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Health effects of ionising radiation:
Summary of expert meeting in Ulm, Germany, October 19th, 2013P

hysicians and scientists have issued a warning about
the possible health risks of ionising radiation. Even
low doses of about 1 millisievert (mSv) increase therisk of developing radiation-induced diseases. There is nothreshold below which radiation could be consideredharmless.
On October 19th, 2013, the German and Swiss affiliates of
the International Physicians for the Prevention of Nuclear
War (IPPNW) invited physicians and scientists from thefields of radiobiology, epidemiology, statistics and physics
to an expert meeting in the city of Ulm, the birthplace ofAlbert Einstein. The participants discussed current scientific evidence relating to the health effects of ionising radiation, especially in the area of low-dose radiation.
The group of experts concluded that a revision of existingradiation protection guidelines is essential in order to reflect the current level of scientific knowledge. Ionisingradiation can cause discernible detrimental health effects,
some of which can be predicted and quantified using models from epidemiological data. In the past, health risk
assessment of ionising radiation has been based on studies performed on survivors of the nuclear bombings ofHiroshima and Nagasaki. However, this reference group
can no longer be considered suitable in the light of new
statistical evidence. Even very low doses of radiation cancause disease.
1. Even background radiation causes adverse health effects
that are measurable
Even low doses of background radiation (from terrestrial
and cosmic radiation, inhaled radon and ingested naturalradioisotopes) lead to adverse health effects that can bemeasured in epidemiological studies. It is therefore misleading to claim that radiation exposure can be considered harmless as long as it falls within the dose range of“natural” background radiation.1-17

Foto: Ian Thomas Ash, documentingian.com

The conclusions of the Ulm expert meeting are as follows:
1. Even background radiation causes adverse health effects
that are measurable;
2. The use of radiation for medical diagnostics causes adverse
health effects that are measurable;
3. The use of nuclear energy and the testing of nuclear 		
weapons cause adverse health effects that are measurable;
4. On the basis of epidemiological studies that use the concept
of collective dose, health risks of low-dose radiation can bereliably predicted and quantified;
5. The ICRP practice of using studies on Hiroshima and Nagasaki survivors as a basis for determining risk factors for lowdose radiation must be considered outdated;
6. An improved risk-based concept of radiation protection isneeded, combined with stringent implementation of the imperative of radiation exposure minimisation

HEALTH EFFECTS OF IONISING RADIATION
2. The use of radiation for medical diagnostics causes adverse
health effects that are measurable

Leukaemia and many other forms of cancer have been
induced by low doses of ionising radiation, from nuclear
weapon testing, nuclear accidents, in regions with increased background radiation or through diagnostic radiological procedures and occupational exposure.69-92

Both computer tomography (CT) and conventional x-ray
examinations have been shown to cause increased rates
of cancer (most notably breast cancer, leukaemia, thyroid
cancer and brain tumours). Children and adolescents are
at greater risk than adults, while the embryo is the mostvulnerable of all.18-40

As a result of low-dose exposure to radioactive iodine,
thyroid disease - including cancer – has been observed inchildren, adolescents and adults.93-99 Furthermore,
low-dose ionising radiation causes severe non-malignant
diseases such as meningioma and other benign tumour
entities, cardiovascular, cerebrovascular, respiratory,
gastrointestinal and endocrinological disease and disorders, psychiatric conditions, as well as cataracts.100-113

Reducing the use of diagnostic x-rays and nuclear medicine to the absolute necessitated minimum is urgently recommended. Strict indication guidelines should be adhered to and only low-radiation CT scanners used. Wherever
possible, ultrasound or MRI should be preferred.

Studies have also been able to show that in-utero andchildhood exposure of the brain to ionising radiation
leads to impaired cognitive development. Potential sources of radiation are, amongst others, diagnostic x-rays,
radiation therapy and radiation exposure through nuclear
accidents.114-116

Certain population groups have an increased risk of developing cancer subsequent to radiation exposure, forexample women with a genetic predisposition for breast
cancer. Therefore it is recommended that women withsuch risk should not be included in screenings using
x-rays. 41-45

Subsequent to nuclear accidents, teratogenic effects havebeen observed both in animals and humans, even those
only exposed to low levels of radiation.117-120 Some genetic
effects can already be seen in the first generation of descendants, others only begin to appear in following generations. The latter may therefore be difficult to confirm.
Numerous studies carried out in the “death zones” ofChernobyl and Fukushima on animals that have a high generational turnover show severe genetic defects that canbe associated with the level of radiation exposure in theirhabitat. In humans, such defects have long been observed following low-dose radiation exposure. Transgenerational, i.e. genetically fixed radiation effects, have beenfrequently documented, for example in the children of
Chernobyl 'liquidators'.121-128 Numerous other studies alsosuggest genetic or epigenetic long-term damage caused
by ionising radiation.129-146

3. The use of nuclear energy and the testing of nuclear weapons cause adverse health effects that are measurable
Through the use of nuclear weapons (more than 2,000
tests) and severe nuclear accidents, vast quantities of radionuclides have been released and spread widely, exposing large numbers of the world population to increased radiation doses.
Epidemiological studies on the affected populations fromaround the nuclear weapon test sites in Nevada and Semipalatinsk and from the regions affected by the Chernobyl nuclear disaster show increased rates of morbidity
and mortality.46-54
Even the normal routine operation of nuclear power
plants leads to discernible adverse health effects in thesurrounding population. Depending on the distance, higher incidence rates of leukaemia and other forms of cancers in children under five years of age have been foundin the vicinity of nuclear power plants. (Currently, thestrongest evidence can be found in Germany with consistent results in studies from Switzerland, France and theUK.)55-59

4. On the basis of epidemiological studies that use the concept of collective dose, health risks of low-dose radiation canbe reliably predicted and quantified
The concept of collective dose is the current evidencebased school of scientific thought used for quantitatively
predicting stochastic radiation risk. Extensive new clinicalstudies confirm the linear-no-threshold model, which states that there is no lowest dose threshold of radiation,
below which no health effects can be expected.147,148

Workers occupationally exposed to ionising radiation
show significantly higher rates of cancer than othergroups, even when official dose limits are not exceeded.60-64 The health of their children is more damaged
than that of other children.65-64 Employees in uranium mining companies and nuclear weapons’ production plants
show increased rates of chronic lymphatic leukaemia.65-68

When using the collective dose concept, while taking current scientific studies into consideration, the following
risk factors (excess absolute risk, EAR)* should be applied:2

A risk factor of 0.2/Sv should be applied for predicting
mortality from cancer and 0.4/Sv for incidence of cancer.149-151 The UN Scientific Committee on the Effects ofAtomic Radiation (UNSCEAR) and the International Commission on Radiological Protection (ICRP) still adhere to
low risk factors of 0.05/Sv for cancer mortality and 0.1/Sv
for cancer incidence. The World Health Organization(WHO), meanwhile, has recognized in their 2013 Fukushima Health Risk Assessment that ICRP recommended risk
factors should be doubled.152

incorporation of radionuclides. The same is true for longterm exposure to x-rays or gamma-rays through natural
or artificial sources at dose levels comparable to normal
back-ground radiation.158,159
The ionising radiation released by nuclear bombs had an
extremely high dose rate. Earlier, it was assumed that the
mutagenicity would therefore be higher than that of lower dose rates. ICRP currently claims that this assertion
still holds and divides the risk for developing cancer by afactor of 2 in their figures. Studies on occupationally exposed cohorts contradict this assumption and the WHO
also no longer sees any justification for halving the risk
factor.160,161

The risk factors mentioned above pertain to an exposed
population with normal age distribution. However, according to ICRP, the sensitivity to ionising radiation in young
children (< 10 years of age) and foetuses is higher than in
adults by a factor of 3.153-155

The radiation dose acquired through radioactive fallout
and neutron activation was not taken into considerationby the Radiation Effects Research Foundation (RERF), despite the fact that these caused significant effects in thesurvivors of Hiroshima and Nagasaki. The actual radiation-induced effects were subsequently underestimated.162

The risk factors for predicting incidence and mortality of
non-malignant physical disorders (non-cancerous disease), in particular cardiovascular diseases, are of the sameorder as for malignant diseases.156,157
It is recommended that WHO and national radiation protection institutions adopt the above-mentioned risk factors as a basis for health risk assessments following nuclear accidents.

Because the RERF first began its work in 1950, importantdata from the first five years after the nuclear bombingsare missing. It should therefore be assumed that the assessment of teratogenic and genetic effects, as well ascancers with short latency periods, is incomplete.

5. The ICRP practice of basing risk factors for low-dose radiation on studies on Hiroshima and Nagasaki survivors must be
considered outdated

Due to the catastrophic situation after the nuclear bombings of Hiroshima and Nagasaki, it has to be assumed
that those that survived were a select cohort of the especially resilient („survival of the fittest“). Therefore thosestudied were not representative of a normal population.
This selection bias has led to an underestimation of theradiation risk by approximately 30%.163

Institutions such as the ICRP have been using the survivors of the nuclear bombings of Hiroshima and Nagasaki
as a reference for predicting health effects of radiation in
their research. Prediction of risk on this basis is not transferable to other populations exposed over a long periodof time to increased radiation levels for the following reasons:

The survivors of the nuclear bombings were ostracised by
Japanese society. It is very likely that information regarding family origin or morbidity of descendants was withheld or falsified in order not to endanger, for example, theoffspring's chances of marriage and social integration.164

The Japanese survivors were exposed briefly to penetrating, high-energy gamma radiation. Radiobiological re­search has shown that such exposure is less damaging totissue than internal alpha or beta irradiation following the*Note by the editors: The risk factors used in the concept of collective dose describe the probability that due to radiation-induced carcinogenesis, the cancer incidence or cancer mortality rate increases above the base-line rate in agiven population. Usually this excess absolute risk (EAR) is presented in the unit 1/Sv.
A risk factor (EAR) of 0.2/Sv for cancer mortality means that an irradiation of 1 Sv would cause an excess risk of 20%
of death from cancer – in addition to the base-line risk of 25%. An EAR of 0.2/Sv corresponds to an excess relative risk
(ERR) of 0.2/0.25=0.8/Sv .
3

HEALTH EFFECTS OF IONISING RADIATION»» Prof. Dr. rer. nat. Inge Schmitz-Feuerhake, Professor
emer. for Experimental Physics at the University of Bremen, Germany, member of the scientific council of
IPPNW.de6. An improved risk-based concept of radiation protection isneeded, combined with stringent implementation of the imperative of radiation exposure minimisation
Determining how much radiation-induced health risk can
be considered acceptable and reasonable can only be decided on a societal level, including the voice of those affected. To protect people, the risks of ionising radiation
should be assessed as accurately as possible, and presented in an understandable fashion. Such criteria for radiation protection are being adopted increasingly in the medical field.

»» Dr. Hartmut Heinz, MD specialising in occupational medicine, former Chief Medical Officer in Salzgitter, memberof the nuclear energy working group of IPPNW.de»» Dr. Angelika Claußen, MD specialising in psychotherapy, Bielefeld, Germany, member of the nuclear energy
working group of IPPNW.de»» Dr. Winfrid Eisenberg, MD, former Head of the Pediatric Clinic in Herford, Germany, member of the nuclear
energy working group of IPPNW.de

A risk-based concept for assessing the dangers of ionisingradiation can help to reduce harmful effects, also at low
dose rates. Together with the legal minimisation requirements, a concrete set of measures in the framework ofsuch a concept could serve to further lower radiation-associated risks. The existing German Risk Acceptance Concept for Carcinogenic Hazardous Substances can serve asa good example in this regard.165-169»» Dr. Claudio Knüsli, MD, Medical Oncologist at St. Clara
Hospital in Basel, Switzerland, member of the Board of
Directors of IPPNW.ch»» Dr. Helmut Lohrer, MD General Practitioner, Villingen,Germany, member of the IPPNW International Board of
Directors, International Councillor of IPPNW.de

The protection of unborn life and the genetic integrity of
future generations should be given highest priority. Radiation protection must therefore supplement adult-basedmodels and realign them to the particular vulnerability ofthe embryo and the child.

»» Henrik Paulitz, biologist, Seeheim, Germany, nuclear
energy expert of IPPNW.de»» Dr. Alex Rosen, MD, specialising in pediatrics, Berlin,
member of the Board of Directors of IPPNW.de»» Dr. Jörg Schmid, MD, specialising in psychotherapy
from Stuttgart, Germany, member of the nuclear energy
working group of IPPNW.de

Speakers and participants of the expert meeting in Ulm, October 19th, 2013:»» Reinhold Thiel, MD, General Practitioner, Ulm, Germany, leader of the Ulmer Ärzteinitiative, member of thenuclear energy working group of IPPNW.de»» Prof. Dr. Wolfgang Hoffmann, MD, MPH, Professor ofPopulation-based Epidemiology and Community Health,Institute for Community Medicine, University Hospital of
Greifswald, Germany»» Dr. rer. nat. Alfred Körblein, physicist and independentscientist, Nuremberg, Germany, member of the scientificcouncil of IPPNW.de»» Prof. Dr. Dr. h.c. Edmund Lengfelder, MD, Professor
emer. of the Institute for Radiobiology of the Medical University of Munich, Germany, Director of the Otto Hug Radiation Institute for Health and the Environment»» Dr. rer. nat. Hagen Scherb, mathematician, Helmholtz
Centre, German Research Centre for Health and the Environment in Munich, Germany
4

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Miglioretti DL, Johnson E, Williams A, Greenlee RT et al.: The use of computed tomography in pediatrics andthe associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013, Jun 10:1-8.doi: 10.1001/
jamapediatrics 2013.311 (Expub ahead of print)
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Weitere Literatur zu Risiko-Akzeptanz: http://www.dguv.de/dguv/ifa/Fachinfos/Exposition-Risiko-Beziehung(ERB)/Grundlagen-des-Risikokonzeptes/index.jsp

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