Stable chromosome aberrations in atomic bomb survivors: results from 25 years of investigation

Frequencies of stable chromosome aberrations from more than 3,000 atomic bomb survivors were used to examine the nature of the radiation dose response. The end point was the proportion of cells with at least one translocation or inversion detected in Giemsa-stained cultures of approximately 100 lymphocytes per person. The statistical methods allow for both imprecision of individual dose estimates and extra-binomial variation. A highly significant and nonlinear dose response was seen. The shape of the dose response was concave upward for doses below 1.5 Sv but exhibited some leveling off at higher doses. This curvature was similar for the two cities, with a crossover dose (i.e. the ratio of the linear coefficient to the quadratic coefficient) of 1.7 Sv (95% CI 0.9, 4). The low-dose slopes for the two cities differed significantly: 6.6% per Sv (95% CI 5.5, 8.4) in Hiroshima and 3.7% (95% CI 2.6, 4.9) in Nagasaki. This difference was reduced considerably, but not eliminated, when the comparison was limited to people who were exposed in houses or tenements. Nagasaki survivors exposed in factories, as well as people in either city who were outside with little or no shielding, had a lower dose response than those exposed in houses. This suggests that doses for Nagasaki factory worker survivors may be overestimated by the DS86, apparently by about 60%. Even though factory workers constitute about 20% of Nagasaki survivors with dose estimates in the range of 0.5 to 2 Sv, calculations indicate that the dosimetry problems for these people have little impact on cancer risk estimates for Nagasaki.     

Gamma-ray exposure from neutron-induced radionuclides in soil in Hiroshima and Nagasaki based on DS02 calculations

As a result of joint efforts by Japanese, US and German scientists, the Dosimetry System 2002 (DS02) was developed as a new dosimetry system, to evaluate individual radiation dose to atomic bomb survivors in Hiroshima and Nagasaki. Although the atomic bomb radiation consisted of initial radiation and residual radiation, only initial radiation was reevaluated in DS02 because, for most survivors in the life span study group, the residual dose was negligible compared to the initial dose. It was reported, however, that there were individuals who entered the city at the early stage after the explosion and experienced hemorrhage, diarrhea, etc., which were symptoms of acute radiation syndrome. In this study, external exposure due to radionuclides induced in soil by atomic bomb neutrons was reevaluated based on DS02 calculations, as a function of both the distance from the hypocenters and the elapsed time after the explosions. As a result, exposure rates of 6 and 4 Gy h(-1) were estimated at the hypocenter at 1 min after the explosion in Hiroshima and Nagasaki, respectively. These exposure rates decreased rapidly by a factor of 1,000 1 day later, and by a factor of 1 million 1 week later. Maximum cumulative exposure from the time of explosion was 1.2 and 0.6 Gy at the hypocenters in Hiroshima and Nagasaki, respectively. Induced radiation decreased also with distance from the hypocenters, by a factor of about 10 at 500 m and a factor of three to four hundreds at 1,000 m. Consequently, a significant exposure due to induced radiation is considered feasible to those who entered the area closer to a distance of 1,000 m from the hypocenters, within one week after the bombing.     

Radiation-related posterior lenticular opacities in Hiroshima and Nagasaki atomic bomb survivors based on the DS86 dosimetry system

This paper investigates the quantitative relationship of ionizing radiation to the occurrence of posterior lenticular opacities among the survivors of the atomic bombings of Hiroshima and Nagasaki suggested by the DS86 dosimetry system. DS86 doses are available for 1983 (93.4%) of the 2124 atomic bomb survivors analyzed in 1982. The DS86 kerma neutron component for Hiroshima survivors is much smaller than its comparable T65DR component, but still 4.2-fold higher (0.38 Gy at 6 Gy) than that in Nagasaki (0.09 Gy at 6 Gy). Thus, if the eye is especially sensitive to neutrons, there may yet be some useful information on their effects, particularly in Hiroshima. The dose-response relationship has been evaluated as a function of the separately estimated gamma-ray and neutron doses. Among several different dose-response models without and with two thresholds, we have selected as the best model the one with the smallest x2 or the largest log likelihood value associated with the goodness of fit. The best fit is a linear gamma-linear neutron relationship which assumes different thresholds for the two types of radiation. Both gamma and neutron regression coefficients for the best fitting model are positive and highly significant for the estimated DS86 eye organ dose.     

The F value for chromosome aberrations in atomic bomb survivors does not provide evidence for a primary contribution of neutrons to the dose in Hiroshima.

Brenner and Sachs (Radiat. Res. 140, 134-142, 1994) proposed that the ratio of interchromosomal to intrachromosomal exchanges, termed the F value, can be a cytogenetic fingerprint of exposure to radiations of different linear energy transfer (LET). Using published data, they suggested that F values are over 10 for low-LET radiations and approximately 6 for high-LET radiations. Subsequently, as F values for atomic bomb survivors were reported to be around 6, Brenner suggested that the biological effects of atomic bomb radiation in Hiroshima are due primarily to neutrons. However, the F values used for the survivors were means from individuals exposed to various doses. As the F-value hypothesis predicts a radiation fingerprint at low doses, we analyzed our own data for the survivors in relation to dose. G-banding data for the survivors showed F values varying from 5 to 8 at DS86 doses of 0.2 to 5 Gy in Hiroshima and around 6 in Nagasaki with no evidence of a difference between the two cities. The results are consistent with our in vitro data that the F values are invariably around 6 for X and gamma rays at doses of 0.5 to 2 Gy as well as two types of fission-spectrum neutrons at doses of about 0.2 to 1 Gy. Thus, apart from a possible effect at even lower doses, current data do not provide evidence to support the proposition that the biological effects of atomic bomb radiation in Hiroshima are caused mainly by neutrons.     

Prevalence of hepatitis B virus infection among atomic bomb survivors

The aim of this study was to determine whether the prevalence of hepatitis B virus (HBV) carriers increased with atomic bomb radiation dose, and whether radiation decreased the ability to clear HBV among the atomic bomb survivors. The study subjects were 6,121 participants in the Adult Health Study of atomic bomb survivors in Hiroshima and Nagasaki. After adjustment for age, sex, city and potential confounders, the rates of seropositivity for hepatitis B surface antigen (HBsAg), indicating current HBV infections, and anti-hepatitis B core antibody, indicating either cured or current infections, increased with radiation dose. However, no relationship was observed between radiation and anti-hepatitis B surface antibody (indicating cured infection). The proportion of persons who were unable to clear the virus, as the proportion of HBsAg-positive persons among those ever infected by HBV (positive for HBsAg or surface or core hepatitis B antibody), increased significantly with radiation dose among those receiving blood transfusions. This proportion was not related to dose among those who reported no such transfusions. The findings may suggest a lower likelihood of clearance after HBV infection among those who were more likely to have been infected with HBV as adults after atomic bomb irradiation rather than as infants or adults prior to irradiation.     

Investigation on circular asymmetry of geographical distribution in cancer mortality of Hiroshima atomic bomb survivors based on risk maps: analysis of spatial survival data

While there is a considerable number of studies on the relationship between the risk of disease or death and direct exposure from the atomic bomb in Hiroshima, the risk for indirect exposure caused by residual radioactivity has not yet been fully evaluated. One of the reasons is that risk assessments have utilized estimated radiation doses, but that it is difficult to estimate indirect exposure. To evaluate risks for other causes, including indirect radiation exposure, as well as direct exposure, a statistical method is described here that evaluates risk with respect to individual location at the time of atomic bomb exposure instead of radiation dose. In addition, it is also considered to split the risks into separate risks due to direct exposure and other causes using radiation dose. The proposed method is applied to a cohort study of Hiroshima atomic bomb survivors. The resultant contour map suggests that the region west to the hypocenter has a higher risk compared to other areas. This in turn suggests that there exists an impact on risk that cannot be explained by direct exposure.     

Prevalence of anti-hepatitis C virus antibody and chronic liver disease among atomic bomb survivors

To investigate whether exposure to atomic bomb radiation altered the prevalence of hepatitis C virus (HCV) infection or accelerated the progress toward chronic hepatitis after HCV infection, the seropositivity of antibody to hepatitis C virus (anti-HCV) was determined for 6,121 participants in the Adult Health Study of atomic bomb survivors in Hiroshima and Nagasaki. The seropositivity of anti-HCV antibody was 2.5 times higher among those with a history of blood transfusion and 1.2 times higher among those with a family history of liver disease, whereas acupuncture showed no association with anti-HCV. Although the prevalence of anti-HCV was lower for survivors with positive dose estimates than for those with 0 dose (relative prevalence 0.84, P = 0.022), there was no evidence of a smooth dose-response relationship. However, these data suggested that the radiation dose response for chronic liver disease among HCV antibody-positive survivors may be greater than that among HCV antibody-negative survivors (slope ratio 20). In conclusion, no dose-response relationship was found between anti-HCV positivity and radiation dose; a possible increase in the radiation dose response of chronic liver disease among anti-HCV-positive individuals was found. Thus radiation exposure may accelerate the progress of chronic liver disease associated with hepatitis C virus infection.     

The observed relationship between the occurrence of acute radiation effects and leukemia mortality among A-bomb survivors

In an analysis of a follow-up study of a fixed population of 73,330 atomic bomb survivors in Hiroshima and Nagasaki, the slope of an estimated dose response between ionizing radiation and leukemia mortality was found to be steeper (P less than 0.002), by a factor of 2.4, among those who reported epilation within 60 days of the bombings, compared to those who did not experience this sign of acute radiation exposure. The strength of this empirical finding as evidence of biological association in individual radiosensitivity for these two end points is studied here. The major factor complicating the interpretation of this finding as evidence of such an association is the degree of imprecision of the radiation dosimetry system used in assignment of radiation doses to the A-bomb survivors. Using models recently suggested for dealing with dosimetry errors in epidemiological analysis of the A-bomb survivor data, the sensitivity of the apparent association between leukemia mortality and severe epilation to the assumed level of dosimetry error is investigated.     

Effect of radiation dose on the height of atomic bomb survivors: a longitudinal study

We conducted a longitudinal analysis of height after age 20 for atomic bomb survivors in the Adult Health Study (AHS) cohort. The measurements we used were made from July 1958 to June 1998 (AHS examination cycles 1-20). We analyzed only the subjects with known atomic bomb radiation doses, excluding those who were not in the city at the time of bombing (ATB) and those exposed in utero. We also excluded from the analysis measurements made after the occurrence of vertebral fracture. The total number of subjects was 11,862, and the total number of measurements was 109,770; the mean number of measurements per subject was 9.25. Assuming that stature after age 20 is approximately constant, a simple mixed-effects model was fitted to stature after age 20, and linear dose effects for young ATB subjects were modeled for both sexes. The estimated mean heights for subjects born in 1945 in Hiroshima were 166.0 cm for men and 155.4 cm for women. The sex difference in height was 10.6 cm, with men significantly taller than women (P < 0.001). The difference between the cities was not significant (P = 0.162). The birth cohort effects per decade were -1.7 cm for men (P < 0.001) and -2.1 cm for women (P < 0.001). A reduction of stature due to radiation exposure was observed for individuals of both sexes who were below 19 years of age ATB (95% confidence interval, 17-21 years), and the dose effect was larger for women than for men (P = 0.028). The estimated effects per gray for those who were age 0 ATB were -1.2 cm for men and -2.0 cm for women and for those who were age 10 ATB were-0.57 cm for men and -0.96 cm for women.     

Thermoluminescence dosimetry of gamma rays from the atomic bomb at Hiroshima using the predose technique

Thermoluminescence dosimetry measurements of gamma rays produced by the atomic bomb in Hiroshima were made by the predose technique using eight ceramic samples collected from five buildings located at distances between 1271 and 2051 m from the hypocenter. The results of our measurements are compared to both the newer dose estimates (Dosimetry System 1986) and older dose estimates (Tentative 1965 Doses) for survivors of the Hiroshima atomic bomb. In comparison with the older estimates, our results are larger by a factor of 2.3 at 1271 m and 3.9 at 2051 m. Our results and the newer estimates for Hiroshima differ by a factor of only 1.14 +/- 0.16 on the average.     

Effects of radiation on the longitudinal trends of total serum cholesterol levels in the atomic bomb survivors.

The effects of radiation on the long-term trends of the total serum cholesterol levels of the Hiroshima and Nagasaki atomic bomb survivors were examined using data collected in the Adult Health Study over a 28-year period (1958-1986). The growth-curve method was used to model the longitudinal age-dependent changes in cholesterol levels. For each sex, temporal trends of cholesterol levels were characterized with respect to age, body mass index, city and birth year. We then examined whether the temporal trends differed by radiation dose. We showed that the mean growth curve of cholesterol levels for the irradiated subjects were significantly higher than that for the unirradiated subjects, and that the increase was greater for women than for men. No difference in dose response was detected between Hiroshima and Nagasaki. An increased mean level of cholesterol was evident for irradiated women in general, but a notable increase was apparent in males only for the youngest birth cohort of 1935-1945. The difference in the mean cholesterol levels between the irradiated and unirradiated subjects diminished past 70 years of age. It is not known whether this is due to natural progression or is an artifact of nonrandom variation in the rate of participation in the examinations. The maximum predicted increase at 1 Gy for women occurred at age 52 years for the 1930 cohort: 2.5 mg/dl (95% CI 1.6-3.3 mg/dl) for Hiroshima and 2.3 mg/dl (95% CI 1.5-3.1 mg/dl) for Nagasaki. The corresponding increase for men occurred at age 29 years for the 1940 cohort: 1.6 mg/dl (95% CI 0.4-2.8) for Hiroshima and 1.4 mg/dl (95% CI 0.3-2.6) for Nagasaki. Controlling for cigarette smoking did not alter the dose-response relationship. Although the difference in the mean growth curves of the irradiated and unirradiated groups was statistically significant, there was a considerable overlap in the individual growth curves of the two groups. The significant sex difference and the greater magnitude of radiation effects in women suggest that hormonal changes resulting from radiation exposure, such as accelerated menopause, is an area worth investigating to delineate the mechanisms underlying the increased cholesterol levels of the irradiated female subjects. This increase may also partially explain the increased rate of coronary heart disease seen in the atomic bomb survivors.     

Radioepidemiology in the aftermath of the nuclear program of the former Soviet Union: Unique lessons to be learnt

  The military and civilian nuclear activities in the former Soviet Union led to unique exposures and resulted in high cumulative doses in several populations. In comparison to the atomic bomb survivors, at present the most important cohort in radiation epidemiology, collective and individual doses received by early workers in the plutonium production facilities at Mayak (Chelyabinsk), Techa River residents downstream of Mayak, populations downwind of the Semipalatinsk test site, and subpopulations of Chernobyl victims surpass the Hiroshima/Nagasaki experience in most cases. Even more importantly, the dose rates cover the full range of exposures relevant for radiation protection, i.e., acute to year-long chronic exposures from environmental contamination and bone seeking radionuclides. Parallel to the humanitarian need to mitigate health effects from these exposures, the unique opportunities for research on radiation risks related to low dose rate and chronic radiation have to be explored. Increased efforts by the global radiation research community are needed to address the many questions which cannot be answered by the acutely irradiated survivors of Hiroshima/Nagasaki. Specific attention needs to be drawn to the validation of available exposure and health records and to dose reconstruction which must include dietary sources of exposure. Preliminary intercomparison and validation exercises indicate potentially large sources of error, e.g., due to uncertainties in the reconstruction of early exposures and effects and due to continuing incorporation. Received: 29 February 1996 / Accepted in revised form: 6 March 1996     

Gamma-ray thermoluminescence measurements: a record of fallout deposition in Hiroshima?

In certain Hiroshima neighborhoods, radiation measurements using thermoluminescence dosimetry (TLD) exceed what can be explained by the initial gamma-ray doses and uncertainties from the Dosimetry System 2002 (DS02). This problem was not previously recognized as being isolated to certain parts of that city. The ratio between TLD measurements and DS02 dose calculations for gamma rays appear to grow larger than unity up to more than three with increasing ground range, but closer examination shows the excess TLD dose (0.1, 0.2, or possibly up to 0.8 Gray) is correlated with certain neighborhoods and could be due to radioactive fallout. At Nagasaki, the TLD measurements do not show this same excess, probably because there were no TLD measurements taken more than 800 m downwind (eastward) from the Nagasaki hypocenter, so that any small excess TLD dose was masked by larger initial gamma-ray doses of 25–80 Gray in the few downwind samples. The DS02 Report had noted many measurements lower than the DS02 calculation for several Nagasaki TLD samples, independent of ground range. This was explained as being the result of previously unaccounted urban shielding which was observed from Nagasaki pre-bomb aerial photos. However, the Hiroshima excess TLD dose issue was not resolved. If the excess TLD doses at Hiroshima are an indication of fallout, it may be possible to use additional TLD studies to make better estimates of the locations and radiation doses to survivors from the fallout after the bombings at both cities.     

Study of cognitive function among the Adult Health Study (AHS) population in Hiroshima and Nagasaki

Although neuropsychological dysfunction is found among A-bomb survivors exposed in utero as it is among patients who receive central nervous system radiotherapy, neuropsychological examinations have not been conducted on the survivors. Its prevalence may be increased as a result of the increased rate of strokes reported among those exposed to a high radiation dose. In this study, we examined the effects of radiation exposure on cognitive function among adult survivors in the Adult Health Study (AHS). The study subjects were men and women born prior to September 1932 who had undergone biennial examinations during the period 1992-1996 in Hiroshima or 1993-1998 in Nagasaki. We evaluated cognitive performance for 3,113 subjects with the Cognitive Abilities Screening Instrument (CASI), and we examined the relationship between cognitive performance and potentially related factors (sex, age, city where the subjects were exposed, years of education, and radiation dose). In contrast to exposure to radiotherapy, exposure to atomic bomb radiation had no apparent effect on cognitive function. Factors that did affect cognitive function were age, sex, city and years of education. Further investigation, including examination of other neurological functions, is required before a final conclusion regarding radiation-induced neurological dysfunction can be reached.     

Modeling the low-LET dose-response of BCR-ABL formation: predicting stem cell numbers from A-bomb data

Formation of the BCR-ABL chromosomal translocation t(9;22)(q34;q11) is essential to the genesis of chronic myeloid leukemia (CML). An interest in the dose-response of radiation induced CML therefore leads naturally to an interest in the dose-response of BCR-ABL formation. To predict the BCR-ABL dose-response to low-linear energy transfer (LET) ionizing radiation, three models valid over three different dose ranges are examined: the first for doses greater than 80 Gy, the second for doses less than 5 Gy and the third for doses greater than 2 Gy. The first of the models, due to Holley and Chatterjee, ignores the accidental binary eurejoining of DNA double-strand break (DSB) free ends ('eurejoining' refers to the accidental restitution of DSB free ends with their own proper mates). As a result, the model is valid only in the limit of high doses. The second model is derived directly from cytogenetic data. This model has the attractive feature that it implicitly accounts for single-track effects at low doses. The third model, based on the Sax-Markov binary eurejoining/misrejoining (SMBE) algorithm, does not account for single-track effects and is therefore limited to moderate doses greater than approximately 2 Gy. Comparing the second model to lifetime excess CML risks expected after 1 Gy, estimates of the number of hematopoietic stem cells capable of causing CML were obtained for male and female atomic bomb survivors in Hiroshima and Nagasaki. The stem cell number estimates lie in the range of 5 x 10(7)-3 x 10(8) cells.     

Modelling of carcinogenesis and low-dose hypersensitivity: an application to lung cancer incidence among atomic bomb survivors

Lung cancer incidence among the atomic bomb survivors from Hiroshima and Nagasaki was analysed with the two-step clonal expansion (TSCE) model of carcinogenesis. For the baseline incidence, a new set of model parameters is introduced, which can be determined with a higher precision than the parameter sets previously used. The effect of temporal changes in the smoking behaviour on the lung cancer incidence is modelled by allowing initiation, inactivation and division rates of intermediate cells to depend on the year of birth. The TSCE model is further developed by implementing low-dose hypersensitivity in the survival of lung epithelial cells. According to the model fit to the data, the acute gamma exposure of the atomic bomb survivors does not only result in the conventional initiating effect, but also in a promoting effect for lung cancer. Compared to the model in which radiation acts merely on initiation, the new model is in better agreement with the age-at-exposure dependence in the data, and it does not predict an unexpected increase of the excess relative risk (ERR) at 40 years after exposure. According to the new model, the ERR at low doses increases non-linearly with dose, especially during the first 10 years after exposure to older persons.     

Choice of model and uncertainties of the gamma-ray and neutron dosimetry in relation to the chromosome aberrations data in Hiroshima and Nagasaki

Chromosome data pertaining to blood samples from 1,703 survivors of the Hiroshima and Nagasaki A-bombs, were utilized and different models for chromosome aberration dose response investigated. Models applied included those linear or linear-quadratic in equivalent dose. Models in which neutron and gamma doses were treated separately (LQ-L model) were also used, which included either the use of a low-dose limiting value for the relative biological effectiveness (RBE) of neutrons of R(0)=70+/-10 or an RBE value of R(1)=15+/-5 at 1 Gy. The use of R(1) incorporates the assumption that it is much better known than R(0), with much less associated uncertainty. In addition, error-reducing transformations were included which were found to result in a 50% reduction of the standard error associated with one of the model fit parameters which is associated with the proportion of cells with at least one aberration, at 1 Gy gamma dose. Several justifiable modifications to the DS86 doses according to recent nuclear retrospective dosimetry measurements were also investigated. Gamma-dose modifications were based on published thermoluminescence measurements of quartz samples from Hiroshima and on a tentative reduction for Nagasaki factory worker candidates by a factor of 0.6. Neutron doses in Hiroshima were modified to become consistent with recent fast neutron activation data based on copper samples. The applied dose modifications result in an increase in non-linearity of the dose-response curve for Hiroshima, and a corresponding decrease in that for Nagasaki, an effect found to be most pronounced for the LQ-L models investigated. As a result the difference in the dose-response curves observed for both cities based on DS86 doses, is somewhat reduced but cannot be entirely explained by the dose modifications applied. The extent to which the neutrons contribute to chromosome aberration induction in Hiroshima depends significantly on the model used. The LQ-L model including an R(1) value of 15 at 1 Gy which is recommended here, would predict between 10% and 20% of the observed chromosome aberrations to be due to neutrons, at all doses. Because of the good agreement between DS86 predictions and the results of retrospective gamma and neutron dosimetry, the modifications applied here to DS86 doses are relatively small. Consequently, the choices of model and RBE values were found to be the major factors dominating the interpretation of the chromosome data for Hiroshima and Nagasaki, with the dose modifications resulting in a smaller influence.     

Phagocytic and bactericidal activities of leukocytes in whole blood from atomic bomb survivors

This study evaluated the phagocytic and bactericidal activities of peripheral blood leukocytes from Hiroshima and Nagasaki atomic bomb survivors for Staphylococcus aureus. The data were analyzed by multiple linear regression for age, sex, radiation exposure, city of exposure, and neutrophil counts. No significant radiation effect was observed for either blood phagocytic or bactericidal activities. The only significant variable for these functions was the neutrophil count.     

Skin dose from neutron-activated soil for early entrants following the A-bomb detonation in Hiroshima: contribution from β and γ rays

Epilation was reported among atomic bomb survivors in Hiroshima and Nagasaki, including "early entrance survivors" who entered the cities after the bombings. The absorbed dose to the skin by neutron-activated soil via beta and gamma rays has been estimated in a preliminary fashion, for these survivors in Hiroshima. Estimation was done for external exposures from activated soil on the ground as well as skin and hair contamination from activated soil particles, using the Monte Carlo radiation transport code MCNP-4C. Assuming 26 mum thickness of activated soil on the skin as an example, the skin dose was estimated to be about 0.8 Gy, for an exposure scenario that includes the first 7 days after the bombing at 1 m above the ground at the hypocenter. In this case, 99% of the total skin dose came from activated radionuclides in the soil, i.e., 0.19 and 0.63 Gy due to beta and gamma rays, respectively. In contrast, contribution to skin dose due to skin contamination with soil particles was found to be about 1%. To make it comparable to the exposure by neutron-activated soil on the ground, a soil thickness on the skin of about 1 mm would be required, which seems to be difficult to keep for a long time. Fifty-five percent of the 7-day skin dose was delivered during the first hour after the bombing. Our estimates of the skin dose are lower than the conventionally reported threshold of 2 Gy for epilation. It should be noted, however, that the possibility of more extreme exposure scenarios for example for entrants who received much heavier soil contamination on their skin cannot be excluded.     

The effects of neutrons in Hiroshima. Implications for the risk estimates

Risk estimates for radiation-induced late effects are relevant to various considerations in radiation protection. Most of these considerations relate to small doses for which no excess risk can be seen even in extensive epidemiological studies. Risk coefficients for radiation protection must, therefore, be based on uncertain extrapolation of observations obtained at moderate or high doses. The extrapolation can not be replaced, as yet, by new, more direct information on processes such as radiation-induced genetic instability or adaptive response. While the new findings indicate complexities that may be highly relevant to the effectiveness- or lack of effectiveness- of radiation at low doses, they remain insufficiently understood to permit a decision as to whether dose-effect relations are linear, curvilinear, or have a threshold in dose. In view of these uncertainties radiation-protection regulations are, today, based on the conservative assumption of a linear dose dependence without threshold. This approach assures a sufficient degree of protection, but it may become unreasonably over-conservative, when the cautious hypothesis is treated as proven fact, and when-in addition-the assumed initial slope of the dose relation is not critically evaluated. A reliable evaluation needs to be based on the follow-up of the atom-bomb bomb survivors, and several major aspects of current interest are discussed here. a) Mortality from solid tumours in Hiroshima shows a statistically significant excess at a colon dose of 50 mGy; however, it is likely that this is the result of a bias in assigning causes of death. b) The solid cancer mortality data of the atom-bomb survivors are consistent with linearity in dose, but they can be shown to be equally consistent with a considerable degree of curvature. c) Even with the present dosimetry system, DS86, a substantial part of the effect at small doses in Hiroshima could be due to neutrons. If this is the case, the risk estimates for gamma-rays need to be accordingly decreased. d) Numerous neutron-activation measurements in Hiroshima indicate that the DS86 underestimates the neutron doses. The evidence is, up to now, based only on activation products of low energy neutrons, but efforts are currently underway to determine activation products of high energy neutrons. If these measurements should substantiate the present trend, the cancer data in Hiroshima would cease to be reliable proof of an effect of gamma-rays at low doses. Instead the dose dependence for gamma-rays could be purely quadratic, and any initial slope in the linear-quadratic dependence might well be attributable to neutrons only.