Table 3.
Key strengths and weaknesses of selected radiation epidemiology studies post–BEIR VII*
| ID | Study group or name Environmental | Main strengths | Main weaknesses | Study reference(s) |
|---|---|---|---|---|
| 1 | Chernobyl residents | Dose estimates based on detailed analysis; significant cross-validation | Potential for recall bias; contribution from complex internal dosimetry | (28) |
| 2 | TMI residents | Dose estimates based on detailed analysis; some validation of dose estimates from environmental monitoring | Sparse measurement data; plume model was complex and thus error-prone; intentionally conservative assumptions used | (29) |
| 3 | Chinese background | Detailed modeling based on extensive indoor and outdoor measurements; significant dose validation | Small potential for recall bias | (32) |
| 4 | GB background | Dose estimates based on indoor measurements; no differences between cases and controls | Dose estimates for areas larger than ideal; no residential histories | (36) |
| 5 | Swiss background | No case and controls differences; dose estimates for 2×2 km grid | Dose estimates only for outdoor radiation | (41) |
| 6 | Techa River residents | Dose estimates based on detailed analysis; significant cross-validation; medical exposures included | Contribution from complex internal dosimetry | (44) |
| 7 | Finnish background | No case and controls differences; full residential histories available | Crude conversion from outdoor to indoor dose; dose estimates for 8×8 km grid, larger than ideal | (48) |
| 8 | Taiwanese residents | Dosimetric scheme based on numerous measurements | Dosimetry dependent on detailed recollection of occupancy; small potential of recall bias | (49) |
| Medical | ||||
| 9 | Cardiac imaging patients | Used simple and reproducible dosimetry methods | Used effective dose; used average protocol doses; no information on assessment of noncardiac exposures; dose error not assessed | (52) |
| 10 | French pediatric CT | Used organ absorbed dose | Specific protocol parameters not available; analyses did not consider dose from other diagnostic examinations | (55) |
| 11 | UK pediatric CT | Used organ absorbed dose | Specific protocol parameters not available; analyses did not consider dose from other diagnostic examinations | (57) |
| 12 | PIRATES (low dose) | Used organ absorbed dose; analysis of dose estimation errors; adjusted for random error using regression calibration | Specific protocol parameters were not available | (59) |
| Occupational | ||||
| 13 | Korean NW | Measurements from personal monitoring including incorporated radionuclides and neutron dose | Used unadjusted recorded dose; dose from WRX not assessed, although fluoroscopic and photofluorographic procedures unlikely | (63) |
| 14 | Russian CL | Dose estimates based on detailed analysis; individual estimates of absorbed dose to tissues and organs of interest, adjusted for dose error; model validation; advanced treatment of dose estimation errors | Sparse measurement data; complex exposures; potential for recall bias | (64) |
| 15 | UKNRRW | Measurements from personal monitoring; adjustment for missed and notional doses; evaluation of dose estimation errors by sensitivity analysis | Used unadjusted recorded dose; dose from WRX, neutrons, and internal exposures not assessed | (66) |
| 16 | Korean NPW | Measurements from personal monitoring, including incorporated radionuclides and neutron dose | Used unadjusted recorded dose; dose from WRX not assessed, although fluoroscopic and photofluorographic procedures unlikely | (68) |
| 17 | Rocketdyne NW | Measurements from personal monitoring including neutrons; major efforts to reconstruct significant dose contributions from incorporated radionuclides | Used unadjusted recorded dose; assessment of internal dose restricted to a few participants; dose from WRX not assessed | (69) |
| 18 | Japanese NW | Measurements from personal monitoring including incorporated radionuclides and neutron dose | Used unadjusted recorded dose; dose from WRX not assessed, although some evidence of an inverse relationship between cumulative dose and number of x-ray exams among radiation workers (100) | (71) |
| 19 | Canadian NW | Measurements from personal monitoring, including assessment of tritium dose | Used unadjusted recorded dose; potentially incomplete dose histories; dose from WRX, neutrons, and incorporated radionuclides (other than tritium) not assessed; however, workers with recorded neutron dose or “high” internal exposures excluded | (74) |
| 20 | Ukrainian CL | Dose estimates based on detailed analysis; individual estimates of absorbed dose to tissues and organs of interest, adjusted for dose error; model validation; advanced treatment of dose estimation errors | Sparse measurement data; complex exposures; potential for recall bias | (78) |
| 21 | German NPW | Measurements from personal monitoring including incorporated radionuclides and neutron dose | Used unadjusted recorded dose; dose from WRX not assessed | (80) |
| 22 | US NW | Measurements from personal monitoring, including neutron and tritium doses; WRX, neutron exposures, and plutonium uptakes examined in previous case-control studies of leukemia mortality (101–103) | Used unadjusted recorded dose; dose from WRX, internal exposures (excluding tritium) not assessed | (81) |
| 23 | INWORKS | Measurements from person monitoring; dose estimates based on detailed analysis to derive absorbed dose to tissues and organs of interest, adjusted for systematic dose error | Dose from WRX, neutrons, and incorporated radionuclides not assessed | (82, 83) |
| 24 | US atomic veterans | Model validation by intercomparison with another dose reconstruction | Sparse measurement data; random error not accounted for in dose-response analysis | (85) |
| 25 | USRT | Dose estimates based on detailed analysis; model validation; advanced treatment of dose estimation errors | Sparse data from personal monitoring, especially for early exposures | (89–91) |
| 26 | French NW | Measurement from personal monitoring; dose estimates based on detailed analysis; adjusted for systematic dose error; measurements from personal monitoring; companion papers examined confounding effects from internal exposures (104) and exposures to environmental and medical sources (105); missed dose examined in previous analyses (106, 107) | Dose from neutrons and internal exposures not assessed | (95) |
*
BEIR = biological effects of ionizing radiation; CL = Chernobyl liquidators; CT = computed tomography; GB = Great Britain; INWORKS = International Nuclear Workers Study; NPW = nuclear power workers; NW = nuclear workers; PIRATES = Pooled International Radiation and Thyroid Cancer Epidemiology Studies; TMI = Three Mile Island; UKNRRW = United Kingdom National Registry for Radiation Workers; USRT = US Radiologic Technologists; WRX = work-related x-ray examinations.