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Combined Radiations: Biological Effects of Mixed Exposures Across the Radiation Spectrum.

Orfeas Parousis-Paraskevas¹, Angeliki Gkikoudi^1,2, Amer Al-Qaaod³

¹DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou Campus, 15780 Athens, Greece.

|September 27, 2025

Summary

Combined radiation exposures, pairing ionizing and non-ionizing types, show synergistic effects in therapy and spaceflight. Understanding these radiobiological interactions is crucial for radiation protection and medical applications.

Keywords:

DNA damage cancer risk combined radiations ionizing radiation mixed radiation fields non-ionizing radiation radiation protection simultaneous irradiation synergistic effects

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Area of Science:

Radiobiology
Radiation Oncology
Space Medicine

Background:

Combined radiation exposures (ionizing and non-ionizing) are increasingly relevant across medical, spaceflight, and environmental fields.
Understanding the radiobiological effects and mechanisms of combined exposures is critical for various applications.
Existing research highlights synergistic interactions, but a consolidated reference is needed.

Purpose of the Study:

To systematically review the radiobiological effects and therapeutic applications of combined radiation exposures.
To focus on synergistic interactions and underlying biological mechanisms.
To provide a consolidated reference for research and applications involving combined radiation.

Main Methods:

A comprehensive systematic literature search was conducted across major scientific databases (PubMed, Google Scholar, Semantic Scholar, bioRxiv, Europe PMC).
Studies published from the 1960s to 2025 assessing biological responses to simultaneous or sequential radiation types were included.
A total of 172 studies were analyzed and categorized into radiobiological, therapeutic, and space radiation domains, with findings synthesized narratively.

Main Results:

Synergistic and additive radiobiological effects were frequently observed, influenced by dose, sequence, radiation type, and DNA repair dynamics.
Therapeutic combinations of radiation demonstrated enhanced efficacy in treatment applications.
Studies on space radiation revealed complex and multifaceted biological damage from combined exposures.

Conclusions:

Combined radiation exposures exhibit significant synergistic and additive effects, impacting radiobiology, therapy, and spaceflight.
Mechanistic insight and standardized protocols are essential for optimizing combined radiation use in therapy, radiation protection, and space exploration.
This review serves as a key reference for future research and applications in this evolving field.