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Summary It is probably only a matter of time before we witness the next event in which large numbers of people are exposed to ionizing radiation. In the past, planning a response to such an occurrence would have likely focused on the management of casualties from high-dose exposure. However, more recently, a different threat has come to the fore: accidental (through a containment breach in a nuclear power plant, for example) or intentional (via a “dirty bomb”) releases of radioactivity resulting in low-dose exposure to a population. The magnitude of the health risks arising from low-dose radiation exposure is uncertain, and this uncertainty has significant economic implications for public health decision making. U.S. Department of Energy estimated the FY 2013–FY 2090 cost of cleanup at the radioactively contaminated Hanford Site in Washington State to be $114.8 billion (DOE, 2013). Three years after the March 11, 2011, Fukushima nuclear accident, nearly half of the evacuated populations is not able or willing to return to their homes (IAEA, 2011; WNA, 2014). The challenges of dealing with such situations are due in part to the difficulties associated with understanding and communicating radiation-exposure risks and solutions. For these reasons and others, it is important to improve the scientific understanding of biological effects of exposure to low-dose radiation. The U.S. military has a particular interest and stake in understanding the effects of exposure to ionizing radiation. Response to nuclear threats has been a critical part of its planning process since the Trinity atomic test detonation in 1945, and Department of Defense (DoD) has long recognized the importance of maintaining a health-effects research program as part of this process. To that end, it established the Armed Forces Radiobiology Research Institute (AFRRI) in 1961 and gave it the mission to “preserve the health and performance of the U.S. military personnel and to protect humankind through research that advances understanding of the effects of ionizing radiation.” AFRRI conducts research on the prevention, assessment, and treatment of injuries resulting from the effects of ionizing radiation and provides education on medical and emergency response to radiation-exposure incidents. INTENT AND GOALS OF THE STUDY In 2012, the Uniformed Services University of the Health Sciences (USUHS)—the DoD organization that exercises organizational responsibility for AFRRI—requested that the Institute of Medicine (IOM), in concert with the Nuclear and Radiation Studies Board of the National Research Council (NRC), examine recent scientific knowledge about the human effects of exposure to low-dose radiation from medical, occupational, and environmental ionizing-radiation sources, focusing on the work of and opportunities for the Institute. They asked that the study PREPUBLICATION COPY: UNCORRECTED PROOFS S-1

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S-2 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI 1. Identify current research directions in radiobiological science related to human health risks from exposure to low-dose ionizing radiation. 2. Assess how AFRRI programs are advancing research along these directions. 3. Identify opportunities for AFRRI to advance its mission for understanding human health risks from exposure to low-dose ionizing radiation with special emphasis on DoD military operations and personnel. 4. Assess the demand for radiobiology researchers and examine workforce projections. If workforce projections are inadequate to meet demand, suggest ways to accelerate training and investigator development. This report, prepared by the Committee on Research Directions in Human Biological Effects of Low Level Ionizing Radiation, answers that request. FRAMEWORK AND ORGANIZATION The committee organized its approach to responding to its tasks into four primary chapters addressing the following topics: • An introduction to the topic of human health effects from exposure to ionizing radiation; an explanation of the committee’s statement of task; the methodologic considerations that informed the committee’s evaluation of the literature; and summary information on earlier NAS reports addressing such related topics as the health effects of exposure to low-level ionizing radiation; military radiation exposure concerns; radiation exposure in other populations, including civilians; and the research workforce (Chapter 1). • Background on the current directions in radiobiology research, with a focus on the cancer and noncancer health effects associated with exposure to low levels of radiation and the tools available to researchers to study them; the different methods used to analyze biological markers of dose or effect; and the factors that influence the risks associated with exposure (Chapter 2). • The state of the radiobiology research workforce, including a description of the field of study and information on the supply of and demand for professionals in the discipline (Chapter 3). • Details on AFRRI’s organization and its role in radiobiology research: the history of the Institute; its physical plant, staff, budget, and capabilities; its research priorities and portfolio; its education, training, and emergency response responsibilities; and its interactions with the broader research community (Chapter 4). These chapters contain the details and analysis that build the foundation for the findings, conclusions, and recommendations presented in Chapter 5. Chapter 5 puts forward a series of proposals for how AFRRI might build on its strengths and advance its mission while contributing to the body of scientific knowledge on the health effects of exposure to low-dose ionizing radiation. PREPUBLICATION COPY: UNCORRECTED PROOFS

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Summary S-3 THE COMMITTEE’S EVALUATION Current Directions in Radiobiology Research The health effects of exposure to high doses of ionizing radiation (1 gray [Gy] and above) are generally well understood; when they are not, research methods exist to address unanswered questions. Research opportunities in this dose range exist for the study of genetic and epigenetic effects on future generations although these may be of less significance to the military than acute outcomes that affect its ability to carry out missions. Less well-established, even at high doses, are the effects of radiation dose modifiers, such as radiation quality, dose rate, individual sensitivity, and combined injury.1 Studies of the significance of these modifiers at high doses are often feasible with current methods, but their results are typically dependent on the assumptions made to model effects. At lower radiation doses, data interpretation is more challenging because it becomes increasingly difficult to distinguish effects attributable to exposure from other causes. Most of the epidemiological data to date at dose levels less than 1Gy are for carcinogenesis, cardiovascular effects, and cataracts. Other radiation-induced endpoints may be present at lower doses but masked by confounding factors. Methods for lower-dose studies are much less well-established than those for high-dose research. Epidemiological studies are currently quite limited, and laboratory models do not directly relate to radiation-induced carcinogenesis in humans. There are theoretical models for extrapolating risks from higher to lower doses, but these have yet to be validated. Scientific advances are providing new opportunities to understand the effects of ionizing radiation at subcellular levels and to translate this understanding to whole organisms. For example, new molecular biology tools enable the study of radiation effects at doses that are below those considered amenable for study using traditional epidemiological methods. These tools can be used to investigate chemical changes to DNA molecules that affect their signaling capacity and alter molecular expression in the absence of DNA structural damage, thus yielding information that might inform the evaluation of more subtle and long-term health effects in coordination with targeted epidemiological studies. There are thus a number of unanswered questions regarding the human health effects of low-dose ionizing radiation exposures and, while scientific advances provide opportunities to address them, significant challenges are associated with moving forward. For many years, the United States has been the world leader in understanding the health consequences of radiation exposure, but more recently, research in this area has slowed down, and the country lacks a long-term milestone-driven strategic plan for better understanding effects and risks of low doses. Sixteen nations—under the aegis of the Multidisciplinary European Low Dose Initiative and its DoReMi research integration effort—are already pursuing the development and implementation of such a plan, and the United States would benefit from undertaking similar action. 1 A combined injury is “physical, thermal, and/or chemical trauma combined with radiation exposure at a dose sufficient to diminish the likelihood of overall survival or functional recovery” (HHS, 2014). PREPUBLICATION COPY: UNCORRECTED PROOFS

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S-4 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI The Radiobiology Workforce Radiobiology, the study of the effects of ionizing radiation on living things, is a diverse field whose workforce includes individuals who were trained in various disciplines and who engage in varied areas of practice, including clinical care, monitoring of radiation exposure, research, and teaching. As such, it is difficult to evaluate the supply of and demand for professionals because there is no uniformity in the name given to their degree program or their self-identification. Professional societies have some data on their membership, but such information presents an incomplete picture. Although it does not appear that there is currently an acute shortage of researchers in radiobiology and related disciplines, available information suggests that the number of professionals leaving the field through retirement and other means exceeds the number entering and that this trend will continue. Assuming a continuing demand for radiobiology research, it is reasonable to conclude that the supply of professionals will not meet the demand in the coming years. When this committee completed its work, the congressionally chartered National Council on Radiation Protection and Measurements was engaged in an effort to better characterize the magnitude of the problem and offer recommendations for addressing it on a national level. AFRRI Programs, Research, and Resources AFRRI is the only DoD entity dedicated to ionizing-radiation health-effects research. Its unique infrastructure boasts a 1-Megawatt TRIGA® Mark F reactor that is one of the few dedicated to radiobiology research. It also houses X-ray, cesium-137 (137Cs), and cobalt-60 (60Co) exposure sources and a vivarium that maintains rodents, minipigs, and nonhuman primates for studies. The Institute’s research portfolio principally comprises work addressing biodosimetry, combined injury, internal contamination and metal toxicity, and countermeasure development. Some projects are supported by and in some cases conducted at the behest of government or private-sector funders, while the remainder are initiated by its Principal Investigators and supported internally. AFRRI also fulfills its mission by producing manuals and protocols on radiation-exposure response, conducting education and training in these areas, supplying nuclear and radiological emergency response assistance, and providing advice to the federal government. Although AFRRI has conducted a small number of studies at low doses, low-dose radiation exposure was not a specifically-defined research area at the time this report was written. In the dose range 1 Gy and below, studies include the development of models to study carcinogenesis and non-targeted effects at the molecular level. Late effects of radiation (including internal and external contamination from depleted uranium [DU]), countermeasures to prevent those late effects, and associated biomarkers are also being studied. Areas of research that address both low- and high-level exposure include the tissue and cellular effects of combined injuries on the skeletal system, countermeasures to the effects of low dose–rate gamma radiation encountered in nuclear fallout, and some of the Institute’s biodosimetry and exposure characterization work. The Institute’s current portfolio of studies is focused almost exclusively on exposures above 1 Gy—a range that the research community and international organizations classify as moderately high and high dose. This work is consonant with AFRRI’s mission and yields information that is vital to managing the consequences of nuclear and radiological material PREPUBLICATION COPY: UNCORRECTED PROOFS

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Summary S-5 releases as a result of armed conflicts, terrorist actions, and accidents. It does not, though, generate knowledge that would help answer the questions identified as being important to understanding the health risks of low-dose radiation exposure. The committee thus concludes that while AFRRI carries on a robust program of research on the biological and health effects of high dose ionizing radiation exposure, it is not currently substantively advancing low-dose research. THE COMMITTEE’S FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS In the course of its work, the committee examined the full range of AFRRI’s activities. Although its statement of work was focused on low-level radiation, it also offers observations applicable to the full range of AFRRI’s activities and on organizational issues because the success of a low-level radiation program depends on the viability of the Institute’s entire research enterprise. AFRRI’S SCIENTIFIC PROGRAM AND OUTREACH ACTIVITIES AFRRI as a Unique National Asset DoD has tasked AFRRI to conduct research in the field of radiobiology and related matters essential to the operational and medical support of the U.S. military and has given it responsibilities that include operating a radiobiology- and ionizing-radiation– bioeffects research facility; cooperating with other military components, Federal agencies, and outside investigators on relevant studies; providing training in radiobiology, medical and emergency response, and related fields; and consulting with the services and government in their areas of expertise. There is no other DoD-level organization whose mission is so comprehensive and has such a broad scope in radiological health and protection. AFRRI’s programs and outreach activities provide the nation with important fundamental research, basic knowledge, practical applications, tools, and guidance associated with radiobiology and related matters essential to the operational and medical support of DoD and the military services as well as civilian and emergency responders. The Institute’s unique infrastructure, which would be difficult to reproduce elsewhere, positions it to contribute to research on the health effects of low-level ionizing radiation. Opportunities for Additional or Expanded Roles for AFRRI AFRRI’s research currently focuses on issues related to high-dose radiation exposure. Although some low-dose work is conducted, and other existing initiatives either have low-dose applications or could presumably be extended into this exposure range, the Institute appears likely to remain oriented toward high-dose work for at least the short term because that is where the experience and practical knowledge of its personnel are centered. For these reasons, the committee concludes that it is not appropriate to propose a specific low-dose research agenda as indicated in its statement of task. Performing substantive work in this area will first require changes in institutional culture and a reorienting of staff expertise. Nevertheless, the committee PREPUBLICATION COPY: UNCORRECTED PROOFS

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S-6 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI believes that there may be opportunities for AFRRI to contribute to the understanding of human health risks from exposures to low-dose ionizing radiation in a manner that is consistent with its mission; that take advantage of its current expertise, its infrastructure, and its position within the DoD; and that put it on the pathway toward making greater contributions to this area of research in the future. AFRRI has opportunities for additional or expanded work in the following areas: nuclear- and radiological-emergency response; treatment and management of psychological injuries after a nuclear or radiological event; development and evaluation of field radiation instrumentation; training of radiation-research and -response professionals and support of radiation epidemiology and risk research. Some of these entail cooperation with outside investigators to facilitate their low-dose research; others extend existing Institute initiatives to cover low-dose exposures. Preparedness and Response to Nuclear or Radiological Emergencies AFRRI has been primarily concerned with the effects of nuclear weapons on the battlefield and the survival of military personnel in such environments. Much of this knowledge is directly applicable to emergency response and protective actions for the civilian population in the aftermath of a low-level nuclear or radiation-release event. AFRRI has developed and disseminates data-gathering instruments that are needed in the event of such an emergency. However, an opportunity exists for AFRRI to make its nuclear and radiological incidents response educational materials, forms and tools—which are already amenable to civilian applications—more useful to both the military and civilians by adapting them to modern digital devices such as tablets and smart phones and assuring their applicability to low- level exposure incidents. Another potential area is in the training, equipping, and standardizing of the multiple DoD radiological response teams. Currently, the U.S. Army, Navy, and Air Force have their own response teams that were originally chartered to respond to a nuclear weapon accident but whose missions now include radiological accidents and spills. Despite the commonality of their responsibilities, they have different procedures, instrumentation, sample collection and analysis capabilities, and command structures. An opportunity exists for AFRRI to have a coordinating role within the services to facilitate standardization of their radiological response teams, and to ensure they are well trained and equipped to deal with low-level radiation incidents. If DoD chooses to tap the Institute’s expertise, AFRRI’s coordinating role could extend to supporting the procurement of radiation-detecting and -analysis instrumentation (addressed below), contamination-control materials, health-physicist and technician training, command and control, field procedures, external and internal dosimetry, computer projection models, and sample-collection and -analysis methods. Management of Psychological Effects Associated with a Nuclear or Radiological Emergency Nuclear and radiological-exposure incidents pose special challenges because the stressor is invisible and cannot be sensed or avoided like other threats. The management of psychological effects related to a nuclear or radiological event falls under AFRRI’s mission to preserve the health and performance of U.S. military personnel, but the Institute does not currently have psychologists, psychiatrists, risk-communication specialists, or professionals in related fields as PREPUBLICATION COPY: UNCORRECTED PROOFS

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Summary S-7 members of its research staff. USUHS, however, is well positioned to help implement information dissemination, training programs and research intended to give military health care providers and first responders the tools and techniques to treat psychological injuries and deal with other issues resulting from release incidents. Thus, an opportunity exists for AFRRI to serve as a source of information, training, and research on the response to psychological issues raised by low-level nuclear and radiological release incidents if an institutional decision is made to collaborate with USUHS staff for this purpose. This in-house expertise will be helpful in crafting the psychological- injury component of AFRRI’s incident-response training responsibilities. Development and Management of DoD Radiation-Protection Instrumentation DoD has a long history of designing, acquiring, and testing environmentally rugged radiation-protection instruments designed to withstand the harsh environments in which they operate. Despite the fact that all three branches of Military Service have some common radiation- detection and measurement needs, the branches develop their own instrument performance specifications and acquire the instruments independently, which leads to the use of different equipment designs to detect essentially the same radiation(s). This leads to interservice operability problems that compound military-responder training and equipment field maintenance. DoD has recently undertaken to establish a joint acquisition effort to provide personnel with instrumentation that would enable the services to effectively conduct joint operations with interoperable equipment. An opportunity exists for AFRRI to aid in the integration and coordination of DoD purchases, commissioning, acquisition, testing, maintenance, and use of radioactivity detection instruments, and to help ensure such instruments will be useful in low-level exposure circumstances. AFRRI is well suited to support this DoD initiative because it has the qualified staff (health physicists), facilities (calibration-exposure rooms), and dosimetry experience needed to help develop instrument-performance specifications and perform acceptance testing. Investments may need to be made in staff training and for exposure chambers needed for environmental testing of candidate devices should DoD choose to take advantage of this opportunity. Radiation Professionals Workforce Education AFRRI has the necessary infrastructure to help support graduate education in several radiation specialties greatly needed within DoD and the civilian sector, including radiobiology, health physics, medical physics, radioepidemiology, and radioecology. As of January 2014, the USUHS website stated its intent to establish a Radiation Biology track within the school’s Molecular and Cell Biology program. It also listed an Acting Chair of the department (an AFRRI investigator who holds an appointment in the university) and nine faculty members, some of whom are AFRRI investigators and all of whom have adjunct appointments. In response to a question from the committee, AFRRI indicated that although USUHS planned to begin granting degrees in radiation biology in 2013, funding shortages have delayed implementation of the program. PREPUBLICATION COPY: UNCORRECTED PROOFS

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S-8 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI Other degree programs that USUHS does not offer currently—for example, in health and medical physics2 —could be built around the advantages of its proximity to AFRRI. The Institute’s laboratory and reactor facilities are an asset not shared by many universities with graduate health-physics programs and are well suited to train military health physicists, who face some unique challenges not encountered by their civilian counterparts; these include potential exposure to nuclear weapons, reactors used to power ships and submarines, military equipment that uses radioactive sources, and nuclear battlefield operations. Each year the Service branches send junior officers to attend civilian universities to earn graduate degrees in health and medical physics because equivalent graduate-level programs do not exist at DoD Service academies or institutes. An opportunity exists for AFRRI to contribute to the education of radiation professionals through better integration and coordination with USUHS so that the university’s degree programs support AFRRI needs and, in turn, AFRRI’s research facilities support degree candidates’ research. Specifically, implementation of the nascent USUHS program in Radiation Biology would help accelerate training in that field, address concerns over coming shortages of professionals, and facilitate the recruitment of new researchers for the Institute, including those with low-dose radiation expertise. The success of a USUHS program in radiation biology or in other radiation health – related fields will depend critically on the active support of the Military Services, which determine which programs their personnel may be sent to for advanced training, and on the availability of research and graduate education funding Support of Radiation Epidemiology and Risk Research To date, AFRRI has had relatively little involvement in epidemiology research and risk projections, and its staff does not have expertise in these areas. Should the Institute wish to extend into such work, it would be well positioned to support studies conducted by others that are consonant with its current expertise by, for example, providing information on biologic changes induced by radiation exposure and on military populations who have experienced DU exposure or combined injuries, which would feed into research on health outcomes in targeted subpopulations. Further, the study of radiation-induced carcinogenesis will benefit from the identification of biomarkers and bio-indicators of radiation-associated disease that could be used in population studies. Therefore, an opportunity exists for AFRRI to contribute to research on low-level effects through molecular and cellular studies of radiation-induced alterations that could be employed in epidemiologic and risk assessment studies, and by extending its work in areas like DU exposure and combined injures to generate information for use in such investigations. To implement this, AFRRI will need to collaborate with outside subject-matter experts to define hypotheses to be tested. AFRRI’s location in DoD may also allow it to facilitate certain other investigations. The potential exists to link DoD radiation-exposure data with health information gathered by the military health system and the Department of Veterans Affairs and to use “big-data” techniques to conduct studies, thus avoiding the expense of collecting information directly from subjects. In 2 An accredited health physics M.S. and Ph.D. program formerly existed at USUHS but is not currently active, so it is unclear whether this is considered a priority by DoD. PREPUBLICATION COPY: UNCORRECTED PROOFS

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Summary S-9 addition, AFRRI could take advantage of its position within USUHS to collaborate with the faculty and students in the graduate programs in Biomedical Sciences and Public Health. Another source is NCI’s Radiation Epidemiology Branch, which also has interests in the health effects of low-dose exposures and in dosimetry. Opportunities for Expanded and Additional Outside Collaborations Federal Agency Collaborations AFRRI’s responsibilities overlap with those of three other federal bodies with which it would seem to have natural affinities because their common interests in the consequences of nuclear and radiological material releases: the Defense Threat Reduction Agency (DTRA) and Department of Homeland Security (DHS)—which also conduct nuclear and radiation-event response training—and the Defense Advanced Research Projects Agency (DARPA), which is interested in technologies that mitigate radiation health risks. However, it currently conducts rather little work with these governmental bodies and the efforts that have taken place have focused on high-dose questions. An opportunity exists for AFRRI to advance its mission by actively pursuing low-level exposure research funding and collaborations with DTRA, DARPA and DHS. Further, an opportunity exists for AFRRI to better integrate itself into the national nuclear and radiological response mechanism by expanding coverage of low- level exposure topics in their existing training courses and materials and adapting these to civilian emergency responders and international audiences. Opportunities to Facilitate Research by Outside Investigators DoD has specific interests and needs in the low-level realm that may not be priorities for civilian entities, and the committee believes that there are ways for AFRRI to advance these interests without acquiring new staff. Notably, the Institute’s radiation facilities are underused— with the TRIGA reactor free 79% of its operating days and the cobalt-60 source free for 50.5%— and their low-level source is virtually unused. Thus, an opportunity exists for AFRRI to expand its participation in low-level radiation health effects research by making its facilities more open to use by outside investigators interested in conducting research consistent with its mission. Allowing outside investigators to take advantage of the dead time to conduct DoD-relevant studies would not only increase the productivity of these assets but would also create new collaborations and additional sources of support for AFRRI staff. The committee understands that such work is currently possible but that associated logistical and administrative challenges represent a significant barrier to conducting such collaborative research. Facilitating the use of AFRRI facilities by outside investigators, including animals managed by its vivarium, would thus require a change in culture within the organization. Notwithstanding, the committee believes that ways could and should be identified to achieve greater openness while preserving the security of the site and meeting other Institute and DoD requirements. AFRRI ORGANIZATION AND ADMINISTRATION Scientific Leadership AFRRI’s management structure formerly included a Scientific Director, a civilian who, along with the Director and Chief of Staff, comprised the senior leadership of the organization PREPUBLICATION COPY: UNCORRECTED PROOFS

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S-10 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI within an Office of the Director. This position, however, has not been filled since 2012. There is currently a Scientific Advisor who reports to the Director, but whose duties do not include supervision of senior research staff. The committee believes that having a Scientific Director in a leadership position helps to achieve several goals that are important for AFRRI if it wishes to pursue a more extensive program of research on the human health risks from exposures to low-level ionizing radiation and, more generally, to promote its standing and visibility in the radiobiology research community—goals that would not necessarily be fulfilled by someone serving in an advisory role. If this person is well-respected in the low-dose scientific community, it would greatly facilitate AFRRI’s efforts to establish an influential research program, attract new investigators with expertise in low-dose questions, and obtain funding for such work. The committee believes that AFRRI will strengthen its position as an ionizing radiation health effects research organization when the position of Scientific Director is filled. The key roles of this person in new research projects that “advance the understanding of human health risks from exposures to low-level ionizing radiation with a special emphasis on Department of Defense military operations and personnel” will be to • Develop institutional low-dose research capacity by facilitating collaborations with outside subject-matter experts and, where needed, recruiting new personnel; and • Identify and implement low-dose initiatives that are responsive to DoD needs with milestones and deliverables (for accountability, promotion and direction) while building on AFRRI’s existing strengths. External Program Evaluation At present, almost all of AFRRI’s research initiatives are assessed on a project-specific basis with the sponsor’s review mechanisms and program managers performing the evaluation function. The intramural research program is reviewed by a panel of outside experts along with AFRRI scientific leadership, but this work accounts for only about 20% of the Institute’s portfolio. AFRRI does not currently have a long-term research plan, although it indicates that one is under preparation. The committee believes that AFRRI’s existing and new research on human health risks from exposures to low-level ionizing radiation, along with the rest of its scientific enterprise, would benefit from a strong, continuing external program evaluation that examined the totality of the Institute’s work. The purposes of such oversight would be to provide input on the quality and usefulness of current work and to assist in defining and setting reasonable and achievable research directions and priorities on the basis of the collective radiobiology knowledge base and AFRRI’s mission(s). It would further promote a closer working relationship with outside organizations for the purpose of research collaboration and facilitation of greater use of AFRRI’s physical plant assets. There are also other means of facilitating external evaluation of AFRRI’s prospective low-dose and other research activities. Possible means include supporting more of the Institute’s research through a funding mechanism that requires such oversight. Operations and Maintenance (O&M) research funding represented more than 70% of all research support and more than half of the total budget in FY2013. AFRRI’s O&M funding, however, does not have a direct PREPUBLICATION COPY: UNCORRECTED PROOFS

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Summary S-11 connection to a funding source that expects to see an outcome at the end of the project: it often comes with no specific milestones or expectations other than the conduct of some type of radiobiologically related research. Most military-related research conducted in other DoD laboratories is supported by Research Development Testing and Evaluation (RDT&E; also known as Program 6.X) funding sources, which require a client or sponsor for the research. The sponsor specifies the research topic, defines the desired outcome measures, and tracks the research organization’s progress toward the desired outcome. In this funding scenario, projects are driven by the customer, so there is no disconnect between what the client (typically the military, in the case of AFRRI) needs and what the researcher provides. Prior to 2005, AFRRI research was exclusively supported by RDT&E funds, but this has changed in recent years (AFRRI, 2013c). Thus, AFRRI may benefit if more of its radiobiology research were supported by RDT&E funds, leaving O&M research funding to support exploratory studies and educational program costs. This alternative, if pursued by DoD, would increase the accountability of investigators and better tie their work to demonstrable research outcomes. External evaluation—and outreach to the greater research community—would also be facilitated by two other steps. One of these is the resumption of the practice of producing an annual report. A yearly accounting of the Institute’s research initiatives, the accomplishments of its staff and effect of their work, and the ways in which its funds were spent would permit DoD sponsors and outside parties to gain a better understanding of AFRRI’s contributions in radiation research and health. The other step would be to make the seminars conducted by AFRRI staff more accessible to researchers outside of the Institute. While security considerations will limit access to some of the Institute’s work, making the unrestricted seminars more open—by, for example, webcasting them and allowing viewers to actively participate in the proceedings— would permit the kind of informal peer review that improves research products. REFERENCES DOE (U.S. Department of Energy). 2013. 2013 Hanford Lifecycle Scope, Schedule and Cost Report. http://www.hanford.gov/files.cfm/2013%20Fact%20Sheet%20Final%20_1-29-13_.pdf (accessed January 27, 2014). HHS (Department of Health and Human Services). 2014. Radiation + Trauma (Combined Injury). http://www.remm.nlm.gov/radtrauma.htm (accessed May 25, 2014). IAEA (International Atomic Energy Agency). 2011. Fukushima Nuclear Accident Update Log – Updates of 12 March 2011. Vienna, Austria: International Atomic Energy Agency. http://www.iaea.org/newscenter/news/2011/fukushima120311.html (accessed February 20, 2014). WNA (World Nuclear Association). 2014. Fukushima Accident – Updated 26 February 2014. London, United Kingdom: World Nuclear Association. http://www.world-nuclear.org/info/Safety-and- Security/Safety-of-Plants/Fukushima-Accident/ (accessed February 27, 2014). PREPUBLICATION COPY: UNCORRECTED PROOFS

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