Studying One Million U.S. Radiation Workers and Veterans Why, Who and How

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1 Studying One Million U.S. Radiation Workers and Veterans - Why, Who, and How May 9, 2014 Rockville, Maryland BWCHPS Studying One Million U.S. Radiation Workers and Veterans Why, Who and How John D. Boice, Jr. National Council on Radiation Protection and Measurements [email protected]

2 Studying One Million U.S. Radiation Workers and Veterans Why, Who and How What is the level of risk when exposure received gradually over time and not briefly?

3 The Major Issue in Radiation Epidemiology and Radiation Protection is Effect of Chronic Exposure Relevant to : Medicine After Accident or Terrorism Occupation Environment

4 Why Study One Million U.S. Radiation Workers and Veteran? Chronic exposures are relevant today Healthy U.S. workers more similar to today s populations than Japanese 1945 atomic bomb survivors Relevant to regulated worker populations to compensation programs to organ specific risk estimates Goal to integrate with new biology

5 Who: One Million U.S. Radiation Workers and Veterans Robert Oppenheimer, General Leslie Groves, Enrico Fermi, Hans Bethe, Theodore Hall Manhattan Project 360,000 Atomic Veterans 115,000 Nuclear Utility Workers 150,000 Industrial Radiographers 130,000 Medical & other >250,000 OAK (HARDTACK I), Enewetak, 8.9 MT, 28 Jun 1958 Health Physics News October 2012

6 The Pope visits Brazil 1 Million People WSJ

7 Sponsors a National Effort 7

8 Studying One Million U.S. Radiation Workers and Veterans Why, Who and How Start with a Pilot Study

9 The Model Rocketdyne/Atomics International Santa Susana Field Laboratory Simi Valley Sodium reactor Moorpark 1957 Edward R Murrow See it Now Accident 1959 Saturn Engine Leggett et al. J Radiol Prot 2005 Boice et al. Health Physics 2006 Boice et al. Radiat Res 2006 Boice et al. Radiat Res 2011

10 Gamma X-ray (radiographers) Neutrons Types of Exposure Uranium, Plutonium Americium, Polonium Thorium, Strontium Cesium, Tritium External Internal Uniform dose Delivered during exposure Film (TLD) badge reading Non uniform dose Protracted in time Bioassay measurements

11 Discussion Sessions with Former Radiation Workers

12 Career Doses Sources of Additional Radiation Exposure Department of Energy 2,058 NRC REIRS 1,039 Landauer Dosimetry Co. 1,792 Military 26.5% of total occupational dose was received at other facilities both prior to and after employment at Rocketdyne.

13 Rocketdyne Updated Mortality Analysis Larger combined studies of early workers in the United States using similar methodologies are warranted to refine and clarify radiation risks after protracted exposures.

14 Studying One Million U.S. Radiation Workers and Veterans Why, Who and How Follow the Model for Other DOE Sites

15 Mound, Dayton, Ohio Polonium 210 (7,300 Workers) Alexander V. Litvinenko in his hospital bed in London on Nov. 20, 2006 George Koval December 25, 1913 to January 31, 2006

16 Mound Plant, Dayton, Ohio Innovations & Polonium Dosimetry: Polonium, Plutonium, Tritium, 200,000 urine samples, External radiation Tracing: 98.7 % of 7,291 workers (1944+), 98% CODs Cancer incidence - linkage with Ohio Cancer Registry (1996+) Renal Disease Registry linkage (1976+) Historical note: produced triggers for Trinity site and Nagasaki "Fat Man" plutonium bombs

17 2014 Mound Plant, Dayton, Ohio

18 Manhattan Project and other Workers (Selected U.S. Nuclear Facilities) Atomics International / Rocketdyne (1948) Mound Laboratory (1947) Los Alamos National Laboratory (1942) Hanford Reservation (1943) Savannah River Site (1950) Oak Ridge Reservation K-25, X-10 and Y-12 (1942) Sandia National Laboratories (1945) Rocky Flats Environmental Technology Site (1951) Paducah Gaseous Diffusion Plant (1953) Fernald Environmental Management Project (1953) 18

19 Plutonium Workers Other 33,388 Total 154,928 Los Alamos National Laboratory, Remote handling of radiolanthanum

20 Genius is one percent inspiration and ninety-nine percent perspiration Thomas Edison

21 Los Alamos Vital Status 12/2011 Finding the Workers National Death Index (1979+) 19 State Mortality Tapes Social Security Death Index Social Security Vital Statistics State Departments of Vital Statistics Credit Bureaus Other Internet Sources April 2014

22 Scanning 30 Boxes of Death Certificates (29,300)

23 The Scanners --- Employing America s Youth Wake Forest (2), Milligan, Towson State, Gettysburg, U of Virginia, Ohio U

24 Mayak Nuclear Weapons Plant

25 The Mayak PA workers usually had one or more bioassay measurements during the course of their employment (Fig. 2). However, many of the workers included in the cohort had no bioassay examinations, particularly in the early years of plant operations, because an internal dosimetry monitoring system did not exist. Khokhryakov et al 2013

26 Studying One Million U.S. Radiation Workers and Veterans Why, Who and How Start Combining Studies for Statistical Precision and Power

27 Mound Plant + Rocketdyne Ongoing Heart, Stroke, Nonmalignant Respiratory Disease: USC, EPA, Harvard Dementia, Alzheimers Disease: Because of NASA interest and because polonium provides alpha particle exposure to brain

28 Nuclear Power Plant Workers U.S. Early Nuclear Utility Workers 330,000 Hired Before 1985 Large numbers Good dosimetry Range of doses At the time allowable doses could be up to 3 rem per quarter considering 5 x (Age 18) rem Some cumulative doses were as high as 100 rem Hall EJ et al. DOE Workshop. Rad Res 2009

29 Nuclear Power Plant Workers N=148,370 Dresden Generating Station N= 33,118 N=115,225 Number who have died is 30 x greater than N= 31,221 In the large 15-utility * investigation with 1190 deaths among 53,698 workers (Howe et al Rad Res 2004) *COD known for 17,461 N= 198 ~1,000 Leukemia N= 46,500 1,907 Lung 5,345 All Cancer Apr 2014 NDI Returns Just Received

30 Dosimetry Monitoring Records Dept of Energy, Richland Office

31 Nuclear Utility Worker Dose Distribution Preliminary (REIRS & Landauer) Lifetime dose Frequency Percent (msv) < 10 * 30, * 77, , , > 1, <0.1 Total 148,915 Paracelsus: The Poison is in the Dose. *Sampled < 50 msv

32 Dosimetry Validation of recorded doses Sample film badges and control badge from 60 years ago Use modern equipment and compare with recorded values

33 Studying One Million U.S. Radiation Workers and Veterans Why, Who and How Other Populations in the Queue

34 Industrial Radiographers Landauer ~50K REIRS ~ 70K Mirion to consider Combined Population of Industrial Radiographers 115, ,580 21,640 Cause Known 13, Cause Unknown 8,573 8,429 April 2014

35 Medical Workers Radiologists Technologists Interventionalists Cardiologists Oncologists Nuclear Medicine Begun June 2013 Total 5 Million Selected 240,000 55,000 Cause Known 33,000 Cause Unknown 22,000

36 Other Workers - Landauer Data base > 50 msv Dose Distribution Dose category (msv) Frequency Percent < 50 1, , , , > ,180 * 1.7 Problematic Total 70, Japanese atomic bomb survivors > 1000 msv = 2,389 (Preston Rad Res 2004) Japanese atomic bomb survivors > 100 msv = 18,444 compared with 26,536 above

37 Other Radiation Workers Radiologists, nuclear medicine, radiotherapists, other medical, industrial radiographers 2880 rolls of microfilm from the 1950s through 1976 available from Landauer (5 million dosimetry reports from 1 million workers) Microfilm imaged Oct 2013, now being digitized Electronic records after 1976 records (1.5 million dosimetry reports) for the: Over 70,000 non-nuclear utility workers identified with cumulative dose > 50 msv.

38 Study of Atomic Veterans The Eight Series Study

39 Atomic Veterans Tracing Efforts 97% Located 66% have Died < 3% missing cause of death VA BIRLS FaceBook Credit Bureaus Dec 2013

40 Dosimetry for Epidemiology

41 The Healthy Warrior Effect Over Time SMRs Approach Population Expectation SMR SMR = 1.0, same as general population All Causes SMR Overall IshemicHeartDisease Heart SMR Calendar Year 2010

42 The Healthy Warrior Effect Over Time Not so for Cancers 1.10 SMR SMR SMR = SMR 1.0, same = 1.0, as same general as general population population Leukemia SMR 1.01 Lung 1.06 All Causes Cancer SMR Heart 0.70 Overall IshemicHeartDisease Calendar Year 2010 Cancer other than Lung SMR 1.00 Leukemia other than CLL SMR 1.01

43 Rations During WWII included Cigarettes During the Second World War the U.S. Army Quartermaster Corps issued K-rations to paratroops, tank units, rangers, air forces, or wherever space was a factor. Each of the three daily K-ration meals contained a small packet of four cigarettes. Camel, Chesterfield, and Lucky Strike were popular brands with the troops, but all of the major and several of the minor cigarette manufacturers had contracts with the government. Cigarettes

44 All Veterans SMR (N=114,277) Cause No. Deaths SMR 95% CI All causes 73, * All cancer 21, * Lung 7, * All cancer less Smoking Sites 10, Pleura, Meso * Breast Thyroid Leukemia Myelodysplastic Suicide 1, * * p<0.05

45 Pleura, Mesothelioma by Service Service No. Deaths SMR 95% CI Navy * Army * Air Force Marines Total * * p<0.05

46 Levels of Risk for Asbestos Exposure On U.S. Naval Vessels

47 2012 visit to the USS Laffey (DD-724) in Charleston, SC. The USS Laffey participated in 1946 Operation Crossroads, is known as the The ship that would not die and is the last example of a Sumner Class destroyer (58 ships launched between ) in the United States.

48 SMOKY 55 Year Later - CDC

49 SMOKY 55 Year Later - CDC JAMA 1983 Feb 2014 Sitting L-R: Henry Falk, John Boice, Clark Heath, John Till Standing L-R: Mike Mumma, Bob Whitcomb, Glynn Caldwell, Matt Zack

50 Leukemia SMOKY and PLUMBBOB (1957) Years of Follow-Up Test (# soldiers) SMOKY (2,892) PLUMBBOB (12,219) Total OBS SMR OBS SMR OBS SMR * * * p < 0.05.

51 Summary 1,000,000 U.S. Radiation Workers being studied. National Effort 10 time larger than the study of atomic bomb survivors Has more high-dose subjects (30,000 >100 msv to date) Has many more deaths (~400,000 to date) Can evaluated risks to individual organs The study has substantial statistical ability to evaluate risks following gradual exposures Stay tuned!

52 Another Vision US Registry of Radiation Workers NRC REIRS (1950s+) DOE REMS (1940s+) DOE Historical (1940s+) Landauer Electronic (1977+) 5.7 million records from 1.2 million persons 3.5 million records from 0.64 million persons 0.7 million records from 0.52 million persons 29 million records from 5.68 million persons Landauer Microfilm ( ) 5.4 million records from 1 million person Other Dosimetry TOTAL To be determined 44.3 million dose records for 9.0 million persons As of June 2013

53 Vision - Integration INTEGRATING BASIC SCIENCE WITH EPIDEMIOLOGICAL STUDIES ON LOW-DOSE RADIATION EFFECTS

54 Studying One Million U.S. Radiation Workers and Veterans Why, Who and How Get Help from Your Friends!

55 SC 6-9: U.S. Radiation Workers and Nuclear Weapons Test Participants Radiation Dose Assessment A Bouville Chairman R Toohey Co-Chairman H Beck J Cassata L Dauer K Eckerman D Hagemeyer R Leggett B Napier K Pryor M Rosenstein J Thompson D Schauer S Sherbini D Miller D Stram J Till C Yoder C Zeitlin

56 We get by with a lot of help from our friends Thank you

57 friends 2 Thank you

58 friends 3

59 We get by with a lot of help from our friends -4 Thank you