The Board requested a medical opinion concerning any etiological relationship between the veteran’s carcinoma and exposure to X-ray. The following opinion was received: CASE NO.21 Type of Injury: Carcinoma of the Ovary. be insufficient to be carcinogenic with a lesion appearing twenty years BVA’s Decision: Denial Affirmed. after exposure to ionizing radiation. Date of Decision: 1965. Appellant's Allegation: That ovarian carcinoma is due to exposure to X-rays during service or is secondary to a previous service-connected anemia which was noted during service. Facts: The veteran had active service from February 1944 to December 1944. Service records show she was hospitalized from August 1 to 12, 1944 for secondary anemia. The records also indicate that this condition had existed prior to her entrance into service. |! - veteran was again hospitalized August 31, 1944, and did not thereafter return to duty. Her disorder was orginally diagnosed as anemia, secondary to roentgen ray exposure. It was also noted that from 1938 to 1944 she had been an X-ray technician and had worked with a variety of machines, the majority of which, including the machine she was working on during service, were not properly screened. Service records also disclosed she was invalided in 1944 by reason of anemia diagnosis which service medical authorities held had existed prior to service and was not aggravated by service. Veteran continued under medical care for anemia and, on occasions, was hospitalized during the period from her retirement from service in 1944 until October 1964. In October The records in this case have been carefully reviewed. It is my opinion that there is no reasonable medical basis for concluding that the carcinoma of the right ovary initially diagnosed in 1964 wasetiologically related to X-ray exposure during service in 1944. The depth dose received during the course of a technician’s duties, even with equipment that is defective and relatively unprotected, would 1964, a total hysterectomy, bilateral oophorectomy and left salpingectomy was conducted for carcinoma of the right ovary. Medical Evidence: The veteran was under the care of a physician from July to September 1944 while both were in the service. [n reporting that the veteran had anemia while operating an improperly screened X-ray machine, the physician stated: i can only tefl you that [the veteran] served in the naval dispensary at Vero Beach, Florida in 1944 as an X-ray technician, that she had to use a machine without a safety shield for several months and that she developed rather severe anemia which, in my opinion, was related to this fact. I believe that there is a definite relation between over-exposure to radiation and the development of blood dyscrasias and of malignant disease in some persons. Therefore, | can say that, in my opinion, there might be a possibility of relationship in her case. 70 The veteran’s representative requested that an independent medical opinion be obtained and in response to this request the veteran’s claim folder was reviewed by the Chief, Radiation Therapy Department of a leading university medical school. His opinion included the following: ...aS far as I can determine, no real attempt has been madeyet to estimate what her exposure might have been. The absence of any sort of dosimetry in connection with the irradiation precludes any real reliable quantitation in terms of dose-effect relationship. To arrive at a meaningful figure, factors of kilovoltage, current, and filter, field size, type of table, efficiency of the coning and shielding, plus her position in the room in relation to the radiation would all have to be known. It is obvious that at this late date such information would be next to impossible to determine with any degree of accuracy. However, in making use of what is known about such procedures, Cowing and Spalding made a study of fluoroscopic units in 1949, a time period not tuo far removed from [veteran's] period of service and association with similar equipment. They reported that the dose to the radiologist at the level of his right elbow was 10 mr, (1/100 of an r) per hour during fluoroscopy. This was determined by means of film badges and ionization chambers. Obviously this figure is only applicable to the conditions under which it was measured. However, it serves as a starting point in an attempt at estimating a dose to which she might possibly have been exposed. Under the most likely conditions, she would have been standing either beside the patient or the radiologist. Thus she would be out of the prishary beam and be subjected only to scatter radiation. The principal source of the scattered radiation is the patient being examined. Since this radiation is scattered in all directions, it is obvious that the dose rate at one meter from the patient would be very much less than in the primary beam. On the average, according to Quimby, the rate one meter from the scattering object, the patient, and/or the radiologist in this instance, would be about one tenth of one per cent of that incident on the source of scatter. According to [veteran], her principal exposure was at fluoroscopy. Robbins of Harvard reported that the estimated gonadal dose to the patient during a GI series was 140 mr, and 350 mr for a barium enema. This is to the 71