ML23207A114
| ML23207A114 | |
| Person / Time | |
|---|---|
| Issue date: | 03/15/2023 |
| From: | Boice J, Flora R NRC/RES/DSA, Vanderbilt Univ |
| To: | |
| References | |
| Download: ML23207A114 (52) | |
Text
John D Boice Jr Vanderbilt University, Department of Medicine National Council on Radiation Protection & Measurements (NCRP)
RIC 2023 - Navigating the Nuclear Future Million Person Study - Human Health Radiation Risk Assessment in the Nuclear Power & Industrial Radiographer Worker Cohorts --- March 15, 2023 (W14)
Overview of the Million Person Study and Relevance to NRC John.Boice@ncrponline.org
The study of low dose and low-dose rate exposure is of immeasurable value in understanding the possible range of health effects from prolonged exposures to radiation. The Million Person Study of low-dose health effects was designed to evaluate radiation risks among healthy American workers and veterans who are more representative of today's populations than are the Japanese atomic bomb survivors exposed briefly to high-dose radiation in 1945..
Good Science = Informed Regulations =
Protection of Workers
Overview of the Million Person Study and Relevance to NRC John Boice, Director of Science/Professor of Epidemiology, National Council on Radiation Protection and Measurements/Vanderbilt University Medical Center Million Person StudyHuman Health Radiation Risk Assessment in the Nuclear Power and Industrial Radiographer Cohorts Lawrence Dauer, Attending Physicist, Memorial Sloan Kettering Cancer Center The Importance of Radiation Epidemiology to Space Exploration Steve Blattnig, Technical Advisor, National Aeronautics and Space Administration
April 2022 IJRB Special Issue - Million Person Study The Million Person Study, Whence it Came Reviews Relevance to Space Exploration A Million Persons, a Million Dreams and Vision for NCREB Obtaining Vital Status and Cause of Death Methods Statistical Modeling Approaches Dosimetry and Uncertainty Approaches Dosimetry Dosimetry for Atomic Veterans Dosimetry for Medical Radiation Workers Dose Reconstruction for Internal Emitters Mortality Among Nuclear Power Plant Workers Original Articles Mortality Among Medical Workers Mortality Among Mallinckrodt Workers Mortality Among Los Alamos National Laboratory Workers Mortality Among Tennessee Eastman Corporation Workers Sex-Specific Lung Cancer Risks among MPS Cohorts Radium Dial Painters 24 Peer-Reviewed Articles Editors: Andre Bouville, John Boice, Larry Dauer, Ashley Golden, Richard Wakeford
Boice et al. A Million Persons, A Million Dreams IJRB 2022;98(4):795-821
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Recent Findings Summary Future
The Major Gap in Understanding is Health Effects from Exposures Received Gradually Over Time Medicine Accidents or Terrorism Occupation Environment Space and High Altitude Travel Why another study?
Much is Known about Radiation Health Effects When Exposure is Received All at Once (Briefly)
Needed to accurately access risks related to:
Protection Guidelines, Compensation, Risk Assessment/Projection, Representativeness, Specific Relevance, Responsibility to Workers and their Families
Why a Study of a Million Radiation Workers?
To provide the Statistical power (ability) to address:
- low dose effects
- rare cancers
- intakes of radionuclides (and associated high-LET health effects)
- differences between women and men
- other conditions (CVD, CeVD, Dementia, and even Cognition)
Who is Being Studied?
Robert Oppenheimer, General Leslie Groves, Enrico Fermi, Hans Bethe, Theodore Hall Boice et al. The Million Person Study, Whence it Came and Why. IJRB April 2022 Cohort (Source)
No.
Workers Manhattan Project and other cohorts (DOE) 300,000 Atomic Veterans (DOD) 114,270 Nuclear Power Plant Workers (NRC) 135,193 Industrial Radiographers (NRC) 123,556 Medical Radiation Workers (Landauer) 109,019 Nuclear Submariners & Other (US Navy) 210,000 Radium Dial Workers (DOE) 3,200
Dosimetry is the Key to Good Epidemiology Dauer LT et al. Int J Rad Biol Nov 19, 2018 Roadmap for All (Report 178)-2019 Medical Workers (Commentary 30) Internal Emitters - Brain (Commentary 31)-2022
TRACING is Another Key to Good Epidemiology The Pope visits 1 Million People in Philadelphia 2015 AP Photo Personal Identifiers - 30 cohorts - to Trace for Vital Status ( Some last known alive 1940s) ; Obtain Cause of Death; Obtain All occupational exposures; Estimate organ doses; Analyze and combine
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Recent Findings Summary Future
A unique feature of the Million Person Study is incorporating organ-specific doses from intakes of radionuclides in the dose-response analyses.
Leggett RW et al. Methods of improving brain dose estimates for internally deposited radionuclides.. J Radiol Prot 42 (3), 2022 Relevance: Environmental Risk Assessment
Los Alamos National Laboratory, NM (1942) Pu, H-3 Rocky Flats (1951), Savannah River (1950)
Pu, H-3 Hanford, WA (1943)
Pu, Am, U, H-3 Atomics International / Rocketdyne, CA (1948) Po, Pu, Am Mound Laboratory, OH (1947)
Po, Pu, H-3 Mallinckrodt, KS (1942), Middlesex, NJ (1943) Ra, U Fernald, OH (1951)
Ra, U Manhattan Project and other Workers Radionuclide Intakes
Nuclear Power 5,000 Industrial Radiographers 13,000 Mound 2,000 Los Alamos 6,629 Rocky Flats 5,000 Hanford 8,000 K-25 (ORNL) 9,000 Other DOE 40,000 TEC (Oak Ridge) 13,000 Medical 60,000 Radium Dial Painters 3,200 Total already
>160,000 Number of adult Japanese female atomic bomb survivors in 1945 ~30,000 Women in the Million Person Study
13,951 Women employed 1943-1947 (Uranium dust) 652 cases of lung cancer Tennessee Eastman Corporation Women Boice et al. Mortality among TEC uranium processing workers. IJRB 2023
Radium Dial Painters - Reactivated !
Radium Girls (n=3,200) 18 Thanks to DOE for financial support
- Reactivated (Martinez et al. IJRB 2022)
- Lifetime follow-up - 66% alive in 1980
- Improved dosimetry and risk assessment
- Bone cancer, leukemia, breast, nasal sinuses, lung, dementia, cognition
- Lifespan shortening
- Accelerated ageing, DNA methylation
- WARP - training for the future
- Back to the Future - The legacy continues Martinez et al. IJRB April 2022 Relevance: Training Radiation Professionals for Future
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Recent Findings Summary Future
Desert Rock VI exercise (TEAPOT), NTS, 1955 20 Atomic Veterans, Health and Consequences Atomic Veterans - Health Studies - 115,000 - From TRINITY 1945 to HARDTACK 1958
Ischemic Heart Disease (n=16,709)
Among Atomic Veterans Boice et al. Nuclear Weapons Test Participants. Int J Radiat Biol 2022 Dose to Heart (mGy)
-0.1 0
0.1 0
10 20 30 40 50 Hazards Ratio - 1 113,806 Men ERR per 100 mGy -.001 (-0.12, 0.11)
Nuclear weapons test participants 70,300 Other Navy Personnel, e.g., shipyard
~60,000 Nuclear submariners 169,000 Total
~300,000 Navy Personnel (~300,000) in the Million Person Study Insert sub picture
SUBMARINER STUDY - NASA COLLABORATION
- To examine: multiple occupational stressors: Environmental (radiation, air contaminants);
Psychological (confinement, isolation, hostile environnent): Physical (fatigue, high workload, circadian rhythm disruption, sleep deprivation) -- and any interaction with continuous radiation.
- A range of neurological, behavioral, and cognitive impairment disorders will be evaluated, e.g.,
mortality and incidence for Parkinsons disease
- Incidence data already have been obtained for over 67,000 sailors from Medicare records
- Cognitive function scores are available for all submariners admitted to nursing homes
- Other outcomes include heart disease, sleep disruption, cataracts and many others Slide thanks to Robin Elgart, NASA Relevance: Possible Cognition Impairment due to stress and low dose radiation
Epidemiologists will go to any DEPTH in the Public Interest At 600 feet USS Montpelier -
Attack Nuclear Sub
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Novel Findings - neurobehavioral Summary Findings Future
53,801 Women ERR per 100 mGy = 0.09 (95% CI -0.19, 0.36)
Boice et al. Sex-specific lung cancer risk. IJRB 2022 Yoder et al. Dosimetry medical radiation workers. IJRB 2022 Medical Radiation Workers 109,019 Medical Workers employed 1965-1994 General or Interventional Radiography, Nuclear Medicine, Radiation Oncology 370 cases of lung cancer in Women, 480 cases of lung cancer in men 55,218 Men ERR per 100 mGy = 0.16 (95% CI 0.01, 0.32)
Relevance: How important is sex-specific risk differences?
Harmonizing Lung Cancer Risks 27 To date, Little evidence for an effect for fractionation exposures and data appear inconsistent with estimates from atomic bomb survivor study Nuclear Power Plant 135,193
-0.04 (-0.10, 0.01)
Industrial Radiographers 123,556 0.09 ( 0.04, 0.19)
Medical Radiation Workers 109,019 0.15 (0.02, 0.27)
NPP + IR + Medical 367,722 0.02 (-0.03, 0.07)
Atomic Veterans 113,806 0.08 (-0.06, 0.22)
Mound 4,954 0.01 (-0.02, 0.04)
Mallinckrodt 2,514
-0.06 (-0.18, 0.06)
Rocketdyne 5,801 0.06 (-0.50, 1.23)
Los Alamos 26,328 0.00 (-0.16; 0.17)
TEC (women) 13,951 0.01 (-0.12, 0.15)
Cohort No. Workers ERR at 100 mGy (90% CI)
Atomic Bomb Survivor Estimates F: ERR per 100 mGy 0.11 (0.07, 0.16)
M: ERR per 100 mGy 0.04 (0.02, 0.07)
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Novel Findings - neurobehavioral Summary Findings Future
NCRP - NRC Commentary and Report Collaborations
How are the NRC Cohorts Different from the Other MPS Cohorts?
The Dosimetry is Exceptional REIRS Personal Dose Equivalents NCRP Report 178 to Convert to Organ Dose The Follow-up is Exceptional (>99%) for 258,749 Nuclear Power Plant Workers Industrial Radiographers Career Doses obtained from DOE REMS, US Navy, Landauer, other Mumma MT et al. Int J Radiat Biol 2022
https://www.nrc.gov/docs/ML1204/ML12047A243.pdf Generic Letter 1994
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Recent Findings Summary Future
MPS - Selected Results
- Leukemia
- Ischemic Heart Disease
- Parkinsons Disease
Leukemia (non-CLL) - Dose Response Nuclear Power Plant Workers Boice et al. Mortality among nuclear power plant workers. IJRB 2022 ERR = Excess Relative Risk; i.e., RR -1
Boice et al. A Million Persons, A Million Dreams. IJRB 2022 Leukemia Radiation Risks - Meta-analysis - 8 Studies
MPS - Selected Results
- Leukemia
- Ischemic Heart Disease
- Parkinsons Disease
Ischemic Heart Disease (n=9,888)
Nuclear Power Plant + Industrial Radiographers (n=258,703)
Ischemic Heart Disease Risk Estimates Relevance: Based on MPS to date, heart disease should Not be included in a system of radiation protection
MPS - Selected Results
- Leukemia
- Ischemic Heart Disease
- Parkinsons Disease
Its not going to do any good to land on Mars if were stupid. -
Ray Bradbury Place logo or company name here
42 Parkinsons Disease Mayak Workers Azizova T et al. Occupational exposure to chronic radiation. Int J Epidemiol 2020
Parkinsons Disease (n=367,722)
Nuclear Power Plant + Industrial Radiographers + Medical Workers (n=354)
Boice et al. A Million Persons, A Million Dreams. IJRB 2022
Parkinsons Disease Risk Estimates Relevance: Is Parkinsons a radiation effect?
Surprising if so and needs to be confirmed.
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Recent Findings Summary Future
Conclusions - Findings to Date Place logo or compan y name here
- Chronic exposures cause leukemia (not surprising)
- Chronic exposures below 0.5 Gy do not cause IHD
- Chronic exposures are associated with Parkinsons disease - a new finding with complex implications if confirmed
- Chronic exposures may be associated with lung cancer but at a lower level than acute exposures
- Further follow-up & combination with other MPS cohort studies will provide more definitive conclusions
Current: DOE, NASA, US Navy. CDC, and in kind from others U.S. National Effort Past and Present - Funding
Acknowledgments
- Laurence Dauer, Michael Bellamy, Memorial Sloan Kettering
- Sarah Cohen, EpidStrategies Linda Walsh, University of Zurich
- Mike Mumma, Ben French Vanderbilt University Medical Center
- VUMC & Brown University (Laura Keohane, Loren Lippworth; Julie Lima, Kali Thomas)
- ORNL (Rich Leggett, Keith Eckerman, Caleigh Samuels, Derek Jokisch, Nicole Martinez, Nolan Hertel)
- ORAU (Betsy Ellis, Ashley Golden, Dave Girardi, Sara Howard)
- Risk Assessment Corporation (John Till, Harold Beck, Emily Caffrey, Helen Grogan)
- Landauer (Craig Yoder)
- National Council on Radiation Protection and Measurements (NCRP) (Kathy Held)
Funding from NASA, DOE, US Navy, NRC, NCI (NNX15AU88G)
(80NSSC17M0016)
(NNX16AG04G) (80NSSC19M0161)
Topics
Background
DOE Cohorts Military Cohorts Medical Cohort NRC Cohorts Recent Findings Summary Findings Future
- Complete Studies on Dementia, Depression, Cognition - Brave New World
- Harmonize (combine) ensemble/biologically-based models beyond meta-analyses
- Medicare Claims Files for Incidence and Smoking Hx
- Extend Follow-up 10 years for Nuclear Power, Industrial Radiographers
- Consider AI, Machine Learning - BIG DATA - handling ~billions of data points
- Provide evidence on appropriateness of LNT-model for radiation protection
- Seek collaborators - radiation professionals needed for future
- Vision: The National Center for Radiation Epidemiology and Biology Future A Million Dreams are Keeping me Awake (and not retired)
- The Greatest Showman
Educational Videos -- Radiation Epidemiology for Public Health Decision Making Boice JD, Held KD, Shore RE. Radiation epidemiology and health effects following low-level radiation exposure. J Radiol Prot. 2019 Jul 4;39(4):S14-S27.
URL: https://www.cdc.gov/nceh/radiation/emergencies/radiation-epidemiology-videos.htm
Integration of Physics, Biology and Epidemiology in Radiation Risk Assessment Eric J. Grant, Chair Emily A. Caffrey, Vice Chair 2023 NCRP Annual Meeting:
March 27 - 28, 2023