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Review of Toxicologic and Radiologic Risks to Military Personnel from Exposure to Depleted Uranium During and After Combat (2008)
Board on Environmental Studies and Toxicology (BEST)

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat

Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat

Committee on Toxicologic and Radiologic Effects from Exposure to Depleted Uranium During and After Combat

Committee on Toxicology

Board on Environmental Studies and Toxicology

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat Committee on Toxicologic and Radiologic Effects from Exposure to Depleted Uranium During and After Combat Committee on Toxicology Board on Environmental Studies and Toxicology Division on Earth and Life Studies NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat THE NATIONAL ACADEMIES PRESS 500 FIFTH STREET, NW WASHINGTON, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by Contract W81K04-06-D-0023 between the National Academy of Sciences and the U.S. Army. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-11036-5 International Standard Book Number-10: 0-309-11036-X Additional copies of this report are available from The National Academies Press 500 Fifth Street, NW Box 285 Washington, DC 20055 800-624-6242 202-334-3313 (in the Washington metropolitan area) http://www.nap.edu Copyright 2008 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat COMMITTEE ON TOXICOLOGIC AND RADIOLOGIC EFFECTS FROM EXPOSURE TO DEPLETED URANIUM DURING AND AFTER COMBAT Members MERYL H. KAROL (Chair), (Emerita) University of Pittsburgh, Pittsburgh, PA CHERYL B. BAST, Oak Ridge National Laboratory, Oak Ridge, TN DEEPAK K. BHALLA, Wayne State University, Detroit, MI DAVID W. GAYLOR, Gaylor and Associates, LLC, Eureka Springs, AR ROBERT A. GOYER, (Emeritus) University of Western Ontario, London, ON, Canada SIDNEY GREEN, JR, Howard University, Washington, DC KATHRYN A. HIGLEY, Oregon State University, Corvallis SAM KACEW, University of Ottawa, Ottawa, ON, Canada P. ANDREW KARAM, MJW Corporation, Rochester, NY RONALD L. KATHREN, (Emeritus) Washington State University, Richland JAMES N. MCDOUGAL, Wright State University School of Medicine, Dayton, OH BRUCE A. NAPIER, Pacific Northwest National Laboratory, Richland, WA ROY E. SHORE, Radiation Effects Research Foundation, Hiroshima, Japan KATHERINE SQUIBB, University of Maryland, Baltimore Staff KULBIR S. BAKSHI, Senior Program Officer RICK JOSTES, Senior Program Officer SUSAN N. J. MARTEL, Senior Program Officer for Toxicology ELLEN K. MANTUS, Senior Program Officer NORMAN GROSSBLATT, Senior Editor AIDA C. NEEL, Program Associate RADIAH ROSE, Senior Editorial Assistant

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat COMMITTEE ON TOXICOLOGY Members WILLIAM E. HALPERIN (Chair), UMDNJ-New Jersey Medical School, Newark LAWRENCE S. BETTS, Eastern Virginia Medical School, Norfolk EDWARD C. BISHOP, HDR Engineering, Inc., Omaha, NE JAMES V. BRUCKNER, University of Georgia, Athens GARY P. CARLSON, Purdue University, West Lafayette, IN MARION F. EHRICH, Virginia Polytechnic Institute and State University, Blacksburg SIDNEY GREEN, Howard University, Washington, DC MERYL H. KAROL, University of Pittsburgh, Pittsburgh, PA JAMES N. MCDOUGAL, Wright State University School of Medicine, Dayton, OH ROGER G. MCINTOSH, Science Applications International Corporation, Abingdon, MD GERALD N. WOGAN, Massachusetts Institute of Technology, Cambridge Staff EILEEN N. ABT, Senior Program Officer for Risk Analysis SUSAN N. J. MARTEL, Senior Program Officer for Toxicology KULBIR S. BAKSHI, Senior Program Officer ELLEN K. MANTUS, Senior Program Officer MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center TAMARA DAWSON, Program Associate RADIAH A. ROSE, Senior Editorial Assistant

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY1 Members JONATHAN M. SAMET (Chair), Johns Hopkins University, Baltimore, MD RAMÓN ALVAREZ, Environmental Defense, Austin, TX JOHN M. BALBUS, Environmental Defense, Washington, DC DALLAS BURTRAW, Resources for the Future, Washington, DC JAMES S. BUS, Dow Chemical Company, Midland, MI RUTH DEFRIES, University of Maryland, College Park COSTEL D. DENSON, University of Delaware, Newark E. DONALD ELLIOTT, Willkie Farr & Gallagher LLP, Washington, DC MARY R. ENGLISH, University of Tennessee, Knoxville J. PAUL GILMAN, Oak Ridge Center for Advanced Studies, Oak Ridge, TN SHERRI W. GOODMAN, Center for Naval Analyses, Alexandria, VA JUDITH A. GRAHAM (Retired), Pittsboro, NC WILLIAM P. HORN, Birch, Horton, Bittner and Cherot, Washington, DC WILLIAM M. LEWIS, JR., University of Colorado, Boulder JUDITH L. MEYER, University of Georgia, Athens DENNIS D. MURPHY, University of Nevada, Reno PATRICK Y. O’BRIEN, ChevronTexaco Energy Technology Company, Richmond, CA DOROTHY E. PATTON, (Retired) U.S. Environmental Protection Agency, Chicago, IL DANNY D. REIBLE, University of Texas, Austin JOSEPH V. RODRICKS, ENVIRON International Corporation, Arlington, VA ARMISTEAD G. RUSSELL, Georgia Institute of Technology, Atlanta ROBERT F. SAWYER, University of California, Berkeley KIMBERLY M. THOMPSON, Massachusetts Institute of Technology, Cambridge MONICA G. TURNER, University of Wisconsin, Madison MARK J. UTELL, University of Rochester Medical Center, Rochester, NY CHRIS G. WHIPPLE, ENVIRON International Corporation, Emeryville, CA LAUREN ZEISE, California Environmental Protection Agency, Oakland Senior Staff JAMES J. REISA, Director DAVID J. POLICANSKY, Scholar RAYMOND A. WASSEL, Senior Program Officer for Environmental Sciences and Engineering EILEEN N. ABT, Senior Program Officer for Risk Analysis SUSAN N.J. MARTEL, Senior Program Officer for Toxicology KULBIR BAKSHI, Senior Program Officer ELLEN K. MANTUS, Senior Program Officer RUTH E. CROSSGROVE, Senior Editor 1 This study was planned, overseen, and supported by the Board on Environmental Studies and Toxicology.

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Respiratory Disease Research at NIOSH (2008) Evaluating Research Efficiency in the U.S. Environmental Protection Agency (2008) Hydrology, Ecology, and Fishes of the Klamath River Basin (2008) Applications of Toxicogenomic Technologies to Predictive Toxicology and Risk Assessment (2007) Models in Environmental Regulatory Decision Making (2007) Toxicity Testing in the Twenty-first Century: A Vision and a Strategy (2007) Sediment Dredging at Superfund Megasites: Assessing the Effectiveness (2007) Environmental Impacts of Wind-Energy Projects (2007) Scientific Review of the Proposed Risk Assessment Bulletin from the Office of Management and Budget (2007) Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues (2006) New Source Review for Stationary Sources of Air Pollution (2006) Human Biomonitoring for Environmental Chemicals (2006) Health Risks from Dioxin and Related Compounds: Evaluation of the EPA Reassessment (2006) Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006) State and Federal Standards for Mobile-Source Emissions (2006) Superfund and Mining Megasites—Lessons from the Coeur d’Alene River Basin (2005) Health Implications of Perchlorate Ingestion (2005) Air Quality Management in the United States (2004) Endangered and Threatened Species of the Platte River (2004) Atlantic Salmon in Maine (2004) Endangered and Threatened Fishes in the Klamath River Basin (2004) Cumulative Environmental Effects of Alaska North Slope Oil and Gas Development (2003) Estimating the Public Health Benefits of Proposed Air Pollution Regulations (2002) Biosolids Applied to Land: Advancing Standards and Practices (2002) The Airliner Cabin Environment and Health of Passengers and Crew (2002) Arsenic in Drinking Water: 2001 Update (2001) Evaluating Vehicle Emissions Inspection and Maintenance Programs (2001) Compensating for Wetland Losses Under the Clean Water Act (2001) A Risk-Management Strategy for PCB-Contaminated Sediments (2001) Acute Exposure Guideline Levels for Selected Airborne Chemicals (five volumes, 2000-2007) Toxicological Effects of Methylmercury (2000) Strengthening Science at the U.S. Environmental Protection Agency (2000) Scientific Frontiers in Developmental Toxicology and Risk Assessment (2000) Ecological Indicators for the Nation (2000) Waste Incineration and Public Health (2000) Hormonally Active Agents in the Environment (1999) Research Priorities for Airborne Particulate Matter (four volumes, 1998-2004) The National Research Council’s Committee on Toxicology: The First 50 Years (1997) Carcinogens and Anticarcinogens in the Human Diet (1996)

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat Upstream: Salmon and Society in the Pacific Northwest (1996) Science and the Endangered Species Act (1995) Wetlands: Characteristics and Boundaries (1995) Biologic Markers (five volumes, 1989-1995) Review of EPA’s Environmental Monitoring and Assessment Program (three volumes, 1994-1995) Science and Judgment in Risk Assessment (1994) Pesticides in the Diets of Infants and Children (1993) Dolphins and the Tuna Industry (1992) Science and the National Parks (1992) Human Exposure Assessment for Airborne Pollutants (1991) Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991) Decline of the Sea Turtles (1990) Copies of these reports may be ordered from the National Academies Press: (800) 624-6242 or (202) 334-3313 www.nap.edu

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat OTHER REPORTS OF THE COMMITTEE ON TOXICOLOGY Emergency and Continuous Exposure Guidance Levels for Selected Submarine Contaminants, Volume 1 (2007), Volume 2 (2008) Review of the Department of Defense Research Program on Low-Level Exposures to Chemical Warfare Agents (2005) Review of the Army’s Technical Guides on Assessing and Managing Chemical Hazards to Deployed Personnel (2004) Spacecraft Water Exposure Guidelines for Selected Contaminants, Volume 1 (2004), Volume 2 (2007) Toxicologic Assessment of Jet-Propulsion Fuel 8 (2003) Review of Submarine Escape Action Levels for Selected Chemicals (2002) Standing Operating Procedures for Developing Acute Exposure Guideline Levels for Hazardous Chemicals (2001) Evaluating Chemical and Other Agent Exposures for Reproductive and Developmental Toxicity (2001) Acute Exposure Guideline Levels for Selected Airborne Contaminants, Volume 1 (2000), Volume 2 (2002), Volume 3 (2003), Volume 4 (2004), Volume 5 (2007), Volume 6 (2007) Review of the US Navy’s Human Health Risk Assessment of the Naval Air Facility at Atsugi, Japan (2000) Methods for Developing Spacecraft Water Exposure Guidelines (2000) Review of the U.S. Navy Environmental Health Center’s Health-Hazard Assessment Process (2000) Review of the U.S. Navy’s Exposure Standard for Manufactured Vitreous Fibers (2000) Re-Evaluation of Drinking-Water Guidelines for Diisopropyl Methylphosphonate (2000) Submarine Exposure Guidance Levels for Selected Hydrofluorocarbons: HFC-236fa, HFC-23, and HFC-404a (2000) Review of the U.S. Army’s Health Risk Assessments for Oral Exposure to Six Chemical-Warfare Agents (1999) Toxicity of Military Smokes and Obscurants, Volume 1(1997), Volume 2 (1999), Volume 3 (1999) Assessment of Exposure-Response Functions for Rocket-Emission Toxicants (1998) Toxicity of Alternatives to Chlorofluorocarbons: HFC-134a and HCFC-123 (1996) Permissible Exposure Levels for Selected Military Fuel Vapors (1996) Spacecraft Maximum Allowable Concentrations for Selected Airborne Contaminants, Volume 1 (1994), Volume 2 (1996), Volume 3 (1996), Volume 4 (2000)

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat Preface The U.S. armed forces used a new large-caliber (LC) anti-armor munition with a depleted-uranium (DU) penetrator in the 1991 Gulf War (Operation Desert Storm). The use of this high-density, self-sharpening munition helped to end that war quickly because of its effectiveness in reaching and perforating distant armored targets. In Operation Desert Storm, the U.S. armed forces used more than 300 tons of LC-DU munitions. During the course of the 1991 Gulf War, misidentification of U.S. forces in distant vehicles led to a number of incidents in which U.S. armored vehicles were struck by the LC-DU munitions. About 115 U.S. soldiers in or on six Abrams tanks and 14 Bradley fighting vehicles were struck by LC-DU munitions. Some of the 104 crewmembers who survived were injured by DU shrapnel. Most of the large metal fragments in them were removed during treatment for their injuries, but many small fragments remain embedded in their muscle tissue, and the soldiers with embedded fragments continue to be medically monitored. Because of exposure of many soldiers in Operation Desert Storm and the Balkan war and because of concern about the potential health effects on exposed soldiers and civilian contract workers in the battlefield area, the U.S. Department of Defense (DOD) requested that the National Research Council independently review the U.S. Army’s “Capstone Report” Depleted Uranium Aerosol Doses and Risks: Summary of U.S. Assessments. The Capstone Report is a set of documents that detail the basis of the Army’s assessment of the toxicologic and radiologic risks to military personnel from exposures to DU aerosols during and after combat. In response to DOD’s request, the National Research Council convened the Committee on Toxicologic and Radiologic Effects from Exposure to Depleted Uranium During and After Combat, which prepared this report. The members of the committee were selected by the National Research Council for their expertise in pharmacokinetics, toxicology, inhalation toxicology, immunotoxicology, radiation health effects, epidemiology, physiologically based pharmacokinetic modeling, biostatistics, and risk assessment. The committee’s report provides an independent evaluation of the exposure assessment and health-risk assessment provided in the Army’s report. It focuses on exposures of and risks to soldiers exposed to DU during and after combat. It is intended to be useful to DOD in updating combat planning and training involv-

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat ing DU munitions and in developing policies concerning health-care management of military personnel exposed to or injured by DU munitions. A draft of this report was reviewed by persons selected for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following for their review of this report: Gary Diamond, Syracuse Research Corporation; Judith Graham, American Chemistry Council; David Hoel, Medical University of South Carolina; Ralph Kodell, University of Arkansas for Medical Sciences; Loren Koller, Loren Koller & Associates, LLC; Richard Leggett, Oak Ridge National Laboratory; Roger McClellan, Consultant; Richard Schlesinger, Pace University; Michael Thun, American Cancer Society; Mark Utell, University of Rochester Medical Center; and Paul Ziemer, Purdue University. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Floyd Bloom, Scripps Research Institute. Appointed by the National Research Council, he was responsible for ensuring that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution. The committee gratefully acknowledges the valuable assistance provided by the following: David Alberth, Laurie Roszell, Glenn Leach, Steve Kistner, John Rowe, Mark Melanson, and Frances Szrom (all of the U.S. Army), who during public sessions provided technical materials on depleted uranium; and Aida Neel, the project associate. We are grateful to James J. Reisa, director of the Board on Environmental Studies and Toxicology, for his helpful comments. The committee particularly acknowledges Kulbir Bakshi, project director for the committee, and Susan Martel and Ellen Mantus for bringing the report to completion. Finally, I thank all members of the committee for their expertise and dedicated effort throughout the development of this report. Meryl Karol, Chair Committee on Toxicologic and Radiologic Effects from Exposure to Depleted Uranium During and After Combat

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat Contents     SUMMARY   1 1   INTRODUCTION AND TECHNICAL BACKGROUND   9      Natural Uranium,   9      Depleted Uranium and Possible Contaminants That Affect Its Chemical and Radiologic Toxicity,   10      Military Uses of Depleted Uranium,   12      Combat Exposure to Depleted Uranium,   13      Exposure Scenarios,   14      Committee Task and Approach,   15      Report Organization,   16 2   TOXICOKINETICS OF DEPLETED URANIUM   18      Absorption,   18      Distribution,   21      Metabolism,   22      Elimination,   22      Biokinetic Models,   23      Summary,   25 3   TOXIC EFFECTS OF URANIUM ON THE KIDNEYS   26      Background,   26      Human Studies,   27      Animal Studies,   38      Summary,   42 4   TOXIC EFFECTS OF URANIUM ON THE LUNGS   43      Human Studies,   44      Animal Studies,   46      Summary,   46 5   TOXIC EFFECTS OF URANIUM ON OTHER ORGAN SYSTEMS   48      Central Nervous System Effects,   48      Reproductive and Developmental Effects,   51      Hematologic Effects,   55      Hepatic Effects,   55      Immunologic Effects,   56

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat      Musculoskeletal Effects,   58      Cardiovascular Effects,   60      Ocular Effects,   60      Gastrointestinal Effects,   63      Dermal Effects,   63      Summary,   63      Recommendations,   64 6   RADIOLOGIC EFFECTS OF DEPLETED URANIUM   66      Biologic Effects of Ionizing Radiation,   66      Radiation Dose,   68      External Exposure to Depleted Uranium: Direct Radiation,   71      Internal Exposure to Depleted Uranium,   73      Epidemiologic Studies,   76      Radioactive Contaminants in Depleted Uranium,   84      Summary,   84      Recommendations,   85 7   URANIUM CARCINOGENICITY AND GENOTOXICITY   86      Animal Carcinogenicity Studies,   86      Genotoxicity of Uranium,   90      Summary,   94      Recommendations,   94 8   EVALUATION OF THE ARMY’S CAPSTONE REPORT   96      Exposure Assessment,   96      Health Risk Assessment,   107      Summary,   121      Recommendations,   122     REFERENCES   124 APPENDIX A:   BIOGRAPHIC INFORMATION ON THE COMMITTEE ON TOXICOLOGIC AND RADIOLOGIC EFFECTS FROM EXPOSURE TO DEPLETED URANIUM DURING AND AFTER COMBAT   141 APPENDIX B:   RISK OF SELECTED CANCERS AND NONMALIGNANT DISEASES AMONG URANIUM WORKERS   146 TABLES AND FIGURES TABLES S-1   REG Predictions of Chemical Risk to Kidneys in the Army’s Capstone Report,   4 S-2   Committee and Capstone Estimates of Effective Lifetime Committed Radiation Dose Equivalents from DU in Air for Selected Level I Exposure Scenarios, rem (Sv),   6

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat S-3   Capstone Summary of Median (10th-, 90th-Percentile) Estimates of Increased Lifetime Risk of Fatal Lung Cancer (Expressed as %) from Inhalation Exposures of DU for Level I Personnel from Single Perforation of Vehicle,   7 1-1   Natural Uranium Concentrations,   10 1-2   235U and 238U Decay Series,   11 1-3   Important Fission Products and Transuranic Elements Found in Spent Reactor Fuel,   12 1-4   Amount of DU Used in Recent Wars,   13 2-1   Solubility of Uranium Compounds,   19 2-2   Absorption by Exposure Route,   19 3-1   Selected Biomarkers or Biochemical Indicators of Renal Effects of Exposure to Uranium,   27 3-2   Renal Effects of Acute Exposure to Uranium in Humans,   28 3-3   Renal Effects of Chronic Exposure to Uranium in Humans,   33 3-4   Standardized Mortality Ratios (95% Confidence Intervals) and [Observed Numbers of Deaths] from Renal Diseases in Uranium Workers,   36 3-5   Renal Effects of Chronic Inhalation of Uranium Dioxide in Experimental Animals,   41 4-1   Standardized Mortality Ratios (95% Confidence Intervals) [and Observed Number of Deaths] from Nonmalignant Respiratory Diseases in Uranium Workers,   45 5-1   Standardized Mortality Ratios (95% Confidence Intervals) and [Observed Number of Deaths] for Hepatic Cirrhosis in Uranium Workers,   57 5-2   Standardized Mortality Ratios with (95% Confidence Intervals) and [Observed Numbers of Deaths] for Circulatory, Heart, and Cerebrovascular Disease in Uranium Workers,   61 6-2   Radiation Dose (Sv) and Risk per Becquerel (Bq) Intake of Depleted Uranium,   74 6-3   Radiation Dose (Sv) and Risk per Milligram Intake of Depleted Uranium,   75 6-4   Standardized Mortality Ratios with (95% Confidence Intervals) and [Observed Number of Deaths] for Selected Cancers in Uranium Workers,   78 7-1   Experimental Protocol for Inhalation Study,   93 8-1   Capstone Summary of Level I Exposure Scenario Conditions,   100 8-2   Committee-Predicted Concentrations of DU in Air in Vehicles after Impact (mg/m3),   103 8-3   Committee’s Estimated Time-Integrated Concentrations of DU in Air for Various Conditions after Impact (mg-h/m3),   104 8-4   DU Intakes Independently Estimated by Committee for Five Capstone Level I Exposure Scenarios,   104 8-5   Committee’s Estimates of Effective Lifetime Committed Radiation Dose Equivalents from DU in Air for Level I Exposure Scenarios [rem (Sv)] and Selected Capstone Results for Comparison,   105 8-6   REG Predictions of Chemical Risk to Kidneys,   109 8-7   Human Renal Effects of Acute Exposure to Uranium Cited in the Capstone Report,   109 8-8   Renal Effects of Acute and Chronic Exposure of Humans to Uranium from Published Data: Comparison with Level I Estimates in Capstone Report,   112

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat 8-9   Capstone Predicted Renal Uranium Concentrations in Level II and Level III Personnel,   115 8-10   Risk-Factor Coefficients for Fatal Cancers in Worker Population,   117 8-11   Capstone Summary of Median (10th-, 90th-Percentile) Estimates of Increased Lifetime Risk of Fatal Lung Cancer (Expressed as %) from Inhalation Exposures of DU for Level I Personnel from Single Perforation of Vehicle,   119 8-12   Various Methods of Estimating Level II Mean Exposures of DU per Hour of Work by Unprotected Personnel Around and in Vehicles with Single Perforation by DU Munition,   120 8-13   Capstone Upper Estimates of Dose per Hour of Exposure via Inhalation by Unprotected Level III Personnel,   121 B-1   Average Air Concentrations of Uranium,   149 FIGURES 2-1   Biokinetic model for uranium,   24 8-1   Committee-predicted mass concentrations of DU in air in vehicles after impact,   103

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Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat Review of the Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium During and After Combat

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