Deterministic effects.

Abstract

Deterministic effects are distinguished from stochastic effects for radiation protection purposes by the following characteristics: both incidence and severity increase as a function of dose after a threshold dose is reached. Cell killing is central to all deterministic effects with the exception of radiation-induced cataracts. The understanding of radiation-induced killing of cells has increased greatly in the last decade with an extraordinarily intense interest in apoptosis. Programmed cell death has long been known to developmental biologists and the importance of cell death has been recognized and quantified by tumor biologists and students of cell kinetics but the coining of a new name and the increase of understanding of the molecular aspects of cell death has stimulated interest. Some cells appear to be very sensitive to radiation and undergo apoptosis, whereas others such as fibroblasts do not with equal frequency. This characteristic, like many others, underlines the genetic differences among cell types. We are reaching a time that there are techniques and the knowledge to apply them to clinical and radiation protection problems. In radiotherapy, success depends on the differential effect between tumor and normal tissues that is obtained. To design the optimum therapy, a profile of both the tumor cells and the cells of the normal tissues that may be at risk would help. The profile would characterize the radiosensitivity and the underlying factors, which could help in the choice of adjunct therapy for tumor and normal tissue. Fibrosis, a common unwanted late effect, appears to be influenced by genetic factors, at least in experimental animals. Techniques are available for treating people as individuals more than ever before, and that must be a good thing to do. Protection against deterministic effects would seem an easy matter but we are uncomfortably ignorant of the precise effect of protracted low-dose irradiation on tissues, such as the bone marrow and the testis, important features of risk in space. Entering the new century, it may be timely to classify radiation effects, as Radiation Effects Research Foundation (RERF) has done, into cancer, genetic effects, and noncancer effects. The recognition in the atomic-bomb survivors of noncancer effects at doses on the order of 0.5 Sv (half the dose level considered a threshold in earlier studies) should stimulate interest in deterministic effects.