Dose-response assessment deterministic responses

Dose-Response Assessment for Chemicals That Cause Deterministic Effects. For hazardous chemicals that cause deterministic effects and exhibit a threshold in the dose-response relationship, the purpose of the dose-response assessment is to identify the dose of a substance below which it is not likely that there will be an adverse response in humans. Establishing dose-response relationships for chemicals that cause deterministic effects has proved to be complex because (1) multiple responses are possible, (2) the dose-response assessment is usually based on data from animal studies, (3) thousands of such chemicals exist, and (4) the availability and quality of data are highly variable. As a consequence, the scientific community has needed to devise and adhere to a number of methods to quantify the most important (low or safe dose) part of the dose-response relationship. 

There are two possible approaches to estimating the human safe dose for chemicals that cause deterministic effects the use of safety and uncertainty factors and mathematical modeling. The former constitutes the traditional approach to dose-response assessment for chemicals that induce deterministic effects. Biologically-based mathematical modeling approaches that more realistically predict the responses to such chemicals, while newer and not used as widely, hold promise to provide better extrapolations of the dose-response relationship below the lowest dose tested. 

Dose-response concepts. Dose-response assessment for hazardous chemicals that can cause deterministic effects begins with the toxicology data developed during the hazard identification step described in Section 3.1.4.1.2. In many cases, hazard identification and dose-response assessment occur simultaneously. For each chemical, the critical response (a specific response in a specific organ) is identified in the hazard identification process. Using the available data for the critical response, one of the following is established ... 

Although dose-response assessments for deterministic and stochastic effects are discussed separately in this Report, it should be appreciated that many of the concepts discussed in Section 3.2.1.2 for substances that cause deterministic effects apply to substances that cause stochastic effects as well. The processes of hazard identification, including identification of the critical response, and development of data on dose-response based on studies in humans or animals are common to both types of substances. Based on the dose-response data, a NOAEL or a LOAEL can be established based on the limited ability of any study to detect statistically significant increases in responses in exposed populations compared with controls, even though the dose-response relationship is assumed not to have a threshold. Because of the assumed form of the dose-response relationship, however, NOAEL or LOAEL is not normally used as a point of departure to establish safe levels of exposure to substances causing stochastic effects. This is in contrast to the common practice for substances causing deterministic effects of establishing safe levels of exposure, such as RfDs, based on NOAEL or LOAEL (or the benchmark dose) and the use of safety and uncertainty factors. 

Two types of responses from exposure to hazardous substances, called stochastic or deterministic,5 are of concern in risk assessment. The two types of responses are distinguished by the characteristic features of the dose-response relationship, i.e., the relationship between the dose of a hazardous substance and the probability (or frequency) of a response. 

Deterministic Responses. Prevention of deterministic responses is a basic principle of health protection for both radionuclides and hazardous chemicals the goal is to achieve zero probability of such responses. Incidence is the primary measure of deterministic response for any hazardous substance, although prompt fatalities also are of concern at sufficiently high doses. In risk assessments and in establishing deterministic dose limits, no adjustments are made to take into account, for example, the relative severity of different responses with regard to consequent reductions in the quality of life. 

In classifying waste, deterministic responses generally should be of concern only for hazardous chemicals (see Section 3.2.2.1). Therefore, the only important issue for risk assessment is the most appropriate approach to estimating thresholds for induction of responses in humans. The primary concern here is that consistent approaches should be used for all substances that induce deterministic effects. NCRP s recommendation that nominal thresholds in humans should be estimated using the benchmark dose method and a safety factor of 10 or 100, depending on whether the data were obtained in a study in humans or animals (see Section 6.1.2.1), is intended to provide consistency in estimating thresholds for all substances that cause deterministic effects. 

For radiation protection purposes, the biological effects of ionizing radiation are grouped into two main categories, the stochastic and deterministic effects. In both cases, the effects are related to the absorbed doses. Therefore, the knowledge on the dose-response relationships is essential for risk assessment. 

The rationale supporting use of EDi0 as the benchmark dose is that a 10 percent response is at or just below the limit of sensitivity in most animal studies. Use of the lower confidence limit of the benchmark dose, rather than the best (maximum likelihood) estimate (EDio), as the point of departure accounts for experimental uncertainty the difference between the lower confidence limit and the best estimate does not provide information on the variability of responses in humans. In risk assessments for substances that induce deterministic effects, a dose at which significant effects are not observed is not necessarily a dose that results in no effects in any animals, due to the limited sample size. NOAEL obtained using most study protocols is about the same as an LED10. 

In many respects, the foundations and framework of the proposed risk-based hazardous waste classification system and the recommended approaches to implementation are intended to be neutral in regard to the degree of conservatism in protecting public health. With respect to calculations of risk or dose in the numerator of the risk index, important examples include (1) the recommendation that best estimates (MLEs) of probability coefficients for stochastic responses should be used for all substances that cause stochastic responses in classifying waste, rather than upper bounds (UCLs) as normally used in risk assessments for chemicals that induce stochastic effects, and (2) the recommended approach to estimating threshold doses of substances that induce deterministic effects in humans based on lower confidence limits of benchmark doses obtained from studies in humans or animals. Similarly, NCRP believes that the allowable (negligible or acceptable) risks or doses in the denominator of the risk index should be consistent with values used in health protection of the public in other routine exposure situations. NCRP does not believe that the allowable risks or doses assumed for purposes of waste classification should include margins of safety that are not applied in other situations. 

Management of Victims at the Scene of the Accident. At facilities with radioactive sources, trained personnel on every shift should normally provide any first aid required. In case of serious injury, medical personnel from suitable off-site medical centers should be available. The purposes of medical response on-site are to treat traumatic injuries, to assess contamination and perform limited decontamination. If anyone receives high doses exceeding threshold for deterministic effects, it is usually recommended that he or she be transported directly to a highly specialized medical hospital for complete medical examination, treatments, and assessment of the dose. 

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