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Re esearc on Healt Effe ch th ects o of Lo ow-Le evel Io onizing Radiation Expo g n osure: : Oppo ortunit ties fo the A or Armed Forc ces Raddiobio ology Resea R arch In nstitut te Committe on Research Direc ee ctions in Hu uman Biollogical Eff fects of Low Level Ionizing R L Radiation Board on the Hea of Sele Populat o alth ect tions Nuclear and Ra adiation Stu udies Boar rd PR REPUBLICA ATION COP UNCO RRECTED PROOFS PY: D

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This study was supported by Grant No. HT9404-12-1-0028 between the National Academy of Sciences and the Uniformed Sciences University of the Health Sciences. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-xxxxx-x International Standard Book Number-10: 0-309-xxxxx-x Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. IOM (Institute of Medicine). 2014. Research on health effects of low-level ionizing radiation exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. Cover credit: Department of Defense photo by Staff Sgt. Jonathan Steffen, U.S. Air Force/Released Link to photo: https://www.flickr.com/photos/39955793@N07/5568298525/in/photolist-9u3Z9Z-9ymHp9-9unnPG. PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Natio onal Academy of Sciences is a private, nonprofit, self y f-perpetuating society of distinguished sccholars engaged in scientific and engineering research, dedic n d r cated to the fur urtherance of sc cience and technology and to their o use for the general welfar Upon the au re. uthority of the charter granted to it by the C d Congress in 186 the Academ has 63, my a mandate that requires it to advise the federal govern t nment on scien ntific and technnical matters. D Ralph J. Cic Dr. cerone is presiden of the Nation Academy of Sciences. nt nal The National Academy of Engineeri was establ y ing lished in 1964 , under the ch harter of the NNational Acade emy of Sciences, as a parallel organization of outstanding engineers. It is autonomou in its admin o o us nistration and in the selection of its members, sharing with the National Academy of Sc o , A ciences the resp ponsibility for advising the f r federal governmen The National Academy of Engineering also sponsors engineering pr nt. f rograms aimed at meeting na d ational needs, encourages educa ation and resea arch, and recog gnizes the supe erior achievemments of engine eers. Dr. C.D. Mote, Jr., is presi ident of the Na ational Academ of Engineeri my ing. The Institu of Medicin was established in 1970 by the Nationa Academy of Sciences to se ute ne b al f ecure the servi ices of eminent members of app m essions in the examination o policy matte pertaining to the health of the propriate profe of ers public. The Institute acts under the res s sponsibility giv to the Nat ven tional Academ of Sciences by its congres my ssional charter to be an adviser to the federal government and, upon its o a own initiative, to identify issues of medica care, al research, and education. Dr. Harvey V. Fineberg is pr a D Institute of Me resident of the I edicine. The Nation Research Council was organized by th National Ac ademy of Scie nal o he ences in 1916 to associate the broad o e community of science and technology with the Ac y a y cademy’s purp poses of furtheering knowledg and advisin the ge ng federal gov vernment. Fun nctioning in acc cordance with general polici determined by the Acade ies d emy, the Counc has cil become th principal op he perating agency of both the National Acad y N demy of Scien nces and the N National Acade emy of Engineerin in providing services to th governmen the public, a the scient ng g he nt, and tific and engin neering commu unities. The Counc is administe cil ered jointly by both Academi and the Inst ies titute of Medic cine. Dr. Ralph J. Cicerone a Dr. h and C.D. Mote, Jr., are chair and vice chair, respectively, of the National Research Cou , al uncil. www.natio onal-academie es.org PR REPUBLICA ATION COP UNCO RRECTED PROOFS PY: D

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COMMITTEE ON RESEARCH DIRECTIONS IN HUMAN BIOLOGICAL EFFECTS OF LOW LEVEL IONIZING RADIATION HEDVIG HRICAK (Chair), Chair, Department of Radiology, Memorial Sloan-Kettering Cancer Center DAVID J. BRENNER, Director, Center for Radiological Research, Columbia University Medical Center LAWRENCE T. DAUER, Associate Attending Physicist, Department of Medical Physics, Memorial Sloan-Kettering Cancer Center GEORGE X. DING, Professor, Department of Radiation Oncology, Vanderbilt University School of Medicine FRANCESCA DOMINICI, Senior Associate Dean for Research, Professor of Biostatistics, Harvard School of Public Health HELEN GROGAN, President and Founder, Cascade Scientific, Inc. DAVID HOEL, Distinguished University Professor, Medical University of South Carolina EDWARD F. MAHER, Senior Health Physicist, Dade Moeller & Associates, Inc. WILLIAM F. MORGAN, Director of Radiation Biology and Biophysics Biological Sciences, Division Pacific Northwest National Laboratory GEORGINE PION, Research Associate Professor, Department of Psychology and Human Development, Peabody College of Vanderbilt University DAVID RICHARDSON, Associate Professor of Epidemiology, University of North Carolina RUTH WILKINS, Research Scientist, Division Chief, Radiobiology, Health Canada Staff DAVID A. BUTLER, Scholar | Director, Medical Follow-up Agency OURANIA KOSTI, Senior Program Officer CARY HAVER, Associate Program Officer SULVIA DOJA, Senior Program Assistant ANDREA COHEN, Financial Associate FREDRICK ERDTMANN, Director, Board on the Health of Select Populations KEVIN D. CROWLEY, Senior Director, Nuclear and Radiation Studies Board PREPUBLICATION COPY: UNCORRECTED PROOFS v

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Reviewers This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purposes of this independent review are to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: A. Iulian Apostoaei, Researcher, Oak Ridge Center for Risk Analysis Mina J. Bissell, Distinguished Scientist, Life Sciences Division Lawrence Berkeley National Laboratory James E. Cleaver, Professor Emeritus, Departments of Dermatology and Pharmaceutical Chemistry, University of California, San Francisco Richard B. Freeman, Herbert Ascherman Professor of Economics, Harvard University; co- Director, Labor and Worklife Program, Harvard Law School; Program Director for Labor Studies, National Bureau of Economic Research Joe W. Gray, Gordon Moore Endowed Chair; Director, Center for Spatial Systems Biomedicine and Associate Director for Translational Research, Knight Cancer Institute Oregon Health & Science University Kathryn D. Held, Associate Professor of Radiation Oncology (Radiation Biology), Harvard Medical School; Associate Radiation Biologist, Massachusetts General Hospital David Pawel, Statistician, Office of Radiation and Indoor Air, U.S. Environmental Protection Agency Terry C. Pellmar, Radiobiology consultant; formerly, Scientific Director, Armed Forces Radiobiology Research Institute Jonathan M. Samet, Director, USC Institute for Global Health; Professor and Flora L. Thornton Chair, Department of Preventive Medicine University of Southern California David Alan Schauer, U.S. Navy (Retired); formerly, Chief Scientist, SAIC and Executive Director, National Council on Radiation Protection and Measurements Richard J. Vetter, Retired; formerly, Head, Section of Safety and Radiation Safety Officer, Mayo Foundation; Professor of Biophysics Mayo Medical School PREPUBLICATION COPY: UNCORRECTED PROOFS vii

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Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Chris G. Whipple, Principal, ENVIRON. Appointed by the National Research Council and the Institute of Medicine, he was responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS viii

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Contents ABBREVIATIONS AND ACRONYMS, xi SUMMARY, S-1 1 INTRODUCTION AND BACKGROUND, 1-1 2 CURRENT DIRECTIONS IN RADIOBIOLOGICAL RESEARCH, 2-1 3 THE RADIOBIOLOGY WORKFORCE, 3-1 4 AFRRI PROGRAMS, RESEARCH, AND RESOURCES, 4-1 5 OPPORTUNITIES FOR AFRRI, 5-1 APPENDIXES A PUBLIC MEETING AGENDAS, A-1 B U.S. RADIATION RESEARCH PROGRAMS, B-1 C BIOGRAPHIC SKETCHES OF COMMITTEE MEMBERS AND STAFF, C-1 PREPUBLICATION COPY: UNCORRECTED PROOFS ix

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Abbreviations and Acronyms AAPM American Association of Physicians in Medicine AFRRI Armed Forces Radiobiology Research Institute ARS Acute Radiation Syndrome ATSDR Agency for Toxic Substances and Disease Registry BARDA Biomedical Advanced Research and Development Authority (HHS) BAT Biodosimetry Assessment Tool BEIR Biological Effects of Ionizing Radiation BNL Brookhaven National Laboratory BLS Bureau of Labor Statistics CARR Center for Acute Radiation Research CBRN Division of Chemical, Biological, Radiological and Nuclear CBMN Cytokinesis Blocked Micronucleus Assay CDER Center for Drug Evaluation and Research CDRH Center for Devices and Radiological Health CMCR Centers for Medical Countermeasures against Radiation CT Computed Tomography DARPA Defense Advanced Research Projects Agency (DoD) DASA Defense Atomic Support Agency DCA Dicentric Chromosome Assay DDREF Dose Dose-Rate Effectiveness Factor DHS U.S. Department of Homeland Security DNA Deoxyribonucleic Acid DoD U.S. Department of Defense DOE U.S. Department of Energy DoReMi Low Dose Research Towards Multidisciplinary Integration DTP Developmental Therapeutic Program DTRA Defense Threat Reduction Agency (DoD) DU Depleted Uranium EPA U.S. Environmental Protection Agency EPR Electron Paramagnetic Resonance FAA Federal Aviation Administration FDA U.S. Food and Drug Administration FISH Fluorescence In Situ Hybridization FSR&M Facilities Sustainment, Restoration, and Modernization HHS U.S. Department of Health and Human Services HJF Henry M. Jackson Foundation for the Advancement of Military Medicine PREPUBLICATION COPY: UNCORRECTED PROOFS xi

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xii Abbreviations and Acronyms HPS Health Physics Society IAEA International Atomic Energy Agency ICRP International Commission on Radiological Protection IOM Institute of Medicine ISN Bureau of International Security and Nonproliferation LBNL Lawrence Berkeley National Laboratory LET Linear Energy Transfer LINAC Linear Accelerator LNT Linear No-Threshold LSS Life Span Study MCMs Medical Countermeasures MELODI Multidisciplinary European Low Dose Initiative MEIR Medical Effects of Ionizing Radiation MRAT Medical Radiobiology Advisory Team NAS National Academy of Sciences NASA National Aeronautics and Space Administration NCES National Center of Education Statistics NCI National Cancer Institute NCRP National Council on Radiation Protection and Measurements NIAID National Institute of Allergy and Infectious Diseases (NIH) NIH National Institutes of Health (DHHS) NIOSH National Institute for Occupational Safety and Health NRC National Research Council (of the U.S. National Academy of Sciences) NRF National Response Framework NRIA Nuclear/Radiological Incident Annex NSF National Science Foundation NSBRI National Space Biomedical Research Institute O&M Operations and Maintenance OCET Office of Counterterrorism and Emerging Threats ORISE Oak Ridge Institute for Science and Education (ORNL) ORNL Oak Ridge National Laboratory OSCC Oxford Survey of Childhood Cancer OSTP Office of Science and Technology Policy (Executive Office of the President) PCC Premature Chromosome Condensation PI Principal Investigator PNNL Pacific Northwest National Laboratory RadCCORE Radiation Countermeasures Center of Research Excellence RBE Relative Biological Effectiveness RDD Radiological Dispersal Device (“dirty bomb”) RDT&E Research Development Testing & Evaluation PREPUBLICATION COPY: UNCORRECTED PROOFS

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Abbreviations and Acronym xiii REB Radiation Epidemiology Branch (NCI) RRP Radiation Research Program (NCI) RRS Radiation Research Society SED Survey of Earned Doctorates SES Socioeconomic status STEM Science, Technology, Engineering, and Mathematics TRIGA® Training, Research, Isotopes, General Atomics U.S.NRC U.S. Nuclear Regulatory Commission UNSCEAR United Nations Scientific Committee on Atomic Radiation USAF U.S. Air Force USTUR U.S. Transuranium and Uranium Registry USUHS Uniformed Services University of the Health Sciences (DoD) VA U.S. Department of Veterans Affairs WMD Weapon of Mass Destruction PREPUBLICATION COPY: UNCORRECTED PROOFS

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