THE ANNUAL MEMBERS’ dinner speaker on 10 April 2016 was Randall N. Hyer, Deputy Director of the Center for Risk Communication. His presentation was titled “Breaking Bad News in the High-Concern, Low-Trust Setting—How to Get Your Story Heard.” His three key messages were that the world continues to change; all of us must compete, improve, and evolve; and we must use evidence-based tools and techniques. The speed of communication is now almost instantaneous, and the communicator’s goal is to establish trust to create credibility. Public acceptance of the message is based 50% on the communicator’s empathy, 15–20% on honesty and openness, 15% on competence, and 15–20% on all other factors. Nonverbal clues (body language) provide up to 75% of the message content. Storytelling is everything: all stories have a hero, a villain, and a victim, but reporters can assign you an unintended role in your story. Good graphics and pictures improve information recall by 50%.
The 52nd Annual Meeting of NCRP began with the presentation of the colors by the Joint Services Color Guard and the national anthem sung by Kimberly Gaskins of the U.S. Nuclear Regulatory Commission (NRC). Judith L. Bader welcomed the attendees on behalf of the program committee, reviewing who the radiation professionals are, what they do, and where they are (for now). NCRP President, John D. Boice, Jr., then introduced the 13th Annual Warren F. Sinclair Keynote speaker, Richard E. Toohey (M.H. Chew & Associates), speaking on “WARP: Where are the Radiation Professionals?” The long-predicted shortfall of radiation professionals is now arriving; as many as half of the radiation professionals employed in government (both federal and state), industry, academia, and the private sector are at or nearing retirement age, and insufficient replacements are available because student enrollments and degrees granted are falling. Meanwhile, the use of radiation in medicine continues to increase, and an aging population will have an increased need for medical care, especially for cancer diagnosis and therapy. Although the supply of radiation professionals in medicine appears to be adequate for the near term, there may be a shortage of clinical training programs for medical physicists developing. The Fukushima Dai-Ichi nuclear power station accident revealed that the United States already has an inadequate number of radiation professionals for population monitoring, public health advice, medical expertise and treatment, emergency preparedness communications, and resilience and response actions. Student support and faculty research grants must be restored, and the radiological sciences must receive more attention in STEM (science, technology, engineering, and mathematics/medicine) educational initiatives. A joint program support office in the Office of Personnel Management for federal radiation professionals would increase awareness and centralize career management, monitor and coordinate staffing needs, and enhance interagency collaboration. The NCRP will continue to monitor the situation, advocate for support, and advise the government on this specific issue in radiation protection. NCRP has also established Council Committee 2 to perform these tasks.
HOW DID WE GET HERE?
The first session, “How Did We Get Here?” was chaired by Jacqueline P. Williams and Patricia R. Worthington. Scheduled speaker Hedvig Hricak (Memorial Sloan-Kettering Cancer Center) was unable to attend, but Lawrence T. Dauer pinch-hit, presenting “Radiation Brain Drain? The Impact of Demographic Change on U.S. Radiation Protection.” We are witnessing unprecedented convergence of the life sciences, physical sciences, and engineering. Cancer cases are on the rise, but imaging and radiation therapy are now curing cancer. Cardiovascular disease is also rising, requiring radiation-based imaging and intervention. There are 70–80 million computed tomography scans annually, and increased concerns about radiation exposure from these devices began in the late 1990s. Shortfalls in scientists contrast with emerging scientific opportunities and the need for new knowledge. Radiation facilities are also disappearing and research opportunities along with them. As former Defense Secretary Robert McNamara said, “Rationality will not save us.”
The next speaker was Kathryn H. Pryor (Pacific Northwest National Laboratory) on “Membership Trends in Health Physics Society: How Did We Get Here and Where Are We Going?” This issue has been under discussion for at least 20 y. The Health Physics Society (HPS) was formed 25 June 1956 with 212 members and expanded to 800 by the end of 1957. HPS total membership peaked in 1994 at close to 6,500; plenary membership peaked in 1985 at 3,500. Professional societies are competing for time and attention and need to capitalize on social media. Prospective members expect increased value of membership but receive reduced employer support; there is a trend for young professionals to form their own groups, cutting across disciplines, while specialists are looking for more focused groups. Budgets are tight and travel is restricted. The very name “health physics” is not understood and so not conducive to recruitment.
Wayne D. Newhauser (Louisiana State University) spoke on “Review of the Workforce for Radiation Protection in Medicine.” The radiological disciplines relevant to medicine include medical physics, medical health physics, radiation biology, radiation oncology, radiology, nuclear medicine, radiochemistry, and nuclear engineering. Cancer cases are up, so radiation therapy is up, and the number and complexity of new technologies is also increasing. There has been a significant decline in federal research and development support: from 10% of the discretionary budget in 1968, it has fallen to 4% now, and from 1.25% of the gross domestic product in 1977, it has fallen to 0.78% in 2014. The new clinical residency requirement for certification as a qualified medical physicist diverts resources from postdoctoral scientific training. Although supply and demand are balanced for the short term, it is difficult to say how long this will last.
The next speaker was Ruth E. McBurney (Conference of Radiation Control Program Directors) on “The Changing Roles of State Health Physicists.” State health physicists must be generalists, especially in small programs. States regulate nonreactor radioactive material in 37 Agreement States and regulate 86% of nonreactor licenses in the United States. All low-level waste disposal sites are in Agreement States. States are also responsible for offsite emergency planning, incident investigations, and transportation accidents. Source security requirements have increased, financial security requirements are increasing, and complex decontamination and decommissioning issues are becoming more prevalent. States need baby-boomer replacements, staff development and training, awareness of ever-changing technologies and radiation protection issues, competitive salaries and benefits (to slow the revolving door for staff between states), and surge capacity for emergency response.
WHERE DO WE NEED TO BE?
The afternoon session, “Where Do We Need to Be?” was chaired by Robert C. Whitcomb and Adela Salami-Alfie. The first speaker was Jerry W. Hiatt (Nuclear Energy Institute), who spoke on “Commercial Nuclear Power: Assessing and Meeting the Need.” The Nuclear Energy Institute has a workforce strategy development initiative, although needs have been slowed by the Fukushima Dai-Ichi accident and the drop in natural gas prices. A working group was assembled in 2002 to look at the workforce pipeline and demand. A nuclear uniform curriculum program was developed, focused on radiation control technicians and maintenance workers. The 2‐y program is linked to 4‐y programs and has a 75% placement rate vs. 39% for all college graduates. The workforce is not a major issue for utilities, but there is still a need for supplementation during outages.
The next speaker was Kathryn A. Higley (Oregon State University) on “Education or Training—Does It Matter?” Health physics is a diffuse, ill-defined field, with many different specializations. Higher education is moving to a return-on-investment model, and health physics is not sustainable under that model. Professional societies can help by providing information to decision makers; for example, the Office of Personnel Management description of category 1306 (health physicist) is far short of the requirements listed for category 1301 (nuclear engineers). Federal programs with substantial radiation protection obligations must carve out funds for research. Academic programs must cooperate, industry and government must support them, and although scholarships and fellowships are nice, large research grants are needed for faculty support.
The next speaker was David J. Brenner (Columbia University Medical Center) on “Estimating Cancer Risks at Very Low Doses.” We do not have the cancer risk data at low doses; the lowest we can go for atomic-bomb survivors is a dose bin of 5–100 mGy with 25,000 people. There are no radiation-induced cancer markers available for humans. The biophysical argument sets 10 mGy as an anchor point and assumes DNA repair, immunosurveillance, and cell-to-cell communication. We know very little about the latter in radiation carcinogenesis. The bystander effect is best quantified, and where quantitated, shows saturation, so the linear no-threshold model would underestimate risk. Are there radiosensitive subgroups? There is one paper on meningioma following radiation treatment for tinea capitis: all radiation-induced cancers occurred in very few families, although overall meningioma does not. Therefore, genetic susceptibility exists for meningioma. We can, however, provide an upper bound for risk, and such an estimation gives us a reasonable basis for certainty of maximum possible effects.
Nolan Hertel [Georgia Institute of Technology/Oak Ridge National Laboratory (ORNL)] spoke on “Developing a Radiation Protection Hub.” Fellowships do not help faculty; research funding is what counts. Health physics programs at “major” research universities are in jeopardy. ORNL is proposing a Consortium for Advancement of Radiation Protection. Using the existing Center for Radiation Protection Knowledge as a focal point, the consortium would enhance the educational experience, expand research opportunities, develop a practicum program, and eventually become a research hub. NCRP could play a role in setting the research agenda, and the consortium could also try for international extent.
The next speaker was Michael Weber of the U.S. Nuclear Regulatory Commission (NRC) on “Meeting Regulatory Needs.” In 2014, the NRC began a project to transform itself because of an unprecedented pace of change in the world. The first 10 y of the 21st century produced as much change as occurred in all of the 20th century; the 21st century is estimated to produce 10,000 times all of the previous change in the world. The convergence of the Fukushima Dai-Ichi accident, a licensing backlog, growth in fees, reduction in demand, revisited confidence in waste disposal, a restarted Yucca Mountain license, centralized corporate functions, a shutdown and restarted government, and a constrained fiscal environment drive the project. The loss of a handful of professionals can disrupt an entire program, and we are not talking about a handful of retirements; retirement does not include other sources of attrition. A Nuclear Energy Agency survey showed new hires cannot immediately replace retirees. Consequently, concern continues to grow, with increasing complexities and demands in radiation protection.
THE 40TH LAURISTON S. TAYLOR LECTURE ON RADIATION PROTECTION AND MEASUREMENTS
Dr. Boice summoned Dr. Michael T. Ryan to the podium to introduce the 40th Lauriston S. Taylor Lecturer on Radiation Protection and Measurements, Dr. John W. Poston, Sr. (Texas A&M University). Born in Tennessee and grown up in Virginia, Dr. Poston majored in mathematics and minored in physics at Lynchburg College and began his career as a nuclear engineer at Babcock and Wilcox. He joined ORNL in 1964, working on radiation measurements and dosimetry, and attended the Oak Ridge School of Reactor Technology. He took a leave of absence to obtain his M.S. and Ph.D. in nuclear engineering from the Georgia Institute of Technology, later joined Georgia Tech as a faculty member, and eventually moved to Texas A&M University. Not only is he a great lecturer and teacher, he found ways to help students apply the lessons they learned to their research activities in academia and develop their skills in the practice of radiation protection science. He has served on 12 NCRP committees, matched only by the late Dr. Edith Quimby. Dr. Ryan then introduced his teacher, colleague, and friend Dr. John Poston, speaking on “Radiation Protection and Regulatory Science.”
Dr. Poston was introduced to Laurie Taylor by Dr. K. Z. Morgan, and Dr. Taylor followed and assisted his career. As they say in Texas, “If you’re driving down the road and see a turtle sitting on a fencepost, you know he didn’t get there by himself,” and Dr. Poston thanked his students, mentors, and colleagues for their contributions to his career. The term “regulatory science” was proposed by Professor Uchiyama in Japan as “the science of optimizing scientific and technological developments according to objectives geared toward human health.” It is now a well-established branch of applied science that clearly pertains to a wide variety of federal agencies and their regulations. Most agencies have advisory committees to add legitimacy to proposed regulations, but membership can be tightly controlled, as are rules of procedure. In many cases, policy trumps science, and he does not believe regulatory science has a role to play in the future of radiation protection. One actually sees a lot of common sense in practice; unfortunately, radiation protection is no longer a two-pronged discipline, as the research component has been lost. Nuclear power plants in the United States are a good example of how things are done based on common sense under the optimization principle, aided by a strong nuclear safety culture in the industry. This gets people thinking of continuous quality improvement to make things better with a continuous effort from top to bottom of the management chain. Every publication from the International Commission on Radiological Protection (ICRP) seems to change nomenclature, definitions, and goals without any new science driving the changes. What is the cost of these changes in regulations that produce no effect on radiation protection? Federal rule changes, of course, ripple through the Agreement States, which must revise their own regulations. What is the net benefit to all this, when existing doses average <2 mSv annually?
HOW DO WE GET TO WHERE WE NEED TO BE?
The final session of the program “How Do We Get to Where We Need to Be” was chaired by Pamela J. Henderson and Chad A. Mitchell, and the first speaker was Shaheen Dewji (ORNL) on “Critical Issues in Knowledge Management in Domestic Radiation Protection Capabilities.” The Center for Radiation Protection Knowledge at ORNL is designed to provide infrastructure and resources to continue services in radiation protection and dosimetry, capture critical knowledge before it is lost, facilitate decision making, and establish ways to address the back-end of workforce issues (i.e., retiring professionals) rather than the front-end (i.e., incoming hires). Knowledge management looks at people (retirement), processes (recruitment), and resources (technology). Institutions must conduct a knowledge loss risk assessment: identify experts with critical knowledge at risk and prioritize what is not yet captured but must be and look at the attrition risk factor; create a documented knowledge retention plan; monitor and evaluate efforts to measure success; and set milestones (e.g., decrease human performance errors and outsourcing, and meeting goals) while producing innovative output.
The next speaker was Matthew P. Moeller (Dade Moeller) on “The Business of Health Physics: Jobs in a Changing Market.” Today is all about relevance amid changing markets, filling jobs, maintaining specialties, and preserving the science. Current needs include medicine and decontamination and decommissioning, especially in the weapons complex, involving very sizeable costs. Health physics has changed and will continue to do so; our success in controlling radiation exposure has, to some extent, eliminated jobs. Routine operations are the norm, but off-normal events can result in long shutdowns; e.g., the underground waste drum explosion at the Waste Isolation Pilot Plant. Generalists rather than specialists are filling positions. Economics is governing changes, and as a society, we accept some risk to lower costs; economics forces companies to use individuals with lesser education, experience and skills to reduce costs. We need to establish job requirements and standards across the spectrum of radiation protection, but one size does not fit all. We must make it clear that our profession is essential to national security and attract the next generation. We need to accept that economics and developing job standards make health physicists more relevant to broader operations (industrial hygiene, integrated safety management, conduct of operations), and thereby take someone else’s job by capturing more responsibility.
Dr. Stephen V. Musolino (Brookhaven National Laboratory) spoke on “Meeting the Needs of First Responders: Scientific Experiments to Operational Tactics for the First Ten Minutes after an Outdoor Explosive Radiological Dispersal Device.” Radiation protection experts do not routinely respond to emergency situations, and without their advice and assistance, first responders may not adequately manage their own safety or may delay essential lifesaving and treatment actions. Since first responders now have instruments, a radiological event will be rapidly detected. Responders have five missions: recognize, inform, initiate response, measure and map, and transition to the recovery phase. You can’t model your way out of the problem, only measure your way out. So who is the local radiological expert to interpret data and assist decision makers? The answer is ROSS, the radiological operations support specialist. This individual supports the incident command system; accesses special federal resources; interprets and explains data and modeling; provides guidance to responders, incident commanders, elected officials, and decision makers on appropriate protection actions for responders and the public; and aids public and responder communication efforts. In the case of a nuclear detonation, ROSS support will be even more important to decision makers.
The final speaker was Donald P. Frush (Duke University School of Medicine) on “Meeting Medical Needs.” Physicians have not been successful stewards of patient radiation protection, which involves numerous stakeholders. A survey showed patients aged 14 y received doses ranging from 4–25 mSv in some computerized tomography examinations. There is an urgent need for risk literacy among physicians. Global validation of procedures is underway, paralleling the Image Gently®/Image Wisely® initiatives in the United States. There is no need for independent preparation of patient information materials. We need to deal effectively with patient advocacy groups; align with communication experts (content is important, delivery even more so); employ social media strategies; and increase accreditation, regulation, and guidance. Dose monitoring is preferred to dose tracking; a cumulative dose program will be required for hospital accreditation. Benchmarks (derived reference levels) are useful for controlling patient dose. We also need to practice radiological event management. Remember that members of the medical community are not epidemiologists, dosimetrists, nor risk experts, and they need our help.
President Boice then presented “NCRP’s Vision for the Future.” It is clear that there are simply not enough radiation professionals to meet national needs, especially in a radiological emergency. NCRP is not necessarily in lockstep with ICRP; our recommendations are specific to U.S. needs; e.g., guidance on lens dose limits. Communication is a big issue and is in the first line of our charter; every report needs an executive summary in lay language. In his concluding remarks, President Boice thanked the program committee, session chairs, speakers, staff, and volunteers. He stated this was one of, if not the most interactive NCRP meeting ever. There was an unbelievable number of questions and interactions on this vital topic.