Objective: To investigate the change of ATM phosphorylation in HepG2 cells and its effect on HepG2 cell survival under a continuous low dose-rate irradiation. Methods: HepG2 cells were exposed to equivalent doses of irradiation deliv- ered at either a continuous low dose-rate (7.76 cGy/h) or a high dose-rate (4500 cGy/h). The ATM phosphorylated proteins and surviving fraction of HepG2 cell after low dose-rate irradiation were compared with that after equivalent doses of high dose-rate irradiation. Results: The phosphorylation of ATM protein was maximal at 0.5 Gy irradiation delivered at either a high dose-rate or a continuous low dose-rate. As the radiation dose increased, the phosphorylation of ATM protein decreased under continuous low dose-rate irradiation. However, the phosphorylation of ATM protein was remained stable under high dose-rate irradiation. When the phosphorylation of ATM protein under continuous low dose-rate irradiation was equal to that under high dose-rate irradiation, there was no significant difference in the surviving fraction of HepG2 cells between two ir- radiation methods (P > 0.05). When the phosphorylation of ATM protein significantly decreased after continuous low dose-rate irradiation compared with that after high dose-rate irradiation, increased amounts of cell killing was found in low dose-rate irradiation (P < 0.01). Conclusion: Continuous low dose-rate irradiation increases HepG2 cells radiosensitivity compared with high dose-rate irradiation. The increased amounts of cell killing following continuous low dose-rate exposures are associated with reduced ATM phosphorylated protein. Objective: To investigate the change of ATM phosphorylation in HepG2 cells and its effect on HepG2 cell survival under a continuous low dose-rate irradiation. Methods: HepG2 cells were exposed to equivalent doses of irradiation deliv- ered at either a continuous low dose-rate (7.76 cGy / h) or a high dose-rate (4500 cGy / h). The ATM phosphorylated proteins and surviving fraction of HepG2 cell after low dose-rate irradiation were compared with that after equivalent doses of high dose-rate irradiation. : The phosphorylation of ATM protein was maximal at 0.5 Gy irradiation at either a high dose-rate or a continuous low dose-rate. As the radiation dose increased, the phosphorylation of ATM protein decreased under continuous low dose-rate irradiation. However, the phosphorylation of ATM protein was remained stable under high dose-rate irradiation. When the phosphorylation of ATM protein under continuous low dose-rate irradiation was equal to that under high dose-rate irradiati there was no significant difference in the surviving fraction of HepG2 cells between two ir-radiation methods (P> 0.05). When the phosphorylation of ATM protein significantly decreased after continuous low dose-rate irradiation compared with that after high dose-rate irradiation , increased amounts of cell killing was found in low dose-rate irradiation (P <0.01). Conclusion: Continuous low dose-rate irradiation increases in HepG2 cells radiosensitivity compared with high dose-rate irradiation. -rate exposures are associated with reduced ATM phosphorylated protein.