Attachment B Department of Memorandum Veterans Affairs Date: 24 January 1994 From: Susan Mather Subj: Further history of VA Nuclear Medicine/Atomic Medicine Program To: interested parties 1. Attached is a brief summary of the Nuclear Medicine Program in VA from the vantage point of A. Graham Mosley who joined Dr. Lyon in July 1948 as Assistant Chief of the radioisotope Section in VACO and later served as Special Assistant to the ACMD for Research and Education. He retired in 1966. 2. It does mention that Dr. Lyon joined the VA with the Title of Special Assistant to the CMD for Atomic Medicine and that "this position was set up to prepare for the proper evaluation of future claims from veterans who might claim injuries from exposure to atomic radiation." Mr. Mosley describes Dr. Lyon's experiences in the Navy as part of the Manhattan Project and his involvement with atomic bomb tests. He remarks later that "Since this area was not being publicized and was in the area of research, Dr. Lyon's office was made a part of the Research and Education organization." 3. Mr. Mosley replaced Dr. Herber Allen in VACO. Dr. Allen is retired now in Houston, after a VA career that took him to VAMCs in Van Nuys, West Los Angeles and houston. His address and telephone number are available. I am not sure of Mr. Mosley's current status. The history was written in April 1985 and was provided to this office by Dr. Blahd, the Chief of Nuclear Medicine in West L.A. 4. I am also enclosing a technical bulletin on the subject dating from 1949 for your information. SUSAN MATHER Department of Veterans Affairs VHA FAX TRANSMITTAL This transmission is intended only for use of the person or office to whom it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that receipt of this message does not waive any applicable privilege or exemption from disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this communication in error, please notify us immediately at the telephone number shown below. Thank you. Fax# (FTS) (700) 748-6952 Comm Fax# (310) 824-6952 Comm# (310) 824-3130 GRAPHIC PICTURE The physician I referred to in our recent conversation is Herbert C. Allen, Jr., M.D., 6410 Fannin #100, Houston, TX 77030 (713) 790-0542 Fax: (713) 790-0542 To: Dr. Robert E. Allen (116) Fax Number (202) 535-7572 Date: 1-21-94 No Pages Attached 6 Subject: VA Nuclear Medicine Program (A. Graham Moseley, Jr.) From: W. H. Blahd, M. D. Chief, Nuclear Medicine Svc (115) Phone Number: (310) 824-3130 VETERANS ADMINISTRATION NUCLEAR MEDICINE PROGRAM In 1947 Dr. George M. Lyon was released from active duty as a captain in the Navy Medical Corps, and joined the Veterans Administration with the title Special Assistant to the Chief Medical Director for Atomic Medicine. This position was set up to prepare for the proper evaluation of future claims, from veterans who might claim injuries from exposure to atomic radiation. Dr. Lyon had been a pediatrician in Huntington, W. Va., but held a commission in the U.S. Naval Reserve and had been called to active duty about 1941. He had been involved with the Manhattan Project, had experience with safety aspects of the thermal diffusion plant tried as a means of concentrating fissionable uranium, was present for the first atomic bomb test in a lamagordo in 1945, and had served as personnel safety advisor to Admiral Blondy for the bomb tests at Bikini in 1946. Since this area was not being publicized and was in the area of research, Dr. Lyon's office was made a part of the Research and Education organization, with Dr. E. H. Cushing as the Assistant Chief Medical Director. At this time Dr. Paul B. Magnuson was the Chief Medical Director. The only other person who was considered a part of this Automic Medicine effort at first was Dr. Charles Spruitt, a retired Brig. Gen. in the Army Medical Corps, who was employed as a consultant, doing library research to compile statistics on radiation injuries. Also in 1947 radioisotopes became available to medical investigators under strict licensing requirements of the Atomic Energy commission. Recognizing the need for coordination of any use of radioisotope in VA hospitals, a Radioisotope Section was set up in the Research Service, and Dr. Lyone wore a second hat as Chief, Radioisotope Section. In early 1948, I believe, Dr. Lyon recruited Dr. Herbert C. Allen, Jr. as his Assistant Chief, Radioisotope Section. Dr. Allen was newly released from active duty in the Air Corps, as a flight surgeon, and agreed to help in the starting of this new program if he could later be assign to a VA hospital to actually practice atomic medicine. In keeping with this commitment, Dr. Allen was transferred to the VA Hospital, Van Nuys, Calif. in late 1948. he later moved to the VA Center, Los Angeles and subsequently to the Va Hospital, Houston, Texas. In July 1948, I, A. Graham Moseley Jr., agreed to join Dr. Lyon, to succeed Dr. Allen. I had been a college chemistry teacher for about 20 years, the past 18 at Marshall College in Huntingon, W. Va., where I had known Dr. Lyon. I was commissioned a Lt. (jg) in the Naval Reserve and place on active duty in July 1942. Upon release in December 1945 I returned to my teaching, but went back on active duty to serve as a radiological safety monitor in Operation Crossroads, the Bikini bomb tests in 1946. At the time I joined the program there were eight VA hospitals using radioisotopes to some extent. These were: VAH Praminghame, Mass. VAH Bronx, N.Y. VAH Cleveland, Ohio VAH Hines, Il. VAH Minneapolis, Minn. VAH Dallas, Texas VAH Van Nuys, Calif. VAC Los Angeles, Calif. Dr. Lyon had set up a Central Advisory Committee On Radioisotopes, which held frequent meeting to review policy and activities of the program. the committee also advised Dr. Lyon, I am sure, on matters relating to his Special Assistant for Atomic Medicine duties. The Members of this committee were: Dr. Shields Warren, Boston Dr. Perrin H. Long, Baltimore Dr. Stafford L. Warren, Rochester Dr. Hymer Friedell, Cleveland (later, Los Angeles) Dr. Hugh Morgan, Nashville These experts also served as consultants to the VA hospitals in their areas, as needed. Late in 1948 Dr. Lyon recruited Harold P. Weiler to join the Radioisotope Section Staff. Mr. Weller had been a public school teacher and administrator in Fairfax County, Va., and was teaching in a private school in Alexandria at that time. Early in 1950, I believe, Dr. Cushing resigned as ACMD for Research and Education, with about 3 years remaining of his current four year term. Dr. Lyon was appointed to fill this unexpired term. Dr. Lyon reorganized the office, retaining the three divisions, (research, education, and atomic medicine). Under research General Medical Research was under Harold F. Weiler as Chief, and I was made Chief of Radioisotope Research. During this approximate time also, Dr. Nagnuson resigned as Chief Medical Director and Dr. Williams S. Middleton became his successor. Also, about this time (1950) Dr. W. Edward Chamberlain was brought in, to assume Dr. Lyon's duties as Special Assistant for Atomic Medicine but titled as Chief Atomic Medicine Service, and the Radioisotope Division was designated under that service. In 1953, I believe, Dr. Lyon's appointment as ACMD for R.E. expired and he left Central Office to become Director of the VA Hospital in Huntington, W.Va.. After a period when Dr. John C. Nunemaker served as Acting ACMD for R. & E., Dr. John B. Barnwell was appointed ACMD for R. & E.. During the terms of Drs. Cushing and Lyon, Mr. Ralph T. Castell had served as Special Assistant to the ACMD for R. & E, handling most administrative matters for all of R. & E.. Soon after Dr. Barnwell's appointment Mr. Casteel was promoted to a position as Special Assistant to the Chief Medical Director, and I was asked to take over the position as Special Assistant to the ACMD (Dr. Barnwell). I did not want to relinquish the radioisotope program, but agreed to try to hand both for a **** period. This **** period turned out to be for a period of about nine years during which I wore both "hate", under Dr. Barnwell and his successors, Dr. James Mosser and Dr. B.B. Wells, until about a year before my retirement, when I was relieved of the Special Assistant duties and gave full time to the Radioisotope Program. During this period the use of radioisotopes had expanded greatly, and at the time of my retirement in 1966, there were radioisotopes in use in sixty six VA hospitals. During all these years the use of radioisotopes had been carried as a research activity, and funded entirely (except for physicians' salaries) from funds appropriated for research. The rapidly expanding use of radioisotopes for diagnostic purposes, and to a lesser degree for therapy, indicated that we were getting to the stage Dr. Lyon had foreseen. In 1964, I believe, I was successful in getting funds from the patient care category to those hospitals doing clinical radioisotope work, and recovered some research funds for other uses. The amount here was not nearly the total budget needed for the clinical program, but was a start in this direction. This was the first step toward what Dr. Lyon had foreseen as a part of patient care, after the early days of research support. In 1965 the Atomic Energy Commission licensing division began to relax the stringent requirements for individual licensing of each radioisotope and each use, and we selected the VA Center in Los Angeles as the first to apply for a broad medical license, the uses and isotopes within a stated group, to be approved by a local Isotope Committee. This was approved by the ABC and several other VA hospitals were approved within the next six months or so. In early 1966, I arranged a meeting of several VA physicians using radioisotopes, at the VA hospital in Minneapolis, where we discussed the growing clinical applications of radioisotopes and drew up a proposal for the establishment of a Nuclear Medicine Service in the Department of Medicine and Surgery. This proposal was submitted, through the Deputy Chief Medical Director, who referred it to the Assistant Chief Medical Director for Professional Services for review and comment. The proposal disappeared for several months, but in the fall it was exhumed by Dr. Musser, then Deputy Chief Medical Director, submitted to the Chief Medical Director, who as I recall, was Dr. Engle at that time. (He served between the terms of Dr. Middleton and Dr. Musser). It was approved and Dr. Richard E. Ogborn of the VA Hospital, Omaho, Nebraska, was appointed as the first Director of the newly approved Service. I retired on December 30, 1966, with the felling I had left an established Service that would continue without interruption. Unfortunately, no one knew that Dr. Ogborn was suffering from metastatic carcinoma of the pancreas, which within a few months had invaded both lungs and caused his death. After my retirement I had no contact with VA activities, so my summary of my recollections of the program ends at this point. I would like to mention a few item that seem of great importance. 1. The early days were times of great problems with instrumentation, recruiting, methodology, licensing, and information exchange between users. One development has been controversial. I know that Dr. Allen was trying to do "scans" by laboriously taking individual Geiger measurements over a grid arranged over the patient. Who first suggested or conceived the automatic scanner for thyroid use in controversial, but there is no doubt that the first clinical trials of this machine, built by scientists of the UCLA Medical Center, was at the VA Center, Los Angeles. This began an era of rapid development of scanners. 2. The VA hospital, Omaha, was, I believe, the first to have a nuclear enactor installed in the hospital itself. The story of how this was done perhaps should not be told. There were no construction funds available. These were requested and controlled outside the Department of Medicine and Surgery. Somehow we stumbled on the technique of buying the reactor as a piece of equipment on an installed basis. That is, the vendor did the installation as a part of the total bid price. It was a bit difficult to explain photos that showed up in Central Office showing heavy equipment working at a VA Hospital that had no construction project. We used this technique successfully to install a radiation free room below ground a VA Hospital, Iowa City, Iowa. This was two concentric metal tanks separated by 5 feet of distilled water on side and top and entered through a serpentine passage from the sub-basement. We also furnished a third floor laboratory at VA Hospital Minneapolis, by buying benches and hoods installed on utilities roughed in during another project. 3. In 1947 when Dr. Bernard Roswit started using radioisotopes in the VA Hospital Bronx, N.Y., he found a physicist who was teaching at Hunter College, as a consultant on his instrumentation problems. Later, this physicist, Dr. Rosalyn S. Yalow joined the VA staff full time. Her work in collaboration with Dr. Solomon Berson covered a wide field of investigation, but the development of the technique of radioimmunological assay brought them great recognition and to Dr. Yalow the Nobel Prize in Medicine, after Dr. Berson's ultimately death. 4. No report of the Radioisotope program, now Nuclear Medicine would be complete without mention of a person who was associated through most of my service. When I reported in 1946 I was assigned a secretary, on a temporary basis, since she was a grade above that approved for me. This was Clo Nolen. She helped me through the very abrasive period of adjustment to the bureaucracy ( I never really accepted it), then was transferred. A bit later she was married, left the VA, had two children got them to school age and returned to the VA in another office. Some years later she rejoined my program and was of great help to me throughout. It is rare that a person in a government position could enter employment with the same secretary he had upon retirement over eighteen years later. Mrs. Clo N. Gooding is now retired from VA. NOTE: This material has been written strictly from memory and so the date may not be precise. I believe the events described are correct, however. A.Graham Moseley Jr. April 1985 RADIOISOTOPE UNITS IN OPERATION 1954 Director (or Acting Director) Atlanta, Ga. Dr. Walter H. Cargill Birmingham, Ala. Dr Wm. L. Hawley Boston, Mass. Dr. J. F. Ross Bronx, N.Y. Dr. Bernard Hoswit Cleveland, Ohio Dr. Reginald A. Shipley Coral Cablos, Fla. James E. Miller Dallas, Texas Dr. Donald A. Sutherland Denver, Colo. Dr. Harold Elrick Durhan, N.C. Dr. Wallace N. Jenson Fort Howard, Maryland Dr. Arthur F. Abt Hines, Ill. Dr. John A. D. Cooper Houston, Texas Dr. Herbert C. Allen, Jr. Iowa City, Ia. Dr. R.E. Peterson Kansas City, Mo. ------- Long Beach, Calif. Dr. M. E. Morton Los Angeles, Claif. Dr. Franz K. Bauer Loisville, Ky. Dr. Maurice Nataro Martinsburg, W. Va. ------- Memphis, Tenn. Dr. B. R. Gendel Minneapolis, Minn. Dr. Lislie Zieve Nashville, Tenn. Dr. G.R. Meneely New Orleans, La. Dr. Juliam D. Boyd Omaha, Neb. ------- Philadelphia, Pa. Dr. Robt. M. Dowoen San Francisco, Calif. Dr. Wm. A. Reilly Seattle, Wash. Dr. Rex L. Huff West Haven, Conn. Dr. Donald L. Buchanan