Zusammenfassung
Seit der Einführung ionisierender Strahlen als ein Mittel zur Behandlung und Diagnose beim Menschen haben Wissenschaftler versucht, ihre Nebenwirkungen und potenziellen Risiken für die Gesundheit einzuschätzen. Es gibt nun ausreichende Evidenz für das grundsätzliche Vorliegen einer direkten Beziehung zwischen höheren Dosen und Nebenwirkungsrisiken. Die meisten Unsicherheiten liegen auf dem Gebiet der Niedrigdosisforschung v. a. im Hinblick auf das Risiko der Induktion von Krebs. Niedrigdosiseffekte sind üblicherweise von Bedeutung in der diagnostischen Medizin, während Hochdosisbestrahlungseffekte typischerweise nach strahlentherapeutischen Behandlungen oder nuklearen Unfällen beobachtet werden. Der derzeitige Stand der „Krieg der Theorien“ kann folgendermaßen zusammengefasst werden: die eine Partei von Wissenschaftlern und Vertretern der Gesundheitsbehörden bevorzugt die Hypothese, dass es keine Grenzdosis („linear no threshold hypothesis [LNT] of radiation“) gibt, welche als sicher betrachtet werden kann. Die Kritiker dieser Hypothese schlagen jedoch vor, dass die Risiken unterhalb von 50 mSv nicht messbar oder überhaupt von klinischer Signifikanz sind und außerdem nicht durch eine lineare Dosis-Wirkungs-Beziehung beschrieben werden können. Das Ziel dieses Artikels ist es, die wichtigsten nicht geklärten Fragen auf diesem Gebiet zusammen zu fassen. Argumente werden präsentiert, warum die Gültigkeit des LNT-Modells im Niedrigdosisbereich als zumindest inkonsistent und fragwürdig betrachtet werden sollte.
Abstract
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.
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Selzer, E., Hebar, A. Biologische Wirkung und Tumorrisiko diagnostischer Röntgenstrahlen. Radiologe 52, 892–897 (2012). https://doi.org/10.1007/s00117-012-2336-x
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DOI: https://doi.org/10.1007/s00117-012-2336-x