ate LA 2222 Committee e en Ro ; ; “if : REPORT TO THE SURGEON GENERAL U. $. PUBLIC HEALTH SERVICE ON PROTECTING AND IMPROVING HEALTH THROUGH THE RADIOLOGICAL SCIENCES PREPARED BY THE NATIONAL ADVISORY COMMITTEE ON RADIATION APRIL 1966 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service CONTENTS Page National Advisory Committee on Radiation Membership __._-_. iv Summary and Recommendations ____..... Vv Introduction ____-___--_--- 1 Historical Review of the Radiological Sciences_______- is 1 Developing Role of PHS in Uses and Control of Ionizing Radiation ______ 3 (a) Scope of the Radiological Sciences __ its 8 (b) Benefits and Risks of Ionizing Radiation _____ 3 (c) Relationship of PHS to State and Local Health Agencies _______ 5 (d) Radioactive Contamination of the Environment ______ | 6 (e) Medical Applications of Ionizing Radiation ___.__ 6 Manpower Shortages and Related Academic Problems in the Radiological Sciences __..-- qT (a) Growth in Clinical Demand for Radiological Service ____ qT (b) Growth in Physician Manpower in the Radiological Sciences ____ 11 (c) Future Needs in Physician Manpower in the Radiological Sciences 13 (d) Causes of Physician Manpower Shortages in the Radiological Sciences ___------ 13 (e) Current Trends in Academic Radiology _-.-.--.-. 18 (f) Other Manpower Needs in the Radiological Sciences _____._____ 19 (g) Correction of Manpower Shortages in the Radiological Sciences __ 20 PHS Program Development in the Radiological Sciences ___.__ 24 Restatement of Recommendations __....---- 26 Bibliography ..-.---0- . 27 iil NATIONAL ADVISORY COMMITTEE ON RADIATION Dr. RUSSELL H. MorGan, Chairman Radiologist-in-Chief Johns Hopkins Hospital 601 North Broadway Baltimore, Maryland Dr. JOHN H. BARR Professor of Radiology Tufts University 186 Harrison Avenue Boston, Massachusets Dr. CYRIL L. COMAR Head, Dept. of Physical Biology New York State Veterinary College Cornell University Ithaca, New York Dr. RALPH E. Dwork Deputy Secretary of Health Pennsylvania Department of Health State Capitol Health and Welfare Building Harrisburg, Pennsylvania Mr. ALEXANDER GRENDON Donner Laboratory University of California Berkeley, California Dr. HERMAN E. HILLEBOE Columbia University School of Public Health & Administrative Medicine 600 W. 168th Street New York, New York Dr. LEON O. JACOBSON Prof. and Chairman Dept. of Medicine University of Chicago 950 East 59th Street Chicago, Illinois Dr. RoscoE P. KANDLE State Commissioner of Health State of New Jersey Dept. of Health Box 1540 Trenton, New Jersey Dr. LAURENCE L. ROBBINS Radiologist-in-Chief Department of Radiology Massachusetts General Hospital Boston, Massachusetts Dr. J. NEWELL STANNARD Prof. of Radiation Biology & Assoc. Dean for Graduate Studies University of Rochester School of Medicine and Dentistry 260 Crittenden Boulevard Rochester, New York Dr. ARTHUR C. UPTON Chief, Pathology and Physiology Sect. Biology Division Oak Ridge National Laboratory Oak Ridge, Tennessee Dr. RUSSELL I. PIERCE, Exec. Secretary Chief, State Assistance Branch Division of Radiological Health, BSS U.S. Public Health Service Washington, D.C. iv SUMMARY AND RECOMMENDATIONS This is the third in a series of reports pre- pared by the National Advisory Committee on Radiation for the Surgeon General of the Public Health Service. The first two were directed to the broad responsibilities of the Service in the field of radiation control and to problems con- cerned with the protection of the public against undue radiation exposure from contamination of the environment with radioactive materials. In this report the Committee traces the remark- able growth that has taken place in the uses of ionizing radiation in the health professions, in industry, and in other walks of life. It also notes a number of emerging problems which net only are of importance from the point of view of radiation protection, but also, if not alleviated, threaten the quality of medical care in the United States and the translation of the advances of atomic research into needed bene- fits for the people. These problems include (a) serious weaknesses in academic departments of radiology which have restricted efforts to provide adequate instruction of medical and post-doctoral students in the clinical applica- tions of ionizing radiation, including radiation protection; and (b) an increasingly severe shortage of manpower in all branches of the radiological sciences. The magnitude and com- plexity of these problems are sufficiently great that a concerted effort is needed by the Public Health Service to correct them. The alleviation of the problems just cited is but a part of a more comprehensive series of responsibilities faced by the Service in the radiclogical sciences. The Service must play an important role in the prevention of undue ex- posure of the population from medical, occupa- tional, and environmental sources of ionizing radiation; at the same time, it must actively support the development and application of radiological methods in the diagnosis and treat- ment of diseases. In order that the Service may effectively meet its enlarging responsibilities in the radiological sciences, the Committee in this report makes a number of recommendations to the Surgeon General and urges that he take appropriate steps for their early implementa- tion. For convenience, these recommendations are summarized as follows: 1. The Public Health Service should take im- mediate steps to strengthen its programs in the radiological sciences by unifying their adminis- trative direction. Such action is needed to assure an orderly development of the broad spectrum of radiological activities for which the Service is responsible and to give continu- ous attention to the balance of benefit and risk in all matters pertaining to the human applica- tion of ionizing radiation. 2.The Service should undertake the follow- ing training and research and development pro- grams to upgrade the quality of the radiological services which have become such a critical part of medical and dental care and to improve radiation protection practices in the health professions: (a) a series of training programs: (i) to strengthen radiological instruction of medical students; (ii) to increase the number of academic radiologists in American medical schools; and (iii) to increase the number of practicing radiologists in the United States. (b) a series of training programs to pro- vide increasing numbers of radiochemists, radiological engineers, radiobiologists, radio- logical physicists and radiological health specialists. (c) a series of training programs to pro- vide increasing numbers of technologists in the several disciplines of the radiological sciences. (d) a series of applied research and devel- opment programs to increase the effective- ness and safety with which radiological pro- cedures are employed in the health professions. (e) a series of programs to provide train- ing and research facilities for academic de- partments of radiology in American medical schools. 3, The Service should take the initiative in the formulation and promulgation of (a) stand- ards dealing with the qualifications of person- nel who operate x-ray equipment or who use radioactive materials not regulated by the Atomic Energy Commission; (b) design stand- ards for sources containing radium and other radioactive materials that are not reactor by- products; and (c) standards for the premarket- ing clearance of x-ray equipment used in the health professions and in industry. vi 4, The Service should take appropriate action to assure that official health agencies play an increasingly prominent role in the appraisal of the health risks associated with the construc- tion and operation of major nuclear facilities. 5. The Service should take immediate steps to strengthen its laboratory and statistical re- sources in the radiological sciences. These re- sources are essential components of the PHS effort to meet the Surgeon General’s responsi- bilities to the nation. 6. If needed, appropriate legislative authority should be sought at the earliest possible time to carry out the foregoing recommendations.