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Should the ALARA concept and the Image Gently campaign be terminated? Mohan Doss, PhD, MCCPM Medical Physicist, Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, PA, USA E-mail:

Presentation at: International Pediatric Radiology 2016, Chicago, IL, on May 17, 2016

Version 1.01 dated March 21, 2016 Copyright Š 2016 by Mohan Doss.

Disclaimer: Opinions expressed in this presentation are my own professional opinion, and do not necessarily represent those of my employer. 1

Should the ALARA concept and the Image Gently campaign be terminated? ALARA concept • based on the linear no-threshold (LNT) Model assumption and/or low-dose radiation cancer concerns Image Gently campaign • based on the (assumed) higher radio-sensitivity of children to low-dose radiation-induced cancers Examine the validity of both of these assumptions. The LNT Model is based on the concepts • Radiation  Mutations • Cancerous Mutations  Cancer (Linear relationships assumed) 2

Do mutations increase linearly with radiation dose?

When radiation dose increases, at low doses, mutations decrease. 3

Do Cancers Increase Linearly with Mutations?

Mutations accumulate at the highest rates during the period of growth at young age, when most cell divisions are taking place. Cancers however occur at the lowest rates during young age, for mice and humans. Percentage of patients with cancerous mutations is unchanged from middle age to old age, whereas cancer rates increase drastically at old age.

Cancers do not increase linearly with mutations There are many more reasons to conclude: Mutation model of cancer is not valid.


Atomic Bomb Survivor Data are Inconsistent with the LNT Model

LNT model was assumed in the analysis of the data to extract the Excess Relative Risks. As radiation dose increases from 0.25 Gy to 0.5 Gy, cancers decrease, results in significant curvature in dose-response relationship, contradicting the LNT model.

Atomic bomb survivor data (generally regarded as the most important data for estimating health effects of radiation) no 5 longer support the LNT model

Effect of low-dose radiation exposures on cancer Figure legend: LNT model Prediction – Using BEIR VII Report (NRC, 2006) Taiwan - Residents of radio-contaminated apartments in Taiwan (Hwang, 2006) NSWS - Radiation workers in Nuclear Shipyard Worker Study (Sponsler, 2005) British Radiologists - British Radiologists who entered service during the period 19551979 (Berrington, 2001) Mayak - Evacuated residents of villages near Mayak Nulcear Weapons Facility (Kostyuchenko, 1994)

There are many faulty publications that claim support for the LNT model or low-dose radiation carcinogenicity. Such publications should not be used.

Low-dose radiation exposures have resulted in reducing cancers contradicting the LNT model prediction


Immune Suppression Model of Cancer

The tremendous increase in cancers when immune system is suppressed indicates immune suppression may be the primary cause of cancers. There are many more reasons to support: Immune Suppression Model of Cancer


What is the effect of low-dose radiation on the immune system?

Low-dose radiation enhances the immune system response and it reduces cancers as seen in an earlier slide. 8

Evidence for Radiation Hormesis in Atomic Bomb Survivor Data

(Ozasa et al, 2012) utilized lowest radiation dose data (extrapolated to zero dose) as the baseline cancer rates while calculating the Excess Relative Risk for cancer. Since low-dose radiation exposures would reduce cancers (as seen earlier), baseline cancer rates used would have a negative bias.

The shape of dose-response curve, with the correction for the likely bias in the baseline cancer rate, is consistent with the concept of radiation hormesis.

In atomic bomb survivor data, low radiation doses reduce cancers. 9

Are children more radio-sensitive? Data generally shown to claim higher radio-sensitivity of children However, excess cancers are observed for high-dose radiation exposures only in atomic bomb survivors.

Only by LNT model extrapolation, these graphs are extended to lowdoses. But since there is no evidence/justification for the LNT model, extension of the graph to low doses is not valid.

Higher sensitivity of children to radiation-induced cancers is for high-dose radiation only. This cannot be extrapolated to 10 low-doses as the LNT model is not valid.

Are children more radio-sensitive? Other arguments used to raise concerns regarding low-dose radiation exposures in children: Children - have higher proportion of dividing cells, - more susceptible to mutations due to radiation. This argument ignores defenses triggered by low-dose radiation. Low-dose radiation ďƒ enhances antioxidants, DNA repair enzymes, etc. - reduces overall mutations - enhances the immune system - would reduce cancers There are many faulty publications that conclude CT scans cause cancer in children. Such publications should be ignored, and not used. There should be no concerns regarding low-dose radiation exposures to children, e.g. from CT scans 11

Consequences of Misinformation on CT Scan Cancer Risk Referring to pediatric CT scan data collected from many hospitals as reported in (Goske, 2013), in an article describing harms from CT radiation dose concerns, (Brody, 2014) stated: “1 in 20 paediatric abdominal CT scans …..were inadequate for diagnostic purposes due to excessive radiation dose reduction efforts.”

Consequences of Misinformation: • Non-diagnostic CT scans • Needed CT scans not being performed Result in harm to pediatric patients


Should the ALARA concept and the Image Gently campaign be terminated?

No benefit from ALARA/Image Gently but only harm to pediatric patients

Hence, the definitive answer is:



Should ALARA concept be terminated (Mohan Doss) USofA  
Should ALARA concept be terminated (Mohan Doss) USofA