An Evaluation of Radiation Exposure Guidance for Military Operations

Interim Report

Committee on Battlefield Radiation Exposure Criteria

Fred A. Mettler, Jr.,

Chairman

J. Christopher Johnson and Susan Thaul, Editors

Medical Follow-up Agency

Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, D.C.
1997



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--> An Evaluation of Radiation Exposure Guidance for Military Operations Interim Report Committee on Battlefield Radiation Exposure Criteria Fred A. Mettler, Jr., Chairman J. Christopher Johnson and Susan Thaul, Editors Medical Follow-up Agency Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C. 1997

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. This work is supported by the U.S. Army Medical Research and Materiel Command under Contract No. DAMD17-96-C-6095. The views, opinions, and/or findings contained in this report are those of the authors and should not be construed as an official Department of Army position, policy, or decision unless so designated by other documentation. International Standard Book No. 0-309-05895-3 First Printing, September 1997 Second Printing, January 1999 Additional copies of this report are available for sale from: National Academy Press 2101 Constitution Avenue, N.W. Box 285 Washington, DC 20055 Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s online bookstore at www.nap.edu. This report is available on line at www.nap.edu/readingroom. For more information about the Institute of Medicine, visit the IOM home page at www2.nas.edu/iom. Copyright 1997 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 Staatlichemuseen in Berlin.

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--> COMMITTEE ON BATTLEFIELD RADIATION EXPOSURE CRITERIA FRED A. METTLER, JR., Chairman, Professor and Chair, Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico JOHN F. AHEARNE, Director, Sigma Xi Center, Research Triangle Park, North Carolina, and Adjunct Professor of Civil and Environmental Engineering, Duke University, Durham, North Carolina GEORGE J. ANNAS, Professor and Chair, Health Law Department, Boston University School of Public Health, Boston, Massachusetts WILLIAM J BAIR, Radiation Biologist (retired, Senior Advisor for Health Protection Research, Pacific Northwest National Laboratory), Richland, Washington RUTH R. FADEN,* Philip Franklin Wagley Professor of Biomedical Ethics and Director, The Bioethics Institute, Johns Hopkins University, Baltimore, Maryland SHIRLEY A. FRY, Senior Advisor, Environmental and Health Sciences Division, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee LAWRENCE O. GOSTIN, Professor of Law, Codirector, Georgetown/Johns Hopkins University, Program on Law and Public Health, Washington, D.C. RAYMOND H. JOHNSON, JR., President, CSI-Radiation Safety Training and Communication Sciences Institute, Inc., Kensington, Maryland LEONARD D. MILLER, Brigadier General, US Army, Retired, Fairfax, Virginia WILLIAM A. MILLS, Consultant, Radiation Safety, Olney, Maryland BERNHARD T. MITTEMEYER, Lieutenant General/Surgeon General, US Army, Retired; Professor of Urological Surgery, Texas Tech University School of Medicine, Lubbock, Texas THEODORE L. PHILLIPS,* Professor and Chair, Department of Radiation Oncology, University of California, San Francisco GENEVIEVE S. ROESSLER, Associate Professor Emeritus, Nuclear Engineering and Radiology, University of Florida RAYMOND L. SPHAR, Captain, Medical Corps, US Navy, Retired; Department of Veterans Affairs, retired, Washington, D.C. Study Staff J. CHRISTOPHER JOHNSON, Study Director SUSAN THAUL, Associate Study Director STEVEN SIMON, Senior Program Officer PAMELA C. RAMEY-McCRAY, Administrative Assistant *    Member of the Institute of Medicine.

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--> BOARD OF THE MEDICAL FOLLOW-UP AGENCY DAVID G. HOEL, Chair, Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston JOHN C. BAILAR, III,* Professor and Chief, Department of Health Studies, University of Chicago, Chicago, Illinois DAN G. BLAZER,* J.P. Gibbons Professor of Psychiatry, Dean of Medical Education, Duke University Medical Center, Durham, North Carolina NORMAN BRESLOW,* Professor of Biostatistics, University of Washington, Seattle GERMAINE BUCK, Associate Professor, Department of Social and Preventive Medicine, State University of Buffalo, Buffalo, New York DONALD L. CUSTIS, Senior Medical Advisor, Paralyzed Veterans of America BARBARA HULKA,* Professor, Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina THOMAS A. LOUIS, Professor and Head, Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota ROBERT W. MILLER, Scientist Emeritus, Genetic Epidemiology Branch, National Cancer Institute, Bethesda, Maryland NANCY MUELLER, Professor of Epidemiology, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts H. ELDON SUTTON, Professor of Zoology, Director, The Genetics Institute, The University of Texas at Austin RAYMOND L. SPHAR, Captain, Medical Corps, US Navy, Retired; Department of Veterans Affairs, retired, Washington, D.C. MARIE G. SWANSON, Professor, Cancer Center at Michigan State University, East Lansing NANCY F. WOODS,* Director, Center for Women's Health Research, School of Nursing, University of Washington, Seattle Staff RICHARD N. MILLER, Director, Medical Follow-up Agency NANCY DIENER, Financial Associate PAMELA RAMEY-McCRAY, Administrative Assistant *    Member of the Institute of Medicine.

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--> Preface In May 1995, the Office of the Surgeon General (OTSG) of the U.S. Army contacted the Institute of Medicine, requesting that it consider studying the health and ethical implications of conducting military operations in low-level nuclear environments. The request was prompted by the Surgeon General's participation with the North Atlantic Treaty Organization (NATO) in the development and standardization of procedures and equipment for detection, measurement, removal, and disposal of low-level radioactivity. The IOM responded in July 1995 with a proposal to establish an expert committee to undertake the study, which was funded in September 1996. The committee's charge was developed in conjunction with the OTSG and consisted of two major tasks. In the first, we were to review draft NATO radiation protection guidance from a technical perspective and suggest improvements. The Army was most interested in receiving that review as quickly as possible. This report fulfills that desire. Our second task will be to consider broader issues of law and ethics. We have included sufficient technical background in this first report that it can stand alone. Nevertheless, the reader should recognize that without the law and ethics component, the committee's work is incomplete. The second report, due a year from now, will expand the current report to consider the ethical, moral, and legal basis from which soldiers are exposed to and protected from radiation. The development of a complete system of radiation safety for the soldier will require not just the technical information discussed in this report but also the ethical foundations to be presented in the next. Making this report useful to the widest possible audience within the Army has been a challenge. The technical basis of radiation safety is complex and given to its own jargon. On the one hand, we have made every effort to be as precise as possible in the discussion of background material. On the other hand, we have made some difficult choices to leave out some details that, if included, would have compromised clarity. We hope that diverse groups from radiation safety specialists to combat soldiers will find this report useful. FRED A. METTLER, JR., CHAIRMAN

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--> Acknowledgments The committee and staff are grateful to LTC Carl A. Curling (Medical Nuclear, Biological, and Chemical Staff Officer) at the Office of the Army Surgeon General. As our project officer, he worked to explore the scope of the overall project, organized briefings and materials for the committee, and acted as a liaison to other military staff. We also acknowledge the important work of LTC John Bliss (International Chairman, NATO Working Group 2 on Low-Level Radiation) and LTC William J. Klenke, LTC Curling's predecessor, in initiating and supporting this project. COL David Jarrett (Director, Military Medical Operations Office, Armed Forces Radiobiology Research Institute), CPT Marc Umeno (Nuclear Medical Science Officer, US Army Nuclear and Chemical Agency), MAJ Debra Schnelle (Manager, Medical Health Physics Program; US Army Center for Health Promotion and Preventive Medicine), MAJ Brett Armstrong (Chief, Nuclear, Biological, and Chemical Sciences Branch; US Army Medical Department Center and School), CAPT Richard LaFontaine (US Navy), and LCDR Phillip Liotta (US Marine Corps) presented useful background material and perspective to the committee. Others whose efforts enhanced this report are Institute of Medicine-National Research Council staff—Claudia Carl, Mike Edington, and Linda Kilroy; and consulting editors—Peter Slavin and Beth Gyorgy.

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--> Contents     Summary   1 1   Introduction   9 2   Principles of Radiation Protection   13     Radiation Physics   13     Radiation Units and Measurements   14     Radiation Units   14     Radiation Measurement   16     Sources of Radiation Exposure   18     Radiation Biology   19     Deterministic Effects   20     Stochastic Effects   22     Radiation Dose Reduction   24 3   Standard Practices in Civilian Radiation Protection   25     Control Philosophy   25     Notification, Training, and Informed Understanding   31     Recordkeeping   31 4   Current Paradigms for Radiation Protection in the Army   33     Occupational Exposure   33     High-level Exposures in Nuclear War   35     Summary of Existing Army Programs   36 5   Evaluation of the ACE Directive in Light of Civilian Standard Practices   40     Underlying philosophy of Radiation Protection   40     Terminology   42     Prospective Risk Assessment   42     Definition of a Radiological Area   43     Dosimetry Requirements   43

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-->     Dose Units   44     Internal Dose   44     Dose Cumulation Times   45     Reference Levels for Operational Exposure Guidance   45     Recordkeeping Requirements   47 6   Recommendations for Revisions of the ACE Directive   48     Underlying Philosophy   48     Terminology in the ACE Directive   49     Prospective Risk Assessments   50     Dosimetry Requirements   50     Operational Exposure Guidance Below 700 mGy   52 7   Conclusion   53     References   55     Appendix: The ACE Directive   59

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--> Tables Table 2-1.   Comparison of Three Expressions of Dose in Biological Tissue   16 Table 2-2.   Distribution of Annual Doses (1996) for Army Personnel (Military and Civilian) Monitored for Occupational Exposure to Radiation   19 Table 2-3.   Estimated Threshold Doses for Deterministic Effects of Acute Radiation Exposure   21 Table 3-1.   Examples of Typical Radiation Doses and Dose Limits or Reference Levels (mSv)   30 Table 4-1.   Nuclear Radiation Exposure Status and Degree of Risk Exposure   36 Table 4-2.   Operational Exposure Guidance for Low-Level Radiation   38

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