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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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