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NCRP Vision for the Future and Program Area Committee Activities

Boice, John D. Jr.

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doi: 10.1097/HP.0000000000000638
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Abstract

WHERE ARE THE RADIATION PROFESSIONALS?

REMEMBER THE popular books “Where’s Waldo”? Well, similar to radiation professionals, it seems that even allowing global positioning system location on his smartphone won’t help much—if there’s no one to answer the call! Where are the radiation professionals (WARP), and where are you? We’re losing human capital, and the losses are increasing. If you believe we have a national crisis, do you have ideas on how we can avert the impending disaster or mitigate its consequences? The National Council on Radiation Protection and Measurements (NCRP) tried with our workshop in 2013 with representatives from government, academia, industry, and societies, which resulted in a synopsis and now a fuller statement available on the NCRP website (NCRP 2015). We shouldn’t be limited by conventional notions of what is practical or feasible. We need to be imaginative and visionary. NCRP advocates a sequence of activities in the areas of education, training, research, and personnel management to address this urgent national need. But more can be done:

  • Restore significant federal and state funding for scholarships, fellowships, and faculty research to increase and sustain a credible workforce of radiation professionals;
  • Reinvigorate partnerships among universities, government, and the private sector to ensure that undergraduate and graduate programs are adequately resourced to support the training and qualification of radiation professionals, including those who will educate the next generation;
  • Establish a Joint Program Support Office for radiation professionals in the federal civil service to manage utilization and career development of personnel more effectively;
  • Monitor trends in the supply of and demand for radiation professionals; and
  • Establish basic and advanced competency profiles to serve as guidance upon which to base the education, training, qualification and appropriate use of radiation professionals.

NCRP has created Council Committee (CC) 2, "Meeting the Needs of the Nation for Radiation Protection," where we will continually monitor and make suggestions on ways to address vanishing professionals. Further, the 2016 Annual Meeting (11–12 April 2016) was similarly titled: "Meeting the Needs of the Nation for Radiation Protection," and new ideas to mitigate the impending disasters are anticipated.

Remember the days when people were smart and phones where dumb? When the call comes, will there be anyone home to answer the phone (smart or otherwise)? Public health, radiation safety, emergency preparedness, and the environment are all at risk. The clarion call to act is now!

A SNAPSHOT OF NCRP CURRENT AND PLANNED ACTIVITIES

A brief listing of NCRP initiatives follows:

  • Integrating Radiation Biology and Epidemiology (Chairs: Sally A. Amundson, Jonine Bernstein)—commentary published late 2015;
  • Dosimetry for Workers and Veterans (Chairs: Andre Bouville, Richard E. Toohey);
  • The Million Person Study of Low Dose Health Effects (Coordinator: John D. Boice, Jr.);
  • Radiation Protection Guidance for the United States (update NCRP Report No. 116) (Chairs: Kenneth R. Kase, Donald A. Cool);
  • Recent Epidemiologic Studies and Implications for the Linear No-threshold Model (Chairs: Roy E. Shore, Lawrence T. Dauer);
  • Dose Limits for the Lens of the Eye (Chairs: Eleanor A. Blakely, Lawrence T. Dauer);
  • Space Radiation and Central Nervous System Effects—Phase I (Chairs: Leslie A. Braby, Richard S. Nowakowski)—commentary published in 2016;
  • Space Radiation and Central Nervous System Effects—Phase II (Chairs: Leslie A. Braby, Jacob Raber);
  • Dosimetry for Emergency Responders (Chairs: Stephen V. Musolino, Adela Salame-Alfie);
  • Emergency Response and Preparedness [2017 Annual Meeting (Program Chairs: Armin Ansari, Adela Salame-Alfie)];
  • Sealed Radioactive Sources (Chair: Kathryn H. Pryor);
  • Dentistry (Chairs: Alan G. Lurie, Mel L. Kantor);
  • Nanotechnology (Chairs: Mark Hoover, David S. Myers);
  • Communicating Risks and Institutional Review Board Guidance (Chair: Julie E.K. Timins);
  • Computed Tomography Dose Optimization (Chair: Mannu K. Kalra);
  • Radiological Society of North America (RSNA) Refresher Course on “Radiological and Nuclear Terrorism: Like It or Not, Radiologists will be in the ‘Hot Seat’” (annual meeting in 2015 and a reprise in 2016);
  • Bioeffectiveness of Low-Energy Radiation (Chair: Steven L. Simon);
  • Naturally Occurring Radioactive Material and Technologically Enhanced Naturally Occurring Radioactive Material—Hydraulic Fracturing (Chair: William E. Kennedy, Jr.);
  • WARP—Where are the Radiation Professionals? Now CC 2 (Chairs: Richard E. Toohey, Kathryn A. Higley, Kathryn H. Pryor); and
  • “Boice Report”—a monthly column since June 2012 in Health Physics News intended to provide brief reports on recent activities in radiation protection, measurements, science, and health.

There is so much that is ongoing and really needs to be done, and we need professionals to continue these and future activities.

PAC 1: BASIC CRITERIA, EPIDEMIOLOGY, RADIOBIOLOGY, AND RISK

Program Area Committee (PAC) 1 is led by Gayle E. Woloschak and Kathryn D. Held. This year Jonine Bernstein will replace Kathy Held when Kathy becomes the Executive Director and Chief Science Officer of NCRP. We meet and discuss the important issues for the United States that require science-based evaluations of health issues. John W. Poston last night in the 40th Lauriston S. Taylor Lecture (Poston 2017) stressed that the United States is not lock-stepped with the International Commission on Radiological Protection (ICRP) recommendations. We consider and incorporate most but not all. A recent divergence was in the lens of the eye dose limit. NCRP, based on a review of recent science, lowered the recommendation from 150 mSv y−1 to 50 mSv y−1, but not as low as the ICRP recommendation of 20 mSv y−1 (ICRP 2012). As our name reflects—the National Council on Radiation Protection and Measurements—we are U.S.A.-centric.

One of the most exciting collaborations and partnerships that we have is with the National Aeronautics and Space Administration. We have been involved for many decades in providing guidance with regard to the radiation risk for astronauts, most recently when going to Mars, and it’s not just the cancer risk but now central nervous system (CNS) effects and potential heart effects. We completed a commentary that is just published (NCRP 2016) and started Phase 2 with a new set of committee members. The concern is the high energy and high atomic number particles, such as iron ions, hitting the brain, and possibly increasing the risk for cognitive dysfunction, lowering reaction times in such a serious manner that the mission cannot be completed. A trek to Mars will take almost 3 y (there and back and a stay on the surface), and the cumulative dose is of the order of 700–1,000 mSv. Is it possible that dementia, Alzheimer’s Disease, and other motor neuron conditions will increase such that the astronaut won’t remember where he or she went?! It is a complex topic with very limited human data but ongoing animal experiments, such that a lot of sound judgment will be needed to assimilate these data and provide practical guidance.

The linear no-threshold (LNT) model has been the basis for radiation protection for many decades; i.e., 40–50 y. We are looking at all the recent epidemiologic studies of health effects since the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR 2014) and the National Academies/National Research Council Biological Effects of Ionizing Radiations Committee (BEIR) reports (NA/NRC 2006) and asking whether they are strong enough to change our use of the LNT model, and if so to suggest an alternative.

What are the opportunities for PAC 1? There are many: integrating epidemiology with biology for improved risk assessment at low doses, cardiovascular disease, dose and dose-rate effectiveness factor, CNS risk following low linear-energy transfer radiation, and what is the impact of biology on regulatory work?

PAC 2: OPERATIONAL RADIATION SAFETY

PAC 2 is our boots on the ground, operational radiation safety committee. Kathryn H. Pryor is the chair. Practical issues in terms of occupational radiation safety are dealt with. One report to be out within a year is the radiation safety of sealed sources.

Nanotechnology. Does smallness matter? In terms of protection, should small be handled differently? Are there monitoring issues? This report will be coming out this year. The chairs are Mark D. Hoover and David S. Myers.

PAC 2 would like to consider next the safe use of handheld and portable x-ray fluorescent analyzers. Other initiatives, if resources became available, would include updating a number of stellar reports such as No. 57, Instrumentation and Monitoring Methods for Radiation Protection (NCRP 1978). Radiation protection guidance for industrial accelerators and irradiators would be important. PAC 2 tries to fill in gaps where guidance would be valuable for the country.

PAC 3: NUCLEAR AND RADIOLOGICAL SECURITY AND SAFETY

PAC 3 is an exciting but sobering committee, dealing with the nuclear and radiological security and emergency response when an improvised nuclear device or radiological dispersive device has gone off. How are we going to respond to such events? You see the terrorist attacks in Paris and Brussels, Copenhagen, Madrid, in Boston and New York and San Bernardino and Canada. Radiological sources or devices have not yet been involved, but it will happen in the United States. Are we going to be able to respond? So we have a committee that deals with these concerns and how to address them. What are the issues on evacuation? Who are emergency workers? How do you define them? What about the bus drivers? How do you measure or estimate radiation doses for the first responders; i.e., the firemen and policemen?

PAC 3 opportunities include enhancing guidance on medical response and addressing biodosimetry; predicting estimates for triaging following the exposures; managing the response in terms of radiation-contaminated fatality management, radiation contaminated facility management, and characterizing the incident; and initial response. How do you monitor, harmonize the decontamination and screening criteria, and then recommend protective and response actions? Next year’s Annual Meeting is titled Emergency Preparedness for Nuclear Terrorism: What are Remaining Gaps and Is There Need for Realignment of National Efforts?

PAC 4: RADIATION PROTECTION IN MEDICINE

Remember the famous pie charts in NCRP Report No. 160 (NCRP 2009) that indicated, for the first time, that the U.S. population receives more radiation per capita from medical exposures than from natural background? That was a major revelation in our Report No. 160. It was a paradigm shift in thinking about radiation exposures to the population—most comes from medicine! Computed tomography (CT) and imaging examinations have reached almost 80 million per year compared with 60 million when Report No. 160 was published. The advances in radiotherapy are just phenomenal with patients being treated with new modalities, such as protons and perhaps carbon ions in the future. NCRP has embarked on a new committee to update the medical exposures to the U.S. population. Billions of dental x rays are given every year! A new report will be coming out within a year on the radiation protection issues surrounding cone beam CT dental examinations. Emergency response and preparedness means constant vigilance and planning for the worst. One new initiative is partnering with the RSNA in sponsoring refresher courses. This is for the physicians, the people in the hospital. An event occurs, and like it or not, the radiology professionals will be in the “hot seat.” They will be expected to give guidance to patients and hospital staff. They will have to know where to find the tool kits.

PAC 4 opportunities include the areas of error prevention in radiation therapy; effect of diagnostic and therapeutic radiation doses on implantable medical devices (e.g., pacemakers and insulin pumps); methods and uncertainties associated with organ dose estimation in CT; radiation protection for positron emission tomography (PET)-CT and multimodality (hybrid) imaging systems (e.g., PET-magnetic resonance imaging); radiation protection for allied professionals and service engineers; compendium of resources for medical radiation protection; and cancer survivorship in the context of radiation protection (out of field doses in pediatric patients). Again, there is so much to do, and we’re capable but limited only by resources to meet these national concerns in medicine.

PAC 5: ENVIRONMENTAL RADIATION AND RADIOACTIVE WASTE ISSUES

PAC 5 is led by Shih-Yew (S.Y.) Chen and Bruce A. Napier. One of the initiatives is on technologically enhanced naturally occurring radioactive material (TENORM) led by William E. Kennedy, Jr. We’re trying to address the issues that the states are facing regarding naturally occurring radioactive sludge that comes with hydraulic fracturing. One of the issues that is of concern for the states is that there is no federal guidance. Federal authority does not address naturally occurring radioactive materials (NORM). The states are on their own to develop their own independent guidance, and it’s not often the same. So NCRP is to provide general guidance for a uniform approach with regard to the management of the radioactive exposures, waste, and other issues of TENORM.

PAC 5 opportunities include: follow-on work of NCRP Report No. 175, waste management from wide-area contamination, a report on radioecology, and characterizing radionuclides of interest to regulatory rulemaking (NCRP 2014). Some of our NCRP documents on radionuclides in the environment are 20–30 y old, and there is a lot of new science that can be used to update guidance on important radionuclides, such as tritium.

PAC 6: RADIATION MEASUREMENTS AND DOSIMETRY

It is often forgotten that NCRP is the National Council on Radiation Protection and Measurements, with measurements being an extremely important but under-appreciated area of emphasis. The PAC is chaired by Steven L. Simon. PAC 6 (a.k.a., Steve Simon) is taking the lead in a new report on the “Bioeffectiveness of Low Energy Radiations,” which should be out in a year’s time. The Million Person Study is moving forward slowly but surely. Dosimetry is the key to good epidemiology, and our Scientific Committee (SC) 6‐9 headed by Andre Bouville and Richard E. Toohey includes the best people we have in the United States providing practical dosimetry guidance for epidemiology. They are covering the issues involved with dosimetry for atomic veterans, U.S. Department of Energy workers who ingested radionuclides and workers in the nuclear industry, taking into account orientation and job characterizations, industrial radiographers, and early radiologists, cardiologists, interventionists, nuclear medicine workers, and radiation oncologists. This report will be under review in the coming year by the Council.

What are the opportunities? Many include practical methods for data collection for dose reconstruction following mass exposure events; update of NCRP Report No. 58 on radioactivity measurements (NCRP 1985); scientifically based regulatory framework for radiation biodosimetry; simulation studies of direct astronaut space exposure with simultaneous modeling of detector responses; improvements to microdosimetry for dosimetry in space; and eye dosimetry.

PAC 7: RADIATION EDUCATION, RISK COMMUNICATION, OUTREACH, AND POLICY

PAC 7 will be a critical component to the NCRP program for protection. It is our hope that our PAC 7, Radiation Education Risk Communication, Outreach, and Policy, will play a major role in our future. We are in a series of change, with Randall N. Hyer taking on the leadership reins. We have many new ideas (the ones over the last 50 y haven’t worked that well) on how we can become effective communicators. It is interesting that NCRP, chartered by Congress in 1964, has communications in the first line of our charter. It is the delivery of information for the public good and for public protection. We’re not just to publish scientific reports but also communicate their meaning to members of the public. Ongoing liaison activities include those with CC 1 on Radiation Regulations; SC 1‐25 on LNT and Radiation Protection; SC 3‐1 on Emergency Response Dosimetry; and SC 5‐2 on TENORM in the Oil and Gas Industry. There might be a need for a comprehensive review of the psychosocial effects of radiation incidents; i.e., the health consequences of “the fear of radiation.”

FINAL COMMENTS

There’s much to do for the nation and fewer and fewer professionals to meet our needs currently and certainly not in the future. It is really a matter of resources, and it would be a disaster if the nation needs scientists, health physicists, emergency responders, regulators, radiation biologists, radiation epidemiologists, and organizational leaders and there is no one to call. Perhaps those remaining will be trained but won’t know the difference between a becquerel and a mackerel! Failure to plan is planning to fail. Those who can't remember the past are condemned to repeat it. And as Yogi Berra might have said, "If we wait until it's too late, it will be too late!" Let's do something now. We have to do something now!

REFERENCES

International Commission on Radiological Protection. ICRP statement on tissue reactions/early and late effects of radiation in normal tissues and organs—threshold doses for tissue reactions in a radiation protection contest. Thousand Oaks, CA: Sage Publications; ICRP Publication 118, Ann. ICRP 41(1/2); 2012.
National Academies/National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, DC: National Academies Press; 2006.
National Council on Radiation Protection and Measurements. Instrumentation and monitoring methods for radiation protection. Bethesda, MD: NCRP; Report No. 57; 1978.
National Council on Radiation Protection and Measurements. A handbook of radioactivity measurements procedures. Bethesda, MD: NCRP; Report No. 58; 1985.
National Council on Radiation Protection and Measurements. Management of persons contaminated with radionuclides. Bethesda, MD: NCRP; Report No. 161; 2008.
    National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. Bethesda, MD: NCRP; Report No. 160; 2009.
    National Council on Radiation Protection and Measurements. Where are the radiation professionals (WARP)? Bethesda, MD: NCRP; Statement No. 12; 2015. Available at http://ncrponline.org/wp-content/themes/ncrp/PDFs/Statement_12.pdf. Accessed 17 October 2016.
    National Council on Radiation Protection and Measurements. Potential for central nervous system effects from radiation exposure during space activities. Phase I: overview. Bethesda, MD: NCRP; Commentary No. 25; 2016.
    Poston JW Sr. Fortieth Lauriston S. Taylor lecture: radiation protection and regulatory science. Health Phys 112(2):000; 2017.
    United Nations Scientific Committee on the Effects of Atomic Radiation. Sources, effects and risks of ionizing radiation. UNSCEAR 2013 report to the general assembly, with scientific annexes. New York: United Nations; 2014.
      Keywords:

      National Council on Radiation Protection and Measurements; dose assessment; emergency planning; radiation protection

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