Paper
SIXTEENTH ANNUAL WARREN K. SINCLAIR KEYNOTE ADDRESS:
FRONTIERS IN MEDICAL RADIATION SCIENCE
C. Norman Coleman1,2
Abstract—On the occasion of the 90th anniversary of National Coun-
cil on Radiation Protection and Measurements (NCRP) and its 55th
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anniversary since being Congressionally Chartered, the theme of
“Providing Best Answers to Your Most Pressing Questions about
Radiation” is most appropriate. The question proposed here is,
“What are the new frontiers for the NCRP with its breadth of talent
and expertise in the rapidly evolving era of precision medicine?”
Three closely related themes are presented for new applications of
radiation science for research and career opportunities: (1) intro-
duction of the new concept of defining radiation dose in biological
perturbations in addition to physical dose, particularly for cancer
treatment; (2) assessment of early biomarkers of radiation injury
for mass casualty exposure (biodosimetry) to guide triage and for
clinical application to guide radiation therapy; and (3) proposal
to expand opportunities for radiation professionals, including
consideration of a new training program within NCRP’s “Where
are the radiation professionals?” initiative that trains radiation
oncologists as molecular radiation epidemiologists.
Health Phys. 118(4):349–353; 2020
Key words: National Council on Radiation Protection and Measure-
ments; nuclear terrorism; radiation emergency; radiation oncology
INTRODUCTION
ON BOTH a personal and professional level, it is an honor for
my research and that of my clinical and policy-minded col-
leagues to be recognized. Surveying the prior Warren Sin-
clair Keynotes (NCRP 2019) since their inception in 2004,
this lecture fits squarely within over half the talks, including
radiological terrorism (Poston 2005; Covello 2011; Herrmann
1
Radiation Research Program, Division of Cancer Treatment and Di-
agnosis and Radiation Oncology Branch, Center for Cancer Research, Na-
tional Cancer Institute, Bethesda, MD; 2Office of the Assistant Secretary
of Preparedness and Response, Department of Health and Human Ser-
vices, Washington, DC.
The authors declare no conflicts of interest.
For correspondence contact the author at Radiation Research Program,
Division of Cancer Treatment and Diagnosis and Radiation Oncology
Branch, Center for Cancer Research, National Cancer Institute, Bethesda,
MD, or email at ccoleman@mail.nih.gov.
(Manuscript accepted 5 November 2019)
0017-9078/20/0
Copyright © 2020 Health Physics Society
DOI: 10.1097/HP.0000000000001240
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2018), radiation medicine (Brink 2008; Mettler et al. 2013;
Rosenstein 2019), and “Where are the Radiation Profes-
sionals?” (Bushberg 2015; Toohey 2017). The varied and
timely topics are a credit to Warren Sinclair in recognition
of his service to the National Council on Radiation Protection
and Measurements (NCRP) and its vision for the future.
This meeting marks the transition of presidents of the
NCRP between two colleagues of mine. These professional
relationships go back first to the 1980s when I was at Stanford
studying secondary cancers in patients treated for Hodgkin’s
disease, at which time I learned a great deal from the ep-
idemiology work of John Boice, who was at the National
Cancer Institute (NCI) and from one of his students who
became my colleague at Stanford, Peggy Tucker; and sec-
ond to the 1990s from my translational radiation biology re-
search (before it was called that) at Harvard Medical School
having discussions with my colleague Kathy Held at the
Massachusetts General Hospital. In accordance with the
theme of this 90th anniversary of NCRP, which is defined
as “Providing Best Answers to Your Most Pressing Ques-
tions about Radiation,” I discuss from my vantage point in
the NCI Radiation Research Program, “What are the new
frontiers for the NCRP with its breadth of talent and exper-
tise in the rapidly evolving era of precision medicine?”
Rather than an encyclopedic review, this concept paper
with three closely related themes uses selected data and in-
formation from both my laboratory and policy work along
with that of my colleagues to describe unique opportunities
surrounding this question. I recognize that many others con-
tribute to these three topics.
DISCUSSION
When considering the frontiers of medical radiation
science and the potential for NCRP, a good starting point
is the breadth of the role of radiation science in federal agen-
cies and through them, via collaborations and funding, the
academic and private sectors. Radiation and its interactions
with people are essential scientific topics for the National
Institutes of Health (NIH), in particular NCI, but also other
349
350 Health Physics
institutes where radiation may be used for immune modula-
tion, such as the National Institute of Allergy and Infectious
Diseases (NIAID). Research is conducted into the normal
tissue effects from radiation exposure and potential means
to mitigate such effects in the Radiation and Nuclear Coun-
termeasures Program of NIAID (2013), the National Aeronau-
tics and Space Administration (NASA 2019) Human Research
Program, and the US Department of Defense Armed Forces
Radiobiology Research Institute (USU 2018). Other agen-
cies have interest in environmental or industrial radiation
exposure [such as the US Environmental Protection Agency
(US EPA 2019)] and radiation as an energy source (the De-
partment of Energy and the Nuclear Regulatory Commission).
The critical need for the National Institute of Standards and
Technology may be more essential than appreciated in ra-
diobiology (Desrosiers et al. 2013).
Theme #1: A new concept of defining radiation dose in
biological as well as physical terms
Around 2004, our translational laboratory-clinical
research team was developing the use of nonsteroidal anti-
inflammatory agents as clinical radiation sensitizers for pros-
tate cancer based on preclinical data from work done at the
Harvard Joint Center for Radiation Therapy (Palayoor et al.
1998). At the time, we sought biomarkers of drug effect prior
to a clinical trial as is now required. We used gene expression
arrays following three conditions: (1) the nonsteroidal anti-
inflammatory agent drug concentrations (both COX2 and
nonspecific COX inhibitors) used in most laboratory exper-
iments to determine mechanism of action, (2) the concen-
tration actually achievable in the clinic, and (3) molecular
techniques (RNAi) to knock down expression of the COX2
protein that is the primary target of the COX2 inhibitors. We
found that the clinically achievable drug concentration had
very limited efficacy (John-Aryankalayil et al. 2009), and
thus we did not conduct a clinical trial. This turned out to
be a correct assessment as the drug was demonstrated to
not be effective in a number of clinical trials. This observa-
tion led us to consider the question of what happens to cells
and tumors that survive multiple fractions of clinically rele-
vant radiation therapy with the hypothesis that “adaptation
to radiation therapy may induce changes across tumor types
that can be targets for molecular-targeted therapy.” This is
different than using radiation plus drugs together, which
is often called chemo-radiotherapy; rather, this work aims
to administer a fractionated or single dose (SD) of radia-
tion to make drugs work after the radiation is finished.
Certainly, this would be compatible with the current uses
of chemo-radiotherapy.
To briefly highlight over 15 y of research in our labora-
tory and those of our collaborators (James Mitchell, Radiation
Biology Branch, NCI; Silvia Formenti, Sandra Demaria,
Claire Vanpouille-Box, New York University and now Weill
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April 2020, Volume 118, Number 4
Cornell Medical Center; and Chip Petricoin and Lance
Liotta, George Mason University), we have demonstrated:
1. Multi-fraction (MF110) (1 Gy twice daily  10 over 5
d) compared to SD (10 Gy 1) for prostate cancer cells
in vitro (John-Aryankalayil et al. 2010; Makinde et al.
2013) and in three-dimensional cultures (Eke et al.
2018a) produces many more changes in gene expres-
sion at the end of radiation, although there are changes
after both MF and SD. Interestingly, recent data looking
at long-term survivors after 2 mo shows this pattern re-
versed with SD > MF (Eke et al. 2018b). We are currently
investigating what these adaptations are, how the cells
have adapted, and how to target the adaptation:
2. In the 5 d (1 Gy twice a day) studies, there is an inflec-
tion point of gene expression after six to seven fractions,
when cells are given treatment with 1 Gy either two or
three times per day. The gene ontology class with the
most changes is immune response (John-Aryankalayil
et al. 2010), but there are other changes seen with prote-
omics and metabolomics that are potentially targetable
(Makinde et al. 2013). In the initial SD and MF studies
by Tsai et al. (2007) in Jim Mitchell’s laboratory, changes
are observed in vivo as well as in vitro.
3. In proof-of-principle studies, molecular targets induced
both short-term (immediately after) (Eke et al. 2018a)
and long-term (months later) (Eke et al. 2018b) can be
targeted with drug treatment post-exposure.
4. The initial tumor gene expression profile does not pre-
dict the adaptive response. This has implications for
how to use molecular profiling for determining a course
of cancer treatment, suggesting the need for repeat inter-
rogation beyond the initial profile used for diagnosis. It
may be that repeated interrogation and treatment ad-
aptation will be necessary. These could involve both
imaging and investigating tumor samples or circulating
biomarkers, as are in progress.
5. From work of our NCI (Mansoor Ahmed and Jim Hodge)
(Aryankalayil et al. 2014) and Cornell (Vanpouille-Box
et al. 2017) collaborators (above), the immune response
to immune checkpoint inhibitors can be enhanced, and
the fractionation pattern matters in the production of
the abscopal response (in which treatment of the pri-
mary tumor causes a response in metastases).
6. Changes with MF and SD are seen in short-term cultures of
endothelial cells (Palayoor et al. 2014) so that normal tissues
also respond differently to radiation fractionation and dose.
7. Using MF 0.5Gy  10 that produces very little cell kill-
ing can induce changes (Simone et al. 2013). This im-
pacts normal tissues even distant to the tumor.
A 2017 NCI workshop “Defining the Shades of Gy:
Utilizing the Biological Consequences of Radiotherapy in
 Warren K. Sinclair Keynote c C. N. COLEMAN 351

the Development of New Treatment Approaches” has ad-
ditional information on the concept of using both the
physical dose and biological perturbations for cancer treat-
ment (Ahmed et al. 2018).
The various “omics” in biology, including coding and
non-coding RNA, metabolomics, and proteomics, are now
used to understand cancer biology, patient prognosis, and treat-
ment effect. In a concept proposed by our laboratory in 2000
dubbed “focused biology” (Coleman 2003), the aim is to
consider radiation “as a drug” assessing the pharmacokinet-
ics and pharmacodynamics from radiation as is done with
systemic therapies. This novel approach uses the ability to
focus the radiation delivery, thus adding up to “accurate,
precision radiation medicine.”
Theme #2: Radiological and nuclear incidents and the
need for medical and radiobiological expertise
A number of laboratories, including ours, are investigat-
ing normal tissue response using molecular profiling sup-
ported by both NIAID and Biomedical Advanced Research
and Development Authority (DHHS 2019) with the goal of
establishing biomarkers for normal tissue injury from radiolog-
ical or nuclear incidents (Aryankalayil et al. 2018a and b). Such
biomarkers may also be useful for clinical radiation therapy.
Pertinent to this lecture is the importance of subject matter
expertise being involved directly with the major decision
makers during a radiation/nuclear incident due to the com-
plex physics, biology, spectrum of injury, and medical care
and for the public’s concern about radiation exposure. The im-
portance of this was learned from first-hand experience as part
of a team of subject matter experts in the US Embassy in
Tokyo during the nuclear power plant crisis in Fukushima
in 2011 (Simon et al. 2012; Coleman et al. 2013; Koerner et al.
2014). Building on a concept proposed by Irwin (Koerner et al.
2014) for the creation of the Radiological Operations Sup-
port Specialist (Irwin 2018), a major effort has been under-
taken by experts from government, academia, and the
community to propose a new category of medical expertise,
the CBRNE Medical Officer Science Support Expert
(Coleman et al. 2019). The new opportunities for radiation
scientists in the first two themes relate to basic research,
clinical care and emergency preparedness and response, in-
cluding discovery and validation of biomarkers that can be
relevant for normal tissue damage for cancer care and for
population or industrial radiation exposure. Theme #3 ex-
pands the opportunities for radiation science even further.
Theme #3. Accurate, precision radiation medicine
A few years ago, colleagues from the NCI Radiation Re-
search Program and CERN/Geneva were considering future

Fig. 1. The Radiation Rotary. There are a number of crossroads facing the field of radiation sciences, best addressed as part of a rotary. Four sets of
issues are illustrated, with both sides of a particular issue in circles of the same shade: (1) cancer care; (2) global collaboration; (3) nuclear policy;
and (4) mitigating radiation injury, as discussed in the text. Talent and ideas entering the rotary face challenges and choices that will lead to unique
collaborations, new knowledge, and products that, in turn, will impact greater society in general. The scope of talent and opportunities is large. Even
in the more limited context of cancer treatment, a wide range of expertise is needed to carry out the work intended in the radiation rotary, including
specialized chemistry, physics, biology, and medical skills. Abbreviations: IGRT—image guided radiation therapy; LINAC—linear accelerator
(Coleman et al. 2018; reprinted with permission).
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352 Health Physics
possibilities for radiation research and described a number of
“crossroads.” Recognizing that seemingly disparate radiation
science careers intersect much more than may be recognized,
we proposed the idea of the Radiation Rotary (Coleman
et al. 2018) (Fig. 1) in which four sets of crossroads come
together. The figure (reprinted with permission) is largely
self-explanatory, where opposite sides are contrasts of the
same theme (shaded circles) but all of the themes interact.
Opportunities that can impact society are noted.
Among the challenges for NCRP is addressing the issue
proposed by John Boice in the NCRP report of “WARP—
Where are the Radiation Professionals?” (Boice 2014). Dis-
cussions among a few of us regarding potential careers led
to the following proposal: the training of molecular radiation
epidemiologists building from radiation oncologists who have
expertise in clinical medicine who will acquire further training
in molecular cancer biology and epidemiology to become
MD- or PhD-level molecular radiation epidemiologists. A
proposal for NCRP to consider such a path, working with
a few medical schools that also have schools of public health,
was submitted at the 2019 NCRP business meeting. Should a
few pilot programs be successful, this may produce a new ca-
reer path for this critical expertise for academia, govern-
ment agencies, and the private sector and expand the role
of physician-scientists in epidemiology of radiation expo-
sures and possibly other environmental factors as well.
CONCLUSION
There are remarkable opportunities for the application
of emerging cancer and radiation biology to further enhance
the contributions by NCRP and other radiation-related socie-
ties and fields. The role of radiation in a broad range of soci-
etal needs, including medical care, energy policy, terrorism,
space exploration, environmental exposures and global
health, provides exciting opportunities for radiation exper-
tise (Bernhard et al. 2013)
Acknowledgments—to multiple colleagues who are co-authors of the references
and many others who participate in the programs and projects described in this
manuscript.
Disclaimer: This presentation is the personal opinion of the author and does
not represent opinion or policy of the National Cancer Institute, National Institutes
of Health, U.S. Department of Health and Human Services, or U.S. Government.
REFERENCES
Ahmed MM, Coleman CN, Mendonca M, Bentzen S, Vikram B,
Seltzer SM, Goodhead D, Obcemea C, Mohan R, Prise KM,
Capala J, Citrin D, Kao G, Aryankalayil M, Eke I, Buchsbaum
JC, Prasanna PGS, Liu FF, Le QT, Teicher B, Kirsch DG, Smart
D, Tepper J, Formenti S, Haas-Kogan D, Raben D, Mitchell J.
Workshop Report for Cancer Research: defining the shades
of gy: utilizing the biological consequences of radiotherapy in
the development of new treatment approaches—meeting view-
point. Cancer Res 78:2166–2170; 2018.
Aryankalayil MJ, Makinde AY, Gameiro SR, Hodge JW, Rivera-
Solis PP, Palayoor ST, Ahmed MM, Coleman CN. Defining
www.health-physics.com
Copyright © 2020 Health Physics Society. Unauthorized reproduction of this article is prohibited.
April 2020, Volume 118, Number 4
molecular signature of pro-immunogenic radiotherapy targets
in human prostate cancer cells. Radiat Res 182:139–148; 2014.
Aryankalayil MJ, Chopra S, Levin J, Eke I, Makinde A, Das S,
Shankavaram U, Vanpouille-Box C, Demaria S, Coleman CN.
Radiation-induced long noncoding RNAs in a mouse model af-
ter whole-body irradiation. Radiat Res 189:251–263; 2018a.
Aryankalayil MJ, Chopra S, Makinde A, Eke I, Levin J, Shankavaram U,
MacMillan L, Vanpouille-Box C, Demaria S, Coleman CN. Micro-
array analysis of miRNA expression profiles following whole body
irradiation in a mouse model. Biomarkers 23:689–703; 2018b.
Bernhard E, Blumenthal D, Boice J, Coleman N, Maidment B,
Miller C, Noska M, Schauer D, Toohey R, Whitcomb R. National
crisis “Where are the Radiation Professionals?” [online]. 2013.
Available at https://ncrponline.org/wp-content/themes/ncrp/
PDFs/WARP_Workshop_Summary.pdf. Accessed 20 July 2019.
Boice JD Jr. WARP—where are the radiation professionals? Health
Phys News XLII:22; 2014.
Brink JA. Fourth Annual Warren K. Sinclair Keynote Address.
The use and misuse of radiation in medicine. Health Phys 95:
465–501; 2008.
Bushberg JT. Eleventh Annual Warren K. Sinclair Keynote Address—
science, radiation protection and NCRP: building on the past,
looking to the future. Health Phys 108:115–123; 2015.
Coleman CN. Linking radiation oncology and imaging through
molecular biology (or now that therapy and diagnosis have sep-
arated, it's time to get together again!). Radiol 228:29–35; 2003.
Coleman CN, Blumenthal DJ, Casto CA, Alfant M, Simon SL,
Remick AL, Gepford HJ, Bowman T, Telfer JL, Blumenthal
PM, Noska MA. Recovery and resilience after a nuclear power
plant disaster: a medical decision model for managing an effec-
tive, timely, and balanced response. Disaster Med Public Health
Prep 7:136–145; 2013.
Coleman CN, Prasanna PGS, Bernhard EJ, Buchsbaum JC, Ahmed
MM, Capala J, Obcemea C, Deye JA, Pistenmma DA, Vikram
B, Bernier J, Dosanjh M. Accurate, precision radiation medi-
cine: a meta-strategy for impacting cancer care, global health,
and nuclear policy and mitigating radiation injury from necessary
medical use, space exploration, and potential terrorism. Int J
Radiat Oncol Biol Phys 101:250–253; 2018.
Coleman CN, Bader JL, Koerner JF, Hrdina C, Cliffer KD, Hick JL,
James JJ, Mansoura MK, Livinski AA, Nystrom SV, DiCarlo-
Cohen A, Marinissen MJ, Wathen L, Appler JM, Buddemeier
B, Casagrande R, Estes D, Byrne P, Kennedy EM, Jakubowski
AA, Case C, Weinstock DM, Dainiak N, Hanfling D, Garrett
AL, Grant NN, Dodgen D, Redlener I, MacKAY TF, Treber M,
Homer MJ, Taylor TP, Miller A, Korch G, Hatchett R. Chemical,
biological, radiological, nuclear, and explosive (CBRNE) sci-
ence and the CBRNE medical operations science support expert
(CMOSSE). Disaster Med Public Health Prep 1–16; 2019.
DOI 10.1017/dmp.2018.163.
Covello VT. Risk communication, radiation, and radiological emer-
gencies, tools, and techniques. Health Phys 101:511–530; 2011.
Desrosiers M, DeWerd L, Deye J, Lindsay P, Murphy MK, Mitch
M, Macchiarini F, Stojadinovic S, Stone H. The importance of
dosimetry standardization in radiobiology. J Res Natl Inst Stand
Technol 118:403–418; 2013. DOI 10.6028/jres.118.021.
Eke I, Makinde AY, Aryankalayil MJ, Sandfort V, Palayoor ST, Rath
BH, Liotta L, Pierobon M, Petricoin EF, Brown MF, Stommel
JM, Ahmed MM, Coleman CN. Exploiting radiation-induced
signaling to increase the susceptibility of resistant cancer cells
to targeted drugs: AKT and mTOR inhibitors as an example.
Mol Cancer Ther 17:355–367; 2018a.
Eke I, Makinde AY, Aryankalayil MJ, Reedy JL, Citrin DE, Chopra
S, Ahmed MM, Coleman CN. Long-term tumor adaptation after
radiotherapy: therapeutic implications for targeting integrins in
prostate cancer. Mol Cancer Res 16:1855–1864; 2018b.
 Warren K. Sinclair Keynote c C. N. COLEMAN
Herrmann J. Fourteenth Annual Warren K. Sinclair Keynote Address:
aren't we ready yet? Closing the planning, response, and recovery
gaps for radiological terrorism. Health Phys 114:122–127; 2018.
Irwin W. The ROSS: A radiological/nuclear subject matter expert
filling a critical national need. Health Phys 114:141–147; 2018.
John-Aryankalayil M, Palayoor ST, Cerna D, Falduto MT, Magnuson
SR, Coleman CN. NS-398, ibuprofen, and cyclooxygenase-2
RNA interference produce significantly different gene ex-
pression profiles in prostate cancer cells. Mol Cancer Ther 8:
261–273; 2009.
John-Aryankalayil M, Palayoor ST, Cerna D, Simone CB II, Falduto
MT, Magnuson SR, Coleman CN. Fractionated radiation ther-
apy can induce a molecular profile for therapeutic targeting. Radiat
Res 174:446–458; 2010.
Koerner JF, Coleman CN, Murrain-Hill P, FitzGerald DJ, Sullivan
JM. The medical decision model and decision maker tools for
management of radiological and nuclear incidents. Health Phys
106:645–651; 2014.
Makinde AY, John-Aryankalayil M, Palayoor ST, Cerna D, Coleman
CN. Radiation survivors: understanding and exploiting the phe-
notype following fractionated radiation therapy. Mol Cancer Res
11:5–12; 2013.
Mettler FA Jr, Constine LS, Nosske D, Shore RE. Ninth Annual
Warren K. Sinclair Keynote Address: Effects of childhood
radiation exposure an issue from computed tomography scans
to Fukushima. Health Phys 105:424–429; 2013.
National Aeronautics and Space Administration. Human Research
Program [online]. 2019. Available at https://www.nasa.gov/
hrp. Accessed 20 July 2019.
National Council for Radiation Protection and Measure-
ments. Warren Sinclair lectures [online]. 2019. Available
at https://ncrponline.org/publications/wk-sinclair-keynote-
addresses/. Accessed 20 July 2019.
National Institute of Allergy and Infectious Disease. Radiation and Nu-
clear Countermeasures Program [online]. 2013. Available at https://
www.niaid.nih.gov/research/radiation-nuclear-countermeasures-
program. Accessed 20 July 2019.
Palayoor ST, Bump EA, Calderwood SK, Bartol S, Coleman CN.
Combined antitumor effect of radiation and ibuprofen in human
prostate carcinoma cells. Clin Cancer Res 4:763–771; 1998.
Palayoor ST, John-Aryankalayil M, Makinde AY, Falduto MT,
Magnuson SR, Coleman CN. Differential expression of stress and
www.health-physics.com
Copyright © 2020 Health Physics Society. Unauthorized reproduction of this article is prohibited.
353
immune response pathway transcripts and miRNAs in normal
human endothelial cells subjected to fractionated or single-
dose radiation. Mol Cancer Res 12:1002–1015; 2014.
Poston JW Jr. Warren K. Sinclair Keynote Address: current
challenges in countering radiological terrorism. Health Phys 89:
450–456; 2005.
Rosenstein M. The 15th Annual Warren K. Sinclair Keynote
Address—jus•ti•fied and com•men•su•rate. Health Phys 116:
117–125; 2019.
Simon SL, Coleman CN, Noska MA, Bowman T. Response of the
U.S. Department of Health and Human Services in protecting
civilian Americans in Japan during the Fukushima nuclear cri-
sis. Health Phys 102(5):570–579; 2012.
Simone CB II, John-Aryankalayil M, Palayoor ST, Makinde AY,
Cerna D, Falduto MT, Magnuson SR, Coleman CN. mRNA ex-
pression profiles for prostate cancer following fractionated irradi-
ation are influenced by p53 status. Transl Oncol 6:573–585; 2013.
Toohey RE. Thirteenth Annual Warren K. Sinclair Keynote Address:
where are the radiation professionals (WARP)? Health Phys 112:
121–125; 2017.
Tsai MH, Cook JA, Chandramouli GV, DeGraff W, Yan H, Zhao S,
Coleman CN, Mitchell JB, Chuang EY. Gene expression profiling
of breast, prostate, and glioma cells following single versus frac-
tionated doses of radiation. Cancer Res 67:3845–3852; 2007.
Uniformed Services University. Armed Forces Radiobiology Re-
search Institute [online]. 2018. Available at https://www.
usuhs.edu/afrri. Accessed 10 May 2019.
US Department of Health and Human Services. Biomedical Ad-
vanced Research and Development Authority [online]. 2019.
Available at https://www.phe.gov/about/barda/Pages/default.
aspx. Accessed 20 July 2019.
US Environmental Protection Agency. Radiation protection
[online]. 2019. Available at https://www.epa.gov/radiation.
Accessed 20 July 2019.
Vanpouille-Box C, Alard A, Aryankalayil MJ, Sarfraz Y, Diamond JM,
Schneider RJ, Inghirami G, Coleman CN, Formenti SC, Demaria S.
DNA exonuclease Trex1 regulates radiotherapy-induced tumour
immunogenicity. Nat Commun 8:15618; 2017.
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