Harnessing the promise of radiation: The art of reasonableness

September 11, 2020, 3:04PMNuclear NewsPaul Locke, Amir Bahadori, Antone Brooks, Shaheen Dewji, Mary Lou Dunzik-Gougar, Marilyn Kray, and Alan Waltar

Radiation has benefited mankind in many ways, including its use as an energy source and an indispensable tool in medicine. Since the turn of the 20th century, society has sought ways to harness its potential, while at the same time recognizing that radiological exposures need to be carefully controlled. Out of these efforts, and the work of many dedicated professionals, the principles of justification, optimization, and limitation have emerged as guiding concepts.

Justification means that the use of radiation, from any radiation source, must do more good than harm. The concept of optimization calls for the use of radiation at a level that is as low as reasonably achievable (ALARA). Dose constraints, or limitation, are meant to assist in reaching optimization and protection against harm by setting recommended numerical levels of radiation exposure from a particular source or sources. Together, these three principles form the bedrock of the international radiation protection system that drives decision-­making and supports societal confidence that radiation is being used in a responsible manner.

In January 2020, a delegation from the American Nuclear Society participated in an OECD Nuclear Energy Agency workshop in Lisbon, Portugal, titled “Optimization: Rethinking the Art of Reasonable.” The objective of the workshop was to discuss the nature and intent of optimization in radiological protection and to explore reasonableness in applying the optimization principle. The workshop title recognized that optimization is an art, with a foundation in science and tempered by the individual situations to which it is applied, the communities that are affected by the radiation, and the effects of decisions on present and future generations.

The ANS delegation to the OECD Nuclear Energy Agency workshop included (from left) Antone Brooks, Washington State University (retired); Mary Lou Dunzik-Gougar, Idaho State University; Paul Locke, Johns Hopkins University; Marilyn Kray, Exelon Corporation; Shaheen Dewji, Texas A&M University; Alan Waltar, Pacific Northwest National Laboratory (retired); and Amir Bahadori, Kansas State University.

It is often the case that reasonableness is displaced in radiation protection decision-­making by dose minimization. Of course, it is always appropriate to consider ways to keep radiation exposures in a safe range. However, optimization means much more. It demands a careful analysis of the situation at hand and the context in which radiation is being used. A reasonableness analysis refocuses decision-­making on overall well-­being in the broadest sense. It must take into consideration “prevailing circumstances,” which were defined at the workshop as the radiological, societal, economic, local, political, and individual aspects that should flow into decision-­making. Through this lens, overall protection solutions concentrate on allocating resources to the most serious risks, which may not be the effects of radiation exposure. Reasonableness leads to radiation protection decisions that are optimal while addressing prevailing circumstances and stressing the goal of well-­being.

Integrating Science, Policy, Communication, and Leadership

The ANS delegation came to the workshop to emphasize that in balancing and calibrating how to optimize the use of radiation, reasonableness should be a driving force. The members of the ANS delegation contributed their perspective and expertise to advancing the concept and application of reasonableness in optimization, challenging the workshop attendees to expand their use of reasonableness in making policy and regulatory choices.

Marilyn Kray, ANS president at the time of the workshop, now immediate past president, shared an overview of optimization issues in the United States. She provided a high-­level view of issues affecting optimal radiation protection solutions in various circumstances in the United States. After giving a brief history of ANS, she explained that ANS has taken on several “Grand Challenges,” including Grand Challenge One, which accentuates the issues at the heart of the workshop. More specifically, Kray emphasized that ANS was moving from “revolution” to “evolution” by refocusing on the broader societal benefits of expanding nuclear energy and reaping its benefits, including cleaner air, less carbon, and, consequently, more lives saved because of less air pollution. She made the case that moving away from a rote adherence to dose minimization is a societal good. While ALARA is an important concept, it does not simply mean driving down dose to zero. To the contrary, reasonableness demands consideration of non-­radiological costs and benefits, including the psychological impacts of radiation-­related stigma.

ANS is actively working to put the principle of reasonableness into action in the United States by working with government agencies, professional societies, and universities. Kray set out four overall recommendations to smooth the path to reasonableness. First, provide K–12 students with appropriate literature to help them understand ionizing radiation. Second, dispatch outreach teams to educate those affected by radiation-­related events about the risks they face. Third, establish a common technology for radiation detection, with known levels of accuracy, so that a “true” radiation exposure can be assessed consistently. Fourth, develop a global consensus for dose-­based regulations that are sufficiently protective and understandable to stakeholders so that they can make reasonable decisions about their health and safety in response to a radiation accident.

Alan Waltar, an ANS past president (1994–1995), challenged the workshop attendees to think about reasonableness in the context of societal issues that will have an impact on the future use of radiation, and the use of the linear no-­threshold model in regulation. He noted that public fear is often a stumbling block to advancing the beneficial uses of nuclear technologies.

Waltar posed challenging questions to the workshop: How did this fear originate, and what is its source? He offered several theories. Some will point to the way radiation was introduced to a wide segment of the global population, namely, the detonation of the atomic bombs above Hiroshima and Nagasaki. This history links the word “radiation” to the mushroom cloud. Others point to the panic originating from major nuclear accidents, such as Three Mile Island, Chernobyl, and Fukushima. Waltar also challenged the workshop attendees to examine the role that the linear no-­threshold approach is playing. Many in the public are confused by this concept and believe that radiation disease and damage can occur with just miniscule exposures.

But is it true? We know that humans evolved, and spend their lives, in a radiation-­rich environment. Everyone on the planet is exposed to low levels of radiation almost every day. Keeping this fact in mind, the fear of radiation exposure is at odds with our day-­to-­day reality. Waltar explained that when former ANS president Andrew Klein issued an appeal to define the challenges that need to be resolved within our profession over the next two decades, resolving the low-­level radiation issue was designated by the ANS Board of Directors as the Number One Grand Challenge.

In closing, Waltar thanked the workshop organizers for recognizing the importance of reasonableness and their acknowledgement that it should play a larger role in decision-­making. ANS’s Grand Challenge One captures these themes and emphasizes the Society’s central role in better defining and applying reasonableness.

Shaheen Dewji, past chair of the ANS Radiation Protection and Shielding Division, chaired a panel session on practical approaches to optimization that reviewed how reasonableness was applied in different situations and in a variety of prevailing circumstances. Dewji’s panel covered (1) emergency management, (2) recovery management, (3) radon, and (4) food and drinking water. Several important lessons emerged from her session. Regarding emergency management, reasonableness has yet to be a driving force. Certain prevailing circumstances in emergency situations, such as psychological stress, are not quantified. The critical questions that the public asks—Will I be safe? Will my family be safe?—cannot be answered by radiation dose reference levels alone.

In the area of recovery management, Norway has had success in applying reasonableness to decisions regarding the contamination of reindeer, which have an important role in the lives of the indigenous Sámi, after contamination from the Chernobyl accident. Soon after the accident, Norway imposed strict contamination limits on food, including reindeer meat, which had negative consequences for the communities of reindeer herders. It soon became clear that the most important prevailing circumstance was the disruption in lifestyle and community faced by the reindeer herders. This fact became central in working out an optimization solution that ultimately set aside strict dose levels so that lifestyle needs could be met.

Radon protection in Ireland also employs optimization by taking prevailing circumstances into account. Instead of a one-­size-­fits-­all approach, the Irish program focuses on high-­risk situations. First, areas where radon levels are elevated are targeted for additional attention. Second, schools are tested and, if needed, remediated to protect children, a vulnerable population. Finally, employers are required to assess their workplaces and protect workers from elevated exposures to radon. A reasonableness philosophy drives these policies.

Amir Bahadori, chair of the working group that is revising ANS Position Statement 41, “Health Effects of Low-­Level Radiation,” led the discussion of a panel of emerging leaders in radiation protection. The panel consisted of representatives from Austria, France, Japan, Portugal, and the United States. The challenge posed by the workshop to the panelists was to consider how new technology, including social media, could assist in implementing reasonableness in radiation protection today and in the future.

First, the panelists pointed out that young professionals from these five countries and many others were significantly impacted by the Great Recession, an event that was rooted in a perception of little or no risk of financial collapse. This leads to a degree of cynicism and general mistrust of authorities and others in positions of power who try to alleviate concern by saying, “Trust us, everything is fine.” In contrast, the panelists were impressed by the honest nature of the discussion at the workshop, where many prominent leaders in radiation protection pointed out the difficulty of defining and implementing good reasonableness practices for a variety of situations involving radiation.

New media is clearly playing an important role in today’s world, and reasonableness in radiation protection should be no different. Information tends to be communicated in smaller pieces, particularly in the form of “memes” associating imagery with concept. Facebook and Twitter are often used for complementary messaging with other media events, such as television programming. People look to YouTube and Reddit to learn from others in a “rapid-­fire” format.

Fundamentally though, the public is looking to connect with people they can trust. Often this includes influencers who aim to connect with people directly through apps such as Instagram. Reasonableness about radiation protection issues should be communicated through these new channels in a responsible way by people who are trusted. Other ideas discussed by the panel included the use of crowdsourcing to better understand stakeholders, improve communication, and give stakeholders a greater sense of process ownership, and the use of machine learning to create reasonableness tools that account for as many factors as possible, including prevailing circumstances, to assist decision-­makers. Finally, the panel encouraged the retiring generation to connect with young professionals to ensure that knowledge and invaluable experience in reasonableness are preserved.

Paul Locke, an environmental health scientist, made a presentation that covered key elements of risk communication, starting with a discussion about how to prepare for a risk communication encounter. If we are to be successful at implementing reasonable decisions, effective communication is a must. Locke also covered some practice tips and talked about how to avoid common mistakes. Finally, he addressed likely stakeholders.

Locke noted that optimization and the application of reasonableness require an understanding of social interactions and a way to relate effectively with communities about potentially stressful issues. One of the most important goals in radiation risk communication is gaining the trust of communities and stakeholders. Locke stressed that radiation risk communicators must create a level playing field for idea exchange and discussion, and that risk communication is a two-­way street. The essence of successful communication is to recognize that it is a continuous process and that a variety of possibly conflicting viewpoints and concerns will be expressed. In addition to trust, other social factors affect risk communication, including the familiarity of the risk, its voluntariness, how the risk is controlled, and whether it is acute or long term. When interacting with communities and stakeholders, Locke said, avoid using jargon, make sure you explain the risk in terms of its impact on individuals and communities, explain how the risk can be mitigated, and be clear about what you know (and do not know). One effective way of communicating is to use stories, not statistics, to make your point. Finally, remember that risk communication involves both process and substance. To be successful, you need to get both of them right.

Antone Brooks, who served as chief scientist for the Department of Energy’s Low Dose Radiation Research Program, addressed the science behind radiation protection, arguing that future research into low-­dose radiation was needed. This research could be instrumental in how reasonableness is applied to optimization. In addition, Brooks discussed the differences in biological responses to low-­dose and high-­dose radiation. Following low-­dose radiation, many unique genes and biological processes are activated that can protect against cellular damage. These phenomena provide evidence that responses at low doses are not the same as responses at high doses.

Brooks believes that these data suggest that the linear no-­threshold model overestimates damage at low doses. He compared the regulatory responses to radiation fallout in southern Utah (from aboveground atomic bomb testing in Nevada) to the regulatory responses after the accident at Fukushima, noting that the actions at Fukushima did more harm than good in terms of protecting health and improving welfare. In contrast, in southern Utah, few actions were taken, and as a result, fear and the impact on the local economy were minimal. Brooks reminded the workshop attendees that Utah has the lowest cancer rate in the United States, and that Washington County, where the highest fallout occurred, has the third-­lowest cancer rate in Utah.

Grand Challenge One, The promise of reasonableness, and ANS’s continuing role

This workshop holds out the promise that future decision-­making can incorporate creativity, community input, science, and societal well-­being. These are some of the key inputs into decisions that are organized around reasonableness as it is applied to optimization. In the future, optimization must move beyond simple dose minimization. It is clear that reasonableness meshes well with the goals and objectives laid out in Grand Challenge One, and ANS will continue to be actively involved in improving radiological decision-­making through workshops such as this one, and in other significant ways.

Applying reasonableness

While this workshop begins an important move in the right direction, continued involvement from ANS is necessary to clarify how reasonableness can be implemented. The workshop provided some examples of reasonableness in action, but much more information is needed. ANS members have been involved in all sorts of decisions in a variety of situations, and this knowledge needs to be shared.

Improving low-­dose science

Science is a key feature of all radiological decision-­making. The area of low-dose radiation research is of crucial importance, because it studies the impact of radiation doses in the ranges that are most relevant to typical human exposures. ANS has been actively involved in seeking additional support for this research, which is a central feature of Grand Challenge One. Presentations at this workshop by Waltar and Brooks demonstrated the importance of continuing low-­dose radiation studies.

Communicating reasonableness

In addition to improving the scientific basis for radiation protection, the workshop showed that effectively engaging stakeholders and communities is an essential tool for optimization decisions. Expanding efforts to “get the communication right” will yield benefits. Reasonableness recognizes the need to balance many factors in a quest for optimal well-­being. Transparent and fair risk communication strategies are needed so that these discussions can take place and solutions can be designed and implemented.

Looking forward

Mary Lou Dunzik-­Gougar, the then ANS vice president/president-­elect, current ANS president, was a member of the ANS delegation to the workshop and summarized the way forward. “This workshop offered an important international platform to exchange ideas about a concept—reasonableness—that is long overdue,” she said. “One of my goals as ANS president is to accelerate our progress toward a future that takes full advantage of the benefits of current nuclear technologies and accelerates innovation in our fields. Better, more inclusive decision-­making in radiation protection can help us reach this goal, and also contribute to Grand Challenge One.

“Still, we need to recognize that this workshop is only a start, and there is much additional work to do,” Dunzik-­Gougar added. “ANS is well positioned to be a catalyst in moving things forward. Our members have extensive experience in radiological protection across a range of ‘prevailing circumstances,’ to borrow a key idea from the workshop. I want to share our expertise with the OECD [Organization for Economic Cooperation and Development], ICRP [International Commission on Radiological Protection], UNSCEAR [United Nations Scientific Committee on the Effects of Atomic Radiation], and U.S. agencies and policymakers so we can continue to improve the art of reasonableness and its application to optimization."

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