[Biological effect and tumor risk of diagnostic x-rays. The "war of the theories"]

Since the introduction of ionizing radiation as a treatment and diagnostic tool in humans, scientists have been trying to estimate its side effects and potential health risks. There is now ample evidence for the principal existence of a direct relationship between higher doses and the risks of side effects. Most of the uncertainties lie in the field of low-dose effects especially with respect to the risk of cancer induction. Low-dose effects are usually of relevance in diagnostic medicine while high-dose radiation effects are typically observed after radiotherapeutic treatment for cancer or after nuclear accidents. The current state of the "war of theories" may be summarized as follows: one group of scientists and health regulatory officials favors the hypothesis that there is no threshold dose, i.e. the linear-no-threshold hypothesis (LNT) of radiation which can be regarded as safe. On the contrary, the critics of this hypothesis suggest that the risks of doses below 50 mSv are not measurable or even of clinical relevance and are not adequately described by a linear dose-response relationship. The aim of this article is to summarize the major unresolved issues in this field. Arguments are presented why the validity of the LNT model in the low-dose range should be regarded as at least inconsistent and is thus questionable.