Roger H Clarke, Chairman, ICRP

INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION ——————————————————————————————————————

NKS TODAY AND TOMORROWNKS TODAY AND TOMORROW20 - 21 MARCH, ROSKILDE, DENMARK20 - 21 MARCH, ROSKILDE, DENMARK

RADIOLOGICAL PROTECTION RADIOLOGICAL PROTECTION AT THE START OF THE 21ST AT THE START OF THE 21ST

CENTURY:CENTURY:

A PROGRESS REPORTA PROGRESS REPORT

Roger H Clarke, Chairman, ICRPRoger H Clarke, Chairman, ICRP


THE FIRST PHASETHE FIRST PHASE1895 - 19551895 - 1955

Protection was concerned with keeping Protection was concerned with keeping INDIVIDUAL WORKERS below the INDIVIDUAL WORKERS below the THRESHOLDS for deterministic effectsTHRESHOLDS for deterministic effects

No SOCIETAL concerns, indeed low doses No SOCIETAL concerns, indeed low doses deemed beneficial and consumer deemed beneficial and consumer products aboundedproducts abounded


18902


THE MIDDLE PHASETHE MIDDLE PHASE1955 - 19901955 - 1990

UTILITARIAN* UTILITARIAN* ethics applied classical Cost- ethics applied classical Cost- Benefit Analysis to address the question -Benefit Analysis to address the question -

‘‘How much does it cost and how many lives are How much does it cost and how many lives are saved?’saved?’

The use of Collective Dose emphasised the The use of Collective Dose emphasised the protection of protection of SOCIETYSOCIETY and the inability to take and the inability to take account of individual riskaccount of individual risk

*‘The doctrine that the greatest good of the greatest number should be the*‘The doctrine that the greatest good of the greatest number should be theguiding principle’ - Oxford English Dictionaryguiding principle’ - Oxford English Dictionary


1990 RECOMMENDATIONS ON 1990 RECOMMENDATIONS ON OPTIMISATIONOPTIMISATION

‘‘This procedure should be constrained by This procedure should be constrained by restrictions on the doses to individuals restrictions on the doses to individuals (Dose (Dose Constraints)Constraints),….., so as to limit the inequity ,….., so as to limit the inequity likely to result from the inherent economic likely to result from the inherent economic and social judgementsand social judgements.’.’


CURRENT PHASECURRENT PHASE1990 -1990 -

Recommendations since 1990 are in terms ofRecommendations since 1990 are in terms of - firstly restrictions on individual dose- firstly restrictions on individual dose - then a requirement to optimise- then a requirement to optimise

A shift from A shift from UTILITARIAN UTILITARIAN values, so as to include values, so as to include the recognition of individual rights by usingthe recognition of individual rights by using EGALITARIAN* EGALITARIAN* ethicsethics, an equity-based system, an equity-based system

* ‘Holding the principle of equal treatment for all persons’ * ‘Holding the principle of equal treatment for all persons’ - Oxford English Dictionary- Oxford English Dictionary


MAIN COMMISSION 2001-5MAIN COMMISSION 2001-5

ABEL GONZALEZ JOHN BOICE ABEL GONZALEZ JOHN BOICE ANNIE SUGIER PAN ZI QIANG ANNIE SUGIER PAN ZI QIANG

GRETA DICUS GRETA DICUS ROGER CLARKE ROGER CLARKE

FRED METTLER LARS-ERIK HOLM RUDOLF ALEXAKHIN FRED METTLER LARS-ERIK HOLM RUDOLF ALEXAKHIN

ROGER COX BERT WINKLER YASUHITO SASAKI CHRISTIAN STREFFER ROGER COX BERT WINKLER YASUHITO SASAKI CHRISTIAN STREFFER


THE OBJECTIVES AND SCOPE THE OBJECTIVES AND SCOPE OF THE RECOMMENDATIONSOF THE RECOMMENDATIONS


RISKS AT LOW DOSES AND RISKS AT LOW DOSES AND LOW DOSE RATESLOW DOSE RATES

--is there a threshold below which repair is is there a threshold below which repair is totally effective?totally effective?

-are low doses more dangerous than we -are low doses more dangerous than we currently assume?currently assume?

Epidemiology alone cannot answer these Epidemiology alone cannot answer these questions, so support is needed from questions, so support is needed from molecular studiesmolecular studies


LOUI SVILLE 51

Backgroundincidence

Background dose

Probability ofstochastic effects, p

Annual dose, D

D p

D DIn this zonetherelationshipis irrelevant

average 2.4 mSvhigh 10 mSv

5% / Sv

THE ‘LNT’ HYPOTHESISTHE ‘LNT’ HYPOTHESISabove the prevalent background dose, an increment in dose above the prevalent background dose, an increment in dose

results in a proportional increment of riskresults in a proportional increment of risk


JUSTIFICATIONJUSTIFICATION

The practice leading to an exposure must The practice leading to an exposure must produce an overall benefitproduce an overall benefit

It is a policy matter for decision makers, It is a policy matter for decision makers, -with radiological protection issues being a -with radiological protection issues being a minor inputminor input

For medical doctors, it is a matter both of the For medical doctors, it is a matter both of the generic procedure and then the individual generic procedure and then the individual referralreferral


PRINCIPLES OF PROTECTIONPRINCIPLES OF PROTECTION for generically justified medical proceduresfor generically justified medical procedures

Justify the examinationJustify the examination

individual-based criterionindividual-based criterion

Optimisation Optimisation

Reference Levels as indicators of Reference Levels as indicators of good practicegood practice


PRINCIPLES OF PROTECTIONPRINCIPLES OF PROTECTIONFor a justified practice or for an environmental For a justified practice or for an environmental

sourcesource

Protective Action LevelsProtective Action Levels basic levels of health protection for the basic levels of health protection for the individualindividual

OptimisationOptimisation

the optimum level of health protection for a the optimum level of health protection for a given sourcegiven source


PEOPLEPEOPLE 10 x10 x

AVERAGE NATURAL BACKGROUND

DISCHARGESDISCHARGES 0.1 x0.1 x

EXCLUSION EXCLUSION 0.01 x0.01 x

PROTECTIVE ACTION LEVELSPROTECTIVE ACTION LEVELS


OPTIMISATION OF PROTECTIONOPTIMISATION OF PROTECTION

The ‘stakeholder’ process of involving The ‘stakeholder’ process of involving most affected individuals is an most affected individuals is an important approach important approach

-EMPOWER THE WORKFORCE-EMPOWER THE WORKFORCE

-ENGAGE THE PUBLIC(S)-ENGAGE THE PUBLIC(S)-Leading to the -Leading to the

optimum level of health protectionoptimum level of health protection


RECOMMENDATIONS FOR THE RECOMMENDATIONS FOR THE START OF THE 21st START OF THE 21st

CENTURY(i)CENTURY(i)Develop the System of ProtectionDevelop the System of Protection

- describe the Ethical Basis- describe the Ethical BasisDefine doses of interest for risk Define doses of interest for risk

- few mSv/a- few mSv/a JustificationJustification

- for practices, - for practices, - medical exposures to be separate - medical exposures to be separate

Protective Action LevelsProtective Action Levels - based on natural background- based on natural backgroundOptimisationOptimisation - replace differential equations with - replace differential equations with

common sensecommon sense


RECOMMENDATIONS FOR THE RECOMMENDATIONS FOR THE START OF THE 21st START OF THE 21st

CENTURY(ii)CENTURY(ii)Definition of an individual Definition of an individual

- revisit critical group- revisit critical groupStakeholder involvementStakeholder involvement

- how is this to be achieved- how is this to be achievedNatural radiation exposures Natural radiation exposures

- philosophy as for radon?- philosophy as for radon?wwR R and and wwTT

- values for Effective Dose- values for Effective DoseProtection of the EnvironmentProtection of the Environment

- policy needed- policy neededRegulatory guidance Regulatory guidance

- not prescriptive, but flexible- not prescriptive, but flexible


OVERALL CONCLUSIONSOVERALL CONCLUSIONS

Before the 1950s Before the 1950s - protect workers- protect workers 1960s to 1990s 1960s to 1990s - Utilitarianism and cba- Utilitarianism and cba Currently Currently - shift to Egalitarianism- shift to Egalitarianism

PROTECTION AT THE START OF THE 21ST PROTECTION AT THE START OF THE 21ST CENTURYCENTURY

Use the existence of natural background toUse the existence of natural background toset set PROTECTIVE ACTION LEVELSPROTECTIVE ACTION LEVELS and and

simplify, engage, explainsimplify, engage, explain

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Roger H Clarke, Chairman, ICRP