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Ulanowski A, Ban N, Ozasa K, Rühm W, Semones E, Shavers M, Vaillant L. Time-integrated radiation risk metrics and interpopulation variability of survival. Z Med Phys 2024; 34:64-82. [PMID: 37669888 PMCID: PMC10919971 DOI: 10.1016/j.zemedi.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
Task Group 115 of the International Commission on Radiological Protection is focusing on mission-related exposures to space radiation and concomitant health risks for space crew members including, among others, risk of cancer development. Uncertainties in cumulative radiation risk estimates come from the stochastic nature of the considered health outcome (i.e., cancer), uncertainties of statistical inference and model parameters, unknown secular trends used for projections of population statistics and unknown variability of survival properties between individuals or population groups. The variability of survival is usually ignored when dealing with large groups, which can be assumed well represented by the statistical data for the contemporary general population, either in a specific country or world averaged. Space crew members differ in many aspects from individuals represented by the general population, including, for example, their lifestyle and health status, nutrition, medical care, training and education. The individuality of response to radiation and lifespan is explored in this modelling study. Task Group 115 is currently evaluating applicability and robustness of various risk metrics for quantification of radiation-attributed risks of cancer for space crew members. This paper demonstrates the impact of interpopulation variability of survival curves on values and uncertainty of the estimates of the time-integrated radiation risk of cancer.
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Affiliation(s)
- Alexander Ulanowski
- International Atomic Energy Agency, IAEA Laboratories, Friedensstrasse 1, A-2444 Seibersdorf, Austria.
| | - Nobuhiko Ban
- Nuclear Regulation Authority, 1-9-9 Roppongi, Minato-ku, Tokyo 106-8450, Japan
| | - Kotaro Ozasa
- Health Management Center, Kyoto Prefectural University of Medicine, Kyoto 602-8566 Japan
| | - Werner Rühm
- Federal Office for Radiation Protection, Ingolstädter Landstraße 1, 85764 Oberschleißheim, Germany
| | - Edward Semones
- NASA Space Radiation Analysis Group, Johnson Space Center, Houston, TX, USA
| | - Mark Shavers
- KBR Human Health and Performance, NASA Johnson Space Center, Houston, TX, USA
| | - Ludovic Vaillant
- Centre d'étude sur l'Evaluation de la Protection dans le domaine Nucléaire, 28 rue de la Redoute, 92260 Fontenay aux Roses, France
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2
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Shavers M, Semones E, Tomi L, Chen J, Straube U, Komiyama T, Shurshakov V, Li C, Rühm W. Space agency-specific standards for crew dose and risk assessment of ionising radiation exposures for the International Space Station. Z Med Phys 2024; 34:14-30. [PMID: 37507310 PMCID: PMC10919966 DOI: 10.1016/j.zemedi.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
The Partner Agencies of the International Space Station (ISS) maintain separate career exposure limits and shared Flight Rules that control the ionising radiation exposures that crewmembers can experience due to ambient environments throughout their space missions. In low Earth orbit as well as further out in space, energetic ions referred to as galactic cosmic radiation (GCR) easily penetrate spacecraft and spacecraft contents and consequently are always present at low dose rates. Protons and electrons that are trapped in the Earth's geomagnetic field are encountered intermittently, and a rare energetic solar particle event (SPE) may expose crew to (mostly) energetic protons. Space radiation protection goals are to optimize radiation exposures to maintain deleterious late effects at known and acceptable levels and to prevent any early effects that might compromise crew health and mission success. The conventional radiation protection metric effective dose provides a basic framework for limiting exposures associated with human spaceflight and can be communicated to all stakeholders. Additional metrics and uncertainty analyses are required to understand more completely and to convey nuanced information about potential impacts to an individual astronaut or to a space mission. Missions to remote destinations well beyond low Earth orbit (BLEO) are upcoming and bestow additional challenges that shape design and radiation protection needs. NASA has recently adopted a more permissive career exposure limit based upon effective dose and new restrictions on mission exposures imposed by nuclear technologies. This manuscript reviews the exposure limits that apply to the ISS crewmembers. This work was performed in collaboration with the advisory and guidance efforts of International Commission on Radiological Protection (ICRP) Task Group 115 and will be summarized in an upcoming ICRP Report.
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Affiliation(s)
- Mark Shavers
- KBR Human Health and Performance, NASA Johnson Space Centre, Houston, TX, USA.
| | - Edward Semones
- NASA Space Radiation Analysis Group-Johnson Space Centre, Houston, TX, USA
| | - Leena Tomi
- Canadian Space Agency, Saint-Hubert, Quebec, Canada
| | - Jing Chen
- Radiation Protection Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Ulrich Straube
- European Space Agency ESA, European Astronaut Center EAC, Space Medicine HRE-OM, Cologne, Germany
| | - Tatsuto Komiyama
- Japan Aerospace Exploration Agency (JAXA), Tsukuba Space Center, Ibaraki, Japan
| | | | - Chunsheng Li
- Radiation Protection Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Werner Rühm
- Federal Office of Radiation Protection, Munich, Germany
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Gaza R, Johnson AS, Hayes B, Campbell-Ricketts T, Rakkola J, Abdelmelek M, Zeitlin C, George S, Stoffle N, Castro A, Amberboy C, Semones E. The importance of time-resolved personal Dosimetry in space: The ISS Crew Active Dosimeter. Life Sci Space Res (Amst) 2023; 39:95-105. [PMID: 37945094 DOI: 10.1016/j.lssr.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023]
Abstract
Monitoring space radiation is of vital importance for risk reduction strategies in human space exploration. Radiation protection programs on Earth and in space rely on personal and area radiation monitoring instruments. Crew worn radiation detectors are crucial for successful crew radiation protection programs since they measure what each crewmember experiences in different shielding configurations within the space habitable volume. The Space Radiation Analysis Group at NASA Johnson Space Center investigated several compact, low power, real-time instruments for personal dosimetry. Following these feasibility studies, the Crew Active Dosimeter (CAD) has been chosen as a replacement for the legacy crew passive radiation detectors. The CAD device, based on direct ion storage technology, was developed by Mirion Dosimetry Services to meet the specified NASA design requirements for the International Space Station (ISS) and Artemis programs. After a successful Technology demonstration on ISS, the CAD has been implemented for ISS Crew operations since 2020. The current paper provides an overview of the CAD development, ISS results and comparison with the ISS Radiation Assessment Detector (RAD) and the Radiation Environment Monitor 2 (REM2) instruments.
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Affiliation(s)
- Ramona Gaza
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America.
| | - A Steve Johnson
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America
| | - Bryan Hayes
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America
| | - Thomas Campbell-Ricketts
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America
| | - Jani Rakkola
- Mirion Technologies Inc., Dosimetry Services, Oak Ridge TN 37830, United States of America
| | - Mena Abdelmelek
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; KBR Human Health & Performance, Houston, TX 77058, United States of America
| | - Cary Zeitlin
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America
| | - Stuart George
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; University of Houston, Department of Health and Human Performance, Houston, TX 77204, United States of America
| | - Nicholas Stoffle
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America
| | - Andrew Castro
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America
| | - Clif Amberboy
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; Leidos, Civil Group Integrated Missions Operation, Houston, TX 77058, United States of America
| | - Edward Semones
- Space Radiation Analysis Group, NASA Johnson Space Center, Houston TX 77058, United States of America; NASA Johnson Space Center, Houston TX 77058, United States of America
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Feiveson A, George K, Shavers M, Moreno-Villanueva M, Zhang Y, Babiak-Vazquez A, Crucian B, Semones E, Wu H. Predicting chromosome damage in astronauts participating in international space station missions. Sci Rep 2021; 11:5293. [PMID: 33674665 PMCID: PMC7935859 DOI: 10.1038/s41598-021-84242-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 02/12/2021] [Indexed: 01/12/2023] Open
Abstract
Space radiation consists of energetic protons and other heavier ions. During the International Space Station program, chromosome aberrations in lymphocytes of astronauts have been analyzed to estimate received biological doses of space radiation. More specifically, pre-flight blood samples were exposed ex vivo to varying doses of gamma rays, while post-flight blood samples were collected shortly and several months after landing. Here, in a study of 43 crew-missions, we investigated whether individual radiosensitivity, as determined by the ex vivo dose-response of the pre-flight chromosome aberration rate (CAR), contributes to the prediction of the post-flight CAR incurred from the radiation exposure during missions. Random-effects Poisson regression was used to estimate subject-specific radiosensitivities from the preflight dose-response data, which were in turn used to predict post-flight CAR and subject-specific relative biological effectiveness (RBEs) between space radiation and gamma radiation. Covariates age, gender were also considered. Results indicate that there is predictive value in background CAR as well as radiosensitivity determined preflight for explaining individual differences in post-flight CAR over and above that which could be explained by BFO dose alone. The in vivo RBE for space radiation was estimated to be approximately 3 relative to the ex vivo dose response to gamma irradiation. In addition, pre-flight radiosensitivity tended to be higher for individuals having a higher background CAR, suggesting that individuals with greater radiosensitivity can be more sensitive to other environmental stressors encountered in daily life. We also noted that both background CAR and radiosensitivity tend to increase with age, although both are highly variable. Finally, we observed no significant difference between the observed CAR shortly after mission and at > 6 months post-mission.
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Affiliation(s)
| | | | | | - Maria Moreno-Villanueva
- NASA Johnson Space Center, Houston, TX, 77058, USA.,Human Performance Research Centre, Department of Sport Science, University of Konstanz, Box 30, 78457, Konstanz, Germany
| | - Ye Zhang
- Kennedy Space Center, Cape Canaveral, Florida, USA
| | | | | | | | - Honglu Wu
- NASA Johnson Space Center, Houston, TX, 77058, USA.
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5
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Hu S, Barzilla JE, Semones E. Acute radiation risk assessment and mitigation strategies in near future exploration spaceflights. Life Sci Space Res (Amst) 2020; 24:25-33. [PMID: 31987477 DOI: 10.1016/j.lssr.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
As more exploration spaceflights are planned to travel beyond the protective Earth magnetosphere to deep space destinations, acute health risks due to possible high radiation doses during severe Solar Particle Events (SPEs) are of greater concern to mission planners and management teams. It is expected that some degree of Acute Radiation Syndromes (ARS) symptoms may be observed, but the specific list of health risks that are relevant to exploration missions has been ambiguous and debatable in the past. This mini-review gives a brief summary of the features of radiation exposure if astronauts encounter severe SPEs beyond Low Earth Orbit (LEO), the evidence of ARS radiobiological studies at exposure levels close to recommended limits, and the shortcomings of previous dose projection approaches for ARS risk assessment. Some ARS biomathematical models, particularly those pertinent to the dose ranges that severe SPEs beyond LEO could generate, are reviewed and evaluated, focusing on their capability to predict the incidence of performance incapacitation and time-phased health effects with subsequent medical care recommendations. Using onboard active dosimeter input for estimating organ doses and likely clinical outcomes for SPEs in real time, a new strategy for ARS assessment and mitigation is described to cope with the potential threats of severe SPEs for planned deep space missions.
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Affiliation(s)
- S Hu
- KBR, Houston, TX, United States.
| | | | - E Semones
- NASA Johnson Space Center, Houston TX, United States
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Norbury JW, Schimmerling W, Slaba TC, Azzam EI, Badavi FF, Baiocco G, Benton E, Bindi V, Blakely EA, Blattnig SR, Boothman DA, Borak TB, Britten RA, Curtis S, Dingfelder M, Durante M, Dynan WS, Eisch AJ, Robin Elgart S, Goodhead DT, Guida PM, Heilbronn LH, Hellweg CE, Huff JL, Kronenberg A, La Tessa C, Lowenstein DI, Miller J, Morita T, Narici L, Nelson GA, Norman RB, Ottolenghi A, Patel ZS, Reitz G, Rusek A, Schreurs AS, Scott-Carnell LA, Semones E, Shay JW, Shurshakov VA, Sihver L, Simonsen LC, Story MD, Turker MS, Uchihori Y, Williams J, Zeitlin CJ. Galactic cosmic ray simulation at the NASA Space Radiation Laboratory. Life Sci Space Res (Amst) 2016; 8:38-51. [PMID: 26948012 PMCID: PMC5771487 DOI: 10.1016/j.lssr.2016.02.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 05/21/2023]
Abstract
Most accelerator-based space radiation experiments have been performed with single ion beams at fixed energies. However, the space radiation environment consists of a wide variety of ion species with a continuous range of energies. Due to recent developments in beam switching technology implemented at the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL), it is now possible to rapidly switch ion species and energies, allowing for the possibility to more realistically simulate the actual radiation environment found in space. The present paper discusses a variety of issues related to implementation of galactic cosmic ray (GCR) simulation at NSRL, especially for experiments in radiobiology. Advantages and disadvantages of different approaches to developing a GCR simulator are presented. In addition, issues common to both GCR simulation and single beam experiments are compared to issues unique to GCR simulation studies. A set of conclusions is presented as well as a discussion of the technical implementation of GCR simulation.
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Affiliation(s)
| | - Walter Schimmerling
- East Carolina University, Greenville, NC 27858, USA; Universities Space Research Association, Houston, TX 77058, USA
| | - Tony C Slaba
- NASA Langley Research Center, Hampton, VA 23681, USA
| | | | | | - Giorgio Baiocco
- Department of Physics, University of Pavia, 27100, Pavia, Italy
| | - Eric Benton
- Oklahoma State University, Stillwater, OK 74074, USA
| | | | | | | | - David A Boothman
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | | | - Stan Curtis
- 11771 Sunset Ave. NE, Bainbridge Island, WA 98110, USA
| | | | - Marco Durante
- GSI Helmholtz Center for Heavy Ion Research, 64291 Darmstadt, Germany
| | | | - Amelia J Eisch
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | | | - Peter M Guida
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | | | | | - Janice L Huff
- Universities Space Research Association, Houston, TX 77058, USA
| | - Amy Kronenberg
- Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | | | | | - Jack Miller
- Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | | | - Livio Narici
- University of Rome Tor Vergata & INFN, 00133 Rome, Italy
| | | | - Ryan B Norman
- NASA Langley Research Center, Hampton, VA 23681, USA
| | | | | | | | - Adam Rusek
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | | | | | | | - Jerry W Shay
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Lembit Sihver
- Technische Universität Wien - Atominstitut, 1020 Vienna, Austria; EBG MedAustron GmbH, 2700 Wiener Neustadt, Austria
| | | | - Michael D Story
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Yukio Uchihori
- National Institute of Radiological Sciences, Chiba 263-8555, Japan
| | | | - Cary J Zeitlin
- Lockheed Martin Information Systems & Global Solutions, Houston, TX 77058, USA
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Kroupa M, Bahadori A, Campbell-Ricketts T, Empl A, Hoang SM, Idarraga-Munoz J, Rios R, Semones E, Stoffle N, Tlustos L, Turecek D, Pinsky L. A semiconductor radiation imaging pixel detector for space radiation dosimetry. Life Sci Space Res (Amst) 2015; 6:69-78. [PMID: 26256630 DOI: 10.1016/j.lssr.2015.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
Progress in the development of high-performance semiconductor radiation imaging pixel detectors based on technologies developed for use in high-energy physics applications has enabled the development of a completely new generation of compact low-power active dosimeters and area monitors for use in space radiation environments. Such detectors can provide real-time information concerning radiation exposure, along with detailed analysis of the individual particles incident on the active medium. Recent results from the deployment of detectors based on the Timepix from the CERN-based Medipix2 Collaboration on the International Space Station (ISS) are reviewed, along with a glimpse of developments to come. Preliminary results from Orion MPCV Exploration Flight Test 1 are also presented.
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Affiliation(s)
| | - Amir Bahadori
- Space Radiation Analysis Group, National Aeronautics and Space Administration, Johnson Space Center, Houston, TX, USA
| | | | | | | | | | | | - Edward Semones
- Space Radiation Analysis Group, National Aeronautics and Space Administration, Johnson Space Center, Houston, TX, USA
| | | | | | - Daniel Turecek
- University of Houston, Houston, TX, USA; Institute of Experimental and Applied Physics, Czech Technical University in Prague, Prague, Czech Republic
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Bahadori A, Picco C, Flores-McLaughlin J, Shavers M, Semones E. MO-F-110-05: Automation of PCXMC and ImPACT for NASA Astronaut Medical Imaging Dose and Risk Tracking. Med Phys 2011. [DOI: 10.1118/1.3613027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bahadori A, Shavers M, Baalen MV, Semones E, Bolch W. MO-F-BRA-05: Comparison of Organ Dosimetry for Astronaut Phantoms: Earth-Based vs. Microgravity-Based Anthropometry and Body Positioning. Med Phys 2011. [DOI: 10.1118/1.3613000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Reitz G, Berger T, Bilski P, Facius R, Hajek M, Petrov V, Puchalska M, Zhou D, Bossler J, Akatov Y, Shurshakov V, Olko P, Ptaszkiewicz M, Bergmann R, Fugger M, Vana N, Beaujean R, Burmeister S, Bartlett D, Hager L, Pálfalvi J, Szabó J, O'Sullivan D, Kitamura H, Uchihori Y, Yasuda N, Nagamatsu A, Tawara H, Benton E, Gaza R, McKeever S, Sawakuchi G, Yukihara E, Cucinotta F, Semones E, Zapp N, Miller J, Dettmann J. Astronaut's Organ Doses Inferred from Measurements in a Human Phantom Outside the International Space Station. Radiat Res 2009; 171:225-35. [DOI: 10.1667/rr1559.1] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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O'Sullivan D, Zhou D, Semones E, Heinrich W, Flood E. Dose equivalent, absorbed dose and charge spectrum investigation in low Earth orbit. Adv Space Res 2004; 34:1420-3. [PMID: 15881785 DOI: 10.1016/j.asr.2003.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Particle intensity, dose equivalent and absorbed dose have been measured on board the space shuttle Endeavour during STS-108 in December 2001 by Dublin Institute for Advanced Studies (DIAS). The dose estimates are based on very accurate measurements of recoils produced in CR-39 by cosmic ray primary and secondary protons and heavier nuclei and by secondary neutrons. The corresponding LET spectra were used to determine dose equivalent and absorbed dose values. Estimates of the total flux of Z > or = 2 nuclei have been undertaken and a preliminary charge spectrum was measured. Some comparisons are made with preliminary data obtained on STS-105 (ISS Expedition) and other missions using CR-39 detectors.
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Affiliation(s)
- D O'Sullivan
- Dublin Institute for Advanced Studies, Astrophysics Section, Dublin, Ireland.
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Job PK, Pisharody M, Semones E. Absorbed Dose from 7-GeV Bremsstrahlung in a PMMA Phantom. J NUCL SCI TECHNOL 2000. [DOI: 10.1080/00223131.2000.10874879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Semones E. Therapy for acute otitis media. Arch Pediatr Adolesc Med 1996; 150:1315. [PMID: 8954012 DOI: 10.1001/archpedi.1996.02170370093024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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