Research on Health Effects of
Low-Level Ionizing Radiation Exposure

Opportunities for the Armed Forces Radiobiology Research Institute

Committee on Research Directions in Human Biological Effects of
Low-Level Ionizing Radiation

Board on the Health of Select Populations

Nuclear and Radiation Studies Board

            INSTITUTE OF MEDICINE AND       
NATIONAL RESEARCH COUNCIL
                         OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Research on Health Effects of Low-Level Ionizing Radiation Exposure Opportunities for the Armed Forces Radiobiology Research Institute Committee on Research Directions in Human Biological Effects of Low-Level Ionizing Radiation Board on the Health of Select Populations Nuclear and Radiation Studies Board

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern­ ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer­ ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appro­ priate balance. This study was supported by Grant No. HT9404-12-1-0028 between the National Academy of Sciences and the Uniformed Sciences University of the Health Sci­ ences. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13:  978-0-309-30209-8 International Standard Book Number-10:  0-309-30209-9 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient ­­ Greece, now held by the Staatliche Museen in Berlin. Cover credit: Department of Defense photo by Staff Sgt. Jonathan Steffen, U.S. Air Force/Released Link to photo: https://www.flickr.com/photos/39955793@ N07/5568298525/in/photolist-9u3Z9Z-9ymHp9-9unnPG. Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2014. Research on health effects of low-level ionizing radiation exposure: Opportunities for the Armed Forces Radio­ iology Research Institute. Washington, b DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad­ emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi­ neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer­ ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi­ dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti­ tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences ­ in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The C ­ ouncil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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

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Reviewers This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purposes of this independent review are to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: A. Iulian Apostoaei, Oak Ridge Center for Risk Analysis Mina J. Bissell, Life Sciences Division, Lawrence Berkeley National ­ Laboratory James E. Cleaver, Departments of Dermatology and Pharmaceutical Chemistry, University of California, San Francisco Richard B. Freeman, ­ arvard University; Labor and Worklife H Program, Harvard Law School; National Bureau of Economic Research Joe W. Gray, Oregon Health & Science University Kathryn D. Held, Harvard Medical School; Massachusetts General Hospital David Pawel, Office of Radiation and Indoor Air, U.S. Environmental Protection Agency Terry C. Pellmar, Armed Forces Radiobiology Research Institute vii

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viii REVIEWERS Jonathan M. Samet, USC Institute for Global Health; Department of Preventive Medicine, University of Southern California David Alan Schauer, U.S. Navy (Retired); SAIC and National Council on Radiation Protection and Measurements Richard J. Vetter, Retired; Section of Safety and Radia­ion Safety t Officer, Mayo Foundation; Mayo Medical School Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Chris G. Whipple, Principal, ENVIRON. Appointed by the National Research Council and the Institute of Medicine, he was responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully con­ sidered. Responsibility for the final content of the report rests entirely with the authoring committee and the institution.

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Contents ABBREVIATIONS AND ACRONYMS xi SUMMARY 1 1 INTRODUCTION AND BACKGROUND 15 2 CURRENT DIRECTIONS IN RADIOBIOLOGICAL RESEARCH 27 3 THE RADIOBIOLOGY WORKFORCE 53 4 AFRRI PROGRAMS, RESEARCH, AND RESOURCES 75 5 OPPORTUNITIES FOR AFRRI 111 APPENDIXES A PUBLIC MEETING AGENDAS 131 B U.S. RADIATION RESEARCH PROGRAMS 135 C BIOGRAPHIC SKETCHES OF COMMITTEE MEMBERS AND STAFF 157 ix

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Abbreviations and Acronyms AAPM American Association of Physicists in Medicine AFRRI Armed Forces Radiobiology Research Institute ARS acute radiation syndrome ATSDR Agency for Toxic Substances and Disease Registry BARDA Biomedical Advanced Research and Development Authority (HHS) BAT Biodosimetry Assessment Tool BEIR biological effects of ionizing radiation BNL Brookhaven National Laboratory CARR Center for Acute Radiation Research CAMI Civil Aerospace Medical Institute CBMN cytokinesis-blocked micronucleus assay CBRN Division of Chemical, Biological, Radiological and Nuclear CBRNE Chemical, Biological, Radiological, Nuclear, and Explosives CDER Center for Drug Evaluation and Research CDRH Center for Devices and Radiological Health CMCR Centers for Medical Countermeasures against Radiation CT computed tomography DARPA Defense Advanced Research Projects Agency (DoD) DASA Defense Atomic Support Agency DCA dicentric chromosome assay DDREF dose and dose-rate effectiveness factor xi

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xii ABBREVIATIONS AND ACRONYMS DHS U.S. Department of Homeland Security DNA deoxyribonucleic acid DoD U.S. Department of Defense DOE U.S. Department of Energy DoReMi Low Dose Research Towards Multidisciplinary Integration DTP Developmental Therapeutic Program DTRA Defense Threat Reduction Agency (DoD) DU depleted uranium EPA U.S. Environmental Protection Agency EPR electron paramagnetic resonance FAA Federal Aviation Administration FDA U.S. Food and Drug Administration FISH fluorescence in situ hybridization FSR&M facilities sustainment, restoration, and modernization HHS U.S. Department of Health and Human Services HJF Henry M. Jackson Foundation for the Advancement of Military Medicine HPS Health Physics Society IAEA International Atomic Energy Agency ICRP International Commission on Radiological Protection IND improvised nuclear device IOM Institute of Medicine ISN Bureau of International Security and Nonproliferation LBNL Lawrence Berkeley National Laboratory LET linear energy transfer LINAC linear accelerator LNT linear no-threshold LSS Life Span Study MCM medical countermeasure MEIR medical effects of ionizing radiation MELODI Multidisciplinary European Low Dose Initiative MRAT Medical Radiobiology Advisory Team NAS National Academy of Sciences NASA National Aeronautics and Space Administration NCES National Center of Education Statistics

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ABBREVIATIONS AND ACRONYMS xiii NCI National Cancer Institute NCRP National Council on Radiation Protection and Measurements NIAID National Institute of Allergy and Infectious Diseases (NIH) NIH National Institutes of Health (HHS) NIOSH National Institute for Occupational Safety and Health NRC National Research Council (of the U.S. National Academy of Sciences) NRF National Response Framework NRIA Nuclear/Radiological Incident Annex NSBRI National Space Biomedical Research Institute NSF National Science Foundation NSRSS NASA Space Radiation Summer School O&M operations and maintenance OCET Office of Counterterrorism and Emerging Threats ORISE Oak Ridge Institute for Science and Education (ORNL) ORNL Oak Ridge National Laboratory OSCC Oxford Survey of Childhood Cancer OSTP Office of Science and Technology Policy (Executive Office of the President) PCC premature chromosome condensation PI principal investigator PNNL Pacific Northwest National Laboratory RadCCORE Radiation Countermeasures Center of Research Excellence RBE relative biological effectiveness RDD radiological dispersal device (“dirty bomb”) RDT&E research development testing and evaluation REB Radiation Epidemiology Branch (NCI) RRP Radiation Research Program (NCI) RRS Radiation Research Society SED Survey of Earned Doctorates SES socioeconomic status STEM science, technology, engineering, and mathematics TRIGA training, research, isotopes, general atomics UNSCEAR United Nations Scientific Committee on the Effects of Atomic Radiation U.S. NRC U.S. Nuclear Regulatory Commission

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xiv ABBREVIATIONS AND ACRONYMS USAF U.S. Air Force USTUR U.S. Transuranium and Uranium Registry USUHS Uniformed Services University of the Health Sciences (DoD) VA U.S. Department of Veterans Affairs WMD weapon of mass destruction