Response: Commentary: Low-dose ionizing radiation and the exposure–lag response: protocol for a prospective cohort study on The Health Effects of Chongqing Occupational Radiation Workers

changes in cell counts under radiation However, to date, no studies have employed 29 the model to examine the association between radiation exposure and blood changes in 30 radiation workers. As such, we aim to detect a minimum difference of 0.18 between two groups to 31 estimate an appropriate sample size. Following the of the DLNM to identify potential 32 exposure-lag responses, we will perform a post-hoc power analysis to ensure that the study achieves 33 statistical power exceeding 90%.The sample size was determined based on our primary outcome 1 , which is the complete blood count.For studies that involve multiple endpoint events, the primary outcome is critical in sample size 36 determination 2 . Primary outcome measures must be sensitive to changes in the target population 2 . 37 Bone marrow is the most sensitive to ionizing radiation, and the peripheral blood cell count changes 38 relatively early when the exposed dose exceeds the human tolerance level 3, 4 . Complete blood count 39 includes multiple indicators, such as white blood cells, red blood cells, and platelets. Two meta-40 analyses demonstrated that white blood cells exhibit abnormal changes at an early stage in response 41 to low-dose ionizing radiation exposure 5, 6 . Therefore, white blood cells were selected as the reference 42 indicator for sample size calculation in this study. We calculate the sample size based on the primary outcome (white blood cells). The sample size is 56 calculated using this equation as follows: 57