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Analysis of Chromosomal Aberrations in the Blood Lymphocytes of Astronauts after Space Flight

It is a NASA requirement that biodosimetry analysis be performed on all US astronauts who participate in long duration missions of 3 months or more onboard the International Space Station. Cytogenetic analysis of blood lymphocytes is the most sensitive and reliable biodosimetry method available at present, especially if chromosome damage is assessed before as well as after space flight. Results provide a direct measurement of space radiation damage in vivo that takes into account individual radiosensitivity and considers the influence of microgravity and other stress conditions. We present data obtained from all twenty-five of the crewmembers who have participated in the biodosimetry program so far. The yield of chromosome exchanges, measured using fluorescence in situ hybridization (FISH) technique with chromosome painting probes, increased after space flight for all these individuals. In vivo dose was derived from frequencies of chromosome exchanges using preflight calibration curves of in vitro exposed cells from the same individual, and RBE was compared with individually measured physically absorbed dose and projected organ dose equivalents. Biodosimetry estimates using samples collected within a few weeks of return from space lie within the range expected from physical dosimetry. For some of these individuals chromosome aberrations were assessed again several months after their respective missions and a temporal decline in stable exchanges was observed in some cases, suggesting that translocations are unstable with time after whole body exposure to space radiation. This may indicate complications with the use of translocations for retrospective dose reconstruction. Data from one crewmember who has participated in two separate long duration space missions and has been followed up for over 10 years provides limited data on the effect of repeat flights and shows a possible adaptive response to space radiation exposure.

George, K.↗

Fundamentals of Aerospace Medicine: Cosmic Radiation

Cosmic rays were discovered in 1911 by the Austrian physicist, Victor Hess. The planet earth is continuously bathed in high-energy galactic cosmic ionizing radiation (GCR), emanating from outside the solar system, and sporadically exposed to bursts of energetic particles from the sun referred to as solar particle events (SPEs). The main source of GCR is believed to be supernovae (exploding stars), while occasionally a disturbance in the sun's atmosphere (solar flare or coronal mass ejection) leads to a surge of radiation particles with sufficient energy to penetrate the earth's magnetic field and enter the atmosphere. The inhabitants of planet earth gain protection from the effects of cosmic radiation from the earth s magnetic field and the atmosphere, as well as from the sun's magnetic field and solar wind. These protective effects extend to the occupants of aircraft flying within the earth s atmosphere, although the effects can be complex for aircraft flying at high altitudes and high latitudes. Travellers in space do not have the benefit of this protection and are exposed to an ionizing radiation field very different in magnitude and quality from the exposure of individuals flying in commercial airliners. The higher amounts and distinct types of radiation qualities in space lead to a large need for understanding the biological effects of space radiation. It is recognized that although there are many overlaps between the aviation and the space environments, there are large differences in radiation dosimetry, risks and protection for airline crew members, passengers and astronauts. These differences impact the application of radiation protection principles of risk justification, limitation, and the principle of as low as reasonably achievable (ALARA). This chapter accordingly is divided into three major sections, the first dealing with the basic physics and health risks, the second with the commercial airline experience, and the third with the aspects of cosmic radiation appertaining to space travel including future considerations.

Bagshaw, Michael↗

Persistence of Space Radiation Induced Cytogenetic Damage in the Blood Lymphocytes of Astronauts

Cytogenetic damage in astronaut's peripheral blood lymphocytes is a useful in vivo marker of space radiation induced damage. Moreover, if radiation induced chromosome translocations persist in peripheral blood lymphocytes for many years, as has been assumed, they could potentially be used to measure retrospective doses or prolonged low dose rate exposures. However, as more data becomes available, evidence suggests that the yield of translocations may decline with time after exposure, at least in the case of space radiation exposures. We present our latest follow-up measurements of chromosome aberrations in astronauts blood lymphocytes assessed by FISH painting and collected a various times beginning directly after return from space to several years after flight. For most individuals the analysis of individual time-courses for translocations revealed a temporal decline of yields with different half-lives. Since the level of stable aberrations depends on the interplay between natural loss of circulating T-lymphocytes and replenishment from the stem or progenitor cells, the differences in the rates of decay could be explained by inter-individual variation in lymphocyte turn over. Biodosimetry estimates derived from cytogenetic analysis of samples collected a few days after return to earth lie within the range expected from physical dosimetry. However, a temporal decline in yields may indicate complications with the use of stable aberrations for retrospective dose reconstruction, and the differences in the decay time may reflect individual variability in risk from space radiation exposure. In addition, limited data on multiple flights show a lack of correlation between time in space and translocation yields. Data from one crewmember who has participated in two separate long-duration space missions and has been followed up for over 10 years provides limited information on the effect of repeat flights and show a possible adaptive response to space radiation exposure.

George, Kerry↗

Persistence of Space Radiation-Induced Cytogenetic Damage in the Blood Lymphocytes of Astronauts and the Effects of Repeat Long Duration Space Missions

The yield of chromosome damage in astronauts blood lymphocytes has been shown to increase after long duration space missions of a few months or more. This provides a useful in vivo measurement of space radiation induced damage that takes into account individual radiosensitivity and considers the influence of microgravity and other stress conditions. We present our latest follow-up analyses of chromosome damage in astronauts blood lymphocytes assessed by fluorescence in situ hybridization (FISH) chromosome painting and collected at various times, from directly after return from space to several years after flight. For most individuals the analysis of individual time-courses for translocations revealed a temporal decline of yields with different half-lives. Dose was derived from frequencies of chromosome exchanges using preflight calibration curves, and estimates derived from samples collected a few days after return to earth lie within the range expected from physical dosimetry. However, a temporal decline in yields may indicate complications with the use of stable aberrations for retrospective dose reconstruction, and the differences in the decay time may reflect individual variability in risk from space radiation exposure. Limited data on three individuals who have participated in repeat long duration space flights indicates a lack of correlation between time in space and translocation yields, and show a possible adaptive response to space radiation exposure.

George, Kerry A.↗

Identification of Trends into Dose Calculations for Astronauts through Performing Sensitivity Analysis on Calculational Models Used by the Radiation Health Office

The Radiation Health Office (RHO) determines each astronaut s cancer risk by using models to associate the amount of radiation dose that astronauts receive from spaceflight missions. The baryon transport codes (BRYNTRN), high charge (Z) and energy transport codes (HZETRN), and computer risk models are used to determine the effective dose received by astronauts in Low Earth orbit (LEO). This code uses an approximation of the Boltzman transport formula. The purpose of the project is to run this code for various International Space Station (ISS) flight parameters in order to gain a better understanding of how this code responds to different scenarios. The project will determine how variations in one set of parameters such as, the point of the solar cycle and altitude can affect the radiation exposure of astronauts during ISS missions. This project will benefit NASA by improving mission dosimetry.

Adams, Thomas↗

Directional Spherical Cherenkov Detector

A proposed radiation-detecting apparatus would provide information on the kinetic energies, directions, and electric charges of highly energetic incident subatomic particles. The apparatus was originally intended for use in measuring properties of cosmic rays in outer space, but could also be adapted to terrestrial uses -- for example, radiation dosimetry aboard high-altitude aircraft and in proton radiation therapy for treatment of tumors.

Wrbanek, John D.↗

Effect of Anatomical Modeling on Space Radiation Dose Estimates: A Comparison of Doses for NASA Phantoms and 5th, 50th, and 95th Percentile UF Hybrid Phantoms

The estimate of absorbed dose to individual organs of a space crewmember is affected by the geometry of the anatomical model of the astronaut used in the radiation transport calculation. For astronaut dosimetry, NASA currently uses the computerized anatomical male (CAM) and computerized anatomical female (CAF) stylized phantoms to represent astronauts in its operational radiation dose analyses. These phantoms are available in one size and in two body positions. In contrast, the UF Hybrid Adult Male and Female (UFHADM and UFHADF) phantoms have organ shapes based on actual CT data. The surfaces of these phantoms are defined by non-uniform rational B-spline surfaces, and are thus flexible in terms of body morphometry and extremity positioning. In this study, UFHADM and UFHADF are scaled to dimensions corresponding to 5th, 50th, and 95th percentile (PCTL) male and female astronauts. A ray-tracing program is written in Visual Basic 2008, which is then used to create areal density maps for dose points corresponding to various organs within the phantoms. The areal density maps, along with appropriate space radiation spectra, are input into the NASA program couplet HZETRN/BRYNTRN, and organ doses are calculated. The areal density maps selected tissues and organs of the 5th, 50th, and 95th PCTL male and female phantoms are presented and compared. In addition, the organ doses for the 5th, 50th, and 95th PCTL male and female phantoms are presented and compared to organ doses for CAM and CAF.

Bahadori, A.↗

International Space Station Acoustics - A Status Report

It is important to control acoustic noise aboard the International Space Station (ISS) to provide a satisfactory environment for voice communications, crew productivity, and restful sleep, and to minimize the risk for temporary and permanent hearing loss. Acoustic monitoring is an important part of the noise control process on ISS, providing critical data for trend analysis, noise exposure analysis, validation of acoustic analysis and predictions, and to provide strong evidence for ensuring crew health and safety, thus allowing Flight Certification. To this purpose, sound level meter (SLM) measurements and acoustic noise dosimetry are routinely performed. And since the primary noise sources on ISS include the environmental control and life support system (fans and airflow) and active thermal control system (pumps and water flow), acoustic monitoring will indicate changes in hardware noise emissions that may indicate system degradation or performance issues. This paper provides the current acoustic levels in the ISS modules and sleep stations, and is an update to the status presented in 20031. Many new modules, and sleep stations have been added to the ISS since that time. In addition, noise mitigation efforts have reduced noise levels in some areas. As a result, the acoustic levels on the ISS have improved.

Allen, Christopher S.↗

Analysis of Noise Exposure Measurements Made Onboard the International Space Station

The International Space Station (ISS) is a unique workplace environment for U.S. astronauts and Russian cosmonauts to conduct research and live for a period of six months or more. Noise has been an enduring environmental physical hazard that has been a challenge for the U.S. space program since before the Apollo era. Noise exposure in ISS poses significant risks to the crewmembers, such as; hearing loss (temporary or permanent), possible disruptions of crew sleep, interference with speech intelligibility and communication, possible interference with crew task performance, and possible reduction in alarm audibility. Acoustic measurements are made aboard ISS and compared to requirements in order to assess the acoustic environment to which the crewmembers are exposed. The purpose of this paper is to describe in detail the noise exposure monitoring program as well as an assessment of the acoustic dosimeter data collected to date. The hardware currently being used for monitoring the noise exposure onboard ISS will be discussed. Acoustic data onboard ISS has been collected since the beginning of ISS (Increment 1, November 2000). Noise exposure data analysis will include acoustic dosimetry logged data from crew-worn during work and sleep periods and also fixed-location measurements from Increment 1 to present day. Noise exposure levels (8-, 16- and 24-hr), LEQ, will also be provided and discussed in this paper. Discussions related to hearing protection will also be included. Future directions and recommendations for the noise exposure monitoring program will be highlighted. This acoustic data is used to ensure a safe and healthy working and living environment for the crewmembers aboard the ISS.

Limardo, Jose G.↗

Life Support and Habitation Systems: Crew Support and Protection for Human Exploration Missions Beyond Low Earth Orbit

Life Support and Habitation Systems (LSHS) is one of 10 Foundational Domains as part of the National Aeronautics and Space Administration s proposed Enabling Technology Development and Demonstration (ETDD) Program. LSHS will develop and mature technologies to sustain life on long duration human missions beyond Low Earth Orbit that are reliable, have minimal logistics supply and increase self-sufficiency. For long duration exploration missions, further closure of life support systems is paramount, including focus on key technologies for atmosphere revitalization, water recovery, waste management, thermal control and crew accommodation that recover additional consumable mass, reduce requirements for power, volume, heat rejection, crew involvement, and which have increased reliability and capability. Other areas of focus include technologies for radiation protection, environmental monitoring and fire protection. Beyond LEO, return to Earth will be constrained. The potability of recycled water and purity of regenerated air must be measured and certified aboard the spacecraft. Missions must be able to recover from fire events through early detection, use of non-toxic suppression agents, and operation of recovery systems that protect on-board Environmental Control and Life Support (ECLS) hardware. Without the protection of the Earth s geomagnetic field, missions beyond LEO must have improved radiation shielding and dosimetry, as well as warning systems to protect the crew against solar particle events. This paper will describe plans for the new LSHS Foundational Domain and mission factors that will shape its technology development portfolio.

Barta, Daniel J.↗

Cytogenetic Biodosimetry Using the Blood Lymphocytes of Astronauts

Cytogenetic analysis of blood lymphocytes remains the most sensitive and reliable method available for in vivo assessment of the biological effects of exposure to radiation and provides the most informative measurement of radiation induced health risks. To date chromosome damage has been assessed in lymphocytes from more than 30 astronauts before and after they participated in long-duration space missions of three months or more on board the International Space Station. For all individuals, the frequency of chromosome damage measured within a month of return from space was higher than their prefight yield and biodosimetry estimates lie within the range expected from physical dosimetry. Biodosimetry data provides a direct measurement of space radiation damage, which takes into account individual radiosensitivity in the presence of confounding factors such as microgravity and other stress conditions. In contrast to physical measurements, which are external to body and require multiple devices to detect all radiation types all of which have poor sensitivity to neutrons, biodosimetry is internal and includes the effects of shielding provided by the body itself plus chromosome damage shows excellent sensitivity to protons, heavy ions, and neutrons. In addition, chromosome damage is reflective of cancer risk and biodosimetry values can therefore be used to validate and develop risk assessment models that can be used to characterize excess health risk incurred by crewmembers. A review of astronaut biodosimetry data will be presented along with recent findings on the persistence of space radiation induced chromosome damage and the cytogenetic effects of repeat long duration missions

George, Kerry↗

Cancer Risk Estimates from Space Flight Estimated Using Yields of Chromosome Damage in Astronaut's Blood Lymphocytes

To date, cytogenetic damage has been assessed in blood lymphocytes from more than 30 astronauts before and after they participated in long-duration space missions of three months or more on board the International Space Station. Chromosome damage was assessed using fluorescence in situ hybridization whole chromosome analysis techniques. For all individuals, the frequency of chromosome damage measured within a month of return from space was higher than their preflight yield, and biodosimetry estimates were within the range expected from physical dosimetry. Follow up analyses have been performed on most of the astronauts at intervals ranging from around 6 months to many years after flight, and the cytogenetic effects of repeat long-duration missions have so far been assessed in four individuals. Chromosomal aberrations in peripheral blood lymphocytes have been validated as biomarkers of cancer risk and cytogenetic damage can therefore be used to characterize excess health risk incurred by individual crewmembers after their respective missions. Traditional risk assessment models are based on epidemiological data obtained on Earth in cohorts exposed predominantly to acute doses of gamma-rays, and the extrapolation to the space environment is highly problematic, involving very large uncertainties. Cytogenetic damage could play a key role in reducing uncertainty in risk estimation because it is incurred directly in the space environment, using specimens from the astronauts themselves. Relative cancer risks were estimated from the biodosimetry data using the quantitative approach derived from the European Study Group on Cytogenetic Biomarkers and Health database. Astronauts were categorized into low, medium, or high tertiles according to their yield of chromosome damage. Age adjusted tertile rankings were used to estimate cancer risk and results were compared with values obtained using traditional modeling approaches. Individual tertile rankings increased after space flight and analysis of follow up samples indicated that the tertile rankings remained in the high category for more than 50% of the individuals assessed so far. Crewmembers that shift and remain in the high category are projected to have increased life-time cancer risk.

George, Kerry A.↗

New Modeling Approaches to Investigate Cell Signaling in Radiation Response

Ionizing radiation damages individual cells and tissues leading to harmful biological effects. Among many radiation-induced lesions, DNA double-strand breaks (DSB) are considered the key precursors of most early and late effects [1] leading to direct mutation or aberrant signal transduction processes. In response to damage, a flow of information is communicated to cells not directly hit by the radiation through signal transduction pathways [2]. Non-targeted effects (NTE), which includes bystander effects and genomic instability in the progeny of irradiated cells and tissues, may be particularly important for space radiation risk assessment [1], because astronauts are exposed to a low fluence of heavy ions and only a small fraction of cells are traversed by an ion. NTE may also have important consequences clinical radiotherapy [3]. In the recent years, new simulation tools and modeling approaches have become available to study the tissue response to radiation. The simulation of signal transduction pathways require many elements such as detailed track structure calculations, a tissue or cell culture model, knowledge of biochemical pathways and Brownian Dynamics (BD) propagators of the signaling molecules in their micro-environment. Recently, the Monte-Carlo simulation code of radiation track structure RITRACKS was used for micro and nano-dosimetry calculations [4]. RITRACKS will be used to calculate the fraction of cells traversed by an ion and delta-rays and the energy deposited in cells in a tissue model. RITRACKS also simulates the formation of chemical species by the radiolysis of water [5], notably the .OH radical. This molecule is implicated in DNA damage and in the activation of the transforming growth factor beta (TGF), a signaling molecule involved in NTE. BD algorithms for a particle near a membrane comprising receptors were also developed and will be used to simulate trajectories of signaling molecules in the micro-environment and characterize autocrine and paracrine cell communication and signal transduction.

Plante, Ianik↗

Analysis of Noise Exposure Measurements Acquired Onboard the International Space Station

The International Space Station (ISS) is a unique workplace environment for U.S. astronauts and Russian cosmonauts to conduct research and live for a period of six months or more. Noise has been an enduring environmental physical hazard that has been a challenge for the U.S. space program since before the Apollo era. Noise exposure in ISS poses significant risks to the crewmembers, such as; hearing loss (temporary or permanent), possible disruptions of crew sleep, interference with speech intelligibility and communication, possible interference with crew task performance, and possible reduction in alarm audibility. Acoustic measurements were made onboard ISS and compared to requirements in order to assess the acoustic environment to which the crewmembers are exposed. The purpose of this paper is to describe in detail the noise exposure monitoring program as well as an assessment of the acoustic dosimeter data collected to date. The hardware currently being used for monitoring the noise exposure onboard ISS will be discussed. Acoustic data onboard ISS has been collected since the beginning of ISS (Increment 1, November 2001). Noise exposure data analysis will include acoustic dosimetry logged data from crew-worn dosimeters during work and sleep periods and also fixed-location measurements from Increment 1 to present day. Noise exposure levels (8-, 16- and 24-hr), LEQ, will also be provided and discussed in this paper. Future directions and recommendations for the noise exposure monitoring program will be highlighted. This acoustic data is used to ensure a safe and healthy working and living environment for the crewmembers onboard the ISS.

Limardo, Jose G.↗

ISS and Space Shuttle Radiation Measurements at Solar Minimum

A summary of 2008-2011 ISS and Space Shuttle radiation dosimetry results for inside vehicle radiation monitoring in low-Earth orbit will be presented. Results include new data from ISS Expedition 22-25/20A radiation area monitors (RAM) and Shuttle Missions STS127-STS133 passive radiation dosimeters (PRD). ISS 20A radiation measurement locations included three Node 2 crew quarters locations at NOD2S5_CQ, NOD2P5_CQ and CQ-3 (Deck), as well as ESA Columbus, and JAXA Kibo locations. ISS 20A and STS127-STS133 missions were flown at 51.6 inclination with an altitude range of 330-350 km. The passive radiation results will be presented in terms of measured daily dose obtained using luminescence detectors (i.e., Al2O3:C, LiF:Mg,Ti and CaF2:Tm). In addition, preliminary results from the DOSIS 2 Project, in collaboration with the German Space Agency (DLR) will be presented. SRAG s participation to the DOSIS 2 exposure on ISS (11/16/2009-05/26/2010) involved passive radiation measurements at 10 different shielding locations inside the ESA Columbus Module.

Gaza, Ramona↗

NASA Tech Briefs, December 2005

Topics covered include: Video Mosaicking for Inspection of Gas Pipelines; Shuttle-Data-Tape XML Translator; Highly Reliable, High-Speed, Unidirectional Serial Data Links; Data-Analysis System for Entry, Descent, and Landing; Hybrid UV Imager Containing Face-Up AlGaN/GaN Photodiodes; Multiple Embedded Processors for Fault-Tolerant Computing; Hybrid Power Management; Magnetometer Based on Optoelectronic Microwave Oscillator; Program Predicts Time Courses of Human/ Computer Interactions; Chimera Grid Tools; Astronomer's Proposal Tool; Conservative Patch Algorithm and Mesh Sequencing for PAB3D; Fitting Nonlinear Curves by Use of Optimization Techniques; Tool for Viewing Faults Under Terrain; Automated Synthesis of Long Communication Delays for Testing; Solving Nonlinear Euler Equations With Arbitrary Accuracy; Self-Organizing-Map Program for Analyzing Multivariate Data; Tool for Sizing Analysis of the Advanced Life Support System; Control Software for a High-Performance Telerobot; Java Radar Analysis Tool; Architecture for Verifiable Software; Tool for Ranking Research Options; Enhanced, Partially Redundant Emergency Notification System; Close-Call Action Log Form; Task Description Language; Improved Small-Particle Powders for Plasma Spraying; Bonding-Compatible Corrosion Inhibitor for Rinsing Metals; Wipes, Coatings, and Patches for Detecting Hydrazines; Rotating Vessels for Growing Protein Crystals; Oscillating-Linear-Drive Vacuum Compressor for CO2; Mechanically Biased, Hinged Pairs of Piezoelectric Benders; Apparatus for Precise Indium-Bump Bonding of Microchips; Radiation Dosimetry via Automated Fluorescence Microscopy; Multistage Magnetic Separator of Cells and Proteins; Elastic-Tether Suits for Artificial Gravity and Exercise; Multichannel Brain-Signal-Amplifying and Digitizing System; Ester-Based Electrolytes for Low-Temperature Li-Ion Cells; Hygrometer for Detecting Water in Partially Enclosed Volumes; Radio-Frequency Plasma Cleaning of a Penning Malmberg Trap; Reduction of Flap Side Edge Noise - the Blowing Flap; and Preventing Accidental Ignition of Upper-Stage Rocket Motors.

Source record↗

Computational Transport Modeling of High-Energy Neutrons Found in the Space Environment

The high charge and high energy (HZE) particle radiation environment in space interacts with spacecraft materials and the human body to create a population of neutrons encompassing a broad kinetic energy spectrum. As an HZE ion penetrates matter, there is an increasing chance of fragmentation as penetration depth increases. When an ion fragments, secondary neutrons are released with velocities up to that of the primary ion, giving some neutrons very long penetration ranges. These secondary neutrons have a high relative biological effectiveness, are difficult to effectively shield, and can cause more biological damage than the primary ions in some scenarios. Ground-based irradiation experiments that simulate the space radiation environment must account for this spectrum of neutrons. Using the Particle and Heavy Ion Transport Code System (PHITS), it is possible to simulate a neutron environment that is characteristic of that found in spaceflight. Considering neutron dosimetry, the focus lies on the broad spectrum of recoil protons that are produced in biological targets. In a biological target, dose at a certain penetration depth is primarily dependent upon recoil proton tracks. The PHITS code can be used to simulate a broad-energy neutron spectrum traversing biological targets, and it account for the recoil particle population. This project focuses on modeling a neutron beamline irradiation scenario for determining dose at increasing depth in water targets. Energy-deposition events and particle fluence can be simulated by establishing cross-sectional scoring routines at different depths in a target. This type of model is useful for correlating theoretical data with actual beamline radiobiology experiments. Other work exposed human fibroblast cells to a high-energy neutron source to study micronuclei induction in cells at increasing depth behind water shielding. Those findings provide supporting data describing dose vs. depth across a water-equivalent medium. This poster presents PHITS data suggesting an increase in dose, up to roughly 10 cm depth, followed by a continual decrease as neutrons come to a stop in the target.

Cox, Brad↗

Space Radiation Cancer Risk Projections and Uncertainties - 2010

Uncertainties in estimating health risks from galactic cosmic rays greatly limit space mission lengths and potential risk mitigation evaluations. NASA limits astronaut exposures to a 3% risk of exposure-induced death and protects against uncertainties using an assessment of 95% confidence intervals in the projection model. Revisions to this model for lifetime cancer risks from space radiation and new estimates of model uncertainties are described here. We review models of space environments and transport code predictions of organ exposures, and characterize uncertainties in these descriptions. We summarize recent analysis of low linear energy transfer radio-epidemiology data, including revision to Japanese A-bomb survivor dosimetry, longer follow-up of exposed cohorts, and reassessments of dose and dose-rate reduction effectiveness factors. We compare these projections and uncertainties with earlier estimates. Current understanding of radiation quality effects and recent data on factors of relative biological effectiveness and particle track structure are reviewed. Recent radiobiology experiment results provide new information on solid cancer and leukemia risks from heavy ions. We also consider deviations from the paradigm of linearity at low doses of heavy ions motivated by non-targeted effects models. New findings and knowledge are used to revise the NASA risk projection model for space radiation cancer risks.

Cucinotta, Francis A.↗