Increased frequency of chromosome translocations associated with diagnostic x-ray examinations

Informative studies of cancer risks associated with medical radiation are difficult to conduct owing to low radiation doses, poor recall of diagnostic X rays, and long intervals before cancers occur. Chromosome aberrations have been associated with increased cancer risk and translocations are a known radiation biomarker. Seventy-nine U.S. radiologic technologists were selected for blood collection, and translocations were enumerated by whole chromosome painting. We developed a dose score to the red bone marrow for medical radiation exposure from X-ray examinations reported by the technologists that they received as patients. Using Poisson regression, we analyzed translocations in relation to the dose scores. Each dose score unit approximated 1 mGy. The estimated mean cumulative red bone marrow radiation dose score was 42 (range 1-265). After adjustment for age, occupational radiation, and radiotherapy for benign conditions, translocation frequencies significantly increased with increasing red bone marrow dose score with an estimate of 0.007 translocations per 100 CEs per score unit (95% CI, 0.002 to 0.013; P = 0.01). Chromosome damage has been linked with elevated cancer risk, and we found that cumulative radiation exposure from medical X-ray examinations was associated with increased numbers of chromosome translocations.     

Long-term effects of combined exposure to external 137Cs gamma-radiation and incorporated 239Pu

A study was made of the delayed effects of mixed exposure to 137Cs-gamma-radiation (a single exposure) and 239Pu (a single intravenous injection) in doses approximating optimal blastomogenic ones. The results are calculated per 1 cGy of weighted mean dose within the body with regard for RBE (1 cSv), per cent of osteosarcomas (per 1 cGy in endosteum and periosteum). A conclusion is made of a complete summation of main biological effects per 1 cSv of the dose absorbed.     

Diagnostic X-ray examinations and increased chromosome translocations: evidence from three studies

Controversy regarding potential health risks from increased use of medical diagnostic radiologic examinations has come to public attention. We evaluated whether chromosome damage, specifically translocations, which are a potentially intermediate biomarker for cancer risk, was increased after exposure to diagnostic X-rays, with particular interest in the ionizing radiation dose–response below the level of approximately 50 mGy. Chromosome translocation frequency data from three separately conducted occupational studies of ionizing radiation were pooled together. Studies 1 and 2 included 79 and 150 medical radiologic technologists, respectively, and study 3 included 83 airline pilots and 50 university faculty members (total = 155 women and 207 men; mean age = 62 years, range 34–90). Information on personal history of radiographic examinations was collected from a detailed questionnaire. We computed a cumulative red bone marrow (RBM) dose score based on the numbers and types of X-ray examinations reported with 1 unit approximating 1 mGy. Poisson regression analyses were adjusted for age and laboratory method. Mean RBM dose scores were 49, 42, and 11 for Studies 1–3, respectively (overall mean = 33.5, range 0–303). Translocation frequencies significantly increased with increasing dose score (P < 0.001). Restricting the analysis to the lowest dose scores of under 50 did not materially change these results. We conclude that chromosome damage is associated with low levels of radiation exposure from diagnostic X-ray examinations, including dose scores of approximately 50 and lower, suggesting the possibility of long-term adverse health effects.     

Estimating the lowest detectable dose of ionizing radiation by FISH whole-chromosome painting

Chromosome translocations are the hallmark of exposure to ionizing radiation, but they also occur spontaneously, and their frequencies increase dramatically with age. This complicates dosimetry unless a pre-exposure sample is available for each putatively exposed individual. Here we use published values for translocations in unexposed subjects from a wide range of ages, together with data from an in vitro (137)Cs dose-response curve, to estimate the minimum dose of whole-body radiation that is detectable by translocation analyses in individuals of a given age. For subjects aged 20 to 69 years, we show that the minimum detectable acute dose increases linearly with age at a rate of 0.179, 0.218 and 0.256 cGy per year for significance levels of P = 0.05, P = 0.01 and P = 0.001, respectively. For chronic exposures, the corresponding minimum detectable doses are 1.591, 2.270 and 3.055 cGy per year. For newborns, the 95th and 99th percentiles of translocation frequencies are 0.20 and 0.31 per 100 cell equivalents, respectively, indicating that values greater than these are consistent with exposures at P = 0.05 and P = 0.01, respectively. These results improve our understanding of the requirements and limitations for performing biological dosimetry when only the age of the exposed individual is known.     

Historical review of occupational exposures and cancer risks in medical radiation workers

Epidemiological studies of medical radiation workers have found excess risks of leukemia, skin and female breast cancer in those employed before 1950 but little consistent evidence of cancer risk increases subsequently. Occupational radiation-related dose-response data and recent and lifetime cancer risk data are limited for radiologists and radiologic technologists and lacking for physicians and technologists performing fluoroscopically guided procedures. Survey data demonstrate that occupational doses to radiologists and radiologic technologists have declined over time. Eighty mostly small studies of cardiologists and fewer studies of other physicians reveal that effective doses to physicians per interventional procedure vary by more than an order of magnitude. For medical radiation workers, there is an urgent need to expand the limited information on average annual, time-trend and organ doses from occupational radiation exposures and to assess lifetime cancer risks of these workers. For physicians and technologists performing interventional procedures, more information about occupational doses should be collected and long-term follow-up studies of cancer and other serious disease risks should be initiated. Such studies will help optimize standardized protocols for radiologic procedures, determine whether current radiation protection measures for medical radiation workers are adequate, provide guidance on cancer screening needs, and yield valuable insights on cancer risks associated with chronic radiation exposure.     

Leukemia following radiotherapy for uterine bleeding

Mortality due to leukemia among 4483 women treated with radiation to control uterine bleeding between 1925 and 1965 was twice as high as expected based on U.S. population rates (standardized mortality ratio (SMR) = 2.0; 95% confidence interval (CI): 1.4 to 2.8). Women were followed for an average of 26.4 years. Relative risk was highest 2 to 5 years after treatment (SMR = 8.1) and among women over 55 years at irradiation (SMR = 5.8). The usual method of treatment was intrauterine radium. Average radiation dose to active bone marrow was estimated on the basis of original radiotherapy records (median, 53 cGy). A linear dose-response model provided an adequate fit to the data. The average excess relative risk was 1.9% per cGy (95% CI: 0.8 to 3.2), and the average absolute risk was 2.6 excess leukemia deaths per million women per year per cGy (95% CI: 0.9 to 4.8). Chronic myeloid leukemia predominated during the first 15 years following exposure, whereas acute leukemias and chronic lymphatic leukemia were most common thereafter. The radiation doses experienced during treatment of benign gynecologic disease appear to result in greater leukemia risk per cGy average marrow dose than the considerably higher doses used to treat malignant disease, perhaps because of a decreased likelihood of killing potentially leukemic cells.     

Chromosome aberrations in peripheral lymphocytes and radiation dose to active bone marrow in patients treated for cancer of the cervix

An international study of cervical cancer patients reported a doubling of the risk for leukemia following radiotherapy. To evaluate the extent of residual chromosome damage in circulating T-cell lymphocytes in this population, approximately 200 metaphases were examined from each of 96 irradiated and 26 nonirradiated cervical cancer patients treated more than 17 years ago (average 23 years). Radiation dose averaged over the total red bone marrow was estimated to be 8.1 Gy. The type and frequency of stable and unstable chromosome aberrations were quantified in 24,117 metaphases. Unstable aberrations did not differ significantly between irradiated and nonirradiated patients (P greater than 0.5). Stable aberrations (i.e., translocations, inversions, or chromosomes with deleted segments), however, were significantly higher among irradiated (2.8 per 100 cells) compared to nonirradiated (0.7 per 100 cells) women (P less than 10(4). The frequency of these stable aberrations was found to increase significantly with increasing dose to the bone marrow. These data indicate that a direct relationship between radiation dose and extent of damage to somatic cells persists in populations and can be detected many years after partial-body radiation exposure. The stable aberration rate in irradiated cervical cancer patients was 50 to 75% lower than those observed 25 years or more after radiation exposure in atomic bomb survivors and in ankylosing spondylitis patients treated with radiotherapy. The average marrow dose was only 1 Gy in the examined atomic bomb survivors and 3.5 Gy in the ankylosing spondylitis patients. It appears, then, that a very high dose delivered to the pelvic cavity in fractionated doses resulted in far fewer persistent stable aberrations than lower doses delivered either in acute whole-body exposure or in fractionated doses to the spinal column and sacroiliac joints. The higher radiation dose and the concentration of that dose in a smaller area of the body appear to be responsible for the lower rate of persistent aberrations observed in cervical cancer patients.     

mFISH analysis of chromosome aberrations in workers occupationally exposed to mixed radiation

We performed a study on the presence of chromosome aberrations in a cohort of plutonium workers of the Mayak production association (PA) with a mean age of 73.3 ± 7.2 years to see whether by multi-color fluorescence in situ hybridization (mFISH) translocation analysis can discriminate individuals who underwent occupational exposure with internal and/or external exposure to ionizing radiation 40 years ago. All Mayak PA workers were occupationally exposed to chronic internal alpha-radiation due to incorporated plutonium-239 and/or to external gamma-rays. First, we obtained the translocation yield in control individuals by mFISH to chromosome spreads of age-matched individuals and obtained background values that are similar to previously published values of an international study (Sigurdson et al. in Mutat Res 652:112–121, 2008). Workers who had absorbed a total dose of >0.5 Gy external gamma-rays to the red bone marrow (RBM) displayed a significantly higher frequency of stable chromosome aberrations relative to a group of workers exposed to <0.5 Gy gamma-rays total absorbed RBM dose. Thus, the translocation frequency may be considered to be a biological marker of external radiation exposure even years after the exposure. In a group of workers who were internally exposed and had incorporated plutonium-239 at a body burden >1.48 kBq, mFISH revealed a considerable number of cells with complex chromosomal rearrangements. Linear associations were observed for translocation yield with the absorbed RBM dose from external gamma-rays as well as for complex chromosomal rearrangements with the plutonium-239 body burden.     

Influence of Age,Sex and Calendar Year on Lifetime Accumulated Red Bone Marrow Dose from Diagnostic Radiation Exposure

Our aim is to evaluate the relevance of different factors influencing lifetime accumulated red bone marrow dose, such as calendar year, age and sex. The lifetime dose was estimated for controls interviewed in person (N = 2811, 37.5% women) of the population-based representative Northern Germany Leukemia and Lymphoma Study. Data were assessed in standardized computer-assisted personal interviews. The calculation of doses is based on a comprehensive quantification model including calendar year, sex, kind of examination, and technical development. In multivariate regression models the annual red bone marrow dose was analyzed depending on age, sex and calendar year to consider simultaneously temporal changes in radiologic practice and individual risk factors. While the number of examinations continuously rises over time, the dose shows two peaks around 1950 and after 1980. Men are exposed to higher doses than woman. Until 1970 traditional examinations like conventional and mass screening examinations caused the main dose. They were then replaced by technically advanced examinations mainly computed tomography and cardiac catheter. The distribution of the red bone marrow dose over lifetime depends highly on the technical standards and radiation protection survey. To a lesser extent it is influenced by age and sex of the subjects. Thus epidemiological studies concerning the assessment of radiation exposure should consider the calendar year in which the examination was conducted.     

Biological dosimetry of chernobyl cleanup workers: inclusion of data on age and smoking provides improved radiation dose estimates

We report the results of a study of chromosome translocations in 126 Russian subjects who participated in the cleanup activities at Chernobyl and another 53 subjects, from other places in Russia, who were not exposed at Chernobyl. In agreement with our earlier study, we find increased translocation frequencies among the exposed compared to Russian controls. We describe statistical methods for estimating the dose of ionizing radiation determined by scoring chromosome translocations found in circulating lymphocytes sampled several years after exposure. Two statistical models were fitted to the data. One model assumed that translocation frequencies followed an overdispersed Poisson distribution. The second model assumed that translocation frequencies followed a negative binomial distribution. In addition, the effects of radiation exposure were modeled as additive or as multiplicative to the effects of age and smoking history. We found that the negative binomial model fit the data better than the overdispersed Poisson model. We could not distinguish between the additive and the multiplicative model with our data. Individual dose estimates ranged from 0 (for 43 subjects) to 0.56 Gy (mean 0.14 Gy) under the multiplicative model and from 0 to 0.95 Gy (mean 0.15 Gy) under the additive model. Dose estimates were similar under the two models when the number of translocations was less than 4 per 100 cells. The additive model tended to estimate larger doses when the number of translocations was greater than 4 per 100 cells. We also describe a method for estimating upper 95% tolerance bounds for numbers of translocations in unexposed individuals. We found that inclusion of data on age and smoking history was important for dose estimation. Ignoring these factors could result in gross overestimation of exposures, particularly in older subjects who smoke.     

Structural genomic damages in workers of plutonium production

The research objective is assessment of structural genomic damages in plutonium workers. The study group included the Mayak nuclear workers subject to chronic occupational exposure to incorporated 239Pu and/or external gamma-rays. The analysis was performed based on the culture of lymphocytes in peripheral blood. The yield of intra-chromosomal exchange aberrations of chromosomal type on stained slides was analyzed using in situ fluorescent hybridization, mBAND. Linear relationships were revealed between (a) the total yield of chromosomal type aberrations (e.g. intra- and inter-chromosomal ones) and an absorbed dose from external exposure of the red bone marrow to gamma-rays, an absorbed dose from internal exposure to a-radiation from incorporated 239Pu; and (b) the yield of intra-chromosomal exchange aberrations of chromosomal type and an absorbed dose from exposure of the red bone marrow to 239Pu and 239Pu body burden.     

Genetic efficacy of low doses of ionizing radiation in chronically-irradiated small mammals

Earlier we have established the genetic effects of low dose chronic irradiation in bank vole (somatic and germ cells, embryos), in pond carp (fertilized eggs, embryos, fry) and in laboratory mice (somatic and germ cells) in the range of doses from near-background to 10 cGy. These low dose effects observed in mammals and fish are not expected from extrapolation of high dose experiments. For understanding reasons this discrepancy the comparative analysis of genetic efficiency of low dose chronic irradiation and the higher doses of acute irradiation was carried out with natural populations of bank vole which inhabited the two sites differing in ground of radionuclide deposition. For comparing efficiency the linear regression model of dose-effect curve was used. Dose-effect equations were obtained for animals from two chronically irradiated bank vole populations. The mean population absorbed doses were in the range 0.04-0.68 cGy, the main part of absorbed doses consisted of external radiation of animals exposed to 137Cs gamma-rays. Dose-effect equations for acute irradiation to 137Cs gamma-rays (10-100 cGy) were determined for the same populations. Comparison of genetic efficiency was made by extrapolation, using regression coefficient beta and doubling dose estimation. For chronic exposure the doubling doses calculated from low-dose experiments are 0.1-2 cGy and the doubling doses determined from high-dose experiments are in the range of 5-20 cGy. Our hypothesis that the doubling dose estimate is calculated in higher-dose ionizing radiation experiments should be much higher than the deduced from the low dose line regression equation was verified. The doubling dose estimates for somatic cells of bank vole and those for germ cells of laboratory mice are in close agreement. The radiosensitivity of bank vole chromosomes were shown is practically the same as that for human lymphocytes since doubling dose estimates for acute irradiation close to each other. For low LET radiation a higher genetic efficiency of chronic low doses in comparison with the higher doses of acute gamma-irradiation (137Cs source) was proved by three methods.     

Thyroid neoplasia following low-dose radiation in childhood

The thyroid gland is highly sensitive to the carcinogenic effects of ionizing radiation. Previously, we reported a significant increase of thyroid cancer and adenomas among 10,834 persons in Israel who received radiotherapy to the scalp for ringworm. These findings have now been extended with further follow-up and revised dosimetry. Overall, 98 thyroid tumors were identified among the exposed and 57 among 10,834 nonexposed matched population and 5392 sibling comparison subjects. An estimated thyroid dose of 9 cGy was linked to a fourfold (95% Cl = 2.3-7.9) increase of malignant tumors and a twofold (95% Cl = 1.3-3.0) increase of benign tumors. The dose-response relationship was consistent with linearity. Age was an important modifier of risk with those exposed under 5 years being significantly more prone to develop thyroid tumors than older children. The pattern of radiation risk over time could be described on the basis of a constant multiplication of the background rate, and an absolute risk model was not compatible with the observed data. Overall, the excess relative risk per cGy for thyroid cancer development after childhood exposure is estimated as 0.3, and the absolute excess risk as 13 per 10(6) PY-cGy. For benign tumors the estimated excess relative risk was 0.1 per cGy and the absolute risk was 15 per 10(6) PY-cGy.     

Ionizing radiation and risk of chronic lymphocytic leukemia in the 15-country study of nuclear industry workers

In contrast to other types of leukemia, chronic lymphocytic leukemia (CLL) has long been regarded as non-radiogenic, i.e. not caused by ionizing radiation. However, the justification for this view has been challenged. We therefore report on the relationship between CLL mortality and external ionizing radiation dose within the 15-country nuclear workers cohort study. The analyses included, in seven countries with CLL deaths, a total of 295,963 workers with more than 4.5 million person-years of follow-up and an average cumulative bone marrow dose of 15 mSv; there were 65 CLL deaths in this cohort. The relative risk (RR) at an occupational dose of 100 mSv compared to 0 mSv was 0.84 (95% CI 0.39, 1.48) under the assumption of a 10-year exposure lag. Analyses of longer lag periods showed little variation in the RR, but they included very small numbers of cases with relatively high doses. In conclusion, the largest nuclear workers cohort study to date finds little evidence for an association between low doses of external ionizing radiation and CLL mortality. This study had little power due to low doses, short follow-up periods, and uncertainties in CLL ascertainment from death certificates; an extended follow-up of the cohorts is merited and would ideally include incident cancer cases.     

Frequency of stable chromosomal aberrations determined by FISH in 49 Chernobyl nuclear accident liquidators exposed to various doses of radiation

FISH technique was tested on the 49 liquidators of the Chernobyl Accident. Groups were formed according to average group exposure doses and/or individual ones determined by the method of EPR. The essential variability of spontaneous and irradiation-induced frequencies of reciprocal translocations was observed. In groups with the lowest EPR-doses (below 25 cGy) the average cytogenetic dose was considerably higher then doses determined by EPR-method. The best coincidences between average in-group EPR- and FISH-doses were in the group with 25-50 cGy doses for "acute irradiation" model and in the group with 50-100 cGy and higher for "chronic irradiation" model.     

Cytogenetic effect in peripheral blood lymphocytes of children living in villages in the Ovruch District, Zhitomir Region of the Ukraine contaminated by radionuclides]

For the purpose of genetic indication of low level of chronic radiation exposure the cytogenetic monitoring of some critical children groups living in two contaminated Ukrainian villages was carried out. In all the groups the mean frequency of aberrant cells and chromosome type aberrations (including dicentrics, centric rings, chromosome translocations as well as polyploid cells) significantly exceeded control level. During the repeated examination of children from Vistupovichi (in 13 months after the first one) the striking increase of cytogenetic effect was revealed. Dicentrics and rings were registered in 79% of persons with the individual rate 0.5-1.5 and mean group frequency 0.57 per 100 cells. The authors tried to evaluate the average cumulative doses of radiation for examined groups using G. Littlefield equation for dicentric outcome under the low dose rate Cs-137 source and taking into account the assumption about the reducing of 50% dicentrics per year. According to this rough calculation, the revealed cytogenetic effect can correspond to the mean total dose of 33 cSv for Vistupovichi children.     

Evaluation of the genetic effects of 238Pu incorporated into mice

The genetic effects of 238Pu incorporated into male mice were estimated by several tests. The activity of the administered 238Pu nitrate varied from 7 to 1850 Bq/g of body weight. The average alpha-radiation dose absorbed in the testes ranged from 2 to 96 cGy, with a dose rate of 0.004-1 cGy/day. alpha-Radiation from 238Pu was shown to induce dominant lethal mutations (DLM) and reciprocal translocation (RT), chromosomal fragmentation and formation of abnormal sperm heads (ASH). The effect does not depend on the average alpha-radiation dose absorbed in the testis. The relative genetic efficiency of alpha-radiation, as compared with that of chronic alpha-radiation for the indices under study, was about 10-20.     

Relative biological effectiveness and dose rate effect of tritiated water on chromosomes in human lymphocytes and bone marrow cells

Tritriated water (HTO) is a major toxic effluent from the nuclear power industry, that is released into the environment in large quantities. The low dose radiation effect and dose rate effect of HTO on human lymphocytes and bone marrow cells have not been well studied. The present study was therefore undertaken to investigate the HTO dose-response relationship for chromosomal aberrations in human lymphocytes and bone marrow cells at low in vitro radiation doses ranging from 0.1 to 1 Gy. Lymphocytes (G₀ stage) and bone marrow cells were incubated for 10–150 min with HTO at a dose rate of 2cGy/min (555 MBq/ml). The relative biological effectiveness (RBE) of HTO was calculated with respect to ₆₀Co γ-rays for the induction of dicentric and centric ring chromosomes at low radiation doses. The RBE value for HTO β-rays relative to ⁶⁰Co γ-rays was 2.7 for lymphocytes and 3.1 for chromatid aberrations in bone marrow cells. Lymphocytes were also chronically exposed to HTO for 6.7–80 h at dose rates of 0.5 cGy/min (138.5 MBq/ml) and 0.02 cGy/min (5.6 MBq/ml). There was a 71.5% decrease in the yield of dicentrics and centric rings at the dose rate of 0.02 cGy/min, indicating a clear dose rate effect of HTO. The RBE value for HTO relative to ¹³⁷Cs γ-rays was 2.0 at a dose rate of 0.02 cGy/min, suggesting that low HTO dose rates produce no increase of the RBE values and that the values may be constant between 2 and 3 within these dose rates. These results should prove useful in assessment of the health risk for humans exposed to low levels of HTO.     

Three somatic genetic biomarkers and covariates in radiation-exposed Russian cleanup workers of the chernobyl nuclear reactor 6-13 years after exposure

Three somatic mutation assays were evaluated in men exposed to low-dose, whole-body, ionizing radiation. Blood samples were obtained between 1992 and 1999 from 625 Russian Chernobyl cleanup workers and 182 Russian controls. The assays were chromosome translocations in lymphocytes detected by FISH, hypoxanthine phosphoribosyltransferase (HPRT) mutant frequency in lymphocytes by cloning, and flow cytometic assay for glycophorin A (GPA) variant frequency of both deletion (N/?) and recombination (N/N) events detected in erythrocytes. Over 30 exposure and lifestyle covariates were available from questionnaires. Among the covariates evaluated, some increased (e.g. age, smoking) and others decreased (e.g. date of sample) biomarker responses at a magnitude comparable to Chernobyl exposure. When adjusted for covariates, exposure at Chernobyl was a statistically significant factor for translocation frequency (increase of 30%, 95% CI of 10%-53%, P = 0.002) and HPRT mutant frequency (increase of 41%, 95% CI of 19%-66%, P < 0.001), but not for either GPA assay. The estimated average dose for the cleanup workers based on the average increase in translocations was 9.5 cGy. Translocation analysis is the preferred biomarker for low-dose radiation dosimetry given its sensitivity, relatively few covariates, and dose-response data. Based on this estimated dose, the risk of exposure-related cancer is expected to be low.     

Effect of external gamma radiation on shortening the life expectancy and rates of the formation of absorbed doses from incorporated 239Pu in dogs

External gamma irradiation of dogs with doses of 103.2 and 51.6 mC/kg combined with the effect of inhaled plutonium-239 accelerates the formation of absorbed doses in secondary organs of the radionuclide deposition by 41.7 and 2.4 times, respectively, whereas the dose of 25.8 mC/kg is ineffective. As estimated by the rate of 239Pu accumulation and by the life span shortening, the minimum effective and the maximum ineffective doses are 104.8 and 80.5 cGy and 89.2 and 79.2 cGy, respectively.