! . . refer ' | by the identification of a hack of agencies and labs involved in the Who: . ids but stations. there should be at least one i at ial users meeting with additional meatings as necessary, ‘ s£ coariratorLles in the | 1 in con- . zrned U.S. has placed ? credibility , a viable pri- j ~~ lly. ult in , However, 9 “low Level" strengthened its direce ts to clarify The timing of the BNL field surveys Whent Timing should xe bas.4 2, consequences. planned, high intensity edu- , Risk related pathology- with the absence of many of the leaders; 3) Evenly spaced visits, about 245 months apart will assist the BNL field staff in the follow-up of the pathologie condic ion: d.e., a teloticvely Fixed cine base Line BAS? ? ? 5 =o A - fixed schedule will do much to counter et ae 4 4 f area, more than studying radiation . ms The pathologic upon the best availayl know IE ledge regarding the tise i-terAvoidance of untoward consequences val for the detectio: of rdiaWith strictly limited goals the probability of obtaining tion abnormalities. ¥ valid data and early detection of disease is enhanced by concentration of funds on limited objectives - i.e., minimun How: The BNL medical ivam is 7 dilution of effort. However, the public outery against tie .? currently doing considerab y . * reduction in the program could have serious political /sociolegic must always keep in mind the poor conmunications) ;2) Long lead time and a . _. . i ry “fy, ° and control populations where!J, conditions related to radiation exposure in the range deterever we can locate tiem. “emined for the Marshall Islands is rather limited, Our proib gram under this option would be constrained to this limi:ed 4 well- Terricory. following reasons: 1) Long lead time the charges that BNL has planned its trips to the outer islands to coincide ‘ Flexibility This option offers us little flexibility. care funding by the Truse is of great importance for the notification of the Study group (especially on the outer islands - we ; The cotal cost will be very close to our 1.78 expenditures, The reduction in the patient population will be offset by the cost of the ec 1cational program to explain the reason for Our cut-back in services and by inflation, io f . ; . ; . The risks to DOE/BNL are: The puolic reaction to reduced medical care. We are unable to quantify the risks to the program offered by this option but they would probably ii-iude: lack of patient cooperation (resulting in ? data), vigorous movement to "free a-socia| public procest (locally and internationally) and a vigorous tion" will probably 2" orer ise - * program for DOE/BNL te,at least,return to the previous level the already inadequace wealth of care. Risks to the Marshallese are: 1) Failure to detect 7 Timir + ol ', reduced at this time. The must be included to insure prope: Ver, a cutback lese resulting BNL medical tea has 25 cational program Would be necessary to explain why the medical program was beisty . ‘solute ‘ - Total cost(s) Where: Screening of exposed { with DOE & DOL. In addition, since i the logistics, e.g., transportation is a common problem to all users, . condition (listed under objeccives) will be screened by tha appropriate methodologies, Treatment and follow-up will be assured by appropriate algorichms and check lists. years of experience iaOption A/}’ for screening, treatient and ' follow-up. DOE best suitec to + identify single contict oint. , grams and to establish close liaison TSI (to document thyroid hypofunction,) Each identifted pathologic cient coordination of above. | total care of the Marshallese : "An additional objective would be } to establish a single contact point ‘ tn DOE to coordinate all these pro-- Option . 4 the enrlfest deviation from "normal function" + Screening(prinary de- teccica). Treatment-hort-term, Follow-up,short § long-term, Single contact point fer effi~ | coordination among the various lve teres of: What: i aot materially change the basic objectives of Option A. An addi“ tional objective has been generated alt cf xy the | ee ee IW. Analysis ; A detailed research protocol] will be developed to specify che ~~ Develop possibleapproaches to.) Medical criteria and algorithms for the detection of radiation attaining the objectives, with ,, Yelated pathologic conditions (e.g; disease specific items in each approach being stated in the history, physical €xam and laboratory profile to detect armen | fhe relative constraints would ‘on - ~V-_SelectinnCriteria |__Set forth thecriteriaforthe selectionofanapproach: Performance LIL. Translation nnn lainstatement of refined wbjectives in consideration ‘ats ‘;o& restraints. i b ye > the y care. ee. tennee 35 SRA other than radiation related diseases - with increased nor- bidity and mortality among the exposed & con-rol groups. 2) Possible alienation of the Marshallese by DOE/BNi resulting in a Hreakdown in vital conmunication. Cost /fefFectiveness ~ No data format now exists to compute cost/ effectiveness or cost/benefit, The diffuse funding mechanisns make it very difficult for the principal investigator to obtain ar accurate current accounting of monies expended on the medical proer Tf such dat. were available and all screening, treatment and col’ up ZOais Clearly defined, some be derived cot ee 9 } 9 2 2 2 9 . s3ugh est “ation of cost/patient rL “ te rs em i mi