This document is really useful and well written. It serves as a summary of background and current developments in this area. It primarily deals with the risk of cancer (and genetic effects) from low levels of radiation. These are the basis for determining the primary source of our regulatory limits and in establishing notional bands of risk when applying benefit risk assessments. Applying a universal standard of the detriment associated with low level radiation induced cancer is a difficult. The average person is difficult enough when we take, age gender and radiation susceptibility into account. How an individual’s cancer will impact will on their quality of life will depend on so many aspects including access to advanced health care and technology. The document acknowledges these limitations of detriment assessment. This is particularly true where recent advances in health care, early detection and new treatment can affect overall survival. Also, the impact of key family members, carers, guardians and bread winners being ill on the lives of others.
The importance of this document cannot be underestimated as it provides a basis of notional risk assessment and communication. Although the ESR and ICRP do not recommend use of effective dose equivalent for risk assessment it is the basis of many incident reporting and regulatory interventions. The document is clear, transparent and honest about how these quantities are arrived at. This is essential in deciding the ethical basis for radiation protection. It serves as a useful tool in explaining the concept of radiation detriment, the models used and the complexities therein.
I do not have recommendations for adding or changing the document which is well written and clear. However as medical advances will alter low level radiation induced cancer impact (and inclusion of other effects such as cataracts or cardiovascular), this issue will require regular revisiting.