Exposure to External and Internal Radiation - Radium Studies

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BIOMEDICAL AND ENVIRONMENTAL RESEARCH Exposure t o External and Internal Radiation - A. F. Stehney and those listed i n specific groups I FY Continuing RELATED WORK ( W i t h Same Contractor or Others) .UM POWER AND COST DATA ESTIMATED FOR FISCAL YEARS FY 1974 BUDGET REQUIREMENTS FY 1976 60. DIRECT MANPOWER (Man Yaars) TEMPORARY PAID BY ANL TEMPORARY PAID BY OTHERS TEMPORARY PAID BY ANL TEMPORARY PAID BY OTHERS TOTAL OTHER TECHNICAL TOTAL MAN YEARS MATERIALS AND SERVICES ,539 5 17 - 68 2 4r Health Division Services 50 35 - 3 5 c' See I t e m 8 for explanation of major procurements.

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REPOSITORY: OFFICE OF HUMAN RADIATION COLLECTION: PLUTONIUM INJECTION INVESTIGATION FOLDER: EXTRA COPIES

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Optical Character Reader AI pha Spectrometer Anthropomorphic Calibration Phantom Graphite Furnace for Atomic Absorption Radon Counting System Time - Lapse Photographic Systern A breakdown of manpower and cost distribution for e a c h group is shown below: Scientific Man Years and Cost Radiation Damage to Humans Kadiation Damage to Humans) Trace Elements in Man Seeking Radioisotopes In Man F. Physical Analysis of Bone Containing Microscoplc Analysis of RadiumPhysical Assay of Bone Contalning Deposited Radionuclides)

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BIOMEDICAL AND ENVIRONMENTAL RESEARCH Exposure to External and Internal Radiation - , BUDGET ACTIVITY NO. A. Dose-Effect Relationships for Radiation Damage to Humans (includes the radiation dose and biological damage. The subjects under study are radium dial painters and other human beings with significant body burdens of radioactivity. We have identified and located approximately 2750 persons whose industrial or medidal experience with radium may have resulted i n internal deposition, and body burdens of radium have been determined for 1560 of t h e s e persons. Morbidity and mortality data are being accumulated by computer-assisted examination of records and are being correlated with exposure histories and radioactivity data. To make the studies of subgroups of radium cases m o r e complete, lost cases are being sought and unstudied dead cases are being exhumed. The purpose of this work is t o find quantitative relationships between Purpose and Methods. relationships between the biological effects of radium i n man and the internal levels of exposure to bone-seeking radioisotopes. The research plan is (a) to obtain epidemiologic and dosimetric d a t a by direct study of human beings who have been occupationally or iatrogenically exposed to intake of radium and (b) to formulate the results into dose-response curves of radium toxicity. aspects of this work require full utilization of radiobiological concepts and of models of radiation damage-for part (a), to ensure that a l l the relevant data o n this nonreplaceable radium population a r e obtained, and for part (b), to help determine t h e proper d o s e parameters, the shape of the curve, and methods of extrapolation to t h e low-risk low-dose region. The objective of this program is to find quantitative The primary application is i n setting maximum permissible Mose of the persons under study *re first exposed 30 to 60 years ago, and a considerable body of information from medical examination and radioactivity measurements h a s been developed from previous radium studies and by current work i n the Center for Human Radiobiology. For epidemiological PurPosesf it is necessary to quantify the information from the radium studies and to define the population of radium cases or subgroups to which the. results apply. T h i s effort involves detailed review of individual case histories and examination of the study Plans of the various investigators from whom the data were obtained, because the malor fraction of t h e data (including more than 90% of the cases with malignancies considered to be radium-induced) was obtained from previous studies. Only

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The program set up around t h e radium cases includes clinical, biological, and physical studies of the living cases, a search for new cases, acquisition and study of autopsy material and willed bodies, exhaumations, and epidemiology. In addition , reproductive patterns of female radium patients and medical histories of their children are being studied for evidence that low doses of radiation may affect fetal development. II A field office in Orange, New Jersey, maintains contact with radium cases and searches for new cases along the east coast of the United States. f A satellite laboratory is operated i n Cambridge, Massachusetts, under a subcontract with MET. This laboratory is equipped t o make whole-body radium measurements , radon breath measurements , and bone scan measurements (by t h e Cameron method) on the patients i n this area. Personnel also contribute vigorously to locating radium patients and obtaining willed and exhumed bodies. Medical examinations of the patients , including skeletal x rays., are conducted by cooperating physicians in the Cambridge area. As of March 31, 1974, w e have the names of 3800 persons who have had industrial or medical exposure to radium. Of t h e s e , 1750 living persons have b e e n identified and located and 1000 other persons are now known to be dead. The body burdens , measured either in life or after death, have been estimated for 1560 of t h e 2750 located persons. During the past year, another physician was added to the staff of the Center for Human Radiobiology to perform examinations and to participate in the studies of t h e medical effects of deposited radionuclides. The clinical and x-ray facilities of t h e ANL Health Division continue to be utilized for examination of patients who come to the Argonne site, but the examinations are now done by medical personnel of t h e Center. Under a cooperative arrangement, the University of Chicago Hospitals and Clinics perform detailed ENT and diagnostic radiographic examinations of patients considered to have enhanced risk of developing carcinomas of the paranasal sinuses and the mastoid air cells. All work involving human subjects in the Center for Human Radiobiology is done i n conformity with DHEW policy o n protection of human subjects. The scope of t h e work and protocol of procedures under the project title "Effects of Internal Radiation o n Humans" w a s approved on September 1 7 , 1971, by the ANL Review Committee for Research Projects Involving Human Subjects. A report of CHR studies conducted during 1973 and proposed modifications of the original protocol were reviewed by the Committee, and notice of approval for continued study was received from the Committee on April 8 , 1974.

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recently has computer coding of the available data become sufficiently complete for meaningful analysis, and determination of the present status and future needs of the program is still in progress. Since complete and quantitative study of the radium cases is needed, a large part of this program consists of identification and follow-up of radium cases, record maintenance, data verification, and computer processing for data storage and data reduction. A s of March 31, 1974, we have the names of 3800 persons reported to have had industrial or medical exposure to radium, but practically no personal or exposure data have been obtained for 700 of the persons listed. Of those with known exposures, 1750 living persons have been identified and located and 1000 other persons are now known to be dead. burden of radium have been made for 1560 of the 2750 located persons. Determinations of the body Accomplishments FY 1973 and FY 1974. From July 1, 1972, to March 31, 1974, the present status of 1400 living persons was determined by visit, telephone call, and/or letter, and notification of the recent or past deaths of 150 other radium cases w a s obtained. Appointments and travel arrangements were made and personal assistance was provided for 367 radium patients examined at ANL. results of these examinations and 138 examinations made at MIT were added to the computer data bank of results obtained earlier. The names and present locations were found for 600 additional persons employed in the radium industry. Special efforts are being made to obtain emp!oyment records of radium-dial companies, o r other source documents, that provide complete or unbiased lists of persons exposed to radium under a given s e t of conditions. identify subgroups of radium cases i n which the total exposed population is known and to evaluate the prospects of complete study. A t present, we have payroll records of three radium companies which identify 1146 employees; and 193 employees of another company were identified by s e a r c h of local city directories. Although 1072 of t h e s e 1339 persons have already been located, radium burdens have been determined for only 653 of them, and 173 persons not examined have already died. Increased priorities are t h u s indicated for radioactivity measurements and exhumations of persons in this group. The purpose is to Record files were updated continually as new information was obtained, and all case histories have been microfilmed for safekeeping and for e a s y handling. The original files of the New Jersey Radium Research Project (1957-1967) were examined i n detail and new data from this source were added to the C-HRrecords: included a r e body burdens of radium for 130 persons not measured by MIT or ANL. Exposure histories and laboratory reports of radioactivity measurements of 1500 radium patients were analyzed i n order t o calculate dose parameters and estimates of experimental error. Tables of exposure data, radioactivity data, errors, and d o s e parameters for 1346 radium patients were prepared by computer for the FY 1973 Annual Report (ANL-8060, Part 11). A modified version of the Systematized Nomenclature of Pathology (SNOP) w a s devised for usein CHR computer coding of medical diagnoses of the radium cases. In addition to the standard S N O P fields of Topography, Morphology, Etiology, and Function for e a c h medical finding, a ”Date” field was added in order to F.

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BIOMEDICAL AND ENVIRONMENTAL RESEARCH A comprehensive computer system for storing and processing data on the radium population w a s designed and put into operation. The Center for Human Radiobiology Information System (CHRIS) w a s designed to provide convenient and reliable methods of processing all of the data in the radium project. to the case numbers of the patients are accumulated i n many files, each of which is dedicated to a special purpose. The user may create new data files, search categories of data, prepare reports sorted onone or more items of information, or of the files may be displayed at remote terminals, This system utilizes the ANI, several different files individually or i n any combination to find selected select data for processing by statistical or plotting routines. Information inany central computer facilities, where permanent computer files can be accessed either by the large-core IBM-360/195 general-purpose computer operated as a batch system or t h e IBM-360/75 time-sharing computer with on-line processing through remote terminals. The files are organized according to the type of information each contains, General files summarize the current status of each patient, while other files contain time sequences of data o r the observed and derived quantities obtained i n experimental work. Two general files, containing about 250 000 items of data, have been completely coded. Data f i l e s containing detailed information on medical history, clinical chemistry, body radioactivity measurements, and radiochemical analyses have been developed and partially coded. T o date, approximately 500 000 separate i t e m s of information have been extracted from the case records, coded, and entered into the computer data files. Exposure to External and Internal Radiation - Anticipated Program FY 1975 and FY 1976. population for epidemiological purposes will continue. Efforts to identify t h e radium I Source lists of exposed persons will be sought by inquiring of company officials, radium workers , and earlier investigators and by studying company and hospital records, c i t y directories, government records, and other suitable documents. Search, examination, and exhumation efforts will b e directed toward obtaining a complete study of the group or subgroups of persons identified by the source lists. Groups

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of radium cases found by " search " will also be formulated on the basis of carefully defined criteria for exclusion of cases referred t o u s because of symptoms of radium poisoning. Dose-response relationships will be evaluated for studied persons in suitable subgroups of radium cases. Auxilliary studies will be devised to obtain quantitative estimates of error due to incomplete study. A considerable effort will b e made to determine the history of children born to mothers who had previously acquired radium. Since more than 1600 normal children were born to women in this study, they constitute a n important group for study of the effects of low-level continuous fetal irradiation. The rest of the medical d a t a in t h e CHR Records Center will be coded by means of a n expanded version of t h e Systematized Nomenclature of Pathology. When this task is completed, all medical abnormalities diagnosed for the radium cases will, for the first t i m e , be recorded i n precise medical nomenclature, and this information and the dates of diagnosis and the sources of diagnosis will be available in computerreadable form. The types of mobidity that occur with significant frequency will be identified and tested for correlation with radium. We will also test for correlations between symptoms, examine time relationships, and compare diagnosis by detection of radiation damage and for correlation with radiation dose. The subjects are mainly radium-burdened persons for whom late effects are being evaluated. In addition , current cases of inadvertent exposure to transuranic elements o r other radionuclides are ex'amined . Radiological examination 8cl in bal laboratory tests, autopsies, cytogenetics , hematology, and cytology are included in this work. The purpose is to develop and employ diagnostic procedures for Purpose and Methods. accurate a description a s possible of the clinical history and current status of individuals inthe study . Interim information obtained by communication with the medical assistants or from other sources is verified and incorporated in the record, and persons who are unable, or who refuse, to revisit the Center are cont a c t e d periodically by telephone or by personal visit. This program includes direct or supervisory responsibility for all medical work of the Center for Human records: contacts with patients ' personal physicians; consultations with radiologists, pathologists, and other physicians and .medical specialists; obtaining specimens from surgical procedures and autopsies: and obtaining and preparing willed or exhumed bodies for examination. This program is designed to obtain as complete and medical examinations of radium patients: interpretation of medical Direct research on detection o r evaluation of the biological effects of internal emitters i n humans is also important in this program. Considerable progress has already been made toward cytogenetic analyses of …