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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 delivered 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.