Science-informed Policy Making for Protecting People and the Environment from Radiation.

ABSTRACT: The process to arrive at the radiation protection practices of today to protect workers, patients, and the public, including sensitive populations, has been a long and deliberative one. This paper presents an overview of the US Environmental Protection Agency's (US EPA) responsibility in protecting human health and the environment from unnecessary exposure to radiation. The origins of this responsibility can be traced back to early efforts, a century ago, to protect workers from x rays and radium. The system of radiation protection we employ today is robust and informed by the latest scientific consensus. It has helped reduce or eliminate unnecessary exposures to workers, patients, and the public while enabling the safe and beneficial uses of radiation and radioactive material in diverse areas such as energy, medicine, research, and space exploration. Periodic reviews and analyses of research on health effects of radiation by scientific bodies such as the National Academy of Sciences, National Council on Radiation Protection and Measurements, United Nations Scientific Committee on the Effects of Atomic Radiation, and the International Commission on Radiological Protection continue to inform radiation protection practices while new scientific information is gathered. As a public health agency, US EPA is keenly interested in research findings that can better elucidate the effects of exposure to low doses and low dose rates of radiation as applicable to protection of diverse populations from various sources of exposure. Professional organizations such as the Health Physics Society can provide radiation protection practitioners with continuing education programs on the state of the science and describe the key underpinnings of the system of radiological protection. Such efforts will help equip and prepare radiation protection professionals to more effectively communicate radiation health information with their stakeholders.

The HAS-Choice study: Utilizing the HEART score, an ADP, and shared decision-making to decrease admissions in chest pain patients.

OBJECTIVE: The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care. METHODS: This was a single-center prospective cohort study with historical that included ED patients ≥21years old presenting with a primary complaint of chest pain in two time periods. The primary outcome was patient disposition. Secondary outcomes focused on 30-day ED bounce back and major adverse cardiac events (MACE). We used multivariate logistic regression to estimate the odds ratio (OR) and its 95% confidence interval (CI). RESULTS: In the pre-implementation period, the unadjusted disposition to inpatient, observation and discharge was 6.5%, 49.1% and 44.4%, respectively, whereas in the post period, the disposition was 4.8%, 41.5% and 53.7%, respectively (chi-square p<0.001). The adjusted odds of a patient being discharged was 40% higher (OR=1.40; 95% CI, 1.30, 1.51; p<0.001) in the post-implementation period. The adjusted odds of patient admission was 30% lower (OR=0.70; 95% CI, 0.60, 0.82; p<0.001) in the post-implementation period. The odds of 30-day ED bounce back did not statistically differ between the two periods. MACE rates were <1% in both periods, with a significant decrease in mortality in the post-implementation period. CONCLUSION: Our study suggests that implementation of a shared decision-making tool that integrates an ADP and the HEART score can safely decrease hospital admissions without an increase in MACE.

U.S. radiation protection: role of national and international recommendations and opportunities for collaboration (harmony, not dissonance).

For much of the 20th century, U.S. radiation protection policies were similar to those elsewhere in the world, in large part because the International Commission on Radiological Protection (ICRP) and the National Council on Radiation Protection and Measurements (NCRP) were closely aligned. In the 1970s, several U.S. regulations were released at about the same time as the 1977 recommendations from ICRP. The regulatory development process in the United States can be lengthy with ample opportunities for public involvement. While such deliberation is essential and beneficial, the rulemaking process does not lend itself to making frequent technical updates to rules. For this reason, many of the current radiation protection regulations in the United States are out of step with current recommendations of the ICRP and NCRP. The U.S. Nuclear Regulatory Commission and the U.S. Environmental Protection Agency are considering updates to important radiation protection regulations. These regulatory development actions could present the United States with an opportunity for incorporating the latest science into the U.S. system of radiation protection and provide for consideration of the latest recommendations of ICRP and NCRP. In particular, a revision of the recommendations in NCRP Report No. 116 (Limitation of Exposure to Ionizing Radiation) could provide U.S. agencies with useful advice to be considered in these rulemakings.

U.S. EPA response to the Fukushima Daiichi Nuclear Power Plant accident.

During the spring of 2011, the U.S. Environmental Protection Agency (EPA) used its national radiation monitoring and sampling system, RadNet, to detect, identify, and inform the public about radioactive material in the United States resulting from Japan's Fukushima Daiichi Nuclear Power Plant release. The RadNet system monitors ambient air, drinking water, precipitation, and pasteurized milk for radionuclides. To supplement its existing stationary (fixed) continuous air monitoring system, EPA deployed additional air monitors to Saipan, Guam, and locations in the western United States. The Agency also accelerated the regular quarterly sampling of milk and drinking water and collected an additional round of samples. For two months, staff located at EPA's Headquarters Emergency Operations Center, west coast regional offices, and National Air and Radiation Environmental Lab worked seven days a week to handle the increased radiochemical sample analysis from air filters, precipitation, drinking water, and milk; provide interagency scientific input; and answer press and public inquiries. EPA's data was consistent with what was expected from the Fukushima Daiichi Nuclear Power Plant release. The levels of radioactivity were so low that the readings from the near-real-time RadNet air monitors stayed within normal background ranges. Detailed sample analyses were needed to identify the radionuclides associated with the release. Starting at the end of April and continuing through May 2011, levels of radioactive material decreased as expected.