Radiation Environment and Medicine 2021 Vol.10, No.

1 48–54

Report

Radiation Safety and Public Health for Radiological Professionals:

Meeting Report on The 5th Educational Symposium on Radiation
and Health (ESRAH) by Young Scientists in 2018

Hiroko Yamashina1*, Marin Terashima 2, Joma Oikawa 2, Shingo Naijo,2 Tamao Miyao2,
Yoshie Yachi2, Yusuke Matsuya 2, Masaru Yamaguchi3, Takakiyo Tsujiguchi3, Ryo Saga3,
Hu Jun3, Goh Valerie Swee Ting4, Toshiya Nakamura4, Yoichiro Hosokawa3 and Hiroyuki Date1

1
Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo 060-0812, Japan
Graduate School of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo 060-0812, Japan
2

3
Department of Radiation Science, Graduate School of Health Science, Hirosaki University,66-1 Hon-cho, Hirosaki 036-8564, Japan
4
Department of Bioscience and Laboratory Medicine, Graduate School of Health Science, Hirosaki University; 66-1 Hon-cho, Hirosaki 036-8564, Japan

Received 14 July 2020; revised 28 July 2020; accepted 29 July 2020

The nuclear power plant accident on March 11 2011 in Fukushima prefecture in Japan greatly
increased the interest in the effect of radioactivity and low-dose exposures on the environment
and human beings. Our symposium "Educational Symposium on RADIATION AND HEALTH
(ESRAH) by young scientists" has shifted more to providing information on radiation protection
and inviting international researchers rather than basic radiation research. Since 2014, this
symposium has provided an international forum for information exchange and discussions on
a wide range of subjects related to radiation effects on the environment and the human body,
radiation protection, radiation detection and emergency medical care. The 5th Symposium was
held in Hokkaido University in 2018 under the theme of "Radiation Safety and Public Health for
Radiological Professionals". In this article, we summarize and review of the ESRAH2018.

Key words: ESRAH, radiation safety, meeting report

the second atomic bomb devastated Nagasaki city.

1. Introduction
Decades after atomic bombs dropped, many studies on
Japan has experienced many nuclear and radiological the long-term health effects have been conducted2-4).
events (Table. 1). One of the worst in history is the Although Japanese people have experienced such tragedy
detonation of atomic bombs over H iroshima and f rom the harmf ul ef f ects of radiation exposure,
Nagasaki cities in 1946. On August 6, 1945, black rain technological advances have seen industries use more
drops continued to fall on the heads of Hiroshima-atomic- radioisotopes to the benefit of the Japanese population. By
bombing survivors1). Three days later, the explosion of 2010, Japan developed 19 nuclear power plants with 54
reactors supplying 30% of the country s total electric
*Hiroko YAMASHINA: Faculty of Health Sciences, Hokkaido University, Kita-12, power5).
Nishi-5, Kita-ku, Sapporo 060-0812, Japan
Since 2008, an exchange meeting for scientific study
E-mail: y-hiroko@med.hokudai.ac.jp
between Hokkaido University and Hirosaki University in
Copyright © 2021 by Hirosaki University. All rights reserved. Japan has taken place annually as an opportunity to
 Hiroko Yamashina et al. / Radiation Environment and Medicine 2021 Vol.10, No.1 48–54 49

Table 1. Major nuclear and radiological events in Japan

Year Incident description Location Notes
1945 Nuclear bombing Hiroshima city About 70,000 died
Nuclear bombing Nagasaki city About 39,000 died
1981 Overexposure (INES Level 2) Tsuruga 100 workers exposed
1999 Uranium in solution exceeded (INES Level 4) Ibaraki 2 workers died More than 100 received lesser dose
2011 Meltdowns (INES Level 7)
Note: INES is an abbreviation of the International Nuclear Event Scale which classifies the safety significance of nuclear
and radiological events to the public ranging from a Level 1 anomaly to a Level 7 major accident17). Any event without safety
significance is classified as Level 0.

discuss radiation effects on the human body. However, on 3. Public Health and Roles of the Radiation Expert
March 11, 2011, the Fukushima Daiichi nuclear disaster
occurred after the Great East Japan Earthquake and 2.2. Radiation- Induced Bystander Ef fects
tsunami, and it brought a big change in people s lives and Dr. Fiona M. Lyng from Dublin Institute of Technology
even in our exchange meeting6, 7). This disaster gave rise Centre for Radiation and Environmental Science gave us
to a greater interest in the effect of radioactivity and low- a lecture on Radiation Induced Bystander Effects
dose exposures on the environment and human beings. observed in non-targeted cells. Radiation induced
As a result of this, to promote a better understanding of Bystander Effects are responses in unirradiated cells to
radiation and human health, the meeting was upgraded in signals produced by irradiated cells, which is dominant at
2014 to an international conf erence renamed as low dose and not necessarily proportional to dose. The
Educational Symposium on RADIATION AND HEALTH field started from research on abscopal effects in the
(ESR AH) by young scientists . Since t hen, t his 1960 s and it developed to open up a new paradigm of
symposium has provided an international forum for radiation biology. T he bystander signals can be
information exchange and discussions on a wide range of transferred in various ways: by gap junctional intercellular
subjects related to radiation effects on the environment communication, by the production of soluble factor in
and the human body, radiation protection, radiation media (Irradiated Cell Conditioned Media, ICCM) and by
detection, emergency medical care, and so on8-11). exosomes. Dr. Lyng showed us a lot of valuable data from
The 5th Symposium was held in Hokkaido University experiments. Dr. L yng found out some signaling
in 2018 under the theme of Radiation Safety and Public processes via calcium (known as a ubiquitous intercellular
Health for Radiological Professionals . In this symposium, signal), activated Mitogen-activated Protein Kinase
three honorable researchers gave educational lectures (MAPK) proteins, membrane signaling, Reactive Oxygen
and five outstanding researchers made their presentations Species (ROS) and Nitric Oxide (NO) signaling in
as invited speakers. A poster session was organized for bystander cells. Each phenomenon can increase apoptotic
graduate students and young researchers. In this article, cells, which is observed as the loss of mitochondrial
we summarize and review ESRAH2018. membrane potential. These processes occur quickly,
within minutes after the irradiation, starting from ROS
signaling in the irradiated cells, followed by membrane
2. Educational Lectures and Invited Talks
signaling and calcium influx in the recipient cells. It was
2.1. Overview of Educational Lectures and Invited Talks shown that exosomes are also involved in the bystander
Although seven years have been passed since the effect. Further, she carried out experiments on ICCM in
Fukushima Daiichi Nuclear Power Plant accident, there is prostate cells to confirm out-of-field effects , and is now
still strong public interest on radiation effects and working on new research on the in vivo effects of partial
protection while environmental radiation levels continue body irradiation.
to decrease. Researchers have a responsibility to provide
evidence, suggest the relevant techniques and measures, 2.3. Dose Estimates to Medical Practitioners Following a
and share current status and most up to date knowledge Radiological Incident
of radiation effects and protection. Therefore, the eight Dr. J. E. Davis of the Radiation Emergency Assistance
distinguished speakers mainly focused on public health Center/Training Site (Oak Ridge, Tennessee, USA) gave
aspects of environmental and occupational radiation and a lecture on dose estimates to medical staff following a
their presentations were classified into three themes. radiological incident. In the lecture, three patterns of
1. Biological Health Impacts Safety management contaminated injuries; (a) A uniformly contaminated
2. Radiation Dose Measures and Dosimetry patient, (b) A contaminated patient after clothing was
50 Hiroko Yamashina et al. / Radiation Environment and Medicine 2021 Vol.10, No.1 48–54

removed, (c) An embedded radiological source, were impact of internal radiation has not been examined and
assumed, and the estimated doses to the medical staff will be explored in the future.
treating injuries were reported. Next, estimated results of
the dose to medical staff who responded to historic 2.5. Radiation Saf ety and Health f or the Public and
radiation incidents were introduced. Radiological Professionals
In the case of a uniformly contaminated patient, the Dr. Margaret Chege of Kenyatta University, Kenya has a
dose to medical staff at the distance of about 20 cm from lot of experience on mat hematical modeling of
the patient was 4.47×10-10 mSv h-1 Bq-1 for 60Co and 1.60× radionuclide transport and transfer, measurement of
10-10 mSv h-1 Bq-1 for 137Cs. In addition, the time to reach radon and thoron in traditional mud-walled/bare-floored
occupational dose of 250 mSv was 7.9 h in the case of 60Co (earthen) dwellings, naturally occurring radionuclides in
and 23.9 h in the case of 137Cs (assuming there is uniform soil, building materials, crops and well water, and heavy
contamination of 37 GBq m-2 in each simulation). Dr. metals in well water. Dr. Chege gave a lecture on
Davis noted that the dose to the medical staff is lower Radiation saf et y and health f or the public and
than the above result when the patients were unevenly radiological professionals . As we know, radiation is
contaminated. In the next session, it was reported that broadly classified as non-ionizing and ionizing. The non-
t here were 471 accidents in vol v ing signif icant ionizing radiation has insufficient energy to dislodge an
overexposure to individuals from 1944 to 2018. Among electron from an atom and is located at the lower end of
them, estimated dose to medical staff responding to the the electromagnetic spectrum. In contrast, ionizing
Stationary Low Power Reactor No. 1 (SL-1) accident in radiation is electromagnetic or particle energy capable of
196112) and Indiana incident (loss of an 192Ir source) in removing an electron from an atom, which is considered
199213) were provided as examples. more dangerous than non-ionizing radiation owing to its
At the end of the lecture, it was stated that, based on higher energy. Dr. Chege gave an overview of natural
past cases, medical staff would not receive a lethal and artificial sources of radiation, their risk to human
exposure from contaminated patients, and it is important health and introduced the safety measures against
that medical staff attend to life-threatening medical radiation exposures. Finally, she pointed out that it is
conditions before considering decontamination efforts. Dr. essential to fully understand radiation exposure for the
Davis also emphasized that these results could be used purposes of the application of safety measures, continued
for risk education for medical staff who are first research on radiation sources, health impacts, and
responders at radiation accidents. resource development in radiation protection.

2.4. Study of Public Dose Due to Natural Radioactivity in 2.6. Re-evaluation of Pediatric 18F-FDG Dosimetry
Hi gh Background Area at Mamuju Regenc y, W est Dr. Kitiwat Khamwan from the Chulalongkorn University
Sulawesi, Indonesia (Thailand) introduced his study outcome entitled Re-
Dr. Eko Pudjadi from the Centre for Technology of evaluation of Pediatric 18F-FDG Dosimetry . The study
Radiation Safety and Metrology (BATAN), gave a lecture was conducted by using two types of computational
on the radiation environmental dose monitoring of phantoms. Currently, almost every pediatric absorbed
Mamuju Regency, West Sulawesi, Indonesia. Due to its dose is estimated from adult pharmacokinetic data with
mountainous topography and presence of rare earth radionuclide S-values considering the anatomical
meta ls such as uranium and t horium, t he area differences between adults and children based on the
experiences high natural background radiation dose older Cristy-Eckerman (C-E) stylized phantoms. In his
when compared to other places in Indonesia and the work, absorbed dose of 18F-FDG was calculated using the
world14). The minimum annual effective dose in Botteng S values with hybrid phantoms generated by the
(2.93-10.89 mSv) and Takandeang (4.14-15.87 mSv) University of Florida/National Cancer Institute (UF/NCI)
residents in Mamuju was higher than the world average and the C-E stylized phantoms for a newborn, 1-year-old
of 2.4 mSv. The effective dose was calculated by summing and 5-year-old. The results show that absorbed dose
up external and internal dose measured. There were 63 coefficient estimates in UF/NCI hybrid phantoms and the
houses in Botteng village and 85 houses in Takandeang C-E stylized phantoms are different from each other for
village that participated in this exercise. External dose the lungs, ovaries, red bone marrow, and urinary bladder
was monitored with Exploranium® gamma spectrometer wall. The effective doses coefficient computed with the
GR-135 Plus and Optically Stimulated Luminescence UF/NCI hybrid phantoms with the S values are slightly
dosimeters. Internal dose was estimated from raw water different from those with the C-E stylized phantoms for
sources, food and inhaled airborne particles. Upper all three ages. The absorbed dose coefficients of the brain
respiratory tract diseases were among the most common and urinary bladder wall are highest in both the UF/NCI
disorders in the Mamuju community, but the direct and C-E phantoms. The anatomical features of the
 Hiroko Yamashina et al. / Radiation Environment and Medicine 2021 Vol.10, No.1 48–54 51

phantoms bring about the difference in the internal organ

dosimetry calculations for pediatric nuclear medicine
studies.

2.7. Development and Specialization in Radiological

Nursing: Nursing Diagnosis and Collaboration with other
Academic Fields
Specialization and establishing a more effective education
on radiological nursing were introduced by Dr. Toshiko
Tomisawa from Hirosaki University, Japan. Dr. Tomisawa
talked about ensuring specialization in certified nurse
specialist (CNS) for radiological nursing (RN). The
subjects of radiological nursing are people who have been
exposed to radiation, people who worry about exposure to
radiation, and it will cover a wide range of concepts Fig. 1. Percentage of each category in the poster session from 2014
to 2018
including all developmental stages and environments for
everyone from unborn children to elderly people,
communities to medical facilities, and patients to health
professionals. Dr. Tomisawa showed the academic field of
RN overlaps with cancer nursing on radiotherapy and radioactivity. Examples included, radioactive toothpaste
pain management with cancer patients. It also partially that can kill bacteria, beauty creams containing radium,
covers disaster nursing or emergency nursing and shoe-fitting fluoroscopes to ascertain how well the shoe
overlaps with community health nursing after a nuclear fits the foot, etc. At that time, naturally occurring
accident. In Japan, to get a license to be a CNS for RN, radionuclides were believed to improve health and to
students need to get 38 units for graduating from the lengthen lifespan. However, they caused the cancer or
course, take general subjects, specialized subjects, serious skin inflammation, thus they were found to be
conduct research and gain experience in general nursing harmful to our health. The incomplete knowledge about
practice in a hospital. However, there are some problems radioactivity causes unnecessary radiation exposure,
educating nursing students in the area of radiological significant collective dose and preventable cancer cases.
nursing. They express negative responses to radiation These problems could be minimized by the rules and
such as it is scary, difficult to understand, it is not regulations set down by the authorities.
required. Most education in Japanese Universities are
conducted through one-sided lectures by the lecturer. 2.9. Clinical Trial Dosimetr y Results o f 18F-F DG
The learning pyramid from the National Training Application with a Positron Image Guided Cancer Surgery
Laboratories showed that only 5% of the knowledge Medical Device
learned during a lecture is retained shortly after the Dr. Domokos Mathe of Semmelweis University, Hungary,
lecture15). On the other hand, learning through discussions talked about the clinical trial dosimetry results of
retained 50%, actual practice by the students retained 75%, 2-Deoxy-2-[18F] fluoro-D-glucose (FDG) applications with a
and teaching someone else retained 90% of the knowledge. positron image guided cancer surgery medical device. In
This is why using active learning has a more potent effect clinical oncology, Positron Emission Tomography (PET)
on education than passive learning. Dr. Tomisawa is an extremely valuable tool for tumor diagnosis, staging,
concluded that, to ensure specialization in radiological restaging and for treatment response follow-up. In
nursing, we have to teach students by more effective addition, FDG is the most commonly used tracer, which is
methods such as an active learning. able to assess the typically enhanced glucose transport
and metabolism in malignant tumors, and is superior in
2.8. Radioisotopes as Materials Enhancing Health and detecting residual tumor growth, tumor recurrence and
Beauty? distant metastasis compared to morphologic imaging
Dr. Tibor Kovács of the University of Pannonia, Hungary, procedures 16). Although application of FDG tumor
introduced the current study entitled "Radioisotopes as imaging results in a reduction in operating procedures
materials enhancing health and beauty?". The study and time, absorbed radiation doses of medical personnel
surveyed the health damage caused by ionizing radiation might be the limiting factor for such surgeries. This
from commercial products including radionuclides. The study, therefore, reports the absorbed doses of medical
products were developed and sold in the early 1900 s personnel in radioactive open abdominal surgeries, such
w hen t her e w a s i ncom p le t e k no w led g e a bou t as gastric or pancreatic cancer, and the limiting factors in
52 Hiroko Yamashina et al. / Radiation Environment and Medicine 2021 Vol.10, No.1 48–54

Table 2. List of poster presentation by young scientists

No. Title of poster presentation First author Affiliation
1 The evaluation of clinical laboratory indicators that affect the cell-cycle progression index K. Yanagidate Hirosaki University, Japan
2 Effect of ultraviolet on ciliary zonules Y. Shiroto Hirosaki University, Japan
Modeling for colony formation of human lens epithelial cells following ionizing radiation
3 J. Oikawa Hokkaido University, Japan
exposure
4 Response characteristics of ultraviolet rays for CR-39 T. Suzuki Hirosaki University, Japan
CORRELATION BETWEEN RADON CONSENTRATION AND SEASON INSIDE Center for Nuclear Minerals Technology,
5 M. A. Saputra
TUNNEL IN WEST KALIMANTAN, INDONESIA Indonesia
Regulation of cancer cell radiosensitivity by hyaluronan synthesis inhibitor results in
6 K. Hasegawa Hirosaki University, Japan
radioresistance
Cell surviving fraction model for multi-fractionated radiotherapy considering cancer stem
7 S. Naijo Hokkaido University, Japan
cells (CSCs)
The IκB kinase β inhibitor, IMD-0354, attenuated the radiation-induced individual death in
8 K. Waga Hirosaki University, Japan
mice exposed to ionizing radiation
9 One-phase LSC method application in Rn( Ra) determination in waters
222 226
I. Stojkovi Novi Sad University, Serbia
Direct measurements of attached and unattached radon/thoron progeny using LR-115 Indian Institute of Technology Roorkee,
10 M. Prasad
detector based progeny sensors for dose assessment India
11 A performance test of the filters used for ambient radioactive aerosols Y. Tamakuma Hirosaki University, Japan
12 Short-term follow-up of intestinal flora in radiation-exposed mice T. Tsujiguchi Hirosaki University, Japan
13 The Risk Assessment of Indoor Radon and Thoron Based on a Stochastic Method H. Jun Hirosaki University, Japan
Regulation of radiosensitivity by 4-methylumbelliferone via suppression of interleukin-1 in
14 R. Saga Hirosaki University, Japan
fibrosarcoma cells
The effect of chronic inflammation on chromosomal aberrations and radio-sensitive organs
15 G. V. Swee Ting Hirosaki University, Japan
in T2DM mouse model
16 Cytogenetic analysis of raccoon (Procyon lotor) in Namie town, Fukushima Y. Fujishima Hirosaki University, Japan
17 Estimation of biological effects on normal and tumor cells in IMRT T. Miyao Hokkaido University, Japan
18 Comparison of the spectrum estimate performance of the different unfolding method K. Baba Hokkaido University, Japan
A gene expression analysis of the Keap1-Nrf2 biological defense system in mice exposed to
19 T. Nishida Hirosaki University, Japan
ionizing radiation
Improvement Calibration of Indonesian Radon Detector with Spot-injection method using
20 E. D. Nugraha Hirosaki University, Japan
Hirosaki laboratory Radon Chamber
21 Radiation exposure changes metabolites of gut bacteria Y. Sakamoto Hirosaki University, Japan
22 Dose response and model analysis of radioresistant cancer stem cells R. Takahashi Hirosaki University, Japan
23 Investigation of dose distribution in 320-row multi detector CT (MDCT) M. Terashima Hokkaido University, Japan
24 The effects of X-ray on alveolar elastic fibers Y. Kitayama Hirosaki University, Japan
National Institute for Insurance against
25 Passive radon detectors in the field intercomparisons: experiences and perspectives F. Leonardi
Accidents at Work, Italy
Cotreatment with retinoic acid-inducible gene-I-like receptor agonist and ionizing radiation
26 effectively induces apoptosis through caspase-8 mediated apoptotic pathway in human non- Y. Sato Hirosaki University, Japan
small cell lung cancer A549
Geogenic radon potential and ambient gamma dose equivalent rate investigation in a granitic
27 S. B. Torres Eötvös University, Hungary
area in Hungary
28 Effects of X-ray energy spectrum and electron track structure on DNA damage Y. Yachi Hokkaido University, Japan
Investigation of the fingerprint of climate changes in Tinovul Apa Roșie peat bog (central
29 T. Piroska Babes-Bolyai Univrisity, Romania
Romania) by using 210Pb dating method

a first clinical study. They conducted a clinical trial in surgery staff member (the data is not presented here as it
open abdominal surgeries where patients were injected is not yet published). These results suggested lead
FDG intravenously with an average of 109 (±26 of surgeons, in most cases, were exposed to the highest
standard deviation) MBq radioactivity before the doses compared to other staff. Based on an annual dose
operation. For each surgery each staff member was limit for occupational workers (20 mSv effective dose),
equipped with a whole body dosimeter for H P(10) and H P(10) is the limiting factor for lead surgeons which
optically stimulated luminescence dosimeter placed on corresponds to an average of 56 surgeries per year. If
the forehead and right hand to estimate H P(3) eye lens mean measured values are used, a maximum of 208
dose and H P(0.07) hand skin entrance dose. They surgeries per year are feasible. By limiting the injected
presented the maximum absorbed dose values in each activity to below 125 MBq per patient, the number of
 Hiroko Yamashina et al. / Radiation Environment and Medicine 2021 Vol.10, No.1 48–54 53

surgeries of pancreatic cancer has no limitation. For Theme 3:“International Education and Research Project
higher incidence and more frequent cancer surgeries like based for Safety & Security on Radiation Medicine”,
gastric cancer, they proposed a yearly limit per lead Hirosaki University, Japan.
surgeon for this type of image-guide procedures.
Conflict of Interest
3. Poster Presentations by Young Scientists
The authors declare that they have no conflict of interest.
There were 29 entries in total for poster presentations by
young researchers, consisting of sixteen posters on
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