ATTACHMENT 4 (NASA - CR-1-_____39) STUDIES RELATIVE TO THE M75-32733 RADIOSENSITIVITY OF MAN: BASED ON RETROSPECTIVE EVALUATIONS OF THERAPEUTIC AND ACCIDENTAL TOTAL-BODY IRRADIATION FINAL UNCLAS REPORT (---- RIDGE ASSOCIATED UNIVERSITIES) G3/52 35077 Report written and compiled by R. C. Ricks and C. C. Lushbaugh. Study Completion Date: June 30, 1975 Reported Completed: September 1, 1975 CHAPTER I SUMMARY AND COMMENTS This report compiles in a somewhat abbreviated fashion the bulk of the radiobiologic studies carried out with joint (AEC) ERDA and NASA support during the years 1964 to 1974 at the Medical Division of Oak Ridge Associated Universities. Their termination was directed by a decreased urgency on the part of NASA for broadly focused human radiobiologic data and on the part of ERDA for a redirection of ORAU's Medical Division efforts away from radiotherapy toward occupation medical problems that are being generated by the increasing demands for energy from non-nuclear sources. The physiologic data generated by this study were similar in many ways to those previously observed in other medical radiobiologic experiences. They differed, however, in the methods of data acquisition and analysis. Instead of more conventional analytical methods, pulmonary impedance was recorded and quantitated as a measure of radiation-induced gastrointestinal distress and fatiguability. While refinements in dose response related to gastrointestinal distress were accomplished we also found that through the use of Fourier analysis of pulmonary impedance waveform GI distress could easily be recognized and quantified even when the initial stages of nausea were below the subjects subjective level of recognition. Our results demonstrate that change in pulmonary impedance waveform close parallel well-defined stages of GI distress, i.e., initial nausea, a progressive increase in nausea, and finally vomiting episodes. These stages of GI distress are 2 similar when induced chemically or by exposure to ionizing radiations although that induced by radiation is often sudden in onset and little nausea may proceed the actual acetic episode. Throughout the study period, pulmonary impedance waveform analysis never failed to recognize radiation-induced GI distress. Finally, these data demonstrate that real-time analysis of GI status with continuous data update can be accomplished using Fourier analysis of the pulmonary impedance waveform monitored from a remote, isolated environment. Attempts to measure and quantify radiation-induced physical deconditioning using pulmonary impedance waveform analysis were not as clearly delineated as in the case of gastrointestinal distress. Pulmonary impedance measured before, during, and after controlled exercise stress (ergometry) correlated very well with periods of physical stress. Increased respiratory demand during submaximal exercise stress was accompanied by increased pulmonary impedance variance and within stress periods an increase or decrease in workload was accompanied by respective shifts in pulmonary impedance waveform. However, exposure to ionizing radiations resulted in amplified (increased) pulmonary impedance variance in over 80% of those humans studied although the ergometric workload remained unchanged. Thus, it would appear that exposure to radiation resulted in increased respiratory demand to perform at a constant, non-varying workload. Analysis of cardiac rate during controlled exercise stress in control volunteers and therapeutically likewise demonstrated increased response in over 70% of those patients who participated in the study. We believe that these amplified cardiac rates are indicative of diminished cardiovascular efficiency since workloads were non-varying 3 throughout each patient study period. Since some radiobiologists believe that venodilation and decreased venous compliance occur during early postirradiation periods (hours to several days) a pooling of blood in the venous system could account for increased cardiac rates and increased pulmonary incidence (increased mediastinal blood mass) postirradiation. Efforts to model these data with those of other physical deconditioning experiments led to O2 consumption measurements. Using bed rest as a typical model we found that a remarkable similarity exists between the decrement case but 21 days of bed rest and exposure to 100 R irradiation. Unfortunately, we were able to study only one therapy patient in the period between developing our capability for O2 consumption measurement and the termination of the inpatient therapy program of our Division. The important question remains unanswered as to whether or not radiation-induced physical deconditioning and that induced by bed rest (weightlessness) are additive. If they are the threshold radiation dose would be lowered as mission length was increased unless strong countermeasures were used to prevent or retard zero-G deconditioning. Another facet of this physiologic problem that remains to be considered is whether the level of physical training (vigorous in astronauts) can affect the degree of physical deconditioning. Some studies, needing to be confirmed, suggest that the well-conditioned individual may react more strongly and recover more slowly than a non-conditioned person. Our study of performance after radiation exposure using controlled exercise stress in physically trained and untrained ponies supports this suggestion in that the conditioned animals responded with a greater degree of decrement than the 4 unconditioned ones. The biochemical mechanisms underlying this phenomena need to be studied without necessarily any reference to radiation exposure because of its genal applicability to everyday life as well as to disease. Our hematologic studies concerning the changing patterns of peripheral blood cell numbers after irradiation produced significant improvement in the quantitative aspects of the problem, particularly in defining the doubling times for human leukocytes in terms of repair kinetics. The laboratory studies showed that rapid cell sizing techniques provided an additional parameter to hematologic studies that improved speed of quantitation and diagnosis. In polycythemia rubra vera, for example, changes in RBC morphology proved to be extremely useful in appraising the relative sizes of the iron and erythroblastic pools after radiation exposure. The unique observation of serum CPK rise after a large accidental radiation exposure in a man could not be confirmed in subsequent study in animals. Nevertheless, it led us to evaluate serum CPK levels before and after radiation exposure. The results of this study suggested that changes in muscle CPK as reflected in serum CPK levels may be related to fatigue and ability to perform physical work. This lead needs to be pursued further. The simultaneous studies of human and mouse nomic responses to the same low dose rates and daily dose point up the threefold greater radiation resistance of mouse over man while suggesting what the basic lethal mechanisms may be for man under various conditions of low dose-rate irradiation as it approaches about one rad per day. 5 These studies are, of course, not to be considered definitive and without need for substantiation and extension. Only changing priorities places them, in our opinion, on "the back burner" for the moment. R. C. Ricks C. C. Lushbaugh CHAPTER II OBJECTIVE AND SCOPE The objective of this study was to glean from human accidental and therapeutic irradiation case histories all pertinent radiobiologic information for reappraising and improving our knowledge of man's radiosensitivity. This study was cooperative with an ERDA supported study of total-body irradiation as a therapeutic modality for human blood dyscrasias. Where the AEC/ERDA study concerned itself with clinical aspects, this NASA study was directed toward extracting measurable information on biologic endpoints of radiation effects. Study areas that received major emphasis were: hematology, gastrointestinal side effects, dosimetry, and physiologic monitoring for performance decrement. The need for more quantitative information on the affects of low radiation doses and low-dose-rate exposures was generated by NASA program planning that involved manned space flights. The plans for space laboratories expanded the number of persons at risk from the low doses of natural space radiation and included the possibility that an additional risk might arise from manmade radiation associated with the use of nuclear power generating systems. Our studies were intended to strengthen the confidence we presently have in our knowledge of man's ability re repair radiation damage so that ERDA, NRC, NASA, and other governmental agencies could establish nonoccupational permissible radiation exposure levels and continually review and update NASA occupational career limits for radiation exposure of astronauts as required for engineering design of advanced systems. While knowledge of the effects of larger radiation exposures at 7 high and low dose rates is growing substantially, it is as yet inadequate for deriving dose/response equations that allow high-confidence predictions of the amount of acute and chronic damage that can be expected from small doses to the total body or its parts. Extrapolations that estimate effects from extremely lower exposures accumulated over long periods of time on the basis of studies of high exposure sustained in short periods of time, derive all of their justification from radiobiological studies of lower mammals (chiefly mice). Some observations indicate that after a 5 to 10 rad dose, for example, the probability of a serious consequence occurring in an individual's lifetime is so low that a threshold concept is valid for practical regulatory purposes. Confidence was limited on previous conjectures concerning the levels of radiation that could cause detrimental human reactions. The inherent difficulties in evaluating voluminous clinical data containing numerous variables however have now been largely overcome. Modern research methods using computers with large memory storage capacity have enabled us to construct a human radiation injury data bank containing clinical data from ore than 3000 human total body irradiation exposures in the United States. These charts have been extracted, encoded, and were analyzed by modern mathematical electronic computer methods. The Oak Ridge Associated Universities (ORAU) patient studies obtained in a radiotherapeutic program since 1957 and additional human studies (3000 cases) obtained from other hospital centers with similar studies were incorporated into a study to determine dose relationships in man for anorexia, nausea, vomiting, diarrhea, fatigue, weight loss, fever, arrhythmia, epilation, lymphopenia, granulocytopenia, anemia, thrombocytopenia, cytogenetic damage, decreased 8 resistance to infection, decreased antibody synthesis, increased aging, and carcinogenesis. The values were assessed for degree of clinical and mathematical confidence to permit their use in predicting man's reaction to the ambient radiations of space, and to direct further clinical exploration on the effect of ionizing radiation upon cancerous and normal processes. Additionally, there were multiple reasons for this study overall. Therapeutic total-body irradiation is efficacious in controlling some cases of leukemia and lymphoma and ameliorating symptoms in others. The possibility that low dose rates may favor repair of normal tissue in contrast to malignant processes had not been evaluated in the present modern era of radiotherapy and radiobiology; we proposed to test this hypothesis with a radiation facility producing an isotropic flux of uniform radiation giving low rates of exposure. This irradiator was large enough for patients to live in comfortably for several weeks. Because of expanding programs in nuclear energy and space exploration, the need was more acute than ever for data derived directly by observation of man's reaction rather than assumed from animal studies. The retrospective accumulation of such data as we available showed that the old data suffered from lack of modern dosimetry, tissue depth dose knowledge, biased recording of symptomatology, and incomplete and inaccurate records. Finally, these additional unbiased clinical observations were sorely needed to defend existing environmental and occupational radiation exposure constraints from attack by well-meaning, but impractical, theorists. CHAPTER VI A. List of Reports and Publications Generated by Program 1. Lushbaugh, C.C., Hofatra, R., Roth, R.E., and Andrews, G.A.: ED50 for Gastrointestinal Responses in Man. Radiation Res. 25: 114, May 1965 (abstract). 2. Andrews, G.A., Auxier, J.A., and Lushbaugh, C.C.: The Importance of Disimetry to the Medical Management of Persons Accidentally Exposed to High Levels of Radiation. In Personnel Dosimetry for Radiation Accidents, IAEA, Vienna, August 1965. 3. Lushbaugh, C.C., Comas, F., Saenger, E.L., Jacobs, M.:Radiosensitivity of Man by Extrapolation from Studies of Total-body Irradiation of Patients (invited lecture, February 15, 1966). Radiat. Res. 27: 487-488, March 1966. 4. Andrews, G.A.: Treatment of Radiation Injury. J. Mississippi Med. Assoc. 7: 534-538, 1966. 5. Andrews, G.A., Lushbaugh, C.C., and Kniseley, R.M.: Proceedings of a Panel on Effects of Total-Body Irradiation in the Human Being. IAEA, Vienna, May 17, 1966. 6. Dalton, C.P. and Cloutier, R.J.: An Arrangement of Radioactive Sources for a Low-Exposure-Rate Total-Body Irradiation Facility. Physics in Medicine and Biology 12: 116, 1967. 7. Dalton, C.P. and Cloutier, R.J.: Source Arrangement for a Low-Exposure-Rate Total-Body Irradiation Facility for Man. USAEC Report ORINS-52, May 1, 1967, 205 pages. 8. Fanger, H. and Lushbaugh, C.C.: Radiation Death from Cardiovascular Shock Following a Criticality Accident: Report of a Second Death from a Newly Defined Human Radiation Death Syndrome. Arch. Path. 83: 446-460, May 1967. 9. Lushbaugh, C.C.: Editorial, Radiation and Shock. JAMA 200: 181, 1967. 10. Langham, W., editor: Space Radiation Study Panel: Radiobiologic Factors in Manned Space Flight. July 1, 1967. (1) Lushbaugh, C.C., Andrews, G.A., and Langham, W.: Prodromal Response, p. 76-90. (2) Conrad, R., Andrews, G.A., and Langham, W.: Hematologic Effects, p. 90-105. (3) Langham, W. And Lushbaugh, C.C.: Early Lethality, p.105-124. (4) Thompson, J. And Andrews, G.A.: Chemical and Biological Protection, p. 228-230. 204 11. Lushbaugh, C.C., Comas, F., and Hofstra, R.: Clinical Studies of Radiation Effects in Man: A Preliminary Report of a Retrospective Search for Dose-Response Relationships in the Prodromal Syndrome. Radiat. Res. Suppl. 7: 398-412, November 1967. 12. Andrews, G.A.: Radiation Accidents and Their Management. Radiat. Res. Suppl. 7: 390-397, November 1967. 13. Lushbaugh, C.C.: Some Biological Endpoints of Dosimetric Value Derived from Clinical Data. In First International Symposium on Biological Interpretation of Dose from Accelerator Produced Radiation, March 13-16, 1967, E.J. Vallario, editor, DTLE CONF-670305. 14. Lushbaugh, C.C.: Recent progress in Assessment of Human Resistance to Total-Body Irradiation. In Proceedings of a Symposium Postattack Recovery from Nuclear War- Held at Fort Monroe, Virginia, November 6-9, 1967. 15. Lushbaugh, C.C., Comas, F., Edwards, C.L., and Andrews, G.A.: Clinical Evidence of Dose-Rate Effects in Total-Body Irradiation in Man. In the Proceedings of a Symposium on Dose Rate in Mammalian Radiation Biology, held April 29-May 1, 1968, Oak Ridge, Tennessee, CONF-680410. 16. Beck, W.L., Callis, E.L., and Cloutier, R.J.: Phantom Depth-Dose Measurements with Extruded LiF in a Low-Exposure-Rate Total-Body Irradiator. In Proceedings of the Second International Conference on Luminescence Dosimetry, September 23-26, 1968, USAEC Report CONF-680920, 1968, pp. 976-989. 17. Comas, F.V.: The Time Factor in Fractionated Irradiation of Mouse Skin. In The Proceedings of a Symposium on Dose Rate in Mammalian Radiation Biology, held April 29-May 1, 1968, Oak Ridge, Tennessee, USAEC Report, CONF 680410, pp. 18.1-18.12. 18. Comas, F.V., Andrews, G.A., and Nelson, B.: Spleen Irradiation in Secondary Bypersplenism. Amer. J. Roentgenol. 104: 668-673, 1968. 19. Lushbaugh, C.C., Comas, F.V., and Andrews, G.A.: Radiation Dose-Response Relations Derived from Clinical Data. Health Physics 15(2): 165-166, 1968 (abstract). 20. Bond, V.P., Osborne, J.W., Lesher, S., Lushbaugh, C.C., and Hornsey, S.: Panel Discussion on Mechanism of Intestinal Radiation Death. In Gastrointestinal Radiation Injury, Report of a symposium held at Richland, Washington, September 25-28, 1966. Excerpts Medica, March 1968, pp. 352-373. 21. Ur, A. And Lushbaugh, C.C.: Some Effects of Electrical Fields on Red Blood Cells and Electronic Red Blood Cell Sizing. Brit. J. Haemat. 15: 527-538, 1968. 205 22. Andrews, G.A.: The Therapeutic Use of Bone-Marrow Transplantation. In Proceedings of the International Conference on Leukemia-Lymphoma, Ann Arbor, 1967, edited by Chris J.D. Zarofonetic, Philadelphia, Lea and Febiger, 1968, pp. 423-432. 23. Lushbaugh, C.C.: Theoretical and Practical Aspects of Models Explaining "Gastrointestinal Death" and Other Lethal Radiation Syndromes. In Report of US/Japanese Symposium on Comparative Cellular and Species Radiosensitivity held in Kyoto, Japan, May 20-23, 1968. Edited by V.P. Bond, M.D. and Tsutosu Sugahara, M.D., Igaku Shoin Ltd., Tokyo, Japan, March 1969, pp. 288-297. 24. Lushbaugh, C.C., Frome, E.L., Davis, H.T., and Bibler, D.S.: The Power spectrum of the Impedance Pneumograph: A Data Rediction System Producing an Analytical Parameter of Potential Clinical Usefulness. Aerospace Med. 40: 425-429, 1969. 25. Upton, A.C. and Lushbaugh, C.C.: The Pathological Anatomy of Total-Body Irradiation. In Atomic Medicine, 5th Edition. Charles F. Behrens and E. Richard King, editors, Williams and Wilkins Co., 1969. 26. Andrews, G.A., Kniseley, R.M., Vodopick, Helen, Bergner, P.-E. E., and Lushbaugh, C.C.: Hematologic Responses to Total-Body Irradiation, presented at Gesellschaft Fur nuclearmedizin, Wiesbaden, Germany, September 28, 1968. 27. Lushbaugh, C.C.: Reflections on Some Recent Progress in Human Radiobiology. In Advances in Radiation Biology, Vol. 3, edited by L.G. Augenstein, R. Mason, and M. Zelle, pp. 277-314, 1969. 28. Lushbaugh, C.C. and Auxier, J.: Reestimation of human LD50 Radiation Levels at Hiroshima and Nagasaki. Radiat. Res. 39, 526, 1969 (abstract). 29. Morris, A.C., Jr., Barclay, T.R., and Lushbaugh, C.C.: Monitoring Physiologic Response During Total-Body Irradiation Therapy. Second International Conference on Medical Physics, August 11-15, 1969, Boston, Mass. Phys. Med. Biol. 15: 192, 1970 (abstract). 30. Beck, W.L., Cloutier, R.J. Comas, F.V., and Lushbaugh, C.C.: Human Depth-Dose Estimates in Multidirectional Gamma-Ray Fields. Ibid. P. 144. 31. Upton, A.C., Cosgrove, G.E., and Lushbaugh, C.C.: The Induction of Glandular Carcinoma of the Stomach in Mice by Whole-Body Irradiation. US-Japan Conference on Experimental Carcinoma of the Glandular Stomach, Gann Monograph, 1970. 32. Corrill, L.S., Stokes, T.R., and Lushbaugh, C.C.: Accumulation Rates of GI and Marrow Damage in Pair-Irradiated Mice During Continuous and Fractionated Daily Exposures. Radiat. Res. 43, 271, 1970 (abstract). 33. Lushbaugh, C.C., Corrill, L.S., Stokes, T.R., Humason, G., and Lushbaugh, D.: Mouse Splenic Stem-Cell Response to Protracted Radiation Exposure. Radiat. Res. 43: 212-213, 1970 (abstract). 34. Cloutier, R.J. and Watson, E.E.: Radiation Dose from Radioisotopes in the Blood. In Medical Radionuclides: Radiation Dose and Effects. R.J. Cloutier, C.L. Edwards, and W.S. Snyder, editors. AEC Symposium Series No. 20, CONF-691212, 1970, pp. 325-346. 35. Balish, E., Pearson, T.A., and Chaskes, S.: Irradiated Humans: Microbial Flora, Immunoglobulins, Complement (C'3), Transferrin, Agglutinins, and Bacteriocidins. Radiat. Res. 43: 729, 756, 1970. 36. Comas, F.V., Edwards, C.L., and Vodopick, H.: Splenic Irradiation in Chronic Granulocytic Leukemia: Changes in Leukocyte Values. Radiat. Res. 42: 413-423, 1970. 37. Andrews, G.A., Balish, E., Edwards, C.L., Kniseley, R.M., and Lushbaugh, C.C.: Possibilities for Improved Treatment of Persons Exposed in Radiation Accidents. In Symposium on Handling of Radiation Accidents, IAEA-SM-119/56, 1970. 38. Ricks, Robert C., Lushbaugh, C.C., and Frome, E.: Changes in the Power Spectrum of the Impedance Pneumograph Trace During Radiation-Induced Gastrointestinal Distresss in Man. Fed. Proc. 29(2): 451, 1970 (abstract). 39. Ricks, R.C. and Edwards, C.L.: The Effects of Dose Rate and Exposure Fractionation on Plasma Iron Kinetics in Rats and Man. Radiat. Red. 43: 240, 1970 (abstract). 40. Beck, W.L., Stokes, T.R., Cloutier, R.J., and Lushbaugh, C.C.: Dosimetry for Clinical Total-Body Irradiation. Am. Assoc. Phys. Med., Quart. Bull. 4: 2, 1970 (abstract). 41. Andrews, G.A., Coma, F.V., Edwards, C.L., Kniseley, R.M., Lushbaugh, C.C., and Vodopick, H.: Hematologic and Therapeutic Effects of Total-Body Irradiation (50R-100R) in Patients with Malignant Lymphoma, Chronic Lymphocytic and Granulocytic Leukemias, and Polycythemia. USAEC Report ORAU-112, 1970. 42. Andrews, G.A., Kniseley, R.M., Vodopick, H., Bergner, P.-E., and Lushbaugh, C.C.: Hematologic Respones to Total-Body Irradiation. In Radioisotope in Pharmakokinetik und klinischer Biochemie, F.K. Schattauer Verlag, Stuttgart-New York, pp. 517-527, 1970. 43. McDow, A.E., Jr. and Ricks, R.C.: Uses of a Time-Shared Computer in Quantitative Nuclear Medicine. In Proceedings of Symposium on Sharing of Computer Programs and Technology in Nuclear Medicine, Oak Ridge, 1971. USAEC Report CONF-710425, pp. 155-167. 207 44. Lushbaugh, C.C., Stokes, T.R., and Corrill, L.S.: Dose-Rate Dependence of Mouse Endogenous Splenic Colony Formation and Proliferation During Continuous and Fractionated Daily Irradiation at Low Exposure Rates. Radiat. Red. 47: 344, 1971 (abstract). 45. Ricks, R.C., Lushbaugh, C.C., McDow, E., and Frome, E.: Pulmonary-Impedence Power Spectral Analysis: A Facile Means of Detecting Radiation-Induced Gastrointestinal Distress and Performance Decrements in Man. Proc. Nat. Symposium on Natural and Manmade Radiation in Space. NASA TM X-2440, pp. 238-248, January 1972. 46. Yuhas, J.M., Stokes, T.R., and Lushbaugh, C.C.: Multifactorial Analysis of Human Blood Cell Responses to Clinical Total-Body Irradiation. Ibid., pp. 233-237. 47. Beck, W.L., Stokes, T.R., and Lushbaugh, C.C.: Dosimetry for Radiobiological Studies of the Human Hematopoietic System. Ibid., pp. 974-980. 48. Lushbaugh, C.C.: Predicted Levels of Human Radiation Tolerance Extrapolated from Clinical Studies of Radiation Effects. Ibid., pp. 398-415. 49. Lushbaugh, C.C. and Ricks, R.C.: Some Cytokinetic and Histopathologic Considerations of Irradiated Male and Female Gonadal Tissues. Proc. Symp. Mt. Sinai Cancer Clinic, 1970. University Park Press, 1972. 50. Ricks, R.C., Lushbaugh, C.C., and McDow, A.E., Jr.: Correlation of Heart Rate and CO2 Production with Pulmonary Impedance During Exercise Stress in Man. Fed. Proc. 31: 311, 1972 (abstract 544). 51. Ricks, R.C., Lushbaugh, C.C., and McDow, A.E., Jr. Pulmonary Impedance Power Spectral Analysis: Its Correlation with Heart Rate and Expired CO2 During Exercise Stress in Man. Fed. Proc. 31: 311, 1972 (abstract 544). 52. Stokes, T.R., Lushbaugh, D., Humason, G., and Lushbaugh, C.C. 59Fe Studies on the Erythroblastic Response of Normal and Splenectomized Mice to Low Level Continuous Radiation. Radiat. Res. 51: 472-473, 11972 (abstract). 53. Beck, W.L., Cloutier, R.J., and Watson, E.E. Personnel Monitoring with Film and Thermoluminescent Dosimeters for High Exposures. Health Phys. 25: 421-425, 1973. 54. Cloutier, R.J., Watson, E.E., Rohrer, R.E., and Smith, E.M.: Calculating the Radiation Dose to an Organ. J. Nucl. Med. 14: 53-55, 1973. 55. Lushbaugh, C.C.: Human Radiation Tolerance. Chapter 10. In Space Radiation Biology and Related Topics. C.A. Tobias and P. Todd, eds., Academic Press. New York, 1973, pp. 475-522. 208 56. Lushbaugh, C.C.: Contribution to: HZE-Particle Effects in Manned Spaceflight. D. Grahn, ed. Radiobiologica Advisory Panel, Committee on Space Biology, Space Science Board, National Research Council, Washington, National Academy of Sciences, 1973. 57. Lushbaugh, C.C.: Book Review: Manual on Radiation Haematology. A joint undertaking by IAEA and WHO, Technical Report Series No. 123, IAEA, Vienna, 1971. Health Phys. 24: 456, 1973. 58. Frome, E.L., Fredrickson, E.L., and Ricks, R.C.: Power Spectrum of the Respiratory System via the Pulmonary Impedance Pneumograph. In Proceedings of the 10th Biomathematics and Computer Science in the Life Sciences, Houston, Texas, 1973. 59. Beck, W.L., Stokes, T.R., and Lushbaugh, C.C.: Dosimetry for Total-Body Irradiation Therapy. In Health Physics in the Healing Arts, Seventh Midyear topical Symposium, Health Physics Society, San Juan, Puerto Rico, December 1972. DHEW Publication (FDA) 73-8029, p. 423, 1973. 60. Cloutier, R.J. and Watson, E.E.: Radiation Doses from Nuclear Medicine Procedures. Ibid., pp. 71-78. 61. Ricks, R.C. and Lushbaugh, C.C.: Changes in Serum Creatine Phosphokinase (SCFK) Levels After Total-Body Irradiation. Aerospace Med., 1973. 62. Ricks, R.C. and Lushbaugh, C.C.: The Influence of Exercise Conditioning on the Performance Decrement Effects of Total-Body Irradiation. Health Phys. 27: 614, 1974 (abstract). 63. Ricks, R.C. and Lushbaugh, C.C.: Quantitation of Radiation-Induced Changes in Man. Rad. Res. 59: 39, 1974 (abstract). 64. Lushbaugh, C.C. and Yuhas, J.M.: Pathological Features of Radiation-Induced Murine Pulsonary Carcinomas and Their Metastases. Rad. Res. 59: 222, 1974 (abstract). CHAPTER VII APPENDIX A. List of Cooperating Institutions in Retrospective Studies Hospitals Participating in Study Albert Einstein Medical Center Baylor University: Jefferson Davis Hospital V.A. Hospital at Houston Texas Medical Center Burge Protestant Hospital Cincinnati General City of Hope Medical Center Charity Hospital Colorado General Ellis Fischel State Cancer Center Franklin Hospital Jefferson Medical Center Long Beach Community Hospital Los Alamos Hospital Mary Imogene Bassett Massachusetts General (McG) M.D. Anderson Hospital Medical College of Virginia New York Memorial Hospital Oak Ridge Associated Universities Medical Division Penrose Cancer Clinic Peter Bent Brigham Hospital Portland: Emanuel Hospital Dr. Hyman's Clinic Portland Medical Center Princess Margaret Hospital Providence Hospital Rhode Island Accident Spokane: Deaconess Hospital Rockwood Clinic Sacred Heart Hospital Milo Harris Clinic Swedish Hospital Temple University Thomas M. Fitzgerald Mercy U.S. Naval Hospital U. of California Medical School, S.F. U. of Michigan U. Of Washington V.A. Hospital at Denver V.A. Hospital at Long Beach V.A. Hospital at New Orleans Vancouver: British Columbia Cancer Institute Royal Columbian Hospital Vancouver General Hospital White Memorial Medical Center 214 Medical Paramedical Computer E.G. Anderson E.A. Anderson Paulette Aaron G.A. Andrews Norzal Asbury Thomas Akin Edward Bird Mildred Bailey Robert Beaver F.V. Comas Frances Banner Linda Brown C.L. Edwards T.R. Barclay Ed Frome Dieter Enrich W.L. Beck Arthur Glaster Kong-oo Goh Per-Erik Bergner Martha Hansard F.A. Goswitz Sarah Cecil Janice Ishee K.F. Hubner Carol Chabot Earl McDow R.M. Kniseley Kay Clayton Daniel McFaddin C.C. Lushbaugh Martha Clevenger Richard Queener B. Nelson R.J. Cloutier Mona Smith Etna Palmer Shirley Colyer Jimmie Sanders Ryosaku Tanida Lydia Corrill M. Van Woert J.T. Crockett H.A. Vodopick Evelyn Cunningham Glenda Fritts Dorothy Gaither Lucy Auburn W.D. Gibbs Margie Bagley J.H. Harmon Carol Bingham Joyce Hewins Margaret Blackburn Wanda Hodge Ervin Bobo Harold Hodges Helen Brinker Elizabeth Holloway Ruth Capshaw Julia Hopper James Cozart Mildred Hyp Mary Nell Craig Gretchen Humason John Dean Jane Kimbro Thelma Eden Barbara LeClerc Erin Hartman Kathryn McCulloch June Geldmeier Willa Fae Loveday Mable Helton Dorothy Lushbaugh Rita Holt Kathryn McCulloch Rufus Jackson Maryrose McGown Earl Jacobs Jean McIntyre Sandra Landry A.C. Morris Martha Laxton Francine Pennington Bedford Mayott Evalyn Repplinger Barbara Nance Robert Ricks Benua Pack Emily Roemer Garfield Porter Elizabeth Rupp Naomi Presnell Billie Ryan Mary Rogers Evelyn Sipe Bernice Salley Vivian Smith Lillie Simmons T.R. Stokes Marilyn Smith Katherine Stubbs Elaine Stoetzel Mary Thomas Mary Sutliff Mary Watkins Eugene Weaver Allen Webb Martha Williams Sondra Wilson Lillie Woods