Cataractogenesis following high-LET radiation exposure.

Abstract

Biological effectiveness of ionizing radiation differs with its linear energy transfer (LET) such that high-LET radiation is more effective for various biological endpoints than low-LET radiation. Human exposure to high-LET radiation occurs in cancer patients, nuclear workers, aviators, astronauts and other space travellers. From the radiation protection viewpoint, the ocular lens is among the most radiosensitive tissues in the body, and cataract (a clouding of the normally transparent lens) is classified as tissue reactions (formerly called nonstochastic or deterministic effects) with a threshold below which no effect would occur. To prevent radiation cataracts, the International Commission on Radiological Protection (ICRP) has recommended an equivalent dose limit for the lens according to the threshold for vision-impairing cataracts. ICRP recommended the threshold of >8Gy in 1984 and an occupational dose limit of 150mSv/year in 1980. These remained unchanged until 2011, when ICRP recommended lowering the threshold to 0.5Gy and the dose limit to 20mSv/year (averaged over 5 years with no single year exceeding 50mSv). Although such reduction of the threshold was based on findings from low-LET radiation, the dose limit was recommended in Sv. Historically, the lens is the exceptional tissue for which ICRP had assigned a special factor in addition to a general radiation weighting factor, predicated on a belief that the lens is more vulnerable to high-LET radiation than other tissues. Considering such radiosensitive nature of the lens, a deeper understanding of a cataractogenic potential of high-LET radiation is indispensable. This review is thus designed to provide an update on the current knowledge as to high-LET radiation cataractogenesis. To this end, changes in ICRP recommendations on lenticular radiation protection, epidemiological and biological findings on high-LET cataractogenesis are reviewed, and future research needs are then discussed.