Table of contents

A coherent and overarching framework for health protection from non-ionising radiation (NIR) does not currently exist. Instead, many governments maintain different compliance needs targeting only some NIR exposure situations. An international framework developed by the World Health Organization would promote a globally consistent approach for the protection of people from NIR. Designed based on decades of practical experience the framework provides guidance on establishing clear national health and safety objectives and how they should be achieved. It supports multisectoral action and engagement by providing a common language and systematic approach for managing NIR. The framework should allow governments to respond to policy challenges on how to achieve effective protection of people, especially in a world that is rapidly deploying new NIR technologies. In this paper the concepts and key features are presented that underpin the framework for NIR protection, including examples of implementation.

Gender balance refers to the equitable treatment and access to opportunities for all genders. In order to achieve true gender balance, a variety of proactive approaches developed collaboratively, with insight from multiple perspectives, need to be implemented. With that purpose, the participation of women in professions related to radiation and radiation protection was prioritised and given high visibility by allocating a 'Women in Radiation' (WiR) Special Session at the 15th International Congress of the International Radiation Protection Association (IRPA), hosted by South Korea on 20 January 2021. In this session, various issues related to gender balance and equity/equality were highlighted by the panellists, and further elaborated in a subsequent discussion with attendees. The main goal of the WiR Special Session was to convene women from different organisations, career and age stages, disciplines and countries, in particular to consider the Asian–Oceanic vision and status of gender equality, along with other topics to support a 'Call for Action', with concrete recommendations subsequently provided to IRPA. The discussion stressed the main needs and challenges faced by women working in various radiation fields, along with raising awareness of possible professional and employment opportunities. This paper identifies some steps necessary to encourage, enhance and support the inclusion of more diversity in nuclear professions with specific emphasis on women. In conclusion, gender balance and equality must be at the heart of any strategic plan for the future of the radiological protection profession; international cooperation between relevant bodies is essential for success and could serve as a catalyst for specific policy statements aimed at achieving a balanced representation of women in radiological protection.

Radiation-induced biological changes occurring within hours and days after irradiation can be potentially used for either exposure reconstruction (retrospective dosimetry) or the prediction of consecutively occurring acute or chronic health effects. The advantage of molecular protein or gene expression (GE) (mRNA) marker lies in their capability for early (1–3 days after irradiation), high-throughput and point-of-care diagnosis, required for the prediction of the acute radiation syndrome (ARS) in radiological or nuclear scenarios. These molecular marker in most cases respond differently regarding exposure characteristics such as e.g. radiation quality, dose, dose rate and most importantly over time. Changes over time are in particular challenging and demand certain strategies to deal with. With this review, we provide an overview and will focus on already identified and used mRNA GE and protein markers of the peripheral blood related to the ARS. These molecules are examined in light of 'ideal' characteristics of a biomarkers (e.g. easy accessible, early response, signal persistency) and the validation degree. Finally, we present strategies on the use of these markers considering challenges as their variation over time and future developments regarding e.g. origin of samples, point of care and high-throughput diagnosis.

There is a long history of uranium mining and milling in what is now the Czech Republic, with the main exploitation beginning in the second half of the 19th century. The greatest expansion was during the Cold War, which was then reduced after political changes in eastern Europe in the 1990s. Thereafter, almost all uranium work was stopped, the mines and mills were closed, and plans for decommissioning and remediation of sites and facilities were initiated. The paper describes the application of the regulatory framework for the decommissioning and remediation of the uranium waste sites and facilities in the Czech Republic, illustrated by examples of deep and surface mining, in-situ leaching sites, and ore processing facilities. It builds on information provided as a case study for the Nuclear Energy Agency's Expert Group on Legacy Management. Some practical experience and lessons learned are presented. The sharing of the lessons and experience is noted as an important mechanism for avoiding the creation of future legacies.

The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. This article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.

The ionising radiation created by high intensity and high repetition rate lasers can cause significant radiological hazard. Earlier defined electron temperature scalings are used for dose characterisation and prediction using Monte Carlo modelling. Dosimetric implications of different electron temperature scalings are investigated and the resulting equivalent doses are compared. It was found that scaling defined by Beg et al (1997 Phys. Plasmas4 447–57) predicts the highest electron temperatures for given intensities, and subsequently the highest doses. The atomic number of the target, x-ray generation efficiency and interaction volume are the other parameters necessary for the dose evaluation. The set of these operational parameters should be sufficient to characterise radiological characteristics of ultrashort laser pulse based x-ray generators and evaluate radiological hazards of the laser processing facilities.

This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre's practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura, n = 95) and Group II (Azurion, n = 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm² vs 52.9 Gy cm²; P < 0.001, d = 0.8) and 67% (0.6 Gy vs 0.2 Gy; P < 0.001, d = 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm² and the limits of agreement were +28.49 and −27.71 Gy cm², and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system's features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.

Diagnostic reference levels (DRLs) in digital mammography (DM) serve as a useful benchmark for dose monitoring and optimisation, allowing comparison amongst countries, institutions and mammography units. A systematic review of DRLs in DM, published in 2014, reported a lack of consistent and internationally accepted protocol in DRLs establishment, thereby resulting in wide variations in methodologies which complicates comparability between studies. In 2017, the International Commission of Radiation Protection (ICRP) published additional guidelines and recommendations to provide clarity in the protocol used in DRLs establishment. With the continuing evolvement of technology, optimisation of examinations and updates in guidelines and recommendations, DRLs should be revised at regular intervals. This systematic review aims to provide an update and identify a more consistent protocol in the methodologies used to establish DRLs. Searches were conducted through Web of Science, PubMed-MEDLINE, ScienceDirect, CINAHL and Google Scholar, which resulted in 766 articles, of which 19 articles were included after screening. Relevant data from the included studies were summarised and analysed. While the additional guidelines and recommendations have provided clarifications in the methodologies used in DRLs establishment, such as data source (i.e. the preference to use data derived from patient instead of phantoms to establish DRLs), protocol (i.e. stratification of DRLs by compressed breast thickness and detector technology, and the use of median value for DRLs quantity instead of mean) and percentiles used to establish DRLs (i.e. set at the 75th percentile with a minimum sample size of 50 patients), other differences such as the lack of a standard dose calculation method used to estimate mean glandular dose continues to complicate comparisons between studies and different DM systems. This systematic review update incorporated the updated guidelines and recommendations from ICRP which will serve as a useful resource for future research efforts related to DRLs, dose monitoring and optimisation.

In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By means of a pre-meeting survey, presentations by experts, topical panel discussions and post-meeting feedback to the meeting summary, the meeting identified strengths, common weaknesses and possible solutions and actions for improving radiation protection education and training of health professionals. Available guidelines and resources for radiation protection training were also reviewed. The meeting discussion resulted in a strong consensus for the need of: (a) international guidance on education and training in radiation protection and safety for health professionals, (b) an international description of minimum standards of initial and ongoing competence and qualification in radiation protection for relevant professional groups, considering the available recommendations at international and regional levels. The proposed actions include provisions for train-the-trainer credentialing and facility training accreditation, balance betwee the online and face-to-face training, improved on-the job training, as well as improved inclusion in training programmes of aspects related to application of new technologies, ethical aspects, development of communication skills, and use of software tools for improving justification and optimisation. The need for making the ongoing training practical, applicable, and useful to the trainee was highlighted. The international consultation initiated by the IAEA was appreciated as a good approach to understand and promote coordination and collaboration at all levels, for best results in education and training in radiation protection of health professionals. Implementing such a holistic approach to education and training in radiation protection would contribute towards qualification and competence of health professionals needed to ensure application of high standards for quality and safety in medical uses of ionizing radiation.

Radiological accidents occur mainly in the practices recognized as high risk and which are classified by the International Atomic Energy Agency (IAEA) as Categories 1 and 2: radiotherapy, industrial irradiators and industrial radiography. In Brazil, five important cases in industrial gamma radiography occurred from 1985 to 2018, involving seven radiation workers and 19 members of the public. The accidents caused localized radiation lesions on the hands and fingers. One of these accidents is the focus of this paper. In this accident, a 3.28 TBq ¹⁹²Ir radioactive source was left unshielded for 9 h in a non-destructive testing (NDT) company parking lot, and many radiation workers, employees and public, including teachers of a primary school were exposed. The radioactive source was also directly handled by a security worker for about 1.5 min causing severe radiation injuries in the hand and fingers. This paper presents radiation dose estimates for all accidentally exposed individuals. Four scenarios were considered, and three internationally recognised and updated reconstructive dosimetry techniques were used, named, Brazilian visual Monte Carlo Dose Calculation (VMC), virtual environment for radiological and nuclear accidents simulation (AVSAR) and RADPRO Calculator®. The main radiation doses estimated by VMC were the absorbed dose of 34 Gy for the security worker's finger and his effective dose of 91 mSv; effective doses from 43 to 160 mSv for radiation workers and NDT employees; and effective doses of 9 mSv for teachers in the schoolyard.

Understanding the behaviour of scattered radiation is important for learning appropriate radiation protection methods, but many existing visualisation systems for radiation require special devices, making it difficult to use them in education. The purpose of this study was to develop teaching material for radiation protection that can help visualise the scattered radiation with augmented reality (AR) and virtual reality (VR) on a web browser, develop a method for using it in education and examine its effectiveness. The distribution of radiation during radiography was calculated using Monte Carlo simulation, and teaching material was created. The material was used in a class for department of radiological technology students and its influence on motivation was evaluated using a questionnaire based on the evaluation model for teaching materials. In addition, text mining was used to evaluate impressions objectively. Educational material was developed that can be used in AR and VR for studying the behaviour of scattered radiation. The results of the questionnaire showed that the average value of each item was more than four on a five-point scale, indicating that the teaching material attracted the interest of users. Through text mining, it could be concluded that there was improved understanding of, and confidence in, radiation protection.

The energy distribution (spectrum) of pulsed photon radiation can hardly be measured using active devices, therefore, a thermoluminescence detector (TLD)-based few-channel spectrometer is used in combination with a Bayesian data analysis to help resolve this problem. The spectrometer consists of 30 TLD layers interspaced by absorbers made of plastics and metals with increasing atomic numbers and thickness. Thus, the main idea behind the device is the deeper the radiation penetrates—the higher the radiation's energy when the radiation impinges perpendicular to the front of the spectrometer. From the doses measured in the TLD layers and from further prior available information, the photon spectrum is deduced using a Bayesian data analysis leading to absolute spectra and doses including their uncertainties and coverage intervals. This spectrometer was successfully used in two different scenarios, i.e. for the spectrometry of the radiation field two different industrial type open beam pulsed x-ray generators and secondly in three different radiation fields of a medical accelerator.

The field of radiation countermeasures is growing, however, currently there are no effective and non-toxic compounds which could be administered orally to the individuals post exposure to high doses of ionising radiation. The pigment melanin is ubiquitous through all kingdoms of life and provides selective advantage under radiation stress through its role as a chemical and physical shield, and its capacity to respond and react to exposures. Soluble allomelanin was administered to mice following whole-body exposure to lethal or sublethal doses of gamma radiation to determine its capacity to mitigate the effects of acute radiation syndrome, and its utility as a radiation countermeasure. Allomelanin has shown a trend to improve survival post an 8 Gy sublethal radiation exposure when administered up to 48 h post-irradiation. Furthermore, it improved median and overall survival to a 10 Gy lethal radiation exposure, specifically when administered at 24 h post-irradiation. Histological analysis on the jejunum region of the small intestine of this treatment group indicated that alterations of the mucosal and submucosal architecture, and disruption of the lymphatic system associated with lethal radiation exposure were mitigated when allomelanin was administered at 24 h post-irradiation. Based on this work soluble allomelanin derived from a fungal source could serve as an easily sourced, cost-effective, and viable countermeasure to accidental radiation exposure and merits further investigation.

The Japanese Epidemiological Study on Low-Dose Radiation Effects (J-EPISODE) has been conducted since 1990 by the Radiation Effects Association to analyse health effects for nuclear workers. It uses the recorded doses, i.e. dosimeter readings, evaluated in H_p(10) for estimation of radiation risk; however, the International Commission on Radiological Protection does not recommend the use of effective doses for epidemiological evaluation and instead recommends the use of organ-absorbed doses for assessing cancer risk. Recently, the J-EPISODE has developed a conversion factor that can convert dosimeter readings to organ-absorbed doses following, in principle, the approach adopted by the International Agency for Research on Cancer 15-Country Collaborative Study. The approach was modified based on recent dosimeter usage practices and the Japanese physique. The aim of this study was to reanalyse the excess relative risk (ERR) of cancer mortality for the J-EPISODE using the previous analysis method but substituting the organ-absorbed dose for the recorded dose to confirm the adaptability and relevance of organ-absorbed doses for the J-EPISODE. The organ-absorbed doses from 1957 to 2010 were reconstructed for the whole cohort. The cancer mortality risk was reanalysed with Poisson regression methods, first by comparing the ERR/Gy for all cancers excluding leukaemia with the risk after excluding lung cancer for the whole cohort of 204 103 participants. In the whole cohort, all cancers excluding leukaemia, lung cancer and non-Hodgkin's lymphoma had statistically significant positive ERR/Gy estimates; leukaemia excluding chronic lymphocytic leukaemia had negative but not statistically significant estimates. Gallbladder cancer and pancreatic cancer showed statistically significant negative. Then, a subcohort of 71 733 respondents was selected based on lifestyle surveys with data on qualitative smoking status as well as quantitative smoking information on pack-years. Pack-years for current smokers and former smokers and years since the cessation of smoking for former smokers were used for the smoking-adjusted model. The most important feature of the J-EPISODE revealed to date was a decreasing tendency of the ERR/Sv by the smoking adjustment. For almost all causes of death such as lung cancer and stomach cancer, the estimated ERR/Gy decreased by the smoking adjustment, although those for the colon, prostate and kidney and other urinary organs were almost the same after the adjustment. This tendency remained unchanged even when using the organ-absorbed dose, indicating the appropriateness of using organ-absorbed doses for further risk analysis. At the same time, it indicated that confounding by smoking seriously biased the radiation risk estimates in the J-EPISODE and thus should be accounted even if organ dose is used.

Handling of radioactive material by operators can lead to contamination at the surface of the skin in case of an accident. The quantification of the dose received by the skin due to a contamination scenario is performed by means of dedicated dose coefficients as it is the case for other radiation protection dose quantities described in the literature. However, most available coefficients do not match realistic scenarios according to state-of-the-art of science and technology. Therefore, this work deals with dedicated dose conversion factors for skin contamination. Since there is an increasing demand on dose coefficients in general, these specific coefficients can be used for various calculations in radiation protection. In this work a method to evaluate such coefficients for the skin contamination dose related to photons, electrons, positrons, alpha and neutron particles is proposed. The coefficients are generated using Monte-Carlo simulations with three well established calculation codes (FLUKA, MCNP, and GEANT4). The results of the various codes are compared against each other for benchmarking purposes. The new dose coefficients allow the computation of the skin received dose, in the case of skin contamination scenario of an individual, taking into account the decay radiation of the radionuclides of interest. To benchmark the quantity derived here, comparisons of radionuclide contamination doses to the skin using the VARSKIN code available in the literature are performed with the results of this work.

Considering the higher radiosensitivity of children in comparison to adults, studies related to children's exposure to ionising radiation have been long considered of relevance. For this study, the MCNPX2.7.0 Monte Carlo code and four paediatric voxel computational anthropomorphic phantoms, of both genders and aged 5 and 10 years, were used to simulate scenarios, where children are exposed to natural radiation emitted by sources in the ground by radionuclides of ⁴⁰K and of ²³²Th and ²³⁸U radioactive series. These elements are part of the composition of ten different types of ornamental rocks obtained from three regions of Brazil, and used as architectural material for flooring of houses. The virtual paediatric anthropomorphic phantoms were positioned in a room with dimensions of (4.0 × 5.0 × 2.8) m³ filled with atmospheric air and a 3 cm thick granitic floor acting as a uniformly distributed planar gamma radiation source. The walls of the room were composed of 20 cm thick concrete. Gonads, bone marrow, bladder, colon, and skin were found to be the organs which receive the highest doses. The mean values of effective dose per air kerma at 1 m above the ground summed for all three radionuclides, were 0.96 and 0.68 Sv Gy⁻¹ for the 5 and 10 year old phantoms, respectively. The obtained results showed that the granitic rocks considered implicate annual effective doses which are 69%–78% lower than the annual limits, recommended by ICRP Publication 103.

In case of nuclear power plant accidents resulting in the release of radioactive iodine (¹³¹I) in large amounts, a single intake of stable iodine is recommended in order to prevent ¹³¹I fixation to the thyroid gland. However, in situations of prolonged exposure to ¹³¹I (e.g. Fukushima-Daiichi natural and nuclear disaster), repetitive administration of iodine may be necessary to ensure adequate protection, with acceptable safety in vulnerable populations including pregnant women. Here we conducted toxicological studies on adult rats progeny following prolonged exposure to potassium iodide (KI) in utero. Pregnant Wistar rats were treated with 1 mg kg d⁻¹ KI or saline water for 2 or 4 d either between gestation days gestational day (GD) GD 9–12, or GD13–16. Plasma samples from the progeny were tested 30 d post-weaning for clinical biochemistry, thyroid hormones, and anti-thyroid antibody levels. Thyroid and brain were collected for gene expression analysis. The hormonal status was similar for the mothers in all experimental conditions. In the offspring, while thyroid-stimulating hormone and anti-thyroid peroxidase (anti-TPO) antibody levels were similar in all groups, a significant increase of FT3 and FT4 levels was observed in GD9–GD10 and in GD13–GD14 animals treated for 2 d, respectively. In addition, FT4 levels were mildly decreased in 4 d treated GD13–16 individuals. Moreover, a significant decrease in the expression level of thyroid genes involved in iodide metabolism, TPO and apical iodide transporter, was observed in GD13–GD14 animals treated for 2 d. We conclude that repeated KI administration for 2–4 d during gestation did not induce strong thyroid toxicity.

The selective intra-arterial nimodipine application for the treatment of cerebral vasospasm (CVS) in patients after spontaneous subarachnoid hemorrhage (sSAH) is widely employed. The purpose of this study is to examine the radiation exposure and to determine local diagnostic reference levels (DRLs) of intra-arterial nimodipine therapy. In a retrospective study design, DRLs and achievable dose (AD) were assessed for all patients undergoing (I) selective intra-arterial nimodipine application or (II) additional mechanical angioplasty for CVS treatment. Interventional procedures were differentiated according to the type of procedure and the number of probed vessels. Altogether 494 neurointerventional procedures of 121 patients with CVS due to sSAH could be included. The radiation exposure indices were distributed as follows: (I) DRL 74.3 Gy·cm², AD 59.8 Gy·cm²; (II) DRL 128.3 Gy·cm², AD 94.5 Gy·cm². Kruskal–Wallis test confirmed significant dose difference considering the number of probed vessels (p< 0.001). The mean cumulative dose per patient was 254.9 Gy·cm² (interquartile range 88.6–315.6 Gy·cm²). The DRLs of intra-arterial nimodipine therapy are substantially lower compared with DRLs proposed for other therapeutic interventions, such as thrombectomy or aneurysm coiling. However, repeated therapy sessions are often required, bearing the potential risk of a cumulatively higher radiation exposure.

The International Atomic Energy Agency issued a statement calling for action to strengthen the radiation protection of patients undergoing recurrent imaging. This followed reports of patients receiving cumulative effective doses over 100 mSv from multiple computed tomography examinations. In order to evaluate excess risks of cancer incidence among UK patients, data from an exposure management system covering three hospitals within one trust have been studied over 5½ years. Cumulative effective doses for 105 757 patients, from whom 719 (0.68%) received effective dose over 100 mSv, have been analysed using age and sex specific risk factors for stochastic effects. Two cancers might be expected to be initiated in the patients receiving over 100 mSv, while five might be expected to develop cancer among patients receiving 50–100 mSv. However, the calculations ignore health conditions for which the patients are being treated that may shorten their lives, and rely on the linear-no-threshold dose-effect model which is a subject of debate, so they are likely to overestimate cancer incidence. If health of the patients receiving >100 mSv is taken into account, the risk of mortality from cancer initiated by medical exposure might be the order of 1 in 2000. Recommendations on further strengthening of optimisation should be applied to imaging procedures for all patients with special focus on those performed on children and adolescents.

The long-term condition and potential radiological consequences of legacy radioactive waste stored in a RADON-type of near-surface disposal facility outside the city of Chişinău is of concern to the central government and health protection authorities of the Republic of Moldova. A 'zero alternative scenario' risk assessment has been undertaken in order to evaluate the potential radiological impact on humans and the environment of the facility, were it to be left in its current state with no remediation. The results have been used as a basis for regulatory decision making regarding remediation and decommissioning of the legacy radioactive waste facility. The aim of this study was two-fold: first to demonstrate a complete radiological risk assessment of a real site using a combination of methodologies developed by the IAEA (ISAM and BIOMASS), the second to illustrate the current state-of-the-art in respect of extracting site-specific information from site-descriptive material. We illustrate the practicality of employing geographic information systems techniques on site-specific topographic data to identify relevant biosphere dose objects, thereby allowing customisation of the generic ISAM model framework to site-specific conditions. As a result, a simple method is suggested to bound activity concentrations in well water based on an understanding of water balance in the local catchment area in which the biosphere dose object is embedded. With conservative assumptions, estimated doses from the calculation cases of the design scenario remain lower than the IAEA's dose criteria and environmental screening values. However, the results also indicate that human intrusion activities after the institutional control period could lead to radiological exposures above the IAEA's criteria for a period up to 100 000 years. The long-lived radionuclide ²³⁹Pu dominates doses for the on-site residence scenario. Remediation measures should be implemented were the waste to remain at its present place of disposal.

The detection of radioactive hot-spots and the identification of the radionuclides present have been a challenge for the security sector, especially in situations involving chemical, biological, radiological, nuclear and explosive threats, as well as naturally occurring radioactive materials. This work proposes a solution based on Machine Learning techniques, with a focus on artificial neural networks (NNs), in order to localise, quantify and identify radioactive sources. Firstly, the created RHLnet model uses observations of radiological intensity counts and corresponding localisations to estimate the number, location and activity of unknown radioactive sources present in a given scenario. Then, another model (RHIdnet) gets the gamma spectrum of the sources to perform the identification of the corresponding radionuclides. For this, a training data set composed of simulated data is used during the training process, and so, using algorithms with the models already trained, fast and accurate predictions are achieved, ensuring the reliability of such a NN-based approach. The proposed solution is tested in simulated and real scenarios, with multiple sources, providing a low number of limitations, related to possible false negatives and false positives. Besides, the results have shown that the algorithm is scalable for very large regions, as well as for very small scenarios. Single and multiple isotope identification on each sample is explored, highlighting the benefits as well as possible improvements. Thus, NNs have demonstrated the capability of being an emerging tool with the potential to make a difference in the nuclear field, by helping in the development of novel techniques and new solutions in order to safeguard human lives.

The effect of external radiation on lymphoma, including non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and multiple myeloma (MM) incidence was evaluated in the National Registry for Radiation Workers based upon the third analysis cohort but with an additional 10 years of follow-up. The study includes 172 452 workers, of whom (90%) were men with 5.25 million person-years of follow-up from 1955 through to the end of 2011. A total of 711 cases of NHL, 113 cases of HL and 279 cases of MM were registered. Poisson regression was used to estimate the excess relative risk per unit of cumulative exposure to ionising radiation. A statistically significant association was found between radiation dose and the incidence of NHL and MM. There was no evidence of radiation associated excess risk for HL. The reported associations are based on a very small proportion of exposed workers, in particular among workers with cumulative doses above 0.5 Sv so should be treated with caution, further investigations are necessary to confirm our results.

In order to examine what lessons radiological emergency management may offer for the management of the Covid-19 pandemic, and vice versa, a series of three online webinars were conducted with leading experts, scholars and practitioners from a wide range of disciplines essential for emergency management and long-term risk governance. The first webinar debated the lessons we are learning from the Covid-19 pandemic for radiological risk communication, the second explored issues around longer-term outcomes of a crisis and how to balance these with short-term actions whilst the third focused on the key challenges of the 'transition phase', using lessons learned from the Chernobyl (1986) and Fukushima Daichii (2011) accidents. This paper reviews the discussions and provides valuable lessons for the radiation protection community. Results of the discussions indicated that: (a) non-radiological and non-epidemiological consequences of emergencies, for example psychological (mental health), societal and economic, should not be underestimated; (b) multidisciplinary expertise is imperative for communication efforts and for effective emergency management, including decision-making in the application of protective measures; (c) stakeholder engagement, including the involvement of the potentially affected population, should be encouraged from an early stage; and (d) trust is increased if policy-makers and the main science agencies show a unified voice.

The International Commission on Radiation Units and Measurements (ICRU) has recently proposed a set of new operational quantities for radiation protection. ICRU supplied conversion coefficients for mono-energetic photons but not for photon reference radiation qualities defined by the International Organization for Standardization (ISO) in ISO 4037 and by the International Electrotechnical Commission (IEC) in IEC 61267. Therefore, in this work, conversion coefficients from total air kerma to the newly proposed operational quantities are averaged for photon reference radiation qualities. Also, parameters necessary to determine the influence of the air density on the conversion coefficients are determined. Finally, the impact of the newly proposed quantities upon the response of dosemeters is investigated.

For occupational exposures in planned exposure situations International Commission on Radiological Protection (ICRP) publication 118 recommends an equivalent dose limit for the lens of the eye of 20 mSv yr⁻¹ averaged over five years with no single year exceeding 50 mSv. This constitutes a reduction from the previous limit of 150 mSv yr⁻¹. The Canadian nuclear regulator, the Canadian Nuclear Safety Commission, responded to the ICRP recommendation by initiating amendments to the Radiation Protection Regulations through a discussion paper which was published for comment by interested stakeholders in 2013. The revised equivalent dose limit of 50 mSv in a one-year dosimetry period for nuclear energy workers came into effect in January 2021. This paper presents the outcome of discussions with Canadian stakeholders in diverse fields of radiological work which focused on the implementation of the reduced occupational equivalent dose limit for the lens of the eye in their respective workplaces. These exchanges highlighted the existing practices for monitoring doses to the lens of the eye and identified current technological gaps. The exchanges also identified that, in many cases, the lens of the eye dose is anticipated to be well within the new dose limit despite some of the gaps in technology. The paper also presents the monitoring and eye-lens dose assessment solutions that are available based on different methods for eye-lens monitoring; presented together with criteria for their use.

For radiation dose assessment of computed tomography (CT), effective dose (ED) is often estimated by multiplying the dose-length product (DLP), provided automatically by the CT scanner, by a conversion factor. We investigated such conversion in CT venography of the lower extremities performed in conjunction with CT pulmonary angiography. The study subjects consisted of eight groups imaged using different scanners and different imaging conditions (five and three groups for the GE and Siemens scanners, respectively). Each group included ten men and ten women. The scan range was divided into four anatomical regions (trunk, proximal thigh, knee and distal leg), and DLP was calculated for each region (regional DLP). Regional DLP was multiplied by a conversion factor for the respective region, to convert it to ED. The sum of the ED values for the four regions was obtained as standard ED. Additionally, the sum of the four regional DLP values, an approximate of the scanner-derived DLP, was multiplied by the conversion factor for the trunk (0.015 mSv mGy cm⁻¹), as a simplified method to obtain ED. When using the simplified method, ED was overestimated by 32.3%−70.2% and 56.5%−66.2% for the GE and Siemens scanners, respectively. The degree of overestimation was positively and closely correlated with the contribution of the middle and distal portions of the lower extremities to total radiation exposure. ED/DLP averaged within each group, corresponding to the conversion factor, was 0.0089−0.0114 and 0.0091−0.0096 mSv mGy cm⁻¹ for the GE and Siemens scanners, respectively. In CT venography of the lower extremities, ED is greatly overestimated by multiplying the scanner-derived DLP by the conversion factor for the trunk. The degree of overestimation varies widely depending on the imaging conditions. It is recommended to divide the scan range and calculate ED as a sum of regional ED values.

In the 2019–20 reporting period, 19 mining operations in Western Australia were identified as having workers who were likely to be exposed to ionising radiation stemming from naturally occurring radioactive materials, 17 of which, known hereinafter as reporting entities (REs), were required to submit an annual report of the dose estimates of their workforce to the mining regulatory authority. In 2018 the International Commission for Radiological Protection published the revision of the dose coefficients (DCs) for occupational intakes of radionuclides of the uranium-238 and thorium-232 decay series, in ICRP-137 and ICRP-141. The 2019–20 annual reports are the first to apply the revised DCs to estimate worker doses. The mean effective dose (ED) reported by the 17 REs increased by 32.4% to 0.94 mSv in 2019–20 from 0.71 mSv reported in 2018–19, indicating that the mean ED is approaching the 1 mSv annual dose estimate at which regulatory intervention should be considered. The mean committed effective dose (CED) from inhalation of dusts containing long-lived alpha-emitting (LLα) nuclides has increased by 35% from 0.40 mSv in 2018–19 to 0.54 mSv in 2019–20. The maximum CED from LLα increased by 16.3% from 3.20 mSv in 2018–19 to 3.72 mSv in 2019–20. The authors consider that, in the absence of other explanations provided by the REs, the increase is largely attributable to the revised DC's published in ICRP-137 and ICRP-141, but highlight that there are significant variations between REs that make a generalised conclusion problematic. The maximum reported ED in 2019–20 was 6.0 mSv, an increase of 36.4% from 2018 to 2019 (4.4 mSv). The 2019–20 reporting period is the first time in a decade in which mine worker EDs have been elevated to the point that EDs have exceeded 5 mSv, a level at which personal monitoring and additional institutional controls are required.

The current approach in the system of protection, and the way in which it is implemented in regulation and practical application, has resulted in the allocation of significant and disproportionate societal resources to reduce relatively low-level exposures to even lower levels. The resulting exposure levels are often a fraction of the basic natural background level, and in particular are comparable to, or often significantly less than, the variability of natural background exposures due to individual decision-making, which the system of protection deems acceptable. There are arguments for a wider approach to decision-making at such low doses, recognising the uncertainties in radiation risk estimation and acknowledging the context that all human life takes place in a variable natural background radiation which generally dominates these lower dose exposures. Recommendations are presented for improvements in how decisions are made in controlling low doses.

Radiological protection is often considered a matter of scientific and technological facts only, not of value judgements. This perception is now gradually changing, especially with ICRP Publication 138, which addressed the ethical foundation of the system of radiological protection. It identified values which have guided the Commission's recommendations over the decades, but have not always been made explicit. Four core values are discussed (beneficence/non-maleficence, prudence, justice, dignity) as well as three procedural values (accountability, transparency, inclusivity). The latter are considered critical to the practical implementation of the system of radiological protection. Here we are exploring empathy as a procedural values complementing the three identified in ICRP Publication 138. Empathy can be defined as the 'capability (or disposition) to immerse oneself in and to reflect upon the experiences, perspectives and contexts of others'. It is often understood as a skill that one either has or has not, but research has shown it can be taught and therefore can be required as an attitude of those working in health care, education, design, and technology. We suggest it is an essential prerequisite to the assessment and management of any radiological situation and the health problems accruing from it. The concerns of people affected, their needs and wishes need to be taken seriously from the very beginning of any decision-making process. Even if they are considered unfounded and exaggerated, the insights they provide will be valuable for the understanding of the overall situation. Without empathy, our practice of beneficence and non-maleficence as well as solidarity would be oddly limited.

The medical management of radiation accidents manual on the acute radiation syndrome proposed a successful strategic approach to diagnosing and treating acute radiation syndrome: the response category concept. Based on clinical and laboratory parameters, this approach aimed to assess damage to critical organ systems as a function of time, categorising different therapeutical approaches. After 20 years of its publication, the following paper attempts to provide a broad overview of this important document and tries to respond if proposed criteria are still relevant for the medical management of radiation-induced injuries. In addition, a critical analysis of its limitations and perspectives is proposed.

The major immediate and severe medical consequences in man following exposure to high doses of ionising radiation can be summarised within the concept of the acute radiation syndrome (ARS). In a dose-dependent fashion, a multitude of organ systems can be affected by such irradiation, presenting considerable medical challenges to treating physicians. Accidents or malevolent events leading to ARS can provoke devastating effects, but they occur at a low frequency and in a highly varying manner and magnitude. Thus, it is difficult to make precise medical predictions and planning, or to draw conclusive evidence from occurred events. Therefore, knowledge from on-going continuous developments within related medical areas needs to be acknowledged and incorporated into the ARS setting, enabling the creation of evidence-based guidelines. In 2011 the World Health Organization published a first global consensus on the medical management of ARS among patients subjected to nontherapeutic radiation. During the recent decade the understanding of and capability to counteract organ damage related to radiation and other agents have improved considerably. Furthermore, legal and logistic hurdles in the process of formally approving appropriate medical countermeasures have been reduced. We believe the time is now ripe for developing an update of internationally consented medical guidelines on ARS.