DEPARIMENT OF THE AIR FORCE AIR FORCE LOGISTICS COMMAND WRIGHT-PATTERSON AFB, umo PLUTONIUM DEPOSITION REGISTRY 93 Prepared by: Ki (/Ww 66 30 PROCEEDINGS First Annual Meeting PLUTONIUM DEPOSITION REGISTRY BOARD PURPOSE: To review results of bio-assay data collected in support of Palomares Broken Arrow operation, and related matters. PLACE: Room B-98, USAF Hospital Wright-Patterson, Air Force Logistics Command, Wright-Patterson AFB, Ohio. - TIME: 0830 hours. I DATE: 27 Oct 1966. I Guest Speaker BrigGen John M. Talbot, USAF, MC, Special Assistant to The Surgeon General for Medical Research Hq USAF, Wash-DC Registry Board Members Col Louis B. Arnoldi, USAF, MC - . Chairman Command Surgeon, Hq AFLC Wright-Patterson AF Ohio W. H. ?Langham, Ph. D. Los Alamos Scientific Laboratory Lo-s Alamos NMex W. D. Norwood, M.- D. . - . Medical Director. Hanford Occupational Health Foundation ichland Wa sh Col J. A. Hennessen,tUSAF,"MC' - Commander . USAF Hospital Wright-Patter son Wright-Patterson I . . - LtCol W. Earroemming, USA. MG - a . Preventive 1 Medicine Division, Office of The Surgeon General .- Dept of the Army,- Wash DC I im??w. 2 I - vii 5:355.11521 u, C. F. Tedford, MSC, USN Office of the Director, Submarine 3: Radiation Medicine Div Dept of the Navy, Wash DC. (for Capt J. Schulte, MC, USN) LtCol L. T. Odland, USAF, MC Commander, USAF Radiological Health Laboratory Wright-Patterson AFB Ohio Consultants M. A. QuaifeChief, Special Laboratory of Nuclear Medicine 3: Biology Veterans Administration Hospital, Omaha Nebr LtCol D. Lindall, USAF, Mc I g. Chief, Bionucleonics, Office of the Surgeon General Hq USAF, Wash?DC LtCol K. T. ?Woodward, USA, Mc Director, Division of Nuclear Medicine Walter Reed Army Institute of Research, Wash DC Capt R. K. Skow, MSC, USN Radiation Safety Officer NatiOnal Naval Medical ,Center, Bethesda. Md G. M. Dunning, a Deputy Director, Division of Operational Safety Atomic Energy Commission, Germantownr, Md . Mr. Sheehan Health Physics Department Mound Laboratory, Miamisburg Ohio Maj J. McBain, USAF, MC 1 I Department. of Medicine, USAF Hosp Wright-Patterso-HAEB Ohio. . Capt J. ?Pizzuto, USAF, Office of the Director of Nuclear-Safety I Inspector General-'3 "Office :Kirtland AFB NMex rm a il5ft; W. B. Johnston, Office of the Director of NuclearSafety Inspector General's Office, Kirtiand AFB NMex Speakers? BrigGen M. Talbot Col L. B. Arnoldi . LtCol L. T. Odland Maj J. Taschner Capt J. Pizzuto Capt R. G. Thomas . Lt H. R. Kaufman Obse rver LtCol R. E.?Benson, USAF, . Deputy Commander . - USAF Radl Health Lab, Wright-Patterson AFB Ohio . Capt G. s. Kush, USAF, 'B'sc OIC FilmDosimetry Section USAF Rad1_ Health Lab, Wright-Patterson AFB Ohio R. T. .Beu, USN Radiation Safety Officer . National Naval Medical Center, Bethesda . agitationjsz Mr. W. R. Wood, Jr. Health Physics Department Mound Laboratory, _Miamisbur g, Ohio {23" foam Alisa??- Dr. C. E. Newton Battelle-Northwest - . Pacific Northwest Laboratory, Richiand Wash Loin, 7 I Medical Branch, Division 'of Biology 3.. Medicine USAEC, '-?Wash DC, 5 -. ..oapi .R- Chief, Special Activities Branch '1 7 A- r. - USAF Radl HealthLab, Wright?Patterson AFB Ohio FORMAL PRESEN TA TIONS: _0pening Address - Brig'Gen J. M. Talbot, USAF, MC On behalf of the Surgeon General and the United States Air Force Medical Service. I want to add my welcome to the participants in this first meeting of the USAF Plutonium Deposition Registry Board. The Air Force is particularly grateful to those of you from our sister military services, the Atomic Energy Commission, the Veterans Adminis- tration, and the civilian scientific community who have consented to serve -- as members or as consultants to this board. The large number of observers at this meeting is also gratifying to us. It indicates the continuing interest in Plutonium-239 inhalation andinternal deposition, and further reinforces our belief that establishing and maintaining this permanent registry and its as sociatedboard, are, indeed, essential. For thOse of you who are visiting'Wri'ght-Patterson Air Force Base for the first time I would urge you to visit the USAF . Radiological Health Laboratory, if your time permits. This laboratory is unique in being the only military laboratory within the free world . exclusively devoted to handling all la-boratory.a9pects of occupational - radiological health. In addition, the-Radioisotope'Clinic here in the hospital, the Nuclear Engineering Test Facility reactOr on the other side of the base, and the various component laboratories Of the USAF Aero- space Medical Research Laboratories are'also worth "visiting. In terms of perSOnnel, the Air Force has concentrated a pool ofits finest talent in health physics, applied radiobiology, reactor technology, and nuclear medicine here at Wright-Patterson, in support of these various labora- tories and their headquarters. - . Little needs to be said about the more dramatic: aspects of the Broken Arrow of last January 17. .In the nine months which have elapsed since that tragic day, "Palomares'l has beconfe virtually a householdi ?word, at least, within the military. Television news coverage and special programs in the first three months following the accident were widely r'vieWed. Reams of articles concerning this Broken Arrow-have poured from the popular press, and as recently'as? last month The Reader's Digest magaZine'p'ublished an excellent feature on this subject, in lieu-"of its ?usual best-seller Broadway-play on Palo- "rnare's and the missing bomb is (or was) Scheduled to go' into production this coming'Winter. the role of Dr. Wright 7 -. 7 twp?.- wait?j Jud-miEmu; in . In. 11' mag .. _r "all-titan We, here today, are concerned with less dramatic but equally? significant sequelae to the Palomares Broken Arrow. Shortly after the accident it became evident that the plutonium contamination problem in Palomares was going to be far more extensive than initially supposed-- and that, despite protective measures, a large number of military person- nel involved inthe Clean-up operation were receiving or would receive, at least, a. fraction of a. body burden of Plutonium-239. Concerned individuals in the USAF Medical Service were aware that there was little information in the literature On which to predict medical disability or complications which may arise subsequent to the inhalation and deposition of Plutonium-7239 in the lungs and other organ systems of man. They were further aware __that__ many medical authorities are of the Opinion that small ambunts Of Plutonium-239 detectable in the. urine; 1. e. . amOunts lessthan aCcep'table are of biological significance, since permissible burdens ?as s'sayed by urinalysis may'only vaguely indicate [the amount of the isotope Lwhichirnay?bie- deposited in the lungs. They knew that the Plutonium-2 39 is based on extrapOlations' firpmk?e?xp'eriencgwith "radium-dial painters and small "'"ani'mals. y?Untilth? present. 'we haireth grouprof human expOsures of lstatistically?significant size which we could an attempt to I better define the; medical hazards subsequent to. inhalation of Plutonium.- 239, and such-reports as do appear in the literature for the most part I describe chrOnit occupational,exposures. {Since Plutonium-Z39 was not discovered until 25 sisal-stage, no?caSes "have been followed for longer periods of time. highly-unlikely that any individual involved in the Clean-up o11eration Palomares or would receive suffic ient inte w" 39 to war rant :rcon side ration ofclinical"treatment: iffyis'?iglt Ali- Ferce Medical "Service could be in a precariousp'o'sition the question to arise following-any" future Broken Arrow. No physician in the Air Force has to date, eve-r plutonium deposition. Further, although techniques of are; available, there is no unanimity of Opinion, even-"in the community, as to when treatment should" be initiated and as treatment. The serpentsinspirations largejnumber of military .. ., . ?in: ?if - I ?am-u . .. 'b?r?dnn?l dangling Hintoniu?l-Z? . even thou gh-lat- 1' 55:. 351 25levels vbeelomons?od . A Well aware, instances :alleged.__ionizing. -- . a 2 Tag?? 33;; .. g?.er min snore; a? a - . 0 _;As most .of you are - assessing frequency-- a - .m A. - ?975%? . True, many such claims gareabsurd, but all of themrequi're at least minimal inve stigatio?pi its)? fore stall further urine (is sary', . time - '1 7 .. econsummg a =an expensive ?ction-mover - . - -- ls. (s "gitIgpnbiigty . financial gasoline such his recent schizophrenia. gain or other factors. As often as not, however, the claims are submitted by well-meaning individuals, who are grasping at straws to explain the origin of their disease. The latest such case in which my staff became involved concerned a schizophrenic beatnik in San Francisco, who was a sometime in-patient at a California State Mental Haspital. During his more lucid intervals when he would be released on out-patient Status, he proved to be an inveterate letter- writer, particularly after he decided that his Schizophrenia had been induced by ionizing radiation eXposure received during a 4-year tour of duty with the Air Force between 195471958. Where and whenqhad he been exposed. to this ionising 'radiatiZOn? In hisown words, he 7 I a . ?own?over ?'portio? of the State oftNevada en route from Oxnard ForceVBa'se; near Ventura, California, "'t'oa brief TDY atNellispApir qu'cfe sage in Laps OperationPllumbobi.? Reviewgof his" records revealed that he hadno connection with weapons testing Ope'ration'PlumbOb?Or anyo'ther nuclear test. 'His' service. medical .- 'r e'cord'was negative for except mumps'and both incurred while in service,? might add that this chap wrote A letters" to?the Atomic Energy COmrr?ssion Veterans Admmnistration?and DASA, before settling on Force as the agency responsible-?for p, Medi'csl 'Se'rffiC?' With ,??deiirsapbry midst: in *?Neb'ra ska; Haring? [spring blilzzard' lantejlast. the me dical' a spe ct s2; Paloma re rol?en {Ar ly decidedu?that'. the to *aeyg?i?spza long-range program to provide adequate ?follOw?up, and treatment ?i?when and if equir ed for military onnel with inte rnal plutonium? deposition resulting from the Pal?omares Br'oken?Arrow, _as;well_ any future weapbss 'or? aec'id?its' mowing stanza; plutonium. The" aecbnc?p't or a Re gram; and three f' depo's ition?dip as? ?bi??ldgijcn A 'b??denspsi Eglultfoqmm: f?ur. . 4101?s: a A A if. {Ewan-=2: ind-W} - A 4 .4- i 1 Eman new; awn .. Ll :rrn? we (3) It would provide the medical profession with additional urgently-needed data with which to manage medical problems resulting in future Broken Arrow or laboratory accidents of a similar nature. .149 Since that-meeting in Omaha last March, the Plutonium Deposition Registry and Board have become a reality. i'As originally conceived, the- Beard was to?be trieservice in nature, with non-voting liaison members from the Atomic-Energy Commission, the Veterans .Adniinistration, and Defense-Atomic Support Agency._ However, 'to 7- expedite establishmentofthe. Registry and the Registry Board, they ?-were created withinth'e Air Force, and the selection of the USAF Radio-- logical Health Laboratory as the permanent location for the Registry was I of course, an Vobvious ;choice since almost all of the plutonium bio-asays following the Palomares Broken Arrow were performed here. - ?Further, the USAF Hospital Wright-Patterson is the single USAF Hospital desig- - nated as a specialty center in the treatment of occupational disease; Finally, we have a unique, and,for the purposes of this Registry and . its Board, -a_high1y-desirable ?management' situation in the Office of the Surgeon, Air Force Logistics Command here at Wright-Patterson Air Force Base, to which both the USAF Radiologica'l?Health Laboratory and this hospital report directly.. Colonel Arnoldi and his highly-competent 4staffa're deeply involved and personally interestedin all aspectsof occupational medicine- Thanks-to their-Coope?r?ationand administrative support, a-?establishment of this its Board entailed no financial . "The functionp'of this Registry is, of course, to maintain perma- n'ent records of Plutonium-239 bio-as say and other pertinent laboratory and ?medical data on. all militaryperSOnnel :tho haverec'eived or who -- internaldepositiOn aofPlutonium-rZB?B above r'such?riimitgas may, she et?taeyblished by the Registry. Boarer iBecaus-egit was essential stole stab-E" Skimight?i?QPeJ-?a?te the um'onthsijp rior . me eting .?zoftthe Board the. Me uni "A"V?latgxalily?rseleCted a ,cuti-fosof 9%in ?7 a personnel-Wouldlbeiincludediin 7 - irrevocably fixed, ianldigitraisjedzoril-owered: at? the.? "f gthegR?egl-istry . (request 'cre'dur?e?sxion these individuals, The administrative .prOblems'l-in'volvedin ,fi??j are self?evidentin? ofthe increasing the peatj_j?ewifx 7 19-3; :?ifg' .s 5-1 i" gas-Hggufmsr;guy-w . - - 1 tannins}: .9: . Lei-s: ?1 _y r? I, Lc?l' - already Completed military tours and returned to civilian life. months the mobility of military personnel has also proven to be a large I problem for the Board. Many of the personnel who received internal: deposition of Plutonium-239 in the Palomares clean-up operation have Further, because of the emergency nature .of the clean?up operation, large numbers of military personnel were sent to provide assitance in Palomares on emergency temporary duty orders, some of which did not become formal? ized on paper until a-later This has entailed administrative prob- ,l?em's for-the Registry in'establishing with certainty the home base of certain ?personnelron. whom urine specimens 'were' forwarded to the labora- 7 to-ryfor bio-assay; The current military'r-action in southeast Asia, the 3 current militar?ywithdrawal from France; and the-recent withdrawal of 7 .. Air?Force's Strategic Air "Command from Spain, have increased-the numbers ofpersonneljtr-ansfers; and have further compounded the problem within, - I of per-sOnneLinvolved in the Palomares Broken'Arrow. Thus, . long?-term follow-up of .large'nu'mbers of personnel cannot be assumed to easy taskg?f'?responsible for determining who shall? - be included in the-Registry, and-what'shallbethe nature of routine long- . term follow?-up. The Board will determine -When treatment for Plutonium-_ I 239 internal deposition-"is frequired, Ewill determine" the type of treatment indicated, and will supervise tr-eatme'ntras required. In the event that an individual On the Registry develoPs a pathologic process related or potentially related to ?Plutonium-.2 39 internal deposition, the Board will, inSofar ,as that cemplete'postmortem studies'are per- formed; the exact nature of these'studies tobe determined by the Board I _in cooperation with the Radiation. Pathology Register of the Armed Forces Institute of Pathology.? . A - - . This Boardwill-be' required to imake Some difficult and far- rea?hing decisions. Fortunately} for the threemilitar'y services the Board= includes .two ?ofathe world's :most 'know1e'dgable Scientists. in the area, of and Dr. _Norv'vood. Wantitd'extend specialappreciationito thesel-?twogentlemen-for consenting serve'on the BOard-g-?irin-view?on theiral-rea?dyi?hea-vy schedules in their :oqulaboratories I hope that. the data tavailablez'Eto them through- this't?R gi-str-yzwirll "prove of value. in'the this - rReg-istry - interes' tedigovern?iehtar andiguas?igdve r-xim?nfalrza g?enc'ie?s'. 13w i 35stews til I?r J1 ?Ffwi?? 39?? #3 4 A, ,?h'rrninp?m?n? ?ne It: . Wright?Patterson AFB as a Nuclear Center Col L. B. Arnoldi, USAF, MC Col Arnoldi urged the Board and consultants to consider adopting a common format for the recording of radiation exposure (internal and external) data, and that a central repository be set up to maintain this information and retrieve it as desired. Within limits imposed by operating policies, Col Arnoldi placed at the disposal of the Board, the computer and ancillary facilities of Hg Air Force Logistics Command for whatever use they might suggest. Because of the unique resources in the nuclear energy field available at Wright- Patterson AFB, he urged that-this base be considered as a nuclear - medicine research and operational center. The USAF Hospital, Wright-Patterson, the Nuclear Engineering S, Test Facility, and the USAF Radiological Health Laboratory were singled out as the keystones upon which such a center could be built. I H, - .V-A. FM, Field Ope rations Capt J. S. Pizzuto, USAFB-52 bomber and KC-135 tanker aircraft collided in flight over or near Spanish territory. The resulting impact permitted the uncontrolled dispersion of four nuclear weapons, three of?which "fell On Spanish soil and one in the Mediter- ranean Sea. 6 - . Immediate Search operations located the three devices on the ground and verified that the integrity,r Of two was destroyed. High winds permitted dispersal of 239 -plutonium OVer a wide area. Because the whereabouts of the fourth weapon remained 'a matter for speculation,_ a large-scale search operation continued on land and sea until 26 Mar 66 'when it was removed from the sea. . Nearly ZOOD'American personnel participated in the search,? and many Spanish Nationals were" also involved. During this period the 239? plutonium constituted an inhalation hazard, even though precautions were taken to prevent gross exposure. Before completion of the task, several tons of topsoil were collected, sealed in barrels, and removed to a national nuclear burial ground in the United States. 10 Sample Control System Harold R. Kaufman, USAF The sample control system permitted the laboratory to keep accurate records on all samples received for analysis. In addition, it provided a simple, fast, method of recalling data for repo'rt generation and statistical analysis. The combined resources of the punch?card equipment and the Mathatron desk calculator located in the laboratory, and the IBM 7094 DCS located at Aeronautical Systems Division, gives this labora- t'ory a formidable data-processing capability that should be able to meet any requirement placed on it by the Plutonium Deposition Registry Board. 11 Analytical Chemistry Methods Used in Processing Samples Maj J. C. Taschner, USAF, BSC Initial urine samples from personnel involved in the Palomares search and recoveryoperation were processed, using a gross alpha screening procedure. :The steps in this procedure were: (1) wet ashing of an aliquot of the urine sample with concen- trated nitric acid and hydrogen-peroxide to a white ash; (2) Solubilizing the white-ash and coprecipitation of plutonium with bismuth salts; (3) dissolution with hydrochloric acid followed by the addition of lanthanum carrier before hydrofluoric acid precipitation; (4) direct mounting of the precipitate on a 2" steel planchet; and, (5) counting for 120 minutes in an internal proportional counter. Plutonium-239 spiked pooled urine samples were processed in alike manner to obtain quality control data. Plutonium recoveries of 75. 6 d: 19. 6 percent (68% confidence) were obtained. Because _of field contamination of initial samples, a resampling program was initiated 2-3 months after the personnel returned to their home base. A procedure which'is specific for plutonium was adopted for the resample urines. One-half of the total urine sample was adjusted to pH 2 with concentrated nitric acid. A plutonium-236 internal tracer was added to each sample for quality control. The sample was then heated to boiling to break any metabolic complex-binding plutonium. The plutonium was c0precipitated with the alkaline earth phosphates by adjusting the urine sample to pH 10 with concentrated ammonium-hydrox- ide- The salts were dissolved in nitric acid and c0precipitated with radio-chemically-pure cerium by adjusting to pH 4. 5. This precipitate - was dissolved in hydrochloric acid and passed through an anion-exchange colu?mn which adsorbs-theplutonium. Interfering anions adsorbed on the column were removed by washing with hydrochloric acid. Hydriodic acid was used to elute the plutonium fromthe ion-exchange column. The plutonium was changed to the sulfate salt by?heating the evaporatedcolumn 12 we; gr! A Mad 1 i'm'u'vtihmj .firr? ww-g Kathi-imw? gimme a residue in sulfuric acid. The solution was adjusted to approximately pH 3 and electroplated on a one-half inch steel planchet. A solid state alpha spectrometer was used to measure the plutonium alpha - activity present. Plutonium recoveries of-75. 6 i 16. 2 percent (68% confidence) were obtained. Counting Procedures for 239-Plutonium in Urine Cap-t R. G. Thomas, USAF, BSC 1. Counting procedures used for initial samples: Samples were counted, using Nuclear Measurement Corporation windowless, gas-flow proportional counters. Daily checks were made on instrument performance by counting reference standards of 239-Pu,7to insure constancy of counting efficiency. Samples were counted for'lZO minutes and backgrounds were counted daily, normally for "960 minutes. The daily background counts also served as checks on contamination; the counting chambers were decontaminated when back? ground became greater than 0.1 count per minute. Normal backgrounds ranged from 0.02-0. 06 count per minute. Sample activity was calculated from the following expression: _pCi/ sample (gross counts/gross ctitime) - (bkg counts/bkg time) (counting (procedural yield) . II. "Counting procedures used for resamples: .- The detectors were solid-state surface-barrier types mounted in a vacuum chamber. Charge sensitive preamplifiers, designed and. built by Mr. Robert L. Farr of thelaboratory staff, were used to amplify signals from the detector. Output from the preamplifiers was fed to a Nuclear Data 130 AT multichannel analyzer. Readout from the analyzer was in the form of typewriter printout. Using an electroplated source containing known activities of 239-Pu and 236-Pu, instrument performance was checked each morning before beginning counting, and normally, an additional time each afternoon. The performance check consisted of observing the peak channels for 239-Pu and 236-Pu', and adjusting. the gain of the amplifier system, if necessary, to correct for any gain shifts. Additionally, the counting efficiency of the system was checked at the same time, to insure constancy. Background counts were made each night for 800 minutes' duration, with a blank planchet in the daunting chamber. The- daily background. count also served as a check for any possible contaminationm the 14 Fi?? .9 p. 7. counting chamber. Samples were routinely counted for 100 minutes. The data was collected in an analyzer memory of 255 storage positions. Total counts in two bands, centered on the peak channels of 239-Pu and 236-Pu, and each containing 11 storage locations, were totaled and used for the sample activity calculations. The same bands were used for both sample and background determinations. Sample acti?rity was calculated from the following expression: pCi/sample (net in 239-Pu hand) (dpm 236-Pu added) (net in 236-Pu band 3: (2.22) .. 1 a . where net in 239-Pu band gross 239-Pu band gross time in 239-Pu band time net in 236-Pu band [goes 236-Pu band - gross time 236-Pu band time 236-Pu added activity of 236-Pu spike added to sample corrected ifor decay to, date of count. 15 RESULTS Initial Urine Samples--A1pha Activity LtCol L. T. Odland, USAF. MC Air ,Force Army 31312 Other Numher analyzed .1389 I 7 107? 37 . 33 greater 100%? 19(0) - I 1(0) 0 0 BB 0:99 to 0.09 361 '33 5 8 BB 0.09 to 0.009_ 43'? 23 20 ?7 I BB less than 0.009 522 a '50 12 23 Tota '1571 20 407 537? 607? Systemic body burden (bone, critical organ)--calculated on the basis - of urinary excretion according to expression 435 where systemic body burden 239-Pu activity in 24-hour sample it time in dajrs from exposure to sampling Value of 0; 044 ?pCi 239-Pu for represents one body burden. or 100sum-a simm- 0 - was: (4?61.A--, . . - ,c . :rr RESULTS Miscellaneous Samples LtCol L. T. Odland, USAF, MC WATER Samples analyzed 40 No detectable?activity 7 Range of 0. 1 to 633 pCi/liter 33 Median value of 1. 64 pCi/liter . VEGETATION SWIPES Total swipes counted - 78 No detectable activity . 63 Range of 0.1 to 4.3 pCi 13 NASAL SWIPES Total swipes counted. 120 No detectable activity 70 Range of 1. to 33'? a 50 Mean 24.4. 3.13; 48.0, median 13 17' .. J. RESULTS- -Mis cellaneous Sample a SOIL Total samples -- gamma scan 23 . VE GE TA TION Samples too active for processing 1.8 ?Vera 35492 A: all *th a "3 Hr?irwwau. . . .. 1 . ?Number requested RESULTS Re sampling Prog ram (As of 1 Nov 1966) LtCol L. T. Odland. USAF, MC Total Air Force Army - Navy Other 1 greater 10% 6 BB 1 to 10%: 162 BB less 1% 36 BB zero 124 328 (363) 10/ 11? 30 (33141 373 (409) 1?33 defined as systemic body burden (bone, critical orga?). Analysis ?of BB Greater 1% Group (183 Samples) 239-Pu (curies 10-15) recovery) Sample vclume (liters) Elapsed tinie'i?days) - I 5133 '93 -761 1.3" 7147 - 19 '-63 '70.5 13 Median 77 .75 1.2 7140-? Range 26?390 43-109 .29-3; 1 s11o-237 -1-16 .- 3} a yr; @1531? 753'." 13: 1; SUMMARY OF DISCUSSIONS: Use of the term "body burden. Dr. Norwood expressed objection to the use of the term "body burden" in presenting results. He stated the term is misleading since it could be interpreted to include the entire body when, in reality, it refers only to that portion of 239-Pu distributed by systemic circulation, and, in no way, re?ects that which may be fixed in thoracic viscera. Dr. Norwood further stated that correction values have. been suggested to permit estimating lung burden from system burden. Depending on various factors, a cor- . rection of 10-100 could be applied to systemic burden to estimate lung burden. Dr. Langham stated that the formula he developed for use inesti- mating body burden was never intended to apply to lung burdens. He related some of the history of his early work and that of colleagues on this problem, and questioned the whole concept of critical organ in relation to inhalation exposures of 239-Pu. Systemically, the bone is considered the critical organ, while in the chest it may be lung or nodes, or both, but in the case of inhalation exposures, the thoracic visCera may be the important tissue with bone receiving only an insignifi? cant dose. In summary, Dr. Langham stated that he did not like the application of corrective factors to body burden to estimate lung burdens, particularly when the corrective factor varies by at least a factor of 10, and?the basis upon which this value is derived is somewhat nebulous. Dr. A Norwood agreed that it?Was difficult to assign a corrective factor to body burden in order to arrive at the lung burden. Several other attendees voiced their feelings on this problem, and the consensus was that lung burdens under conditions of uncontrolled acute inhalation exposures, are?impossible to accurately measure at this time. I - In an effort to more accurately present analytical results, the term body burden will be modified to reflect its reference to systemic with . bone as the critical organ, and, in addition, absolute terms of activity per, sample will also-be reported along with sample volume, elapsed time, etc. Reporting of Results. The question was raised whether or, not the individual results should be reported back to appropriate units of assign- ment and entered in medical records. One Objection to reporting results wasthatthey may be misinterpreted at the local level, and perhaps s'et the stage for legal action. Dr. Norwoodfelt the results should be reported i 20 . =52} 53;, L. am because the doctors involved must be given this information. LtCol Froemming stated that the Army wanted something entered in the medical records but was not firm on just what form the entry should - take. Tedford stated the Navy did not want their results entered in medical records, and that the USAF Radiological Health Laboratory should maintain these records as a part of a repository from which the data could readily be retrieved when desired. General Talbot stated that the question, insofar as the Air Force was concerned. should be 5 studied by legal advisors prior to a decision. It was decided that the USAF Radiological Health Laboratory would send results of bio-assay work to the appropriate Surgeon General for . deposition and recording, as he saw fit. Dr. Johnston pointed out that exposures or body burdens of 239-Pu do not have to be given to the individual concerned since this -material'd0es not come under the pro- visions of 21 GENERAL DISCUSSION: Item Nr 1 -- Should continued efforts be made to secure initial and/or . repeat samples on all personnel who have not been tested but who were in the area? The board recommended that continued efforts should be made to i . secure initial samples from individuals who participated in the oper- ation and departed the area without submitting a specimen. In addition, it recommended that continued effort be made to secure a second sample from individuals-whose initial sample contained sufficientactivity to I suggest-a systemic body burden in excess of and who failed to respond - to the resampling program. The maximum extent of this effort should consist?of two letters soliciting:cooperation,I and one telephonecall. Accurate records will be kept of the communications sincethe primary reason for the continued effort is to demonstrate a reasonable effort to screen every individual involved. 'The board felt that it was extremely unlikely that any individual would display excretion values at significant variance from those obtained to date. 22 4.39? Item Nr 2 -- Does the board recommend resampling of individuals whose initial urine samples showed less than 9% of one body burden? The board recommended that no further effort be devoted to resampling individuals whose initial urine sample showed activity suggesting a systemic body burden less than 23 Item Nr 3 -- At what level of body burden, if any, obtained on resamp- ling does the board recommend continued follow-up? What should be the nature and frequency of such follow-up, if recommended? Dr. Langham pointed out that the results of the bio-assay program were very good in terms of preventive medicine and risks to individual patients, but insofar as providing a baSis for follow-up and long-term study, they provided little reason for enthusiasm. Dr. Norwood concur- red in this observation, as did other attendees, all agreeing that the bio-assay data showed levels of activity far below those necessary for a meaningful follow-on pregram to assess excretion patterns, use of . whole-body counting techniques, etc. Capt Skow stated that no follow-up 7 effort should be devoted to any individual whose systemic body burden was less than 50%. Dr. Norwood suggested continued bio-assay studies on . all?individuals whose systemic body burden was 9% or greater. After more discussion on this point, it was agreed that continued follow-up . bio-assay studies at ?a frequency of once every two months would be done on the highest 10% of the reSampling group that showed a systemic body - burden of between l-lO%. This number would be about 17, and would include some with systemic body burdensas low as Consider-able discussion centered around the possibility ?of inciting undue concern in these individuals, perhaps to the point of legal action for compensation. j-j, . However, this was realized, and a certain probability of risk had to be accepted if any follow-up program was to be pursued. All attendees - agreed that whole?body counting techniques are not sufficiently refined to be utilized in any follow-up program on this group, and, certainly . there was no indication for treatment. . 1 . .. '24 "xii. .. rum-h l. ., . A :1-3 - . . Item Nr 4 -- Should whole?body counting techniques be developed by the U. 5. Air Force for detection of 239-Pu-24l?Am as an additional tool, in the event of future similar incidents? If affirmative, what type of hardware is recommended? This subject stimulated a, and detailed discussion on the whole problem of in vivo assay of 239-Pu-24l?Am using whole-body counting-techniques. Dr. Norwood and Mr. Newton discussed the advances that have been made on the problem, and felt that it was just a matter of months before the hardware would be perfected. Dr. Langham related the experience of his group and others in building a - device suitable for detection of 239-Pu in vivo and the application of it to- the Spanish incident. He further related that detection can be done, but the problem of quantitating what is detected is still formidable. Apparently, levels on the order of nanocuries in the thorax can be detected, either by counting 239-Pu or via extrapolation of Z?l-Am content. It became obvious, as the diScussions continued, that whole- body? counting was possible, but that no one is willing to categorically state their limits of detectability, or advertise as being operational and ready to accept candidates. Dr. Dunning expressed'a personal opinion that the USAF Radiological Health Laboratory should develop a capability in this area if it is to be more adequately prepared for the next Broken Agrrow. Dr. Langham and Mr. Newton advised caution on development of whole-body counting techniques by because of the develop- mental effort going forthvin other quarters. However, Dr. Langham felt such experience would be valuable for the USAF in that it would i _plac-e it-in a much more ready'position for future incidents, but . certainly could be of no value in this (Palomares) incident. LtCol Woodward asked where assistance would be available in the event the Army experienced a Broken Arrow of significant proportions. . Specifically, he wanted to know what one group had facilities for whole- - body counting, treatment and bio-assay. Dr. Norwood stated his group had capability to handle a small (5-8) number of patients, could do bio- assay tests in large numbers, and would soon have whole?body counting facilities. Col Hennessen stated his hospital census was running over but he could handle perhaps up to 20 patients at any given time. .No specific recommendations werelobtained with respect to the 3 type of hardware that should be used. 25 Item Nr 5 -- By using ratios of 239-Pu to 24l-Am in the weapon, soil, and urine, is it possible to determine the 239-Pu content of the lungs using 24l-Am values determined by whole-body counting techniques ?Mr. Newton reviewed data on recent studies of 24l-Am and 239-Pu in laboratory animals following inhalation exposures which?indicated that americium may move out of the lun faster than 239-Pu under certain experimental conditions. In these studies the ratio of 239-Pu to 24l-Am varied by a factor of 2 from what it was' in the inhaled - material. Messrs Sheehan and'IWood presented bio-as say (urine) excretion data on five individuals who have appreciable systemic body burdens I of 238-Puas a result of inhalation exposures. The information sug- . - gested that at about 150 days after an acute exposure the urinary excretion values parallel quite closely with those predicted by a com- puter model, and that both follow Langham's equation quite well, subsequent to this .time period. 7 i While certainly not applicable to exposures under consideration, A it was conceded that ifrfuture Broken Arrow incidents resulted in - inhalation and retention of nanOcuries or more of 239-Pu and the . attendant 241-Am, using the ratio of the two in the weapon, and deter- t5 mining a similar relationship in soil and urine, estimates based on whole-body assay of 24l-Am by in vivo counting would give an estimate - 4 of thoracic burden no farther? removed from reality than other "methods or extrapolations currently available44W Was? E3 Err-31.1% a-r ?at-#949 um :24 19h