Appendix B


U.S. Radiation Research Programs

This appendix provides a brief summary of low-level ionizing-radiation health-effects research programs under way in the United States and under the direction of international organizations. These include several branches of the federal government with varied interests in security, defense, preparedness and response, health, and science; private organizations; academic institutions; and nonprofit organizations.

The listing is not meant to be comprehensive but rather an overview of major efforts related to the committee’s task. Websites for further information are listed in Table B-1 at the end of this appendix.

Myriad research, educational, and administrative agencies and organizations have an interest in low-level and low linear energy transfer (LET) radiation. Some are focused on national defense and the risks of nuclear weapons and the resulting public health response, others are dedicated to workers and environments affected by nuclear power generation, and still others are concerned with cosmic radiation. The following section describes U.S. federal programs and initiatives that investigate and plan responses to the effects of low-level radiation exposure. Some of these programs have broad missions, of which radiation and low-level issues are just one piece.

DEPARTMENT OF DEFENSE

The Department of Defense (DoD) sponsors research on the health effects of ionizing radiation in line with its mission to protect and preserve military-force readiness and the health of military personnel. In addition to the other work performed by the Armed Forces Radiobiology Research



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Appendix B U.S. Radiation Research Programs This appendix provides a brief summary of low-level ionizing-radiation health-effects research programs under way in the United States and under the direction of international organizations. These include several branches of the federal government with varied interests in security, defense, pre­ paredness and response, health, and science; private organizations; aca­ demic institutions; and nonprofit organizations. The listing is not meant to be comprehensive but rather an overview of major efforts related to the committee’s task. Websites for further informa­ tion are listed in Table B-1 at the end of this appendix. Myriad research, educational, and administrative agencies and organi­ zations have an interest in low-level and low linear energy transfer (LET) radiation. Some are focused on national defense and the risks of nuclear weapons and the resulting public health response, others are dedicated to workers and environments affected by nuclear power generation, and still others are concerned with cosmic radiation. The following section describes U.S. federal programs and initiatives that investigate and plan responses to the effects of low-level radiation exposure. Some of these programs have broad missions, of which radiation and low-level issues are just one piece. DEPARTMENT OF DEFENSE The Department of Defense (DoD) sponsors research on the health ef­ fects of ionizing radiation in line with its mission to protect and preserve military-force readiness and the health of military personnel. In addition to the other work performed by the Armed Forces Radiobiology Research 135

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136 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE Institute (AFRRI), it is involved in the efforts described in the following sections. Defense Advanced Research Projects Agency Established in 1958, the Defense Advanced Research Projects Agency (DARPA) is dedicated to the advancement of science and technology for the U.S. military and bridging the gap between scientific discovery and military applications (DARPA, 2009). By sponsoring and conducting investigations with multidisciplinary approaches and finite duration, DARPA seeks to advance current knowledge and create innovative solutions through ap­ plied research. The research it conducts and sponsors is intended to be cutting edge, high risk, and high payoff. Its scientific areas include biology, medicine, computer science, chemistry, physics, engineering, mathematics, material sciences, and social sciences. The Agency has a continuing interest in the health effects of radiation and, as noted in Chapter 5, has undertaken three initiatives in the last 10 years related to ionizing radiation health effects. The first of these was a 2005 effort to develop technologies to minimize the warfighter’s vulner­ ability to radiation exposures via vaccines and novel antidotes (DARPA, 2005). The second effort was the Radiation Bio-Dosimetry (RaBiD) pro­ gram, which ran from 2008 through 2011 and whose purpose was to develop “non- or minimally invasive, portable and low-cost radiation bio- dosimeters, as well as novel radiation mitigation technologies that can be administered 12 or more hours after exposure and provide better than 90-percent survivability to humans” (DARPA, 2012). A 2007 solicitation indicates that AFRRI was responsible for testing biodosimeter prototypes developed under the effort (DARPA, 2007). Then, in February 2013, the Agency issued a request for information for “ideas, methodologies, and approaches . . . [that] may be used to support a potential new DARPA program to enable novel therapies for mitigating the effects of ionizing- radiation exposure in military or civilian personnel in the aftermath of a large-scale release of nuclear material that may result from either a natural disaster or a deliberate attack” (DARPA, 2013). Defense Threat Reduction Agency The Defense Threat Reduction Agency (DTRA) was created to ensure the safety of the United States and its allies by working to reduce, eliminate, and counter threats posed by weapons of mass destruction (WMDs), in­ cluding chemical, biological, radiological, nuclear, and high-yield explosive (CBRNE) WMDs. DTRA’s efforts include basic and applied research in addition to operational support and think tanks (DTRA, undated).

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APPENDIX B 137 DTRA also acts as DoD’s executive agent for the Nuclear Test P ­ ersonnel Review (NTPR) Program. This program provides participa­ tion and radiation-dose information to veterans who participated in U.S. ­ atmospheric nuclear tests, served with the American occupation forces of Hiroshima and Nagasaki, Japan, or were prisoners of war in these areas at the conclusion of World War II (DTRA, 2009). More recently, DTRA has conducted assessments and issued reports on radiation exposure in U.S. Coast Guard veterans (DTRA, 2011) and many pertaining to radiation exposure among U.S. forces associated with the Operation Tomodachi response to the Fukushima Daiichi nuclear reactor accident in 2011 (NCRP, 2012). DEPARTMENT OF ENERGY The Department of Energy (DOE) participates in several initiatives sup­ porting research and education concerning low-level and low-LET radiation through diverse programs and laboratories. Those that are most pertinent to the committee’s task are discussed below. Low Dose Radiation Research Program DOE’s Office of Science’s Office of Biological and Environmental Re­ search established the Low Dose Radiation Research Program in 1999 (DOE, 2012). The primary aims of the program were to support experimental re­ search and to generate data that could be adapted by regulatory agencies such as the Environmental Protection Agency (EPA) and the U.S. Nuclear Regu­ latory Commission to set future radiation standards and develop national ­ p ­ olicy for the protection of the public and the workforce during environ­ mental cleanup, nuclear waste storage, and use of nuclear power. Today, radiation-protection standards and operating policies, such as “as low as reasonably achievable,” are derived from the conservative assumption of the linear no-threshold (LNT) model. Because most human exposures to radia­ tion are of low dose or low dose rate, the program concentrates on studies of low-LET exposures delivered at low total doses and low dose rates. The program was intended to take advantage of the advances in m ­ olecular biology and instrumentation that were not available during the previous 50 years of radiation-biology research (Brooks, 2012). As such, it has paid particular attention to experimental research on bystander effects, adaptive responses, genomic instability, and mathematical and risk model­ ing that incorporates knowledge from low-level experimental research into mechanism-based models of tissue function. As of 2013, about 40 percent of the program’s funds supported research projects at academic institutions, and the remaining 60 percent supported

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138 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE research at three DOE-affiliated national laboratories: Lawrence Berkeley National Laboratory (LBNL), Oak Ridge National Laboratory (ORNL), and Pacific Northwest National Laboratory (PNNL) (DOE, 2013a). How­ ever, the (March 2014) DOE fiscal year (FY) 2015 congressional budget request puts forward a substantial decrease in funding levels, from ~$6.2M for FY 2013 to a proposed $2.4M for all radiobiology research in FY 2015 (DOE, 2014). DOE is also a cosponsor of the Million U.S. Worker Study, which is examining health outcomes in a number of cohorts occupationally exposed to low-level radiation, including “uranium and plutonium workers at DOE sites, nuclear weapons test participants, nuclear power plant workers, and industrial radiographers, radiologists, and other medical practitioners” (ORAU, 2013). Low Energy Nuclear Physics Research The Low-Energy subprogram studies the nuclear structure, astro­ hysics, p and fundamental symmetry and neutrinos at two Nuclear Physics Program user facilities. The personnel at the Argonne Tandem LINAC Accelerator System (ATLAS) at Argonne National Laboratory study nuclear properties under extreme conditions and reactions of interest using high-quality beams of all the stable elements up to uranium and selected beams of short-lived nuclei. The Holifield Radioactive Ion Beam Facility at ORNL staff studies exotic nuclei that do not normally exist in nature with beams of short-lived radioactive nuclei. The future Facility for Rare Isotope Beams will have next-generation equipment to advance the understanding of rare nuclear isotopes and the evolution of the cosmos. The subprogram supports four university Centers of Excellence, three with unique low energy–­ ccelerator a facilities and one with infrastructural capabilities for developing advanced instrumentation. The subprogram also partners with the National Recon­ naissance Office and the U.S. Air Force to support limited operations of the 88-inch cyclotron at LBNL for a small in-house research program and to meet national security needs. Additionally, nuclear physicists at the Spall­ ation Neutron Source at ORNL study the properties of neutrinos and their masses (DOE, 2013b). Workforce Development for Teachers and Scientists (WDTS) DOE supports efforts to provide opportunities for science, technology, engineering, and mathematics (STEM) workforce development, known as Workforce Development for Teachers and Scientists (DOE, 2013c). This ef­ fort offers access to leading scientists; world-class scientific user facilities and instrumentation; and large-scale, multidisciplinary research programs un­

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APPENDIX B 139 available in universities or industry. The laboratories also provide opportuni­ ties for science, engineering, and technology training and education for more than 250,000 K–12 students, 22,000 K–12 educators, 4,000 undergraduate interns, 3,000 graduate students, and 1,600 postdoctoral researchers an­ ­ nually. Although these efforts are not focused on ionizing-radiation health research, they do include opportunities for those interested in the field. National Nuclear Security Administration The National Nuclear Security Administration was established by Con­ gress in 2000 to support the management and security of the nation’s n ­ uclear weapons, nuclear nonproliferation, and naval reactor programs. It is a separate agency in DOE that focuses on defense, nuclear non­ proliferation, naval nuclear energy, nuclear security, and counterterrorism and counterproliferation (DOE, undated). NATIONAL AERONAUTICS AND SPACE ADMINISTRATION To continue to its mission of space exploration, the National Aeronautics ­ and Space Administration (NASA) must understand and prevent risk to crew members sent into space, including the risks posed by solar and cosmic radia­ tion. Without the protection of Earth’s atmosphere, space crew may be at increased risk of acute radiation sickness, cancer, and other chronic diseases associated with radiation exposure. High-energy solar radiation from the sun, sun flare, and cosmic radiation originating in deep space pose unique challenges. Space Radiation Health Program NASA’s Space Radiation Health Program, Office of Biological and Physical Research, and DOE jointly fund research to help understand the radiation risks associated with travel in space (NASA, 2014). Because the radiation environment in space differs from that on Earth, NASA is especially interested in the health risks associated with human exposure to low levels of the high-energy ionizing radiation (alpha particles, protons, and high-energy heavy ions) that comprise the solar wind and cosmic rays and in the resulting health risks to crew members. NASA’s research focuses on characterizing the risks resulting from space radiation for cancers, acute or late central nervous system effects, degenerative tissue effects, and acute risks. Its research also seeks to develop radiation countermeasures to ef­ fectively prevent and treat potential cosmic radiation damage. Research is carried out at several research facilities, including the J ­ohnson Space Center, the Langley Research Center, the Ames Research

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140 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE Center, and the Brookhaven National Laboratory (BNL). Efforts are fo­ cused on learning more about the radiation environments that crew mem­ bers will encounter during long-duration missions to the moon and Mars. National Space Biomedical Research Institute The National Space Biomedical Research Institute (NSBRI), founded in 1997 by NASA, is a nonprofit science institute dedicated to ensuring safe and productive spaceflight. It comprises 12 institutions that study the health risks related to long-duration spaceflight and develop methods to reduce those risks. The NSBRI supports the investigation of several areas of medical science, one of which is radiation effects. The Radiation Effects Team supports research on health risks and mitigation strategies specifi­ cally related to cosmic radiation, with an emphasis on acute effects and on dosimetery to monitor and provide advance warning of risks inside ­ the spacecraft and out. The NSBRI Center of Acute Radiation Research (CARR), headquartered at the University of Pennsylvania through 2013, is a central component of the Radiation Effects Team that has multiple p ­ rojects assessing the effects of exposure from solar events, defining associ­ ated health risks, and developing safe and effective methods to prevent and treat acute radiation–syndrome symptoms. The CARR includes researchers from the University of Illinois, the Massachusetts Institute of Technology, and AFRRI (NSBRI, undated a, undated b). NSBRI also includes an educational component with a robust teaching, training, and public outreach program (NSRBI, 2012). Human Research Program NASA’s Human Research Program collects data on radiation exposure from returning crew members. Findings are used to inform guidelines for exposure and safety procedures. The Human Research Program comprises scientists and engineers dedicated to research on radiation exposure dur­ ing space flights and development of solutions and technologies to reduce health risks. Most research focuses on physiology, environment, and tech­ nology study areas. Future research will explore the unique challenges and risks posed by extended space missions (NASA, 2009). DEPARTMENT OF HEALTH AND HUMAN SERVICES Several areas within the Department of Health and Human Services (HHS) are involved in radiation-research and public health–preparedness activities. Its institutes, centers, and agencies pursue a range of endeavors,

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APPENDIX B 141 including research, training, emergency planning and response, outreach, policy support, and regulations related to radiation exposure. National Cancer Institute The National Cancer Institute (NCI) Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch (REB) conducts a number of national and international studies on populations exposed to radiation for medical, environmental, and occupational reasons. Among its international collaborations are efforts with the Research Center for Radiation Medicine in Ukraine to conduct studies of the Chernobyl-affected population, the Southern Urals Biophysics Institute for research on workers at the Mayak nuclear facility, and the University of Newcastle to evaluate the relation­ ship between radiation exposure from computed tomography (CT) scans conducted during childhood and adolescence. REB additionally supports radiation dosimetry work to support the epidemiologic studies. Epidemiologic study activities at REB include • Efforts to identify and quantify the risk of cancer associated with ionizing and nonionizing radiation, especially at low-dose levels; • Characterization of the risk of radiation-induced cancer in terms of tissues at risk, dose response, biological effectiveness, dose rate, time since exposure, sex, age at exposure and at observation, and possible modifying influences of other environmental and host factors; • Methods for radiation-dose reconstruction for environmental, oc­ cupational, and medical exposures; • Applications of dosimetry in studies of countermeasures against radiological and nuclear threats; • Examination of biologically based models of radiation-induced carcinogenesis; • Case-control and cohort studies of cancer risk in populations ex­ posed to occupational, environmental, or medical diagnostic or therapeutic radiation; • Population-based studies to examine biomarkers of radiation ex­ posure; and • Individual variation in radiogenic risk associated with a wide range of demographic, racial or ethnic, geographic, physiologic, hor­ monal and immune function, and genetic factors. REB also advises and collaborates with other agencies and individuals involved in radiation research and regulatory activities (NCI, undated a). The Radiation Research Program (RRP) of the Division of Cancer

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142 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE Treatment and Diagnosis at NCI supports basic, translational, and clinical research in radiotherapy and radiation biology. The RRP is divided into three branches: Radiotherapy Development, Clinical Radiation Oncology, and Molecular Radiation Therapeutics. In its effort to stimulate radio­ therapy and radiation-biology research, the RRP serves as an advisor to researchers, an evaluator of conducted research and future research priori­ ties, and a liaison to the Medical Countermeasures against Radiological and Nuclear Threats Initiative of NCI, the National Institute of Allergy and Infectious Diseases (NIAID), and the Office of the Assistant Secretary for Preparedness and Response. RRP staff also review grant proposals and con­ tracts submitted to DoD and the Biomedical Advanced Research and Devel­ opment Authority (BARDA) and consult on radiation issues with program staff in NIAID (NCI, undated b). The Developmental Therapeutic Program (DTP), which was created by Congress in 1955, serves as the focal point for research on chemotherapeu­ tic agents within NCI. DTP facilitates the work of academic and private sector investigators and has helped to bring a number of widely used agents to market. National Institute of Allergy and Infectious Diseases NIAID’s research focus on immunology, which includes research on adult bone marrow stem cells, transplantation, and immune reconstitu­ tion, is relevant to ionizing-radiation research because ionizing radiation can cause immunosuppression after damage to the hematopoietic cells. Its Radiation and Nuclear Countermeasures Program is a focal point for such work. The NIH Strategic Plan and Research Agenda for Medical Counter­ measures against Radiological and Nuclear Threats is the result of an HHS request to NIAID to develop and guide a research program for the develop­ ment of effective medical countermeasures against possible terrorist-attack scenarios involving radioactive materials (NIAID, 2005). This initiative was the first federal mission to develop countermeasures for civilian popula­ tions. Funding is provided through a special congressional appropriation to HHS’s Office of Public Health Emergency Preparedness. In 2005, NIAID established eight cooperative Centers for Medical Countermeasures against Radiation (CMCR). The CMCR is intended to develop radioprotectors, mitigators, and therapeutic agents to facilitate ef­ fective medical response against radiological and nuclear threats. Addition­ ally, the CMCR supports the development of biomarkers and bio­ osimetry d techniques and devices for rapid triage and treatment of individuals ex­ posed to radiation after a radiological event. Another aim of the CMCR

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APPENDIX B 143 network is to provide new or expanded educational resources to improve expertise in radiation biology. To meet its goals, NIAID works in partnership with the Centers for Disease Control and Prevention, the Food and Drug Administration (FDA), and BARDA to develop, license, procure, and deploy effective medical countermeasures against radiation threats (NIAID, 2013). Office of the Assistant Secretary for Preparedness and Response The Biomedical Advanced Research and Development Authority is responsible for the development and procurement of countermeasures to prepare the nation to respond to and recover from public health emergen­ cies. BARDA is involved in all stages of product development from devel­ opment and manufacture, safety and regulatory affairs, to supply issues, including stockpiling, storage, and transportation. Within BARDA, the Division of Chemical, Biological, Radiological and Nuclear (CBRN) Medi­ cal Countermeasures (MCMs) is responsible for CBRN MCMs required by the HHS to mitigate the adverse health effects arising from public health emergencies, including anthrax, smallpox, various chemical threats, and radiation (BARDA, 2013). FOOD AND DRUG ADMINISTRATION Radiological Health Program The mission of FDA’s Radiological Health Program is to pro­ tect the public from hazardous or unnecessary radiation exposure from r ­adiation-emitting electronic products. The program is carried out as a part of FDA’s Center for Devices and Radiological Health (CDRH). The CDRH aims to support the mission of the radiological health program by supporting • Awareness of new and existing radiation-emitting products, their manner of use, and their manufacturers; • Study of the biological effects of radiation-emitting products and their potential risks to health; • Assessment of radiation-emission levels from products in various applications; • Direction and guidance to the general public and users of radiation- emitting products to minimize unnecessary radiation exposure; and • Product manufacturer compliance with all applicable requirements, pursuing regulatory and enforcement actions to address public health problems.

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144 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE CDRH is able to regulate radiation-emitting electronic products used for both medical and nonmedical applications under authority provided by the Electronic Product Radiation Control provisions and the Medical Device Amendments of 1976 of the Federal Food, Drug, and Cosmetic Act. It also regulates facilities performing mammography under the authority of the Mammography Quality Standards Act. Further, CDRH supports FDA’s radiation emergency–response activities to protect the public and com­ municates with stakeholders from governmental, professional, academic, manufacturing, and consumer-advocacy groups (FDA, 2012). Center for Drug Evaluation and Research The Center for Drug Evaluation and Research (CDER) is respon­ sible for ensuring the safety, effectiveness, and availability of prescription and over-the-counter drugs, including countermeasures for use in a public health emergency. Currently, CDER lists three drugs as safe and effective for the prevention and treatment of radiation effects: potassium iodide, calcium- and zinc-DTPA, and Prussian blue (FDA, 2011). Office of Counterterrorism and Emerging Threats The Office of Counterterrorism and Emerging Threats (OCET) co­ ordinates the various offices and departments within the FDA to oversee the devel­ pment, availability, and safety of emergency medical counter­ o measures and the prevention of contamination, corruption, or disruption of medical supplies in a terrorist attack. OCET also administers the Medical Countermeasures initiative (MCMi) as an effort to coordinate intraagency and interagency communication and emergency-use authorizations, giving the FDA Commissioner the authority to allow the use of unapproved medi­ cal products in an emergency (FDA, 2013). CENTERS FOR DISEASE CONTROL AND PREVENTION Agency for Toxic Substances and Disease Registry The Agency for Toxic Substances and Disease Registry (ATSDR) is dedicated to protecting public health by using the best science available to provide accurate health information and prevent harm from exposure to toxic substances, including radioactive substances and ionizing radia­ tion. ATSDR publishes Toxicological Profiles (ToxProfiles) that summarize the available information about a substance and describe its health effects. ATSDR also assesses industrial sites to determine health risks to workers,

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APPENDIX B 145 cleanup personnel, and surrounding communities. Many of the hazardous waste sites are DOE or military facilities related to nuclear-weapons devel­ opment, research, and testing (ATSDR, 2013; CDC, 2010). National Institute of Occupational Safety and Health The National Institute for Occupational Safety and Health (NIOSH) is the lead federal agency for research on worker injury and illness. As part of its responsibility, it conducted studies of several populations with expo­ sure to low levels of ionizing radiation under the aegis of its Occupational Energy Research Program. This program, which is no longer active, devel­ oped exposure characterization models for and examined health outcomes in several cohorts, including those associated with the Portsmouth Naval Shipyard, Fernald Feed Materials Production Center, Hanford Site, Los Alamos National Laboratory, Mallinckrodt Uranium Works, Mound Site, Oak Ridge Facilities (K-25, X-10, Y-12), Paducah Gaseous Diffusion Plant, Portsmouth Gaseous Diffusion Plant, Rocky Flats, and Savannah River National Laboratory (NIOSH, 2011). The Radiation Dose Reconstruction Program area of the NIOSH Divi­ sion of Compensation Analysis and Support operates in support of the Energy Employees Occupational Illness Compensation Program Act, which is administered by the Department of Labor (DOL, undated). NIOSH performs radiation-dose reconstruction for DOE workers and contractors exposed to radiation in support of the nuclear weapons program for the purposes of compensation. Oversight of the dose reconstruction methods and guidelines and the classification of special exposure cohorts (groups of radiation-exposed workers) is provided by the presidentially appointed Advisory Board on Radiation and Worker Health (NIOSH, 2014). Because few studies have been conducted to characterize the cosmic- radiation exposure and associated health effects in U.S. flight personnel working in commercial aircraft, NIOSH established the Flight Crew Re­ search Program in collaboration with the Federal Aviation Administration (FAA), NCI, HHS Office of Women’s Health, and DoD Women’s Health Research Program. Studies include a variety of outcomes, including men­ strual function, pregnancy outcomes, infertility, cancer, stress, respiratory symptoms, and mortality (CDC, 2012). FEDERAL AVIATION ADMINISTRATION Radiobiology Research Team The Radiobiology Research Team of the FAA performs research on the effects of ionizing and nonionizing radiation on living systems, identi­

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146 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE fies radiation hazards in the aviation environment, and studies methods of protection from such hazards. As part of the FAA’s aerospace medical re­ search program, investigators focus on bioaeronautical aspects of safety and security, including forensic toxicology, functional genomics, biochemistry, radiobiology, environmental physiology, and bioinformatics, at the Civil Aerospace Medical Institute (CAMI). The CARI-6 computer program, developed at CAMI, calculates the effective dose of cosmic radiation received by an individual (based on an anthropomorphic phantom) on an aircraft flying the shortest route (i.e., a geodesic) between any two airports in the world. The program takes into account changes in altitude and geographic location during the course of a flight, as derived from the flight profile entered by the user (FAA, 2013). ENVIRONMENTAL PROTECTION AGENCY Because radiation is ubiquitous in the environment at low levels and is a frequent contaminant resulting from industrial activities, EPA has many duties pertaining to it. Radiation Protection Programs Within EPA several offices are tasked with radiation protection ac­ tivities. The Office of Air and Radiation is primarily responsible for the Radiation Protection Program, but other functions are carried out in other areas. Those areas include waste management; emergency response; air and water; source reduction and management; naturally occurring radiation; cleanup and multi-agency programs; risk assessment and federal guidance; and environmental monitoring and data. Through these programs, EPA has responsibilities to assess and monitor human health risks resulting from envi­onmental radiation exposures; to set standards and regulations for r radio­ ctive emissions in air, water, and soil; to provide guidance for clean- a up of contaminated sites; to communicate with the public about radiation risks such as radon; and to coordinate with other federal agencies for emer­ gency response and homeland security (EPA, 2012). DEPARTMENT OF VETERANS AFFAIRS The interest of the Department of Veterans Affairs (VA) in radiation health effects is primarily focused on providing health care and benefits and disability compensation to veterans. Veterans who were exposed to radia­ tion during their military career may be eligible for disability and health care benefits through the VA for specific cancers and chronic diseases. The VA offers Ionizing Radiation Registry health exams to all eligible veterans

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APPENDIX B 147 who were potentially exposed to ionizing radiation during their military service, including atmospheric nuclear tests, occupation of Hiroshima or Nagasaki, status as a prisoner of war in Japan during World War II, naso­ haryngeal radium-irradiation treatments, service at a DOE gaseous- p diffusion plant, or proximity to an underground nuclear test site. It also produces educational materials for veterans, their families, and physicians on these topics (VA, 2013). Public Health Epidemiology Program The VA’s Epidemiology Program conducts the Cancer Mortality among Military Participants at U.S. Nuclear Weapons Tests study. The study aims to identify cancer risks in Cold War–era veterans who participated in at­ mospheric nuclear weapons tests (1946–1958) (VA, 2012). DEPARTMENT OF STATE The Department of State’s concern for radiation-related exposures and associated health effects stems from its mission to protect and advance the freedom of the American people and its international community. This includes protection from and response to nuclear threats, specifically the proliferation of WMDs and related materials, technologies, and expertise that challenge U.S. national security. The Department of State is home to two radiation-related offices that fulfill this role. It does not conduct or foster health effects–related research, except in the policy arena. Bureau of International Security and Nonproliferation The Bureau of International Security and Nonproliferation (ISN) man­ ages a broad range of U.S. nonproliferation policies, programs, agreements, and initiatives to prevent the spread of WMDs (nuclear, biological, chemi­ cal, or radiological) and delivery systems. The ISN bureau combats the threat posed by the proliferation of WMDs, and terrorist efforts to obtain them, through bilateral and multilateral diplomacy. This is one of the high­ est priorities of the Department of State. Bureau of Counterterrorism The Bureau of Counterterrorism includes several programs and initia­ tives to prevent and respond to terrorism (including WMDs) both domes­ tically and internationally; these efforts include radiologic events at both levels. The Counterterrorism Preparedness Program within the Bureau of

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148 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE Counterterrorism focuses on strengthening the nation’s capacity to prevent, protect from, respond to, and recover from attacks involving WMDs. U.S. NUCLEAR REGULATORY COMMISSION The U.S. Nuclear Regulatory Commission (U.S. NRC) was created by the 1974 Energy Reorganization Act to address several broad public health and safety issues in the nuclear power industry. The commission is respon­ sible for nuclear-reactor oversight, including regulations and licensing. The use of nuclear materials for power generation imposes the risk of radiation exposure on workers and the general public, and regulatory requirements are thus developed to protect public health. U.S. NRC’s research efforts are led by the Office of Nuclear Regulatory Research, which interfaces with all areas of the program and other govern­ ment agencies (such as DOE), universities, and international partners to co­ ordinate activities. The office recommends and conducts research pertaining to nuclear reactors, materials, and radioactive waste to improve knowledge in areas of uncertainty to inform regulatory decisions (U.S. NRC, 2013a, 2014). One such activity is an analysis of cancer risks in populations resid­ ing near nuclear power reactors that is currently being conducted by the National Research Council (U.S. NRC, 2013b). U.S. NRC’s low-level radiation interests include the management and disposal of low-level waste and the risk assessment and mitigation of re­ leases from nuclear power facilities (U.S. NRC, 2013c). SELECTED PRIVATE AND ACADEMIC LOW-LEVEL–RADIATION RESEARCH INITIATIVES Lovelace Respiratory Research Institute Research at the Lovelace Respiratory Research Institute includes eluci­ dating the biological bases for radiation-adaptive responses in the lung and for suppressing lung cancer and using the knowledge gained to produce an improved systems biology–based risk model for lung cancer induction by low-dose, low-LET radiation. Lovelace aims to encourage development of new low-level radiation risk–benefit assessment methods for use in medicine and health, such as low-dose diagnostic radiation for cancer therapy and low-dose, low-LET radiation to prevent lung cancer in high-risk groups (heavy smokers, for example) (LRRI, 2010, 2014).

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APPENDIX B 149 Center for High-Throughput Minimally Invasive Radiation Biodosimetry The Center for High-Throughput Minimally Invasive Radiation Bio­ dosimetry is a consortium of research institutions composed of Georgetown University, Lovelace Respiratory Research Institute, New York University School of Medicine, Translational Genomics Research Institute, and Uni­ versity of Bern, led by Columbia University (Columbia University, 2012). The center, funded by NIAID, applies modern radiation-biological tech­ niques to detect biological changes as a measure of radiation dose. In addition to conducting and funding research and pilot projects, the center supports several training courses and workshops on biodosimetry. U.S. Transuranium and Uranium Registry The U.S. Transuranium and Uranium Registry (USTUR) research pro­ gram is focused on the study of biokinetics, dosimetry, and biological effects of measurable and documented exposures to uranium, plutonium, ameri­ cium, and thorium in humans. Data are gathered from generous partial and whole-body donations from exposed government workers who may have participated in the development and testing of nuclear weapons during the Cold War, been employed at uranium milling and mining operations, or worked at one of many DOE sites such as Hanford or Fernald. The registry includes medical, dosimetry, personal, occupational, and cause-of-death data from 335 donations, with a total of 875 individuals in the registry as of March 31, 2012. USTUR was begun in 1968 and is currently operated by the University of Washington and funded by the DOE Office of Health, Safety, and Security (USTUR, 2007). SELECTED NONPROFIT ORGANIZATIONS National Council on Radiation Protection and Measurements The National Council on Radiation Protection and Measurements (NCRP) is a nonprofit organization chartered by the U.S. Congress to facilitate the dissemination of information on radiation protection and measurements significant to the public interest (NCRP, 2014). The council seeks to facilitate and encourage collaboration between other organiza­ tions involved in the scientific and related aspects of radiation protection and measurement. This bridge creates a platform for conversation between national and international programs involved in similar subjects to discuss and focus on recommendations. NCRP publications serve as guides to research in the field of radiation. As noted in Chapter 3, the organization has an interest in ensuring a robust radiation health–research workforce

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150 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE and has been undertaking efforts to determine whether the future supply of investigators will meet the demand (Pryor, 2013). Electric Power Research Institute The Electric Power Research Institute is an independent nonprofit or­ ganization dedicated to research, development, and demonstration related to power generation, delivery, and public use. Its research spans all aspects of power and is focused on both long- and short-term solutions. It includes a low-dose radiation research program that seeks to gain new knowledge about the biological effects and risks of low doses of radiation associated with the normal operation of nuclear power plants to ensure that workers and the public are adequately protected (Dauer et al., 2010; EPRI, 2009, 2011, 2014). Radiation Countermeasures Center of Research Excellence The Radiation Countermeasures Center of Research Excellence, or RadCCORE, is dedicated to supporting basic, translational, and applied research to further develop medical countermeasures against nuclear at­ tacks. This multidisciplinary-research center seeks to develop and move countermeasure candidates through the regulatory process and to add them to the national stockpile. Specific program areas are dedicated to bio­ osimetry, drug development, therapies to treat acute radiation syn­ d drome, and methods to modulate immune response to radiation exposure. ­ R ­ adCCORE also seeks to expand education resources and improve exper­ tise in radiobiology by offering workshops and seminars and by funding graduate fellowships. The members of RadCCORE come from five uni­ versities (Duke University; University of Arkansas for Medical Sciences; ­ University of Maryland, Baltimore; University of North Carolina; and Wake Forest University) as well as from national laboratories and private enterprises (RadCCORE, 2012). REFERENCES ATSDR (Agency for Toxic Substances and Disease Registry). 2013. About ATSDR. http:// www.atsdr.cdc.gov/about/index.html (accessed January 2, 2014). BARDA (Biomedical Advanced Research and Development Authority). 2013. BARDA unveils path forward in the BARDA Strategic Plan 2011-2016. http://www.phe.gov/about/barda/ Pages/2011barda-stratplan.aspx (accessed January 2, 2014). Brooks, A. L. 2012. A history of the United States Department of Energy (DOE) Low Dose Radiation Research Program 1998-2008 (Review Draft). http://lowdose.energy.gov/pdf/ albRoughDraft/doeHistoryComplete09262012.pdf (accessed January 2, 2014).

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APPENDIX B 151 CDC (Centers for Disease Control and Prevention). 2010. Dose reconstruction and the Cold War. http://www.cdc.gov/nceh/radiation/public_health_research.htm (accessed January 2, 2014). CDC. 2012. The Flight Crew Research Program. http://www.cdc.gov/niosh/topics/flightcrew (accessed January 2, 2014). Columbia University. 2012. Center for High-Throughput Minimally-Invasive Radiation Biodosimetry. http://cmcr.columbia.edu (accessed January 2, 2014). DARPA (Defense Advanced Research Projects Agency). 2005. Bridging the gap. Powered ­ by ideas. http://www.dtic.mil/cgi-bin/GetTRDoc?Location=U2&doc=GetTRDoc. pdf&AD=ADA433949 (accessed December 30, 2013). DARPA. 2007. Proposer information pamphlet for BAA 07-29 for the Defense Advanced Research Projects Agency (DARPA) radiation biodosimetry (RaBiD). https://www.fbo. gov/utils/view?id=96890b83dc24a7efa62f1c2b58d148ec (accessed April 14, 2014). DARPA. 2009. Bridging the gap. Powered by ideas. Presented at the European Command and African Command Science and Technology Conference held in Stuttgart, Germany, on 8-12 Jun 2009. http://www.dtic.mil/dtic/tr/fulltext/u2/a510795.pdf (accessed January 2, 2014). DARPA. 2012. DARPA news: Researchers successfully treat previously lethal doses of radia­tion. January 12, 2012. http://www.darpa.mil/NewsEvents/Releases/2012/01/04.aspx (accessed April 14, 2014). DARPA. 2013. Reducing ionizing radiation risk. Request for information. RFI DARPA- SN-13-24. https://www.fbo.gov/index?s=opportunity&mode=form&id=dfd972858616 4c8cdd7a1d6391d692dd&tab=core&_cview=0 (accessed December 30, 2013). Dauer, L. T., A. L. Brooks, D. G. Hoel, W. F. Morgan, D. Stram, and P. Tran. 2010. Review and evaluation of updated research on the health effects associated with low-dose ionis­ ing radiation. Radiation Protection Dosimetry 140(2):103-136. DOE (U.S. Department of Energy). 2012. Low dose radiation research program. http://low­ dose.energy.gov (accessed January 2, 2014). DOE. 2013a. Radiobiology: Low dose radiation research. Biological systems science division (BSSD). http://science.energy.gov/ber/research/bssd/low-dose-radiation (accessed Janu­ ary 2, 2014). DOE. 2013b. Nuclear physics: Research. Office of Science. http://science.energy.gov/np/­ research (accessed January 2, 2014). DOE. 2013c. Workforce Development for Teachers and Scientists (WDTS). Office of Science. http://science.energy.gov/wdts (accessed January 2, 2014). DOE. 2014. Department of Energy FY 2015 Congressional budget request. Volume 4. Science. Advanced research projects agency—Energy. March 2014. Washington, DC: DOE, Office of Chief Financial Officer. http://www.energy.gov/sites/prod/files/2014/03/f12/Volume_4. pdf (accessed April 3, 2014). DOE. Undated. About us. National Nuclear Security Administration. http://nnsa.energy.gov/ aboutus (accessed January 2, 2014). DOL (U.S. Department of Labor). Undated. About EEOICP. http://www.dol.gov/owcp/en­ ergy/index.htm (accessed January 2, 2014). DTRA (Defense Threat Reduction Agency). 2009. Radiation exposure in the U.S. atmospheric nuclear weapons testing—Fact sheet. October 2009. http://www.dtra.mil/documents/ ntpr/factsheets/Radiation_Exposure.pdf (accessed January 2, 2014). DTRA. 2011. Personnel radiation exposure associated with X-rays emanating from U.S. Coast Guard LORAN high voltage vacuum tube transmitter units. Technical report. DTRA- TR-10-26. July 2011. http://www.dtra.mil/documents/pdfs/DTRA-TR-10-26%20-%20 USCG%20LORAN%20Transmitter%20X-Ray%20Exposure.pdf (accessed January 2, 2014)

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152 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE DTRA. Undated. About DTRA/SCC-WMD. www.dtra.mil/About.aspx (accessed January 2, 2014). EPA (Environmental Protection Agency). 2012. Radiation protection: Basic information. www.epa.gov/radiation/basic/index.html (accessed January 2, 2014). EPRI (Electrical Power Research Institute). 2009. Program on technology innovation: Evalua- tion of updated research on the health effects and risks associated with low-dose ionizing radiation. Final Report, 1019227. Palo Alto, CA: EPRI, Inc. EPRI. 2011. Strategic program: Low-dose radiation. 1023479. Palo Alto, CA: EPRI, Inc. EPRI. 2014. Health and safety. http://www.epri.com/Our-Work/Pages/Health-and-Safety.aspx (accessed January 2, 2014). FAA (Federal Aviation Administration). 2013. Radiobiology research team. www.faa.gov/ data_research/research/med_humanfacs/aeromedical/radiobiology (accessed January 2, 2014). FDA (Food and Drug Administration). 2011. Drugs: Emergency preparedness. http://www. fda.gov/Drugs/EmergencyPreparedness/default.htm (accessed January 2, 2014). FDA. 2012. FDA radiological health program. http://www.fda.gov/Radiation-­EmittingProducts/ FDARadiologicalHealthProgram/default.htm (accessed January 2, 2014). FDA. 2013. Office of Counterterrorism and Emerging Threats. http://www.fda.gov/Emergency Preparedness/Counterterrorism/default.htm (accessed January 2, 2014). LRRI (Lovelace Respiratory Research Institute). 2010. Researching the highs and lows of radi­ ation. Breathe 3(1):10-12. www.lrri.org/Data/Sites/1/breathe/Breathe_Magazine_Fall_10. pdf (accessed January 2, 2014). LRRI. 2014. Home page. http://www.lrri.org (accessed January 2, 2014). NASA (National Aeronautics and Space Administration). 2009. NASA—Areas of study: Ra- diation. Human research program. http://www.nasa.gov/exploration/humanresearch/ areas_study/environment/enviro_radiation.html (accessed January 2, 2014). NASA. 2014. Space radiation research. NASA space radiation program element. http://­ spaceradiation.usra.edu/research (accessed January 2, 2014). NCI (National Cancer Institute). Undated a. Radiation epidemiology branch: Understanding the link between radiation exposure and cancer. http://dceg.cancer.gov/reb/about (ac­ cessed January 2, 2014). NCI. Undated b. Radiation research program. http://rrp.cancer.gov (accessed January 2, 2014). NCRP (National Council on Radiation Protection and Measurements). 2012. SC 6-8: Opera- tion TOMODACHI radiation dose assessment peer review. http://www.ncrponline.org/ Current_Prog/SC_6-8.html (accessed January 2, 2014). NCRP. 2014. Our mission. http://www.ncrponline.org/AboutNCRP/Our_Mission.html (ac­ cessed January 23, 2014). NIAID (National Institute of Allergy and Infectious Disease). 2005. Radiation nuclear countermeasures introduction. http://www.niaid.nih.gov/topics/radnuc/program/Pages/­ introduction.aspx (accessed January 2, 2014). NIAID. 2013. Radiation nuclear countermeasures. http://www.niaid.nih.gov/topics/radnuc/ Pages/default.aspx (accessed January 2, 2014). NIOSH (National Institute for Occupational Safety and Health). 2011. Occupational energy research program. http://www.cdc.gov/niosh/oerp/default.htm (accessed April 10, 2014). NIOSH. 2014. NIOSH program area: Radiation dose reconstruction. http://www.cdc.gov/ niosh/ocas/#drrev (accessed January 2, 2014). NSBRI (National Space Biomedical Research Institute). 2012. NSBRI education & outreach se- lected program highlights. November 2012. http://www.nsbri.org/default/Education%20 and%20Training/NSBRI_EO_Overview_nov12.pdf (accessed January 2, 2014). NSBRI. Undated a. Radiation effects. www.nsbri.org/SCIENCE-and-TECHNOLOGY/ Radiation-Effects (accessed January 2, 2014).

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APPENDIX B 153 NSBRI. Undated b. Center for Acute Radiation Research. http://www.nsbri.org/SCIENCE- and-TECHNOLOGY/Radiation-Effects/Team-Executive-Summary (accessed January 2, 2014). ORAU (Oak Ridge Associated Universities). 2013. ORAU serves as co-investigator in study of radiation effects on one million U.S. workers. http://www.orau.org/occupational-­exposure- worker-health-studies/success-stories/million-worker-study.aspx (accessed Decem­er 6, b 2013). Pryor, K. 2013. The WARP initiative: Where are the radiation professionals? Health Physics News September. RadCCORE (Radiation Countermeasures Center of Research Excellence). 2012. About us. http://www.radccore.org/about-us (accessed January 2, 2014). U.S. NRC (Nuclear Regulatory Commission). 2013a. Research activities. http://www.nrc.gov/ about-nrc/regulatory/research.html (accessed March 27, 2014). U.S. NRC. 2013b. Backgrounder on analysis of cancer risk populations near nuclear fa- cilities–Phase 2 pilot study. http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/ bg-analys-cancer-risk-study.html (accessed March 27, 2014). U.S. NRC. 2013c. History. http://www.nrc.gov/about-nrc/history.html (accessed January 2, 2014). U.S. NRC. 2014. Nuclear regulatory research. http://www.nrc.gov/about-nrc/organization/ resfuncdesc.html#funcdesc (accessed March 27, 2014). USTUR (U.S. Transuranium & Uranium Registries). 2007. About USTUR. http://www.ustur. wsu.edu/AboutUs/overview.html (accessed January 2, 2014). VA (U.S. Department of Veterans Affairs). 2012. Research on health effects of radiation exposure. www.publichealth.va.gov/exposures/radiation/research.asp (accessed January 2, 2014). VA. 2013. Radiation. www.publichealth.va.gov/exposures/radiation/index.asp (accessed Janu­ ary 2, 2014).

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154 HEALTH EFFECTS OF LOW-LEVEL IONIZING RADIATION EXPOSURE TABLE B-1  Websites of Research Programs That Address Low-Level Radiation Questions Entity or Program Primary Web Addressa U.S. FEDERAL GOVERNMENT Department of Defense Defense Advanced Research Projects Agency darpa.mil Defense Threat Reduction Agency dtra.mil Department of Energy Low Dose Radiation Research Program science.energy.gov/ber/research/bssd/ low-dose-radiation Low Energy Nuclear Physics Research science.energy.gov/np/research Workforce Development for Teachers and science.energy.gov/wdts Scientists National Nuclear Security Administration nnsa.energy.gov National Aeronautics and Space Administration Space Radiation Program spaceradiation.usra.edu/research National Space Biomedical Research Institute nsbri.org/SCIENCE-and-TECHNOLOGY/ Radiation-Effects Center of Acute Radiation Research nsbri.org/SCIENCE-and-TECHNOLOGY/ Radiation-Effects/ Team-Executive-Summary Human Research Program nasa.gov/exploration/humanresearch/areas_ study/environment/enviro_radiation.html Department of Health and Human Services National Cancer Institute Division of Cancer Epidemiology and dceg.cancer.gov/reb/about Genetics, Radiation Epidemiology Branch Radiation Research Program rrp.cancer.gov Developmental Therapeutic Program dctd.cancer.gov/ProgramPages/dtp/default. htm National Institutes of Health National Institute of Allergy and niaid.nih.gov/Pages/default.aspx Infectious Diseases Radiation and Nuclear Countermeasures www.niaid.nih.gov/topics/radnuc/program/ Program Pages/introduction.aspx niaid.nih.gov/topics/radnuc/Pages/default. aspx Centers for Medical Countermeasures www.niaid.nih.gov/topics/radnuc/ against Radiation Documents/cmcr_project_descriptions. pdf Office of the Assistant Secretary for Preparedness and Response Biomedical Advanced Research and phe.gov/about/barda/Pages/cbrn.aspx Development Authority Division of Chemical, Biological, www.phe.gov/about/barda/Pages/cbrn.aspx Radiological and Nuclear Medical Countermeasures

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APPENDIX B 155 TABLE B-1  Continued Entity or Program Primary Web Addressa Food and Drug Administration Center for Devices and Radiological Health fda.gov/Radiation-EmittingProducts/ FDARadiologicalHealthProgram/ default.htm Center for Drug Evaluation and Research fda.gov/Drugs/EmergencyPreparedness/ default.htm Office of Counterterrorism and Emerging fda.gov/EmergencyPreparedness/ Threats Counterterrorism/default.htm Centers for Disease Control and Prevention Agency for Toxic Substances and Disease atsdr.cdc.gov Registry National Institute of Occupational Safety and Health Occupational Energy Research Program http://www.cdc.gov/niosh/oerp/default.htm Radiation Dose Reconstruction Program cdc.gov/niosh/ocas/ocasdose.html Flight Crew Research Program cdc.gov/niosh/topics/flightcrew Federal Aviation Administration Radiobiology Research Team faa.gov/data_research/research/ med_humanfacs/aeromedical/ radiobiology Environmental Protection Agency Radiation Protection Program epa.gov/radiation/basic/index.html Department of Veterans Affairs Public Health Epidemiology Program publichealth.va.gov/exposures/radiation/ index.asp Epidemiology Program publichealth.va.gov/exposures/radiation/ research.asp Department of State Bureau of International Security and state.gov/t/isn/index.htm Nonproliferation Bureau of Counterterrorism state.gov/j/ct Nuclear Regulatory Commission nrc.gov/about-nrc/history.html SELECTED PRIVATE AND ACADEMIC INITIATIVES Lovelace Respiratory Research Institute lrri.org Center for High-Throughput Minimally cmcr.columbia.edu Invasive Radiation Biodosimetry U.S. Transuranium and Uranium Registry ustur.wsu.edu SELECTED NONPROFIT ORGANIZATIONS National Council on Radiation Protection ncrponline.org and Measurements Electric Power Research Institute epri.com Radiation Countermeasures Center of radccore.org/home Research Excellence  a  Addresses valid on January 24, 2014.

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