-analysis in the final list of included studies [Tsarna et al, 2019]. There was also no formal synthesis of results presented. Further, the authors mix in vitro, in vivo, epidemiological, and human experimental studies which would require separate systematic reviews. Instead, the authors present a biased narrative review. 

The authors only assessed papers published in the last 5 years and there is no justification for the selection of this timeframe. This is a major source of bias as it excludes many modern high-quality papers on EMF and health. This short time frame for inclusion again highlights how the authors have ignored evidence on this topic. Additionally, the screening process as reported is flawed. The authors reportedly found 10,450 articles from 7 databases and yet only 311 articles remained after duplicates were removed meaning 10,139 articles were duplicates. This cannot be correct. Furthermore, the search strings used for each database search are not presented, nor is the number of articles retrieved from each database.

The authors’ assessment of pregnancy outcomes included nine papers. Of these, eight had clear limitations in their methods, particularly when assessing exposure that would prevent any causal association being made, and the other paper was a measurement study that was not assessing health outcomes. The authors of this review seem to have ignored these limitations when assessing the evidence of the included studies. 

Overall, this review by Al-Jarrah & Rababa failed to fully or adequately assess the available evidence on the impact of EMF on health and pregnancy outcomes. It also relied on papers with low quality methods and poor exposure assessment. Another recent review by Ashrafinia et al (2021) of higher quality studies assessed the impact of mobile phone exposure and adverse maternal, infant and child outcomes and reported no substantiated evidence of an impact from mobile phone exposure. It appears that the authors have “cherry picked” articles that suited their narrative and ignored or rejected papers that didn’t, as studies that did not find an association included in the Ashrafinia et al review were not included in this review despite being within the dubious 5-year timeframe. The particular papers that have been inexplicably excluded from the Al-Jarrah & Rababa review but are present in the Ashrafinia et al review include Sudan et al (2016), Papadopoulou et al (2017), and Choi et al (2017). Furthermore, a major review by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) published in 2015 also found no substantiated evidence of a health impact from EMF exposure [SCENIHR, 2015].

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This systematic review and meta-analysis assessed the associations between occupational exposure to solar ultraviolet radiation (UVR), and melanoma and non-melanoma skin cancer (NMSC). The results were based on data extracted from 53 eligible studies that involved over 457,000 participants in 26 countries. In most studies, the exposure to solar UVR was self-reported in questionnaires (e.g., during interviews), whereas the health outcome of skin cancers was based on histopathological diagnoses. The results showed that compared to non-exposed people, occupationally exposed UVR workers were 1.45 times and 1.60 times more likely to have melanoma and NMSC, respectively. Of NMSC subtypes, the risk of the incidence of squamous cell carcinoma was much higher (Risk Ratio 2.42) compared to that of basal cell carcinoma (Risk ratio 1.50). The report concluded that considering methodological limitations, such as bias and confounding, there is limited evidence for an association between occupational exposure to UVR and skin cancer. 

The effect of occupational exposure to solar ultraviolet radiation on malignant skin melanoma and non-melanoma skin cancer: a systematic review and meta-analysis from the WHO/ILO joint estimates of the work-related burden of disease and injury

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Although the report concluded that there is overall limited evidence for an association between occupational UVR exposure and skin cancer, the results support the current sun protection recommendations of national (e.g., Cancer Council Australia Sun safety | Cancer Council) and international (International Agency for Research on Cancer, IARC) organisations. The  IARC classifies solar UVR as a Group 1 carcinogen (IARC, 1992). Skin cancer accounts for the largest number of cancers diagnosed in Australia each year (Australian Institute of Health and Welfare, 2016). ARPANSA recommends that all people including workers should limit their UVR exposures, and a combination of sun protection measures (e.g., clothing and sunglasses, shade and sunscreen) should be used, wherever applicable. For more information see the ARPANSA factsheet, Sun exposure and health. 

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This cross-sectional study investigated the association between radiofrequency electromagnetic field (RF EMF) exposure and sleep disturbances in Dutch and Spanish preadolescents (9- to 12-year-olds). Using a questionnaire, information was gathered on the participants mobile and cordless phone use, as well as tablet and laptop use to estimate near-field RF EMF brain dose. Far-field RF-EMF exposure from mobile phone base stations, broadcast towers, FM radio and wi-fi was also estimated using exposure modelling. Sleep quality was assessed by measuring total sleep time, sleep efficiency, sleep onset latency and wake after sleep onset. The study found whole-brain RF EMF dose was not associated with sleep disturbances. However, the study found evening doses of RF EMF from phone calls were associated with shorter total sleep time. Although the authors acknowledged that this association may be due to behaviours and not RF EMF exposure.

Estimated all-day and evening whole-brain radiofrequency electromagnetic fields doses, and sleep in preadolescents

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The conclusions of this study are consistent with ARPANSA’s review of the scientific evidence that there are no substantiated effects of RF EMF on sleep quality (ARPANSA, 2014). The Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) opinion on Potential health effects of exposure to electromagnetic fields (EMF) also concluded that there was no substantiated scientific evidence to support disruptions to parameters affecting sleep quality. This supports ARPANSA’s view that exposure to RF EMF at levels below the limits set in the ARPANSA RF Standard (RPS S-1) do not cause any adverse health effects. The standard is based on scientific research that shows the levels at which harmful effects occur and it sets limits, based on international guidelines, well below these harmful levels. The standard is designed to protect people of all ages and health status against all known adverse health effects from exposure to RF EMF.

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This international case-control study examined the association between wireless (mobile and cordless) phone use in childhood and adolescence and brain tumour risk. The study, called MOBI-Kids, recruited 899 people with brain tumours and 1,910 controls aged 10 to 24 from 14 different countries (Australia, Austria, Canada, France, Germany, Greece, India, Israel, Italy, Japan, Korea, the Netherlands, New Zealand, Spain). The study reported no statistically significant increase in the risk of brain tumours. The authors did observe a statistically significant decreased risk, however, this was attributed to bias from wrong information reported on mobile use rather than a protective effect. The authors concluded that the study provides no evidence for a causal association between wireless phone use and brain tumours in children and adolescents. However, the authors stated that due to potential bias they could not rule out the possibility of a small increased risk.

Wireless phone use in childhood and adolescence and neuroepithelial brain tumours: Results from the international MOBI-Kids study

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This is the largest case-control study ever to investigate the association between wireless phone use and brain tumours in children and adolescents. The authors’ findings are consistent with previous studies, including the CEFALO study, that also showed no association between the use of wireless phones and brain tumours in children and adolescents. The findings are also consistent with studies reporting no increase in the incidence of brain tumour despite the increased use of mobile phones (e.g. Karipidis et al 2019 and Villeneuve et al 2021).

Overall, this study provides further evidence that there are no substantiated adverse health effects from exposure to radiofrequency electromagnetic energy from wireless phones where the emissions are below the public exposure limits set in the ARPANSA Standard and the International Commission on Non-ionizing Radiation Protection’s radiofrequency guidelines.

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This study conducted measurements of radiofrequency (RF) electromagnetic energy (EME) in different every day settings (e.g. parks, residences, shopping centres etc.) across 5 European countries (Belgium, France, Spain, Switzerland and Netherlands). The measurements were conducted using a newly developed body-worn meter. The median RF-EME exposure across 267 locations using the new body-worn meter  was 0.13 mW/m² which was similar to the median measurements using other types of meters.

European study finds exposure to radiofrequency electromagnetic fields is well below the safety limits in international guidelines

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The measured RF-EMF levels across all environments in all countries were well below the public exposure limits set in the International Commission on Non-ionizing Radiation Protection’s 2020 radiofrequency exposure guidelines, and the ARPANSA radiofrequency exposure standard (RPS S-1). Although these results were expected, it is still a reassuring result that exposure in environments similar to what we would expect in Australia was well below the ARPANSA safety standard. There is currently no substantiated scientific evidence that exposure to RF-EME at levels below the limits set in the ARPANSA Standard cause any adverse health effects.

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This Canadian study used data from the Canadian Cancer Registry to compare the recorded incidence rates of glioma and the prevalence of mobile phone use (measured by the annual number of mobile phone subscriptions) between 1992 and 2015. The glioma incidence trends were also compared to the risk estimates in three other studies reporting an association between mobile phone use and glioma;  a recent pooled analysis of Swedish case-control studies, the INTERPHONE study, and an analysis of the data collected from the Canadian component of the INTERPHONE study. The authors reported that when comparing the actual number of cases of glioma diagnosed in Canada in 2015 to the risk estimates, these studies overestimated the observed number of gliomas diagnosed by 50%, 86%, and 63%, respectively. Further, the authors also reported that despite the enormous growth in the ownership and use of mobile phones from the early 1980s up to 2015, the observed cases of glioma remained stable over the study period, indicating that there is unlikely to be a causal link between mobile phone use and glioma.

Cell phone use and the risk of glioma: are case-control study findings consistent with Canadian time trends in cancer incidence?

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The results of this study are consistent with a similar study conducted by ARPANSA (Karipidis et al) that reported stable incidence rates of glioma and other types of brain cancer in Australia over the period from 1982 to 2013 despite the increased prevalence of mobile phone use during this time. Both studies used mobile phone subscription data to estimate mobile phone use in the population and this may not be a true indicator of actual mobile phone use. Nevertheless, it is inherently clear that the use of mobile phones in society has increased rapidly during the timeframe accounted for in these studies. This, combined with the stability in brain cancer trends, indicates that case-control studies reporting associations with mobile phone use and brain cancer may be affected by biases in exposure assessment, especially where mobile phone use data is self-reported.

This study adds further evidence that there are no substantiated adverse health effects from exposure to radiofrequency electromagnetic energy from mobile phones and other wireless devices where the emissions are below the public exposure limits set in the ARPANSA Standard and the International Commission on Non-ionizing Radiation Protection’s radiofrequency guidelines. 

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In this study, exposure to radiofrequency electromagnetic energy (RF EME) from Wi-fi was measured by meters carried on the body of 63 volunteers in Mexico over a 24-hour period. The measurements were taken as participants conducted their normal daily routines in a range of environments including homes, workplaces and other public access and urban environments. Volunteers were instructed to avoid using mobile phones, laptops or any other devices connected to Wi-fi during the measurements. When this was unavoidable, participants recorded these activities in a diary outlining the timing and duration of such events to assist in the data analysis. The exposures ranged from a minimum power density of 116.8 microwatts per square meter (µW/m2) to 499.7 µW/m2. Lower levels were measured at night and higher levels during the day. Further, higher measurements were normally associated with office environments. In addition, the authors conducted a follow up survey about health risk perception from exposure to Wi-fi on 35 of the volunteers before and after the measurements were made. The authors reported that the perception of risk generally decreased after participants were made aware of the exposure levels.

Link to Study                  

Wi-fi in Mexico – exposure and risk perception

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This study generated some useful data about personal exposure to RF EME from common wireless devices such as Wi-fi routers. The accuracy of some of the results may have been affected by relying on the participants to keep accurate records of their use of mobile phones and other devices while carrying the meters. However, the results were in line with other studies conducted with stricter measurement protocols such as the Wi-fi in schools measurement study conducted by ARPANSA. The measured levels in both studies were well below the public exposure limits set in the International Commission on Non-ionizing Radiation Protection’s 2020 radiofrequency exposure guidelines and the ARPANSA radiofrequency exposure standard. In Australia, RF EME emissions from all wireless devices such as mobile phones, tablets and Wi-fi routers are required to comply with the public exposure limits set in the ARPANSA standard, where compliance is regulated by the Australian Communications and Media Authority. 

Oddly, the authors express their results using a non-standard unit which they have named “wave intensity” and, although they clearly state that this is synonymous with the accepted term “power density”, this may lead to unnecessary confusion when comparing results to other studies. Further, they do not offer a sound scientific explanation for choosing to use this alternate terminology. The survey that demonstrated that most of the volunteers were more assured of the safety of exposure from these devices after they were provided with measurement results is an interesting observation that may be used to study risk perception of RF EME. Although it does seem to detract from the main purpose of this particular study which was environmental measurement of RF EME and comparison to international guidelines.
 

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The Atomic Bomb Casualty Commission (ABCC) conducted a study on the pregnancy outcomes of children of atomic bomb survivors from 1948 to 1954. This original study and subsequent other reports in 1956, 1981 and 1990 did not find significant associations of ionising radiation exposure with adverse pregnancy outcomes such as neonatal deaths, still births or congenital malformations. However, none of these previous studies included approximately 1200 induced terminations and had other outcome misclassification errors. This new analysis reconstructed and refined the data from the original ABCC study and used more advanced methods for assessing radiation doses received by the subjects and subsequent dose-response relationships. This reanalysis found that radiation is associated with an increased risk of adverse pregnancy outcomes. For fathers exposed to 0.5 – 1 Gy there was an increased risk for major malformations whilst for mothers exposed to 0.5 – 1 Gy there was an increased risk for perinatal death outcomes. However, most of the results were not statistically significant and the generalizability is uncertain due to the extreme circumstances encountered by atomic bomb survivors.

Link to study.

Congenital Malformations and Perinatal Deaths among the Children of Atomic Bomb Survivors: A Reappraisal

Comments by ARPANSA:

In Australia, the system for Radiation Protection draws on international best practice,  particularly, the International Commission on Radiological Protection (ICRP). The ICRP (ICRP, 2007) prudently recommends including the risk of heritable effects within the system of radiation protection and provides risk estimates for its application. This is further underpinned by the work of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR, 2001).

The findings within this study are consistent with ICRP’s approach. This study reported that ionising radiation is associated with an increased risk of adverse pregnancy outcomes, despite most of the results not finding a statistically significant association. It is likely that the lack of statistically significant associations found in both parental categories for exposure over 1 Gy is due to the small sample size for those categories. In contrast, another recent study conducted on clean-up workers from the Chernobyl nuclear accident found no evidence of heritable effects. However, the majority of participants were exposed to less than 0.5 Gy, which is below the level that the Yamada et al. study found a statistically significant association. Despite the lack of statistically significant associations found in the Yamada et al. study, the consistent increase in risk of adverse pregnancy outcomes found across the exposure groups may be useful for risk assessment purposes. This study as well as experimental observations credibly reason that the risk of heritable diseases should be included in radiation risk assessments and considered when setting exposure limits.