Click for next page ( 98


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 97
5 Opportunities for AFRRI This final chapter of the report brings together the information presented in the previous chapters and responds to the third element of the committee’s statement of task, putting forward findings, conclusions, and recommendations regarding opportunities for the Armed Forces Radiobiology Research Institute (AFRRI) to advance its mission for understanding human health risks from exposures to low-level1 ionizing radiation, with special emphasis on Department of Defense (DoD) military operations and personnel. In so doing, the chapter highlights the unique resources associated with the Institute and how they might be better used, identifies possibilities for expanded and additional responsibilities, discusses AFRRI’s role in fostering the next generation of radiation-research professionals, and offers perspectives on the scientific oversight of programs. In the course of its work, the committee examined the full range of AFRRI’s activities. Although its statement of work focuses on low-dose radiation, it also offers observations applicable to the full range of AFRRI’s activities and on organizational issues, because the success of a low-dose 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 As delineated in Chapter 4, DoD has tasked AFRRI with conducting research in the field of radiobiology and related matters essential to the operational and medical support of the U.S. military. DoD has also given AFRRI 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 Military Services and government in their areas of expertise. 1 The committee’s statement of task references “low-level” ionizing radiation; that terminology is retained here and in other places where the report is presenting responses to these directives. PREPUBLICATION COPY: UNCORRECTED PROOFS 5-1

OCR for page 97
5-2 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI No other DoD-level organization has such a comprehensive and broad-scoped mission in radiological health and protection. The threat spectrum that AFRRI is concerned with, illustrated in Figure 5-1, is wide ranging, and the Institute additionally concerns itself with such nonmilitary issues as civilian radiological-accident response and the safety of astronauts exposed to high linear energy–transfer (LET) cosmic radiation. Strategic Theater Nuclear Single Isotopic Accidental Nuclear War War Detonation Weapon Release FIGURE 5-1 The Ionizing Radiation Exposure Threat Spectrum. SOURCE: Adapted from Kang et al., 2011 AFRRI’s physical plant boasts a 1-megawatt (MW) TRIGA® Mark F reactor that is the only such unit in the United States 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 (rhesus macaques) for studies. AFRRI’s research and development goals and collaborations with other government facilities, academic institutions, and civilian laboratories in the United States and throughout the world cover areas that receive relatively little attention elsewhere. These include the pursuit of new drugs to prevent the life-threatening and health-degrading effects of high-dose ionizing radiation, the development of methods for rapidly assessing radiation exposure to ensure appropriate medical treatment, and the investigation of the effects of radiation injury combined with other insults, such as trauma, disease, and chemical exposures. The Institute has DoD’s lead on medical and radiobiological matters for radiological- incident response, maintaining a deployable team of subject experts to support actions taken in military and civilian nuclear or radiological incidents. It trains military and civilian health care providers, disaster-preparedness personnel, and operational planners on the effects of ionizing radiation and the logistical and medical responses to exposures; it disseminates data-collection instruments to help manage such events; and it develops biodosimetry tools. Taken individually, none of the facilities, capabilities, assets, and responsibilities just listed is unique; the fact that all of them are under a single roof and managed by the same command structure is what makes AFRRI unique. AFRRI’s programs and outreach activities provide the nation with important fundamental science, basic knowledge, practical applications, tools, and guidance associated with radiobiology and related matters essential to the operational and medical support of the 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. PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
Opportunities for AFRRI 5-3 Opportunities for Additional or Expanded Roles for AFRRI As documented in Chapter 4, 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 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. The committee’s review of AFRRI’s mission and assets led it to conclude that there are opportunities for an expanded or additional role 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 initiatives to cover low-dose exposures. Specific recommendations are addressed below. Preparedness and Response to Nuclear and Radiological Emergencies AFRRI has been primarily concerned with the effects of nuclear weapons on the battlefield and the survival of members of the Military Services in such environments. On the nuclear battlefield, mortality and morbidity are not limited to radiation injuries; they also include thermal burns, overpressure and underpressure (blast) injuries, and puncture wounds, often involving radiological contamination of the wound. During the 1960s, the Institute emerged as the lead U.S. agency in the assessment of combined-injury triage and medical management, and it still conducts research to develop medical treatments for irradiated personnel whose exposure is compounded by traumatic wounds, burns, hemorrhage, or infection. This work is directly transferable to other areas, including preparedness and response to low-dose, noncombat nuclear and radiological emergencies, a responsibility that AFRRI exercises through its Medical Radiobiology Advisory Team (MRAT)—experts who provide health-physics, medical, and radiobiological advice to military and civilian command and control operations worldwide (AFRRI, 2013a). As Chapter 4 details, the Institute produces guidance for physicians and emergency-response personnel deployed to nuclear and radiological incidents, and it disseminates forms and software tools intended to make screening routine and assess the exposure of potential casualties. At present, the guidance and forms exist as PDFs and the software tools as Windows operating system programs. PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
5-4 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI 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. For example, the Department of Health and Human Services has in recent years implemented its Radiation Emergency Medical Management (REMM) software tool as an application for iPhone/iPad, Android, and BlackBerry platforms (DHHS, 2014). Another area in which AFRRI could potentially lead is the training, equipping, and standardizing of the multiple DoD radiological-response teams. Currently, the U.S. Army,2 Navy, and Air Force3 have their own teams that were originally chartered to respond to a nuclear-weapon accident but that now have expanded missions, including nuclear and radiological accidents and other events. Since 2006, these teams have been listed as part of the federal response assets available under the Nuclear/Radiological Incident Annex (FEMA, 2008) of the National Response Framework, a set of policies that guide how the nation responds to emergencies and disasters. All Services take part in Department of Homeland Security (DHS) and DoD exercises. Despite the commonality of the Service teams’ missions, though, 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. AFRRI is well suited for this role as a triservice organization with the required in-house expertise. Management of Psychological Effects Associated with a Nuclear or Radiological Event Nuclear and radiological exposure incidents pose special challenges because the stressor is invisible and cannot be sensed or avoided like other threats (Vyner, 1988). The psychological effects of such incidents have been demonstrated on numerous occasions, including nuclear power plant accidents such as the 1986 Chernobyl and 2011 Fukushima events. They are often caused by fear of developing cancer in the future without regard to the actual dose of radiation received (Bromet, 2011). Prompt treatment of psychological effects after radiological or nuclear accidents is crucial to the long-term well-being and combat effectiveness of Service personnel. The same is true for the persons who are called on to operate and maintain the civilian infrastructure after an incident and the populations affected by the event (AFRRI, 2010). 2 Radiological Advisory Medical Teams (RAMT) (U.S. Army, 2012) 3 Air Force Radiation Assessment Team (AFRAT) (U.S. Air Force, 2011) PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
Opportunities for AFRRI 5-5 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 (AFRRI, 2013b), but the Institute does not currently have psychologists, psychiatrists, risk- communication specialists, or professionals in related fields as members of its research staff.4 However, the Uniformed Services University of the Health Sciences (USUHS) is well positioned to support training programs to give military health care providers and first responders the tools and techniques to communicate with Service Members and other responders who operate in potentially contaminated areas, treat psychological injuries, and deal with other issues raised in response to nuclear and radiological incidents. Its Center for the Study of Traumatic Stress has a broad mission that includes “trauma exposure from the consequences of combat, operations other than war, terrorism, natural and human-made disasters, and public health threats” (CSTS, 2014). The Center produced white papers on radiological-incidence response in 1999 (Pastel et al., 1999) and 2005 (CSTS, 2005) but does not appear to have conducted work in the area since then. AFRRI’s interest in the topic is evinced by the “Psychological Issues in a Radiological or Nuclear Attack” chapter of the 2013 publication, Medical Consequences of Radiological and Nuclear Warfare, a text that the Institute was intimately involved in producing (AMEDD, 2013). An opportunity thus 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 would additionally 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 radiation-protection instrumentation that is designed to withstand the harsh environments in which the military may operate. The evolution of rugged hand-held radiation-detection instruments has been driven by lessons learned in responses to weapons accidents. These range from the need for a single scaler with multiple attachable probes and protection of battery supplies from extreme temperatures to on-site calibration and repair capabilities and alternative detection technologies for hard-to-detect and alpha emitters. Despite the fact that all three branches of Military Service have some common radiation- detection and measurement needs,5 the branches develop their own instrument performance specifications and acquire the instruments independently, which leads to the use of several 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. The problems associated with this lack of harmony were highlighted in the U.S. military’s relief efforts in response to the 2011 Fukushima Daiichi nuclear plant accident—a low dose-level radiation-exposure incident for the general public. An after-action report on radiation monitoring noted that the dosimetry guidance given to personnel participating in the effort was 4 As noted in Chapter 4, AFRRI formerly had a Behavioral Sciences Department that was disbanded in the 1990s. The current (2013) Director completed a residency in psychiatry, and two PIs have undergraduate or master’s level training in psychology (AFRRI, 2013c). 5 There are also service-specific needs for radiation detection instruments. PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
5-6 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI confusing, delayed, and conflicting and that the different dosimetry systems used by the Services were “[n]ot conducive to a joint operation in a radiological environment” (Sharp, 2012). The U.S. Army Peacekeeping and Stability Operations Institute concluded that [o]verall, all these dosimetry systems/dosimeters were adequate for their designed purpose—occupational dosimetry in a controlled environment—but they all had drawbacks when it came to using them in this particular situation and recommended that DoD designate a single radiation dosimeter and common measurement units and reporting standards for use in joint operations in a radiological environment (PKSOI, 2013).6 A DoD program exists for addressing such needs. The FY 2013-18 strategic goals for the Joint Program Executive Office for Chemical and Biological Defense include combining “common requirements and [seeking] common solution sets in order to achieve interoperability across the larger [Radiological/Nuclear] community,” championing “a truly joint acquisition effort to provide warfighters the most effective [Radiological/Nuclear Defense] systems,” and providing “enhanced personal and tactical dosimeters to detect the location, extent, and level of radiation hazards, and … individual and collective protection measures for our forces” (JPEO- CBN, 2012). The Office’s Joint Project Manager for Radiological & Nuclear Defense released a Request for Information in 2013 seeking input on a dosimeter that would enable the services “to effectively conduct joint operations with interoperable equipment” while meeting requirements for detection of the entire spectrum of radiological/nuclear hazards and threats and for operation in hostile environments (JPN-RND, 2013). The committee believes that AFRRI has the capability to contribute to such work. 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 (triservice 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 that are greatly needed within the DoD and civilian sectors. These specialties include 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 6 The Peacekeeping and Stability Operations Institute also offered other observations about the need for standardization across the Services when responding to radiologic incidents that may be of interest to AFRRI. PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
Opportunities for AFRRI 5-7 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 (AFRRI, 2013c). Other degree programs that USUHS does not offer currently—for example, in health and medical physics7 —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. AFRRI and USUHS have the necessary expertise, experience, infrastructure, and facilities (both classroom and laboratory) to help train and grant graduate degrees in several of the radiation specialties that are in demand within the DoD and civilian marketplace. 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 The National Cancer Institute (NCI) defines the goals of radiation-epidemiology research as identifying, understanding, and quantifying the risk of cancer in populations exposed to medical, occupational, or environmental radiation and advancing the understanding of radiation- induced carcinogenesis (somatic) and deterministic (acute) effects (NCI, 2014). To date, AFRRI has had relatively little involvement in epidemiological research and risk projections, and its staff does not have expertise in these areas. It does, however, conduct work on the development of biodosimetry tools and on retrospective dose reconstruction for exposure assessment that could be used in studies. As discussed in Chapter 2, there is currently much interest in using radiobiology to augment epidemiological studies (Preston et al., 2013), and AFRRI has the staff experience and qualifications to do so. Should AFRRI wish to become involved in such work, it would be well 7 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

OCR for page 97
5-8 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI positioned to support studies that are consonant with its current expertise by, for example, providing information on biological changes induced by radiation exposure and on military populations that have experienced depleted uranium (DU) exposure or combined injuries, which would feed into research on health outcomes in targeted subpopulations. Further, the United Nations Scientific Committee on the Effects of Atomic Radiation asserts that 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 (UNSCEAR, 2012). An opportunity therefore 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. The Institute’s position within the USUHS is one source of such expertise, through collaborations 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. AFRRI’s location in DoD may also allow it to facilitate certain other epidemiological studies. Approximately 2% of the military workforce (~70,000 individuals) are currently monitored for occupational ionizing-radiation exposure, and repositories hold exposure records for some 2 million individuals accumulated since 1945 (Blake and Komp, 2014). Exposure to radiation via medical diagnostic procedures is also recorded. The potential exists to link these data with health information gathered by the military health system and the Department of Veterans Affairs and use so-called big-data techniques to conduct analyses of radiation exposure. Opportunities for Expanded and Additional Outside Collaborations Collaborations with Other Governmental Entities AFRRI’s responsibilities overlap with those of three other federal bodies with which it would seem to have natural affinities because of their common interests in the consequences of nuclear and radiological material releases. The Defense Threat Reduction Agency (DTRA), DoD’s official combat-support agency for countering weapons of mass destruction, includes consequence management and nuclear and radiological response among its major responsibilities. DTRA conducts training in this area and works with other federal agencies and international counterparts to improve global preparedness and response capabilities. AFRRI already cooperates with DTRA, notably through a standing Inter-Service Support Agreement, to provide expertise (via its MRAT) to the agency’s Consequence Management Advisory Teams (DTRA, 2013). AFRRI has also received DTRA funding for research on high-dose questions regarding radioprotective agents and dose assessment, but these contracts ended in 2013 (AFRRI, 2013c). The Defense Advanced Research Projects Agency (DARPA) facilitates cutting-edge research to support military and other national objectives. In the last 10 years, it has undertaken three initiatives aimed at ionizing radiation and health: a 2005 effort to foster technologies to PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
Opportunities for AFRRI 5-9 minimize the warfighter’s vulnerability to high-dose radiation exposures via vaccines and novel antidotes (DARPA, 2005), a 2008 initiative to develop low-cost and minimally-invasive biodosimeters (DARPA, 2013), and a 2013 Request for Information (RFI) seeking ideas, methodologies, and approaches ... 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 deliberate attack (DARPA, 2013). In July 2013, AFRRI did not list any current support from DARPA (AFRRI, 2013c) but it has received funding in the past (Kang et al., 2011). The DHS came into being in 2002 when 22 different federal departments and agencies were unified and integrated into a single cabinet-level agency. Its responsibilities include health aspects of contingency planning for chemical, biological, radiological, and nuclear hazards. However, the committee could not identify any collaboration between AFRRI and DHS other than common participation in advisory committees or working groups (AFRRI, 2013c). Thus, AFRRI currently conducts rather little work with these other governmental bodies that have similar interests, and the efforts that have taken place have focused on high-dose questions. The committee believes, however, that there are areas into which the Institute could expand its reach and pursue its interest in low-level radiation research by using its existing strengths. Two are identified below. Given the interests that DTRA, DARPA, and DHS share and the two DoD agencies’ past work with AFRRI on high-dose questions, new work on low-dose questions represents an unexploited area for expansion. An opportunity exists for AFRRI to advance its mission by actively pursuing low-level exposure research funding and collaborations with DTRA, DARPA and DHS. This will entail outreach to these organizations to determine their low-dose interests and needs, and how AFRRI assets can best be used to meet them. 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. For example, the Institute’s Medical Effects of Ionizing Radiation (MEIR) course has been in existence for more than 40 years and reaches 800-1,000 people per year (Parde, 2012). Its course materials are directly applicable to first responders and first receivers, but—with a few exceptions—the course has not been exported to other domestic or to international governmental organizations.8 8 The MEIR website indicates that “defense contractors and non-DoD civilians” may register for the course but the FY2014 schedule only lists DoD locations for classes (AFRRI, 2014). PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
5-10 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI Other short-course topics that AFRRI—perhaps in collaboration with USUHS—would be well suited to conduct should appeal to agencies like DTRA and DHS. Possible course areas include • Radiological screening and decontamination of large civilian populations after an improvised nuclear device (IND) or radiological dispersal device (RDD) event, • Triage and management of combined injuries after an IND or RDD event, and • Dosimetric assessment of radiologically contaminated wounds. 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. As noted in Chapter 4, the Institute’s radiation facilities are underused: the TRIGA reactor is free 79% of its operating days, the 60Co source is free 50.5%, and the 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 The committee believes that there are steps that AFRRI can take that will promote the successful conduct of current and future low-dose ionizing radiation work by strengthening its overall research enterprise. It thus offers suggestions regarding the Institute’s scientific leadership and external program evaluation for AFRRI’s and DoD’s consideration. Scientific Leadership AFRRI’s management structure includes a Scientific Director in a senior leadership position. A 1968 staff memorandum (AFRRI, 1968, p. 4) defining the Institute’s organization lists a “Deputy Director, Scientific” reporting to the Director and exercising the following duties: 1. Responsible for organization, effective operation, administration and supervision of assigned personnel, subject to the authority, direction and control of the Director, for the Behavioral Science, Radiation Biology, Experimental Pathology, and Physical Sciences departments and the Veterinary Support and Publications Offices. PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
Opportunities for AFRRI 5-11 2. Performs the scientific and technical planning of the AFRRI research program and advises the Director, AFRRI, on technical and scientific matters within the broad field of radiobiology and related scientific disciplines necessary to support radiobiological research programs. 3. Provides assistance and guidance to technical and scientific panels and committees organized within the AFRRI and serves in a scientific liaison capacity with Headquarters, DASA, Atomic Energy Commission, National Institutes of Health, Colleges and Universities, other DOD and other Federal laboratories and the civilian scientific community. DoD Directive 5105.33, November 25, 1987, specifies that the Scientific Director post is to be filled by a civilian.9 A later (September 30, 1992) organizational chart identifies a Scientific Director as one of the three members—along with the Director and Chief of Staff—of the senior leadership of AFRRI within an “Office of the Director” (AFRRI, 1993, p. 124). This position, however, has not been filled since 2012. There is currently a Scientific Advisor who reports to the Director (Chapter 4; Figure 4-1), but whose duties do not include supervision of senior research staff. It is common for DoD organizations that have a research-based mission to have a civilian Scientific Director or Chief Scientist in a senior leadership role. A 2005 National Research Council report lists eight such organizations, including three—DARPA, DTRA, and the Naval Research Lab—that conduct or facilitate ionizing radiation research (NRC, 2005). 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: • As the scientific point person within the Institute, the Scientific Director has the standing to plan and carry out short and long term institutional research goals; make sure that the staff needed to achieve these goals are in place; monitor and review the performance of senior research staff; and provide continuity across the tenures of AFRRI’s Directors. • As a senior member of the USUHS faculty,10 the Scientific Director can be influential in building and maintaining a strong graduate education program that attracts top-flight faculty, developing potential AFRRI researchers, and helping to address concerns over possible future shortfalls in the number of radiation professionals. • As a member of the senior management of a DoD scientific organization, the Scientific Director is in a position to complement the work of the AFRRI Director, serving as a principal science and technology representative on radiobiological research and radiological-emergency response to the federal and civilian scientific communities as 9 DoDD 5105.33, November 25, 1987, §E1b stated that “[t]he Scientific Director shall be a civilian with professional qualifications acceptable to the Board of Governors and the Director, AFRRI.” This Directive—which addressed a number of AFRRI organizational issues—was canceled and superseded by DoD Instruction 5105.33, March 29, 2006. The Instruction did not include any details regarding the “Scientific Director” position. 10 Past AFRRI Scientific Directors have concurrently held faculty appointments at the University. PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
5-12 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI well as to the public at large on behalf of the DoD, and interacting with DoD leadership on scientific issues regarding AFRRI’s mission to fulfill military needs. • As a recognized leader in the radiobiology research community, the Scientific Director can market AFRRI’s unique capabilities and facilities to other federal and civilian agencies, helping to expand its research funding sources and serving as the local advocate for AFRRI research clients and stakeholders. If this person is well-respected in the low-dose scientific community, it will greatly facilitate AFRRI’s efforts to establish an influential research program, attract new investigators with expertise in low-dose radiation 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 evaluated on a project-specific basis with the sponsor’s review mechanisms and program managers performing the evaluative function. AFRRI’s intramural research program is reviewed by a panel of outside experts along with senior AFRRI scientific personnel, but this work accounts for only about 20% of the Institute’s portfolio. In response to a question posed by the committee, AFRRI indicated in October 2013 that the Institute did not have a long-term research plan but that the Scientific Advisor was gathering information to formulate such a plan in consultation with AFRRI leaders and other DoD agencies (AFRRI, 2013d). 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. An Institute-wide continuing program-evaluation function could be provided by Scientific Director– or Chief Scientist–level members from one or more DoD organizations (DTRA, DARPA), other federal agencies (DHS, DOE, Environmental Protection Agency [EPA], National Aeronautics and Space Administration [NASA], Nuclear Regulatory Commission), and PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
Opportunities for AFRRI 5-13 researchers from universities and private-sector organizations who are actively engaged in radiobiological research. 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. As noted in Chapter 4, Operations and Maintenance (O&M) funding represented more than 70% of all research support (including staff salaries) and more than half of the total budget in FY2013. AFRRI’s O&M funding, however, does not have a direct 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). The Institute may have already recognized that this is an issue. In response to a question from the committee, they indicated that [i]n FY2013, as a result of a Board of Governors’ decision, AFRRI’s RDT&E resources were realigned to 1) distinguish protocol-driven research from direct and indirect research support functions, and 2) facilitate oversight of research goals and objectives by the Defense Health Program (AFRRI, 2013b, p. 1). 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. Should DoD decide to pursue such a change, a greater reliance on RDT&E funding would require members of the AFRRI staff and leadership to actively pursue research-marketing outreach to potential DoD and other clients. The committee believes that this role would be best led by a Scientific Director with nationally recognized credentials and good familiarity with the DoD, federal agencies such as the DHS, HHS, DOE, EPA, NASA, and the U.S. Nuclear Regulatory Commission, and executive branch organizations like the Office of Science and Technology Policy. 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. Currently, these presentations are conducted in AFRRI’s PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
5-14 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI conference room, which is located in a secure complex that requires prior clearance to enter. They are neither recorded nor is the information presented at them disseminated. All of these restrictions greatly limit the ability of radiation health experts at other institutions in the DC area and beyond to become better informed about AFRRI’s work and to offer feedback on it. 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 AFRRI (Armed Forces Radiobiology Research Institute). 1968. Organization. AFRRI Staff Memorandum 10-1. https://www.osti.gov/opennet/servlets/purl/16004533-h9b0K3/16004533.pdf (accessed February 10, 2014). AFRRI. 1993. Annual Report on AFRRI Research for Fiscal Year 1992. Bethesda, MD. AFRRI. 2010. Medical Management of Radiological Casualties. Bethesda, MD. AFRRI. 2013a. About AFRRI. http://www.usuhs.edu/afrri/organiza/about_afrri.htm (accessed October 8, 2013). AFRRI. 2013b. Emergency Response Resources- MRAT—Medical Radiobiology Advisory Team. http://www.usuhs.edu/afrri/outreach/emergency_response.html#MRAT (accessed December 18 2013). AFRRI. 2013c. Responses to questions provided by the National Academy of Sciences concerning the statement of work for the Committee on Research Direction in Human Biological Effects of Low- Level Ionizing Radiation. Bethesda, MD, July 12, 2013. AFRRI. 2013d. Responses to supplementary questions provided by the National Academy of Sciences concerning the statement of work for the Committee on Research Direction in Human Biological Effects of Low-Level Ionizing Radiation. Bethesda, MD, October 31, 2013. AFRRI. 2014. MEIR Course Schedule. http://www.usuhs.edu/afrri/outreach/meir/meirschd.htm (accessed April 14, 2014). AMEDD (Army Medical Department). 2013. Medical Consequences of Radiological and Nuclear Warfare. http://www.cs.amedd.army.mil/borden/Portlet.aspx?id=b3cb37ed-08e7-4617-a40c- f148ee3d2303 (accessed December 30, 2013). Blake, P. K., and G. R. Komp. 2014. Radiation exposure of U.S. military individuals. Health Physics 106(2):272-278. Bromet, E. 2011. Lessons learned from radiation disasters. World Psychiatry 10:83-84. CSTS (Center for the Study of Traumatic Stress). 2005. Psychological and Behavioral Issues Healthcare Providers Need To Know When Treating Patients Following a Radiation Event http://www.cstsonline.org/wp-content/resources/CSTS_issues_radiation%20event.pdf (accessed February 6, 2014). CSTS. 2014. About Us. http:// www.cstsonline.org/about-us/ (accessed February 6, 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). PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
Opportunities for AFRRI 5-15 DARPA. 2013. Reducing Ionizing Radiation Risk Request for Information. RFI DARPA-SN-13-24. https://www.fbo.gov/index?s=opportunity&mode=form&id=dfd9728586164c8cdd7a1d6391d692dd &tab=core&_cview=0 (accessed December 30, 2013). DHHS (Department of Health and Human Services). 2014. Download Mobile REMM. http://www.remm.nlm.gov/downloadmremm.htm (accessed May 14, 2014). DTRA (Defense Threat Reduction Agency). 2013. Fiscal Year 2014 Budget Estimates. http://comptroller.defense.gov/Portals/45/Documents/defbudget/fy2014/budget_justification/pdf/01_ Operation_and_Maintenance/O_M_VOL_1_PART_1/DTRA_OP-5.pdf (accessed February 6, 2014). FEMA (Federal Emergency Management Agency). 2008. Nuclear/Radiological Incident Annex. Department of Homeland Security. JPEO-CBN. 2012. Joint Program Executive Office for Chemical and Biological Defense Strategic Plan FY 13-18. http://www.jpeocbd.osd.mil/packs/DocHandler.ashx?DocID=11924 (accessed April 17, 2014). JPM-RND. 2013. Request for Information (RFI) for Radiological Detection System (RDS). https://www.fbo.gov/index?s=opportunity&mode=form&id=75ae84d703f052f00abe024abd117b31&t ab=core&tabmode=list&= (accessed April 17, 2014). Kang, A., D. Gibson, and M. Dempsey. 2011. AFRRI: A unique national resource. Presented at the 2011 Society of American Federal Medical Laboratory Scientists (SAFMLS), New Orleans, LA, March 31, 2011. NCI (National Cancer Institute). 2014. Radiation Epidemiology Branch http://dceg.cancer.gov/about/organization/programs-ebp/reb (accessed February 3, 2014). NRC (National Research Council). 2005. Assessment of Department of Defense basic research. Washington, DC: National Academies Press. Parde, N. 2012. AFRRI: A global authority on ionizing radiation. The Journal (official newspaper for Walter Reed Army Medical Center). September 6, 2012. http://www.dcmilitary.com/ARTICLE/20120906/NEWS11/709069953/AFRRI-A (accessed February 6, 2014). Pastel, R. H., G. R. Kahles, and J. Chiang. 1999. The medical and psychological consequences of radiation dispersal devices. AFRRI white paper on medical and psychological effects of RDDs. Armed Forces Radiobiology Research Institute, September 1999. PKSOI (U.S. Army Peacekeeping and Stability Operations Institute). 2013. Strategic lesson number 15: Radiological hazards during disaster relief operations. Strategic Lessons in Peacekeeping and Stability Operations, Volume 2. (Summer 2013), Pp. 16-19. Preston, R. J., J. D. Boice, Jr., A. B. Brill, R. Chakraborty, R. Conolly, F. O. Hoffman, R. W. Hornung, D. C. Kocher, C. E. Land, R. E. Shore, and G. E. Woloschak. 2013. Uncertainties in estimating health risks associated with exposure to ionising radiation. Journal of Radiological Protection 33(3):573- 588. Sharp, T. 2012. Operation Tomodachi individual radiation monitoring. https://www.pksoi.org/document_repository/Lessons/JFLCC_OperationTomodachi_Individual_Radia tion_Monitoring_(25-Jan-12)-LMS-941.pptx (accessed February 6, 2014). U.S. Air Force. 2011. Air Force Radiation Assessment Team. http://www.wpafb.af.mil/library/factsheets/factsheet.asp?id=18146 (accessed February 6, 2014). U.S. Army. 2012. Army Regulation 40-13. Medical Services. Radiological Advisory Medical Teams. http://www.apd.army.mil/pdffiles/r40_13.pdf (accessed February 6, 2014). PREPUBLICATION COPY: UNCORRECTED PROOFS

OCR for page 97
5-16 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation). 2012. Biological Mechanisms of Radiation Actions at Low Doses. New York: United Nations. Vyner, H. M. 1988. The psychological dimensions of health care for patients exposed to radiation and the other invisible environmental contaminants. Social Science and Medicine 27:1097-1103. PREPUBLICATION COPY: UNCORRECTED PROOFS