title: Technologically enhanced naturally occurring radioactive materials.
abstract: BACKGROUND
  Naturally occurring radioactive materials (NORM) are ubiquitous throughout the earth's crust. Human manipulation of NORM for economic ends, such as mining, ore processing, fossil fuel extraction, and commercial aviation, may lead to what is known as "technologically enhanced naturally occurring radioactive materials," often called TENORM. The existence of TENORM results in an increased risk for human exposure to radioactivity. Workers in TENORM-producing industries may be occupationally exposed to ionizing radiation. TENORM industries may release significant amounts of radioactive material into the environment resulting in the potential for widespread exposure to ionizing radiation. These industries include mining, phosphate processing, metal ore processing, heavy mineral sand processing, titanium pigment production, fossil fuel extraction and combustion, manufacture of building materials, thorium compounds, aviation, and scrap metal processing.
  
  
  METHODS
  A search of the PubMed database ( www.pubmed.com ) and Ovid Medline database ( ovidsp.tx.ovid.com ) was performed using a variety of search terms including NORM, TENORM, and occupational radiation exposure. A total of 133 articles were identified, retrieved, and reviewed. Seventy-three peer-reviewed articles were chosen to be cited in this review.
  
  
  RESULTS
  A number of studies have evaluated the extent of ionizing radiation exposure both among workers and the general public due to TENORM. Quantification of radiation exposure is limited because of modeling constraints. In some occupational settings, an increased risk of cancer has been reported and postulated to be secondary to exposure to TENORM, though these reports have not been validated using toxicological principles.
  
  
  CONCLUSIONS
  NORM and TENORM have the potential to cause important human health effects. It is important that these adverse health effects are evaluated using the basic principles of toxicology, including the magnitude and type of exposure, as well as threshold and dose response.
authors.affiliation: Department of Emergency Medicine, Division of Medical Toxicology, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
authors.forename: David
authors.initials: D
authors.lastname: Vearrier
authors.forename: John A
authors.initials: JA
authors.lastname: Curtis
authors.forename: Michael I
authors.initials: MI
authors.lastname: Greenberg
mesh_terms: D000818:Animals; D001417:Background Radiation / Q000009:adverse effects; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D011839:Radiation, Ionizing; D012306:Risk