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Radiation literature survey
The radiation literature survey provides updates on published literature related to radiation (both ionising and non-ionising) and health.
Published literature includes articles in peer-reviewed scientific journals, scientific-body reports, conference proceedings, etc.
The updates on new radiation literature that are of high quality and of public interest will be published as they arise. For each update, a short summary and a link to the abstract or to the full document (if freely available) are provided. The update may also include a commentary from ARPANSA and links to external websites for further information. The links may be considered useful at the time of preparation of the update however ARPANSA has no control over the content or currency of information on external links. Please see the ARPANSA website disclaimer.
Explanations of the more common terms used in the updates are found in the glossary.
The radiation literature that is listed in the updates is found by searching various databases and is not exhaustive.
The intention of the radiation literature survey is to provide an update on new literature related to radiation and health that may be of interest to the general public. ARPANSA does not take responsibility for any of the content in the scientific literature and is not able to provide copies of the papers that are listed.
Visit the National Library of Australia Australian Government Web Archive to access archived information no longer available on our website.
Cataract Risk in a Cohort of U.S. Radiologic Technologists Performing Nuclear Medicine Procedures
Marie-Odile Bernier, Neige Journy, Daphnee Villoing, Michele M. Doody, Bruce H. Alexander, Martha S.Linet, Cari M. Kitahara
Radiology: Vol 286: Number 2
In 2011, the International Commission on Radiological Protection (ICRP) made changes to their recommendations for the annual limit of ionising radiation exposure to the lens of the eye for occupational workers. The new limit was 20 mSv per annum, averaged over defined periods, with no year exceeding 50 mSv. This adjustment was due to epidemiological evidence relating to tissue reaction effects for doses to the lens of the eye and possible cataract formation.
Researchers in the USA carried out a prospective study in the years 2003-2005 and 2012-2013 and published the findings. The purpose of the research was to estimate the risk of cataract incidents in a cohort of nuclear medicine (NM) technologists based on their work histories and radiation protection practices. Findings indicated an increased risk of cataracts observed among U.S. radiologic technologists who had performed an NM procedure at least once. The study recommended future studies incorporating estimated lens doses.
Previous work in the area of eye dosimetry internationally has been centred on image-guided x-ray interventional procedures (IGIP) that make use of high dose angiographic acquisitions and/or CT fluoroscopy guided interventions1 with the emphasis for the need for optimisation of protection measures with respect to the lens of the eye. Recommendations that staff wear appropriate eye protection and use protective screens have been made. In Australia currently there is no requirement for medical staff to wear eye dosimeters to measure the radiation exposure to the lens of eye. Furthermore, no research has taken place to estimate the doses these people receive and in particular staff that use unsealed radiopharmaceuticals. Based on the published paper above, Australia may have an opportunity to contribute to international knowledge by carrying out clinical surveys and providing analysis of data from across the country.
 COUNCIL DIRECTIVE 2013/59/EURATOM - "interventional radiology" means the use of X-ray imaging techniques to facilitate the introduction and guidance of devices in the body for diagnostic or treatment purposes.
Solarium Use and Risk for Malignant Melanoma: Meta-analysis and Evidence-based Medicine Systematic Review
Burgard B, Schöpe J, Holzschuh I, Schiekofer C, Reichrath S, Stefan W, Pilz S, Ordonez-Mena J, März W, Vogt T, Reichrath J
Anticancer Research: International journal of Cancer Research and Treatment, February 2018; 38 (2) : 591 - 1219
Burgard et al conducted a meta-analysis of solarium use and the risk of malignant melanoma. The authors identified 2 cohort and 29 case-control studies that were deemed eligible for the meta-analysis. These studies included 11,706 malignant melanoma cases and 93,236 controls. The studies covered in the meta-analysis were primarily from Europe, North America and Australia.
The authors found that the data support an association between solarium use and malignant melanoma (Odds Ratio, OR=1.19; 95% Confidence Interval, CI=1.04-1.35). In addition, there was a higher association for high exposure to ultraviolet radiation from a solarium (>10 sessions in a lifetime) and melanoma risk (OR=1.43; 95% CI=1.17-1.74). This supports the existence of a dose-response relationship (i.e. the more UV exposure in a solarium, the higher the risk of melanoma). The authors also reported that they found an association between first exposure to ultraviolet radiation from a solarium before age 25 years and melanoma risk (OR=1.59; 95% CI=1.38-1.83).
Despite these findings, the authors concluded that the papers that were included in the analysis were of poor quality and had high risk of bias supporting these associations. Consequently, the meta-analysis concluded that there was no scientific evidence that moderate/responsible solarium use increases the risk of melanoma.
Based on the reported associations between solarium use and malignant melanoma, the scientific evidence supports Australia’s nation-wide policy to ban all commercial solaria.
Comparison of international policies on electromagnetic fields (power frequency and radiofrequency fields)
National Institute for Public Health and the Environment, RIVM
This report produced by the Netherlands government compares the electromagnetic field (EMF) exposure policies for both the general public and occupational exposure between countries in the EU (European Union) and other countries including Australia. The report grouped countries by how they have responded to EU recommendations based on guidelines by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) for EMF frequencies and how this has influenced government policy. For group 1 EU recommendations were reflected in legislation and policy, for group 2 recommendations were not reflected in legislation and policy and for group 3 legislation and policy was stricter than recommendations. For power frequencies, Australia is within group 2 as there is no official regulations or guidelines for general public exposure. However Australian electricity grid operators do use the prudent avoidance principles and prescribe the ICNIRP guidelines. For radiofrequencies (RF), Australia is within group 1 as there are national standards regulating RF exposure from telecommunications sources.
SCHEER Preliminary Opinion on the potential risks to human health of Light Emitting Diodes (LEDs)
European Commission’s Scientific Committee on Health, Environmental and Emerging Risks (SCHEER)
European Commission’s website
The opinion focussed on four main sources of risk associated with the use of Light Emitting Diodes (LEDs) lighting or displays. These included:
- Hazards to the eyes and skin from direct and diffuse light exposure and long-term health effects in the general population;
- Issues arising from direct viewing of some LED sources where the risk arises from impact on vision such as distraction, glare and after-images;
- Problems with temporal characteristics of the LED emission effecting visual perception of the light or the surrounding environment;
- The effect on the circadian rhythm (sleep wake cycle).
There was sufficient evidence to suggest that the blue light exposure caused disruptions in the circadian rhythm, especially if the exposure occurred in the evening hours before sleep times. This effect was more pronounced in children due to different light penetration properties of the young eye. It was not clear whether this disruption on the sleep wake cycle had any long-term health effects.
The main strengths of the review conducted by SCHEER were:
- SCHEER looked at age-dependent effects including exposure to children under 3, adults, the elderly and susceptible groups;
- The potential health effects were examined for exposure to LEDs under normal use or any reasonably foreseeable misuse;
- The review included comparisons to exposures from traditional lighting sources showing lower exposure from LEDs at wavelengths in the UV and Infrared regions.
Effects of Radon and UV Exposure on Skin Cancer Mortality in Switzerland
Danielle Vienneau, Kees de Hoogh, Dimitri Hauri, Ana M. Vicedo-Cabrera, Christian Schindler, Anke Huss, and Martin Röösli
Environ Health Perspect. 2017 Jun;125(6)
This is a retrospective cohort study which investigated the association between radon and UV exposure and skin cancer. A total of 5.2 million people were included in the study, which contained a total of 2,989 skin cancer deaths primarily due to malignant melanoma. The individuals’ residential exposures to radon and UV were assessed using exposure prediction models which were based on environmental data. The study found that residential radon exposure increased the risk of skin cancer, when combined with UV or independently. The authors found that both radon and UV exposure are relevant risk factors for skin cancer.
The strength of this study was its sample size – it used the famous Swiss National Cohort which consists of more than 5 million people and has been used for numerous studies.
The study assessed individual exposures to radon and UV based on modelled exposures at the place of residence of the subjects The study contained inherent disadvantages of this type of study design i.e. great potential for exposure misclassification as there are many behavioural factors that affect personal exposure to radon and UV compared to residential exposure. Nevertheless the exposure assessment was more convincing for radon compared to UV.
In conclusion, the methods employed were good for this type of study and were a better predictor of the radon skin cancer relationship compared to the UV skin cancer comparison.
Use of mobile and cordless phones and change in cognitive function: a prospective cohort analysis of Australian primary school children
Bhatt CR, Benke G, Smith CL, Redmayne M, Dimitriadis C, Dalecki A, Macleod S, Sim MR, Croft RJ, Wolfe R, Kaufman J, Abramson MJ
Environ Health 2017; 16 (1): 62
This is an Australian prospective cohort study that investigated the effect of wireless (mobile and cordless) phone use and cognitive function in children. A total of 412 children from 36 schools in Melbourne and Wollongong were followed for a period of up to 28 months. The information on socio-demographics and wireless phone use was obtained via questionnaires. The change in various cognitive outcomes (evaluated via computer-based tests) between the start of the study period and the follow-up at the end was assessed. The study found limited evidence that increased wireless phone use was associated with cognitive function.
The World Health Organization (WHO) has previously identified in their radiofrequency (RF) research agenda that studies into children’s behavioural and neurological outcomes associated with RF electromagnetic fields (EMF) exposure are of high priority (http://whqlibdoc.who.int/publications/2010/9789241599948_eng.pdf?ua=1).
ARPANSA recently published an RF research agenda, where it serves as an interim solution to identifying priority research needs for Australia, as the WHO’s 2010 research agenda has become dated. Prospective cohort studies of children and adolescents investigating exposure to RF EMF and various outcomes including cancer and behavioural and neurological disorders remain high in priority. The ARPANSA RF research agenda is available at Radiofrequency Electromagnetic Energy and Health: Research Needs.
Re-examining the association between residential exposure to magnetic fields from power lines and childhood asthma in the Danish National Birth Cohort
Sudan M, Arah OA, Becker T, Levy Y, Sigsgaard T, Olsen J, Vergara X and Kheifets L
PLoS One 2017; 12 (5): e0177651
This is a cohort study which investigated any association between exposure to extremely low frequency (ELF) magnetic fields early in life and asthma in children. A total of 92,676 child and mother pairs were included in the study. The children’s exposures were estimated at the mothers’ residences during pregnancy and at the children’ residences from birth until diagnosis/end of follow up (estimations were based on distance from transmission lines and transmission line configuration details).The study did not find any statistically significant results that indicated an increased risk of asthma in children exposed to different levels of ELF magnetic fields. The authors concluded that there is no association between ELF magnetic fields exposure and asthma in children.
One of the major limitations of epidemiological studies investigating residential ELF magnetic fields exposure lies with the tiny proportion of study participants being exposed above the normal background level i.e. above .3 or .4 microtesla (µT). This leads to a low statistical power to reliably detect any association. ELF magnetic fields above .3 or .4 µT were shown by some epidemiological studies to be associated with childhood leukaemia – association that has not been established up until now. For example, the study by Sudan et al found that the proportion of subjects exposed above .2 µT was only 0.05%.
The Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) in its opinion on potential health effects of exposure to electromagnetic fields in 2015 reported that there were recent studies that found an increased risk of asthma in the offspring associated with exposure to ELF magnetic fields during pregnancy. One major study that found this was a prospective cohort study conducted by Li et al (2011). SCENIHR concluded that even though recent studies for the first time have shown an association between ELF magnetic fields exposure and asthma, the results need to be reproduced to evaluate their significance for risk assessment. It was interesting to note that the study by Sudan et al was designed to replicate the study by Li et al; however the study by Sudan et al did not reproduce the results found by Li et al.
Residential Exposure to Natural Background Radiation and Risk of Childhood Acute Leukemia in France, 1990-2009
Demoury C, Marquant F, Ielsch G, Goujon S, Debayle C, Faure L, Coste A, Laurent O, Guillevic J, Laurier D, Hémon D, Clavel J
Environ Health Perspect. 2017 Apr;125(4):714-720
This is a case-control study which investigated the link between exposure to ionising radiation from natural sources and childhood leukaemia. A total of 2,700 cases (diagnosed during the period 2002-2007) and 30,000 controls were included in the study. The exposure to radon, gamma, and total radiation were estimated using environmental exposure data, based on the child’s municipality at time of diagnosis. Overall, the study did not find any association between childhood leukaemia and exposure to natural background radiation, hence providing no support to the hypothesis that residential exposure to natural background radiation increases the risk of childhood leukaemia.
This study by Demoury et al did not find an association between childhood leukaemia and exposure to natural background radiation, whereas two older studies by Kendall et al in Switzerland and Spycher et al in the UK both found an increased risk of childhood leukaemia at a dose of 1 millisievert per year over 10 years or so. It should be noted that the study by Demoury et al did not rule out a slight association with gamma radiation at the time of birth – which is in line with the findings in the Swiss and UK studies.
All of these three studies are well conducted and are large enough to provide a statistically significant result however differences in the methodology are likely accounting for the difference in results. The two biggest methodological issues in all three studies were (a) the assessment of exposure which was based on residence estimation and not individual dosimetry, and was estimated differently in all three and (b) all three studies used retrospective registry information.
Since all three studies used registry information, other lifestyle, genetic or environmental factors (requiring interview to be determined) were not accounted for. Nevertheless the registry information eliminates the potential for recall bias. Bias due to unknown confounding factors is very unlikely to explain the entire observed effect.
In conclusion, there is currently mixed results on whether background radiation is associated with childhood leukaemia and further research is needed in this area.
Sun exposure and skin cancer, and the puzzle of cutaneous melanoma: A perspective on Fears et al. Mathematical models of age and ultraviolet effects on the incidence of skin cancer among whites in the United States. Am J Epidemiol. 1977; 105: 420-427.
Armstrong BK, Cust AE
Cancer Epidemiol. 2017 May 3. pii: S1877-7821(17)30050-4
This paper reviewed some hypothesised mechanisms of how skin cancers may develop. There was a landmark paper published in 1977 that first hypothesised that melanoma was caused by intermittent solar ultraviolet (UV) exposure (brief episodes of exposure to high-intensity UV) and that non-melanoma skin cancers were caused by progressive accumulation of sun exposure. Taking into account the knowledge since 1977, the authors suggested that while the intermittent sun exposure is still relevant, they elaborated on a new hypothesis called the dual pathway hypothesis (i.e. sun exposure early in life combined with intermittent sun exposure) for melanoma skin cancers.
In 1992 the International Agency for Research on Cancer (IARC) evaluated all the available evidence in relation to solar UV radiation and cancer. Based on “sufficient” evidence of carcinogenicity in humans and animals, IARC classified solar radiation as “carcinogenic to humans” (Class 1).
In 1994, the World Health Organization (WHO) conducted an in-depth review of the scientific literature concerning the effects of UV radiation exposure on human health and the environment.
Maternal cell phone use during pregnancy and child behavioral problems in five birth cohorts
Birks L, Guxens M, Papadopoulou E, Alexander J, Ballester F, Estarlich M, Gallastegi M, Ha M, Haugen M, Huss A, Kheifets L, Lim H, Olsen J, Santa-Marina L, Sudan M, Vermeulen R, Vrijkotte T, Cardis E, Vrijheid M
Environ Int 2017
This meta-analysis investigated the association between mobile phone use during pregnancy and behavioural problems in the offspring. Five cohorts from five different countries were included in the study, resulting in a total of 83,884 mother-child pairs. The information on mobile phone use was obtained via questionnaires – asked during pregnancy in three cohorts and asked when the children were seven years old in two cohorts. The children’s behaviour was analysed when their age was between four and seven years. For overall behavioural and emotional problems, no statistically significant association was found. There was an increased risk of hyperactivity/inattention problems with increased use of mobile phone during pregnancy (medium mobile phone users: odds ratio, OR = 1.11, 95% confidence intervals, 95% CI = 1.01 – 1.22; high users: OR = 1.28, 95% CI = 1.12, 1.48). The authors concluded that maternal mobile phone use during pregnancy may increase the risk of behavioural problems in the offspring.
The 2015 review by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) on “Potential Health Effects of Exposure to Electromagnetic Fields” discussed epidemiological and animal studies on adverse developmental effects of radiofrequency (RF) fields. The SCENIHR review mentions that numerous animal studies have clearly shown that RF fields cause developmental effects at exposure levels that are sufficiently high to cause significant increase in core maternal temperature (greater than 1 degree Celsius). However the SCENIHR review mentions that there were no adverse effects on development from RF fields at non-thermal exposure levels, even with the inclusion of more recent human and animal data. The SCENIHR review concluded that the weight of the evidence is strong against an effect on development at low level RF, such as when using a mobile phone. The results reported by Birks et al need further investigation.