permission of the examinees, copies of all examination and laboratory data from the Brookhaven program are forwarded to the Marshall Islands Health Service hospitals on Ebeye and Majuro and to the 177 Health Care Program, a special program set up for persons from the radiation-affected atolls, with administrative offices at the Majuro hospital. In addition, copies of the examinations and laboratory data are given to the examinees themselves, The Marshall Islands Medical Program, as a satellite clinic of the Clinical Research Center, Brookhaven National Laboratory, is accredited by the Joint Commission on Accreditation of Healthcare Organizations, a nationwide organization that sets standards of performance for institutions dispensing medical care and monitors compliance with those standards. By voluntarily participating in the accreditation process, the: Brookhaven National Laboratory Marshall Islands Medical Program receives a valuable and impartial external review of its policies and procedures, as well as an assessment of the adequacy of the services it provides. Laboratory and radiological services, medical records, patient satisfaction, pharmaceutical services, and clinical competence of physicians are among the many items reviewed by the Joint Commission. Procedures: The exposed population, which in December 1991 numbered 159, must be considered at increased risk for malignant disease as a late complication of radiation exposure. Therefore, the medical program has in place a canceroriented annual health evaluation. The examination follows the guidelines of the American Cancer Society and includes a medical _ history, complete physical examination, advice on decreasing the risk factors for cancer, advice on self-detection of lesions, annual pelvic examinations and Papanicolaou smears, blood | count, urinalysis, stool testing for occult blood, annual mammography (offered to all exposed women andto all unexposed womenforty years of age or older), and flexible sigmoidoscopy (every three years for personsfifty years of age or older). Every two years ophthalmologists are included on the medical team: andslit-lamp examinations are provided, A wide selection of reaging glasses for certain endocrine problems. Thegefore, they receive annual thyroid function blood thyroid examinationsby a specialist in engi or thyroid surgery. Needle biopsies] of thyroid nodules were performed on selected pd@fients in an effort to avoid surgery and the subseqgentloss of normal thyroid tissue. Other serologic tests are performed on a regular basis in an attefpt at early detection of malignant nonthyroidal lesfons. These include serum protein electrophoresf, calcium, prolactin, alpha-fetoprotein levels on pegsons known to have hepatitis B surface antigefemia, and thyroglobulin determinations on those whose thyroid Surgery specimens suggested a maligpant lesion. There is also ongoing monitoring ffor clinical evidence of immune competence, fbr exposed persons may be at increased risk far infectious disease or unusual manifestations thereof. Specialized tests on the comparison popplation were referred as clinically indicated. Medical examinations and serviceg performed during this four-year reporting ppriod were conducted primarily aboard the Liktanyr IT], owned by U.S. Oceanography, San Diego, CA] and the G. W. Pierce, a vessel owned by TracorfMarine, Ft. Lauderdale, FL. These ships were chagtered by the U.S. Department of Energy for the] purpose of supporting several of the Departmeng of Energysponsored Marshall Islands programs, bf which the medical program is but one. Some patients were examinedin the island dispensaries onfMejatto and Utirik, and home visits were arranged for the elderly who preferred not to be moved aboard the ship. Clinical laboratory services for the missions were performed by several Brookhavqn National Laboratory technicians with support fr@m personnel of the Health Services of the Reppblic of the Marshall Islands. Routine hematology testing was performed on a J.T. Baker 5000 electgonic counter and, beginning in the fall of 1989, o@ the Serono Baker 9000 RX automatic 8-parametegcell counter. Leukocyte differentials and platelet counts were part of each evaluation. Clinical chemistfy tests were