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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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 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 competencies and with regard for appropriate 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 Sciences. 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

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Copyright 2014 by the National Academy of Sciences. All rights reserved.

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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 Radiobiology Research Institute. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

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 Academy 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 engineers. 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 engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president 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 Institute 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 Council 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

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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, Harvard University; Labor and Worklife 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

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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 Radiation Safety 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 considered. Responsibility for the final content of the report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×
Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
×

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

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2014. Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Washington, DC: The National Academies Press. doi: 10.17226/18732.
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It is probably only a matter of time before we witness the next event in which large numbers of people are exposed to ionizing radiation. In the past, planning a response to such an occurrence would have likely focused on the management of casualties from high-dose exposure. However, more recently, a different threat has come to the fore: accidental (through a containment breach in a nuclear power plant, for example) or intentional (via a "dirty bomb") releases of radioactivity resulting in low-dose exposure to a population. The magnitude of the health risks arising from low-dose radiation exposure is uncertain, and this uncertainty has significant economic implications for public health decision making.

Research on Health Effects of Low-Level Ionizing Radiation Exposure examines recent scientific knowledge about the human effects of exposure to low-dose radiation from medical, occupational, and environmental ionizing-radiation sources. This report is intended to provide advice to the Armed Forces Radiobiology Research Institute (AFRRI) about its role in low-dose radiation health effects research. The report identifies current research directions in radiobiological science and assesses how AFRRI programs are advancing research along these directions. The recommendations of Research on Health Effects of Low-Level Ionizing Radiation Exposure will provide guidance for AFRRI to build on its strengths and advance its mission while contributing to the body of scientific knowledge on the health effects of exposure to low-dose ionizing radiation.

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