INTRODUCTION 2.0.0... cece cc cece ce cece cece tte e rete cece aneeeveeens 1 HEALTH EFFECTS OF IONIZING RADIATION .......-.-- cee ceveeeeceee 3.1 32 3 Overview 2.0... ccc ccc cc cece rece tne ences meee rene nccccceces 3 Deterministic Effects .......... cc cece ccc ec cere eee e eee n erence cenes 4 3.2.1 Factors Influencing the Clinical Expression of Radiation Injury .......... ccc ccc c ee ence eee r eet e een cnccees 4 33 3.4 3.2.2 Early Clinical Features of Acute Radiation Injury ...............-- 6 3.2.3 Delayed Clinical Features ........... 0c cee cece reece eee neeecees 9 Stochastic Effects. ........ 0... c cece cece cece ce een eee n ones esenes 11 3.3.1 Heritable Genetic Effects ........ 0. cece cece cece cece ee ceenes 11 33.2 Somatic Effects ..... 0... . ccc cee c cece cee e cnet e ener eeenes 11 3.3.3 Risk Estimates ......... 0. cece ccc cece cece cece cee n ee eeenee 12 Psychological Effects ....... 20... ccc cece rece ete cece ence nneees 13 THE INCIDENT AND ITS IMPLICATIONS FOR RADIOLOGICAL HEALTH .. 15 4.1 The Incident ........... ccc ccc wcrc cece e cece tence eenceeee 15 Radiation Dose Estimates ........... 0. cc cee cece reece cece ceneeens 19 42 43 4.4 45 Radiological Exposures ........ 0... cc cece reece eensewe e cere eeoes 4.2.1 Chronology of the Acute Exposures .......... ccc cece cece ceece 42.2 Types of Acute Exposures ......... 0.2... cece cece eee e cee eeees 423 Potential for Protracted Exposures ............. 00 ccceeccceeces The Exposed Population ........... 0... cece eee cece cece reece neces 4.4.1 4.4.2 4.43 4.4.4 External Whole-Body Doses from the Plume .............-.2000External Radiation Doses to the Skin from the Fall-out Contamination ......... 2. eee cece eee nec c cece eer eeeees Internal Radiation Doses ............. cece eee cece eee eeceees Additional Absorbed Doses During Rehabilitation ................ Early Medical Findings 19 21 21 24 ............. cece cece cece eee e cence nec eeee 25 45.1 Acute Systemic Effects ...... 0.0... ccc cee cece eee e cence 45.2 Acute Local Lesions ......... 0... cee eee eee eeeeeee eeee 45.3 Other Early Health Effects .............eee e eee e cece ee eeee 45.4 Association Between the Early Medical Findings and the Radiation Exposure ............. 0 cece eee cece terete en enes 45.5 15 15 16 17 17 Association Between Subsequent Health Experience of the Marshallese 25 25 26 27 and Their Radiation Exposure in 1954 ............ cece eee eens 27 THE RESPONSE1954-1992 2.2... cece ccc cece cece cece tee e reese ences 29 5.1 5.2 5.3 5.4 Follow-Up 1954-1992 2.0... ccc cece cece erect cece tense eeens 5.1.1 Actions 2.0... . cece cece cece eee ee eee een eee eeeaee 5.12 Findings ....... 0... cece cece eee eee eee e ween eenstee. What Should Have Been Done .......... 0... cece cece ee cee eee eeee 29 29 30 30 Factors Limiting Epidemiological Studies of Exposed Marshall Islands Population. 0... cece ccc cece cee eee eee eee tree eee e tenes 32 Primary Purposes of Medical Surveillance .......... 0... ee ee ete eeeees 31 Sabu