Giventhe constraints described, the ORISE team decided to proceed with the assessment from the perspectives of 1) current knowledge of the nature of the early and late health risks associated with exposure to radiation; 2) the radiological hazards of the accident and their potential to impact the health of the inhabitants of the affected islands; 3) the medical programs established to manage the medical care of the exposed inhabitants in the aftermath of the accident, and to monitortheir long-term health with respect to the health effects of their exposure; 4) the nature and scope of the radiological health response to a similar accident occurring today; and 5) recommendations for the nature and scope of the surveillance appropriate for the Marshall Island population through the year 2000. The team metseveral times early in the project to develop the scope of the assessment and outline the organization of the report. Members’ concurrent review ofthe literature molded the report’s final draft which they agreed would be submitted for external peer review before finalizing it for presentation to DOE’s Office of Health. Members then developed material in their areas of expertise within the proposed framework of the report. Thefirst draft document was compiled for members’. input, edited, and circulated for internal review. Members’ comments and suggestions were incorporated as appropriate to the extent reasonable, and the final draft document was prepared for concurrent administrative and peer review. 1.3 Summary and Conclusions Theclinical effects of acute whole-body,local and internal exposureto ionizing radiation above threshold doses for specific cell systems observed among the Marshallese were consistent with similarly exposed populations. This correlation was predictable given the average doses of the Marshallese population; however these doses were estimated a posteriori, and based on the observed clinical effects. Current knowledge of the randomlate effects of radiation suggested the tumorigenic effect of the Marshallese exposures would be the most significant adverse health outcomein the years following initial recovery. Based on the small population originally identified for follow-up (N=239), the total population dose (101.14 Gy), and the large uncertainties in individual doses, the paucity of good data on spontaneous cancer and other disease rates amongthis genetically ii