SENES Oak Ridge, Inc., Center for Risk Analysis, 102 Donner Drive, Oak Ridge, TN 37830, USA.
Health Phys. 2011 Nov;101(5):591-600. doi: 10.1097/HP.0b013e318225c2e1.
Evaluations of radiation exposures of workers and the public traditionally focus on assessments of radiation dose, especially annual dose, without explicitly evaluating the health risk associated with those exposures, principally the risk of radiation-induced cancer. When dose is the endpoint of an assessment, opportunities to communicate the significance of exposures are limited to comparisons with dose criteria in regulations, doses due to natural background or medical x-rays, and doses above which a statistically significant increase of disease has been observed in epidemiologic studies. Risk assessment generally addresses the chance (probability) that specific diseases might be induced by past, present, or future exposure. The risk of cancer per unit dose will vary depending on gender, age, exposure type (acute or chronic), and radiation type. It is not uncommon to find that two individuals with the same effective dose will have substantially different risks. Risk assessment has shown, for example, that: (a) medical exposures to computed tomography scans have become a leading source of future risk to the general population, and that the risk would be increased above recently published estimates if the incidence of skin cancer and the increased risk from exposure to x-rays compared with high-energy photons were taken into account; (b) indoor radon is a significant contributor to the baseline risk of lung cancer, particularly among people who have never smoked; and (c) members of the public who were exposed in childhood to I in fallout from atmospheric nuclear weapons tests and were diagnosed with thyroid cancer later in life would frequently meet criteria established for federal compensation of cancers experienced by energy workers and military participants at atmospheric weapons tests. Risk estimation also enables comparisons of impacts of exposures to radiation and chemical carcinogens and other hazards to life and health. Communication of risk with uncertainty is essential for reaching informed consent, whether communicating to a larger community debating the tradeoffs of risks and benefits of an action that involves radiation exposure or communicating at the level of a physician and patient.
对工人和公众的辐射暴露的评估传统上侧重于评估辐射剂量，特别是年剂量，而没有明确评估与这些暴露相关的健康风险，主要是辐射诱发癌症的风险。当剂量是评估的终点时，沟通暴露意义的机会仅限于与法规中的剂量标准、天然背景或医疗 X 射线引起的剂量以及流行病学研究中观察到疾病发生率统计学显著增加的剂量进行比较。风险评估通常涉及过去、现在或未来暴露可能导致特定疾病的机会（概率）。每单位剂量的癌症风险将取决于性别、年龄、暴露类型（急性或慢性）和辐射类型。发现两个具有相同有效剂量的人具有显著不同的风险并不罕见。风险评估表明，例如：(a) 计算机断层扫描 (CT) 扫描的医疗照射已成为普通人群未来风险的主要来源，如果考虑到皮肤癌的发病率以及与高能光子相比 X 射线暴露的风险增加，那么风险将高于最近公布的估计；(b) 室内氡是肺癌基线风险的重要因素，特别是对于从未吸烟的人；(c) 在童年时期暴露于大气核武器试验落下物中的公众，后来被诊断患有甲状腺癌，他们将经常符合为因大气武器试验而经历癌症的能源工人和军事参与者设立的联邦补偿标准。风险估计还能够比较辐射和化学致癌物以及其他对生命和健康的危害的暴露影响。无论在更大的社区中就涉及辐射暴露的行动的风险和收益权衡进行辩论，还是在医生和患者的层面上进行沟通，都需要对风险进行沟通并说明不确定性，以获得知情同意。
