Mortality among U.S. Industrial Radiographers Exposed to Ionizing Radiation, 1969-2019

A cohort mortality study was conducted of 123,401 industrial radiographers in the United States to estimate risks following protracted radiation exposures. The cohort was constructed from the Nuclear Regulatory Commission Radiation Exposure Information Reporting System and the Landauer, Inc. dosimetry databases. Workers were monitored between 1939 and 2011 and were exposed mainly to external gamma radiation from 192Ir and 60Co. Causes of death were obtained from the National Death Index and state mortality files with follow-up through 2019. The mean duration of follow-up was 27.7 years. Nearly 19% of workers were monitored for more than 10 years. There were 30,617 (24.8%) who worked at shipyards and 5,071 (4.1%) at nuclear power plants with the potential for asbestos exposure. The mean radiation dose to the red bone marrow (RBM) was 15.2 mGy (maximum 1.24 Gy; percent >100 mGy was 3.6%), 17.2 mGy to lung, 18.1 mGy to colon, 11.9 mGy to brain, and 18.1 mGy to heart. Overall, 30,560 deaths occurred; the Standardized Mortality Ratio and 95% confidence interval for all-cause mortality was 0.92 95% CI (0.91, 0.93); for all solid cancers 1.01 (0.99, 1.03; n = 7,734); for ischemic heart disease (IHD) 0.83 (0.81, 0.85; n = 5,820); for cerebrovascular disease (CeVD) 0.88 (0.83, 0.93; n = 1,257); for mesothelioma 6.08 (5.35, 6.89; n = 248); and for asbestosis 13.4 (11.2, 15.9; n = 134). The Cox linear excess relative risk (ERR) per 100 mGy (95% CI) for leukemia (excluding CLL) was 0.45 (0.05, 0.85) and for non-Hodgkin lymphoma (NHL) was 0.33 (0.04, 0.62). For all solid cancers it was 0.06 (0.02, 0.10); lung cancer 0.11 (0.04, 0.19); all solid cancers excluding lung cancer and mesothelioma 0.02 (-0.03, 0.07); Parkinson's disease 0.24 (-0.13, 0.61); IHD -0.03 (-0.06, 0.01); and CeVD 0.05 (-0.08, 0.17). The ERR per 100 mGy for chronic obstructive pulmonary disease (COPD) was 0.19 (0.08, 0.30) and was similar in magnitude to that for lung cancer. This finding suggests that residual confounding by smoking may have influenced the results, warranting cautious interpretations. No significant association was found between cumulative radiation exposure and all solid cancers after excluding lung cancer and mesothelioma, nor for IHD or CeVD. The marginally non-significant increased risk of Parkinson's disease, also seen in other Million Person Study cohorts, requires further investigation. Early workers monitored entirely before 1979 had the same linear ERR per 100 mGy for solid cancers [0.06 (0.00, 0.12) n = 3,587] as for all other more contemporary workers monitored after 1978 [0.07 (0.01,0.13) n = 4,150]. This report provides convincing evidence that low-dose and low-dose-rate exposures over time significantly increases the risk of leukemia (excluding CLL) following cumulative doses up to 200 mGy while also providing information on early versus contemporary workers.