of the onset of leukemia.* In this patient, however, the total dose of
irradiation given in a series of some 15 to 20 diagnostic proceduresis in
all likelihood much less than 100 R.
Figures on the irradiation dosage generated by the old Picker portable
units employed by the Army during World War If may beavailable from
the Atomic Energy Commission or the Armed Forces Institute of
Pathology. Although these instruments were poorly columnated and
permitted scatter to unshielded portions of the anatomy, the estimated
dose or irradiation per fluoroscopic study (which provided a much
higher tissue dose than the diagnostic X-ray) is approximately 0.25 R. A
rough estimate then of this patient’s total radiation exposure stemming
from the initial treatment and follow-up of his tibia! fracture was in the
neighborhood of 5 R, certainly not exceeding 20 R. Secondly, thetibia
in an adult man is not site of proliferative hematopoietic marrow. If
adequate shielding of the axial skeleton was provided during the
diagnostic X-ray procedures, the patient should have received no
exposure of hematopoietic bone marrow.
From these considerations, therefore, this reviewer concludes that the
patient had insufficient radiation exposure to proliferative
hematopoietic marrow to increase his probability of radiation
leukemogenesis on the basis of the diagnostic X-ray procedures required
by the treatment of his combat injury and its follow-up. The role of
chronic osteomyelitis and the genesis of acute leukemia is more obscure
than
that
of irradiation. The patient’s record, however, did not
substantiate chronicity of the patient’s osteomyelitis for more than three
years following his initial injury. Thereis, finally, no conclusive evidence
that a localized chronic osteomyelitis increases the probability of acute
5. Court Brown, W. M., and Doll, R., Mortality from Cancer and
Other Causes After Radiotherapy for Ankylosing Spondylitis, Brit. Med.
J., 1: 1782-1790 (1961).
6. Evans, R.D., The Effect of Skeletally Deposited Alpha-Ray
Emitters in Man (Silvanus Thompson Memorial Lecture), Brit. J. Radiol.,
39: 881-895 (1966).
7, Hasterlik, R. J., Finkel, A. J., and Miller, C. E., The Cancer
Hazards of Industrial and Accidental Exposure to Radioactive Isotopes,
Ann. N.Y. Acad. Sci., 114: 832-837 (1964).
8. Stewart, A., Pennybacher, W., and Barber, R., Adult Leukemias
and Diagnostic X-Rays, Brit. Med. J., 2: 882-890 (1962).
Findings
of the
BVA
and
Basis for
\n_
finding that
the
materially to the veteran’s death the Board said:
The opinions expressed by physicians on behalf of the appellant and
those obtained by this Administration are essentially the same. The
possibility of an etiological relationship between the veteran's
service-connected disabilities with treatment for such conditions andhis
leukemia is conceded. The probability of such relationship, however, is
shown to be remote or speculative, rather than reasonable. The fact that
radiation cannot be “excluded” as a factor does not satisfactorily
demonstrate the existence of a substantial doubt. Recourse to
speculation or conjecture is prohibited.
leukemia. | would conclude, therefore, that though one, on theoretical
grounds, cannot exclude the possible etiologic role of radiation ex posure
and chronic infection in the genesis of acute leukemia after a latent
period of some 19 years, there is no definite evidence either from this
patient’s military medical record or from available medical knowledge
that this patient’s war wound with resultant osteomyelitis and necessary
diagnostic X-ray exposure played any etiologic role in the genesis ofhis
terminal leukemia.
REFERENCES
1. International Commission on Radiological Protection, The
Evaluation of Risks from Radiation, ICRP Publication 8, Pergamon
Press, Oxford, 1966.
2. Seltser, R., and Sartwell, R. E., The Influence of Occupational
Exposure to Radiation on the Mortality of American Radiologists and
Other Medical Specialists, Amer. J. Epidemiology, 81: 2-22 (1965).
3. Court Brown, W. M., and Doll, R., Expectation of Life and
Mortality from Cancer Among British Radiologists, Brit. Med. J., 2:
181-187 (1958).
4. Court Brown, W. M., and Doll, R., Leukemia and Aplastic Anemia
in Patients Irradiated for Ankylosing Spondylitis, Brit. Med. J., 2:
1327-1332 (1965).
46
Decision:
service-connected disability did not cause or contribute substantially or
47