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Perspective |
1 Radioisotope Laboratory, University Hospital, 234 Goodman St., Cincinnati, OH 45219-0577.
Received April 24, 2000;
accepted after revision May 15, 2000.
Address correspondence to E. L. Saenger.
Introduction
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Since 1929, the United States has been well served in matters concerning radiation, including analysis of exposure situations and sources and protection from negative effects of radiation. In fact, compared with other potential insults faced by mankind and other life forms, radiation is perhaps one of the best understood toxic agents. To a large extent, this success is attributable to the voluntary efforts of NCRP professionals.
The NCRP recently noted a decline in medical professionals' awareness about the hazards of ionizing radiation in medicine. Many physicians, including radiologists, assume erroneously that modern medical radiation uses are completely safe, and that physicists can resolve technical problems. Basic medical X-ray units have been subject to federal performance standards for a quarter century, and radioisotope uses are regulated by the Nuclear Regulatory Commission and the Food and Drug Administration.
The end of the Cold War eased the threat of nuclear warfare. The once bright future of nuclear-generated electric power dimmed with bureaucratic and technical problems. Medical uses of radiation remain the largest man-made dose contribution for Americans.
In effect, many in the NCRP's historic community have forgotten that new radiation uses bring new radiation protection problems. Development of X-ray tubes with expanded heat-loading capacities allows better visualization for interventional procedures. Their use has been accompanied by patient doses measured in hundreds of centisieverts and occupational exposures well above recommended levels. New CT techniques also produce patient doses in the hundreds of centisieverts. Radiation treatment of vascular stents to retard vessel reclosure presents a new set of problems. For radiologists, the NCRP and its expert committees face new challenges in balancing the control of risk and considering benefits of radiation.
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At the second International Congress of Radiology in 1928, discussions led to the formal structuring of the International Commission on Radiological Protection and the International Commission on Radiation Units and Measurements. Taylor was named to both international groups. In 1929, he invited the American Roentgen Ray Society, the Radiological Society of North America, the American Medical Association, and leading X-ray equipment manufacturers to create the Advisory Committee on X-ray and Radium Protection as an independent scientific body. He arranged to write, publish, and distribute its reports unofficially through the National Bureau of Standards.
By the time Lauriston Taylor retired from the National Bureau of Standards in 1963, the advisory committee had produced 27 reports. Its scope broadened with the creation of artificial isotopes in the 1930s and the development of the atomic bomb during World War II. Taylor proposed making the committee independent of any federal agency. With help from the American College of Radiology and others, Congress granted a federal charter for a new NCRP in 1964 at which time Lauriston Taylor became its first president. Several sponsoring societies provided start-up funds. W. R. Ney, who had worked with Taylor at the National Bureau of Standards, became the executive director and the only employee.
New reports flowed from drafting committees to council members for review and then to publication. Report 33, "Medical X-ray and Gammaray Protection for Energies up to 10 MeV" [1], became a bible for equipment designers, physicists, and hospital architects. Reports on safe handling of radioactive materials, on X-ray uses in dentistry and in veterinary medicine, on radiation exposure of pregnant women, and on protection in pediatric radiology were soon added.
In 1977, Lauriston Taylor resigned as president. He was succeeded by Warren K. Sinclair, a leading physicist and radiobiologist. Sinclair led the NCRP until 1991 and was succeeded by Charles B. Meinhold, its current president.
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The committees now function through eight focus groups, each led by a scientific vice president. The group on radiation protection in medicine is led by Fred A. Mettler, chairman of radiology at the University of New Mexico. The group on basic criteria, epidemiology, radiobiology, and risk is led by S. James Adelstein of the Harvard Medical School. The group on operational radiation safety is led by Kenneth R. Kase of Stanford University. The other groups deal with environmental issues, nonionizing radiation, public policy and communication, and radiation measurement and radioactive wastes. Thus, the council constitutes a unique scientific resource in the effort to protect life from the effects of radiation.
Many NCRP members also serve on international radiation groups. Charles Meinhold is vice-chairman of the International Commission on Radiological Protection. W. R. Ney, now retired from the NCRP, manages the International Commission on Radiation Units and Measurements from the NCRP office in Bethesda, MD.
Over the years, the NCRP has published 130 reports that constitute the basis for public policy and professional practices in the use of ionizing radiation. Of these reports, 88 are still current. Report 33 on basic medical X-ray protection [1], published in 1968, has been rewritten. Report 102, issued in 1989 [2], is the current version reflecting changes in designs and energy levels up to 50 MeV. A new version is needed. Current titles relating to medical uses include reports on mammography, quality assurance in diagnostic X-ray procedures, population exposures from medical diagnostic procedures, criteria for medical ultrasound exposures, and radionuclide exposures of fetuses. The NCRP issues two to four new reports yearly.
A new report may be recommended by any of the collaborating agencies or may arise from the interest of council members or committees. A chairman and working group with expertise in the subject area are appointed and begin work. Drafts are circulated and approved committee efforts are distributed to all council members for review and comment. The same drafts are furnished to collaborating organizations for their comments. The process allows review by almost every element of the national radiation-using community, including scientists in government agencies. It is a thorough process, but it may be several years before reviews are finished, disagreements are resolved, and the final manuscript goes to publication.
NCRP commentaries, begun in 1980, are produced within a matter of weeks in response to policy questions. Necessarily, they lack the intensive scholarship that marks each report. Proceedings of annual meetings present accounts of discussions on a radiation topic of current interest, such as radiation hazards in space and high-altitude travel and low-level electromagnetic radiation from power lines and appliances. In 1999, the theme was current problems in medical radiation uses. The 2000 program looked at the state of radiation science and future prospects.
NCRP reports are sold to a subscription list and are advertised in scientific publications for purchase by others. They are priced below costs of production and distribution to assure that those who need them can afford them. A list of the NCRP publications series can be obtained by writing or calling the council.
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The yearly operating budget for the NCRP during the 1990s has ranged from $1.5 to $2 million. Money from 14 professional societies and 13 corporate sponsors that make annual contributions supports general council operations.
The larger share of the budget comes from contracts and grants from federal agencies. Recently, these have included contracts for specific reports from the Nuclear Regulatory Commission, the National Cancer Institute, the Environmental Protection Agency, the Department of Energy, the National Aeronautics and Space Administration, the Defense Threat Reduction Agency, the Armed Forces Radiobiology Research Institute, the United States Navy, and others.
Therein lies the current rub. Efforts to reduce government spending and to balance the federal budget have resulted in severe cuts in these federal contract and grant amounts. An unrestricted sustaining fund from the Nuclear Regulatory Commission decreased from $250,000 3 years ago to $50,000 in 2000, with little current hope of expansion.
In response to curtailed revenue, the NCRP eliminated five staff positions at the end of 1999 and is reducing its office space by one third. Three of the lost positions were staff scientists; their tasks have been given to freelance consultants. At best, the reduced support places greater burdens on members of report-writing committees. At worst, it could result in delays in report production and the deferral or rejection of important new reports.
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These topics have immediate import for the practice of radiology and radiation oncology, and guidance for current uses is necessary. Neither professional societies nor government agencies can muster the scientific expertise on these topics that the NCRP commands from its volunteers.
Reports on any of these topics can be considered in the near future only if direct funding can be obtained. More broadly, NCRP function must find support for basic operations. The NCRP faces a series of challenges in support of medical radiation uses. The needs are obvious, the committees are willing. Only the support for their efforts is lacking.
Support can be obtained in two ways. One is to identify specific individuals or other entities that might wish to contribute. The second is to identify organizations that, although new to the mission of the NCRP, would consider offering aid. If you should wish to offer support, please contact Charles B. Meinhold, President, NCRP, 7910 Wood-mont Ave., Ste. 800, Bethesda, MD 20814-3095; telephone: (301) 657-2652; e-mail: ncrpexec@ncrp.com.
The NCRP can continue as a strong, vital factor in this nation's radiation protection and measurement efforts, but only with a strong financial partnership of support between the private and public sectors.
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