Thirteenth Prefectural Oversight Committee Meeting: Fukushima Thyroid Ultrasound Examination Results

The Proceedings of the Thirteenth Prefectural Oversight Committee Meeting for Fukushima Health Management Survey were released on November 12, 2013.  Below is the complete translation of the thyroid ultrasound examination.

Please refer to this post for the short summary.

Original Japanese document can be found here.
The official English translation is here.

Page 1
Implementation status of the "thyroid examination" in Fukushima Health Management Survey

1   Progress status and summary of the results
   (1) The primary examination
   The Fiscal Year 2013 examinations have been conducted, in approximately 158,000 participants from 34 municipalities, since April 22, 2013. In addition, participants from the previously targeted municipalities who have not been examined were encouraged to participate in the following ways: Letters have been sent to them, explaining the examination implementation outside Fukushima Prefecture or in other municipalities; and information about the examination has also been available on the website. As a result, more participants have been examined even after the end of the target year for their municipalities, and 82.4% of overall participants have been examined. ※1
   Moreover, thyroid examinations have been conducted in facilities outside Fukushima Prefecture since November 1, 2012. ※2
   Also, 94.5% of the 238,785 participants had their examination results confirmed and had them mailed. ※3,4

Progress status (as of September 30, 2013: Results have been confirmed for those examined up to August 23)

Number and proportion of nodules and cysts (as of September 30, 2013: Results have been confirmed for those examined up to August 23)

※１ Implementation status by municipality is shown in Supplement 1.
※２ Implementation status in prefectures other than Fukushima Prefecture is shown in Supplement 2.
※３ Results by municipality are shown in Supplement 3.
※４ Age and gender distribution of participants whose results have been confirmed is shown in Supplement 4.
● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down.

Page 2
   (2) The secondary examination
    Fukushima Medical University has been expanding the examination system, in an attempt to accelerate the implementation of the secondary examination. As a result, 73.6% of the 1,559 participants eligible for the secondary examination actually went through it, and 78.1% of them have completed it. ※5
    Also, in addition to Fukushima Medical University, two other medical facilities in Koriyama City and Iwaki City have been conducting the secondary examination since late July.
    Furthermore, out-of-prefecture facilities plan on conducting the secondary examination beginning in November 2013.

Progress status (as of September 30, 2013)

※5　Implementation status by municipalities is shown in Supplement 5.
● Priorities are given to those with urgent clinical needs.
● Regular follow-up examination, beginning April 2014, applies to those who were confirmed to be within the normal range (A1,A2) of the primary examination.
● Regular medical care applies to those who would need a close monitoring in about 6 months to 1 year (using national health insurance) and those who are confirmed to be beyond the normal range of A2.

Page 3
2  Summary of the fine-needle aspiration biopsy results
   (1) Results of biopsy (as of September 30, 2013)

Addendum dated November 14, found here, states, "As for one of the 26 papillary cancer cases, its histologic type is currently under close investigation."

   (2) Age and gender distribution of the 59 cases confirmed or suspected of malignancy by biopsy (as of September 30, 2013; including the case post-surgically confirmed to be benign).

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   (3) Results of the basic survey for the 59 cases confirmed or suspected of malignancy by biopsy, etc.
   21 (35.6%) of them submitted the basic survey questionnaire, and 12 (57.1%) of them were in the dose range below 1 mSv. The meaning and importance of the questionnaire will be explained to the rest of them in order to encourage them to turn it in.

Breakdown of the effective dose estimates by age and gender for those who submitted the basic survey

   (4) Blood tests and urinary iodine (as of September 30, 2013)

※1  FT4: A thyroid hormone with four iodine atoms; high in Basedow's (Graves') disease and low in Hashimoto's disease.
※2  FT3: A thyroid hormone with three iodine atoms; high in Basedow's (Graves') disease and low in Hashimoto's disease.
※3  TSH: A hormone secreted by the pituitary gland in the brain, which orders the thyroid gland to release thyroid hormones; high in Hashimoto's disease and low in Basedow's (Graves')  disease.
※4  Tg (thyroglobulin): A precursor to thyroid hormones.  Present in the thyroid gland in a large quantity.  High levels indicate destruction of the thyroid gland or production by tumor.
※5  TgAb (anti-thyroglobulin antibody): An autoantibody against thyroglobulin; high in Hashimoto's disease or Basedow's (Graves') disease.
※6  TPOAb: An autoantibody against an enzyme called peroxidase; high in Hashimoto's disease or Basedow's (Graves') disease.
※7 FT3 is corrected for age.

Page 5
   (5) Results of the secondary examination by municipality (as of September 30, 2013)

FY 2011 secondary examination results by municipality (13 municipalities nationally designated as the evacuation zones)　

※1　Does not include the case that was suspected of malignancy after biopsy but turned out to be benign after surgery.

※2　Includes subjects from outside the 13 municipalities nationally designated as the evacuation zones but underwent thyroid ultrasound examinations at schools and other locations.

FY 2012 secondary examination results by municipality (Iwaki City includes only some districts such as Hisanohama)

FY 2013 secondary examination results by municipality

Page 6
3   Implementation of the full-scale examination
   The thyroid examination conducted from October 2011 through March 2014, considered the "preliminary examination," will continue as the "full-scale examination" beginning April 2014.
   Summary of the current "preliminary examination" and the improved features in the "full-scale examination" are described below.
   From now on, in order to engage in the maintenance and promotion of participants' health, implementation plans will be established to ensure the smooth and reliable examination with cooperation from the examination facilities inside and outside Fukushima Prefecture, the concerned academic societies and the related organizations.

(1) Summary of the thyroid examination
A. Summary of the preliminary examination

Targeted subjects
Fukushima Prefecture residents who were generally 18 or under at the time of the Great East Earthquake, specifically including those who were born between April 2, 1982 and April 1, 2011.

The primary examination
The examination to assess the current status of thyroid gland (mainly the presence or absence as well as the size of cysts and nodules) using the ultrasound diagnostic equipment.

Assessment results
Assessment A: (A1) No nodules or cysts.
                          (A2) Nodules 5.0 mm or smaller or cysts 20.0 mm or smaller. 
Assessment B: Nodules 5.1 mm or larger or cysts 20.1 mm or larger.
                            Moreover, A2 will be upgraded to Assessment B if the condition of thyroid gland warrants the secondary examination.
Assessment C: The thyroid gland condition warranting the immediate secondary examination.

The secondary examination
The examination conducted on those in need of more detailed tests as a result of the primary examination. It consists of ultrasound examination, blood and urine tests, and fine-needle aspiration biopsy when needed.

(For information)
The regular follow-up examination
Beginning April 2014, the regular follow-up examination (full-scale examination) will continue every 2 years up to age 20 and every 5 years after age 20.
Regular medical care
・A re-examination is conducted, as close monitoring, generally in 6 months to 1 year.
・Consists of examinations and/or medical procedures (such as surgery).

B. Improved features for the full-scale examination
(a) Targeted subjects
   In addition to the targets subjects in the preliminary examination, those born between April 2, 2011 and April 1, 2012 are to be included, giving rise to a total targeted subjects of approximately 385,000.
(b) The implementation period
   All targeted subjects are to be examined in two years from April 2014 to March 2016.
After that, the examination is to be conducted, on a long term, every 2 years up to age 20 and every 5 years after age 20.
(c) The implementation facilities
   The primary and secondary examinations are to be conducted by the examination facilities inside and outside Fukushima Prefecture as well as Fukushima Medical University.
(d) The primary examination implementation system
   Non-school age children, college students and adults will be examined mostly at the examination facilities within Fukushima Prefecture (examinations at public facilities to be concurrently carried out until the examination system is fully established), and elementary, junior high and high school students will be examined at the traveling examinations at schools. Non-Fukushima residents are to be examined at the out-of-prefecture examination facilities.
(e) The secondary examination implementation system
   In order to facilitate the secondary examination and improve the convenience for the participants, efforts will be made towards appropriate examinations at the examination facilities within and outside Fukushima Prefecture as well as Fukushima Medical University.

Page 7 
(2) FY 2015 and FY 2016 examination schedule, proposed

4.   Simplification of the information disclosure procedure for detailed information about the thyroid examination
   In regards to the self request for information disclosure relating to the thyroid examination, 
an easier process has been established. From now on, it will be conducted as below.

   (1) For the identity confirmation, submission of an extract of the family register is no longer required. As a rule, a copy of the examination notification sent tom Fukushima Medical University or the examination result notification is to be used for identity confirmation.
   (2) Multiple steps previously carried out by the person requesting information disclosure will be, as a rule, completed in one step.
   (3) No fee will be charged for the information disclosed.

Details are to be posted on the home page of Radiation Medical Science Center for the Fukushima Health Management Survey at Fukushima Medical University , http://fukushima-mimamori.jp/.

Page 8
Supplement 1
Implementation status of the primary examination by municipality

FY 2011 target municipalities (The 13 municipalities nationally designated as evacuation zones) (as of September 30, 2013)

※1 The top row shows the number of examined participants, the middle row the progress rate in each age group, and the bottom row the proportion of the examined participants in each age group.

※2 The number of the out-of-prefecture residents who were examined during the in-prefecture examination, at the out-of-prefecture examination facilities or or the out-of-prefecture traveling examinations.
※3 The number of examinees who underwent thyroid examination at schools and other facilities outside the 13 municipalities nationally designated as evacuation zones.
● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.
● Age shown is as of March 11, 2011.

Page 9
FY 2012 target municipalities (Iwaki City includes only some districts such as Hisanohama) (as of September 30, 2013)

● Participants examined at their current schools are categorized in municipalities where schools are located. At the completion of the preliminary examination, they will be recategorized in their municipalities of residence at the time of the accident.

FY2013 target municipalities (as of September 30, 2013)

Page 10
Supplement 2
Implementation status of the primary examination by prefecture

● The number of subjects examined includes those examined at out-of-prefecture examination facilities as well as the traveling examinations by Fukushima Medical University.
● The traveling examinations by Fukushima Medical University were conducted in Niigata Prefecture (twice), Yamagata Prefecture (twice) and Kanagawa Prefecture (once).

Page 11
Supplement 3
The results of the primary examination by municipality

FY 2011 target municipalities (The 13 municipalities nationally designated as evacuation zones)　(as of September 30, 2013)

※1 The number of examinees who underwent the thyroid examination at schools and other facilities outside the 13 municipalities nationally designated as evacuation zones.
● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.

Page 12
FY 2012 target municipalities (Iwaki City includes only some districts such as Hisanohama)　(as of September 30, 2013)

● Participants examined at their current schools are categorized in municipalities where schools are located. At the completion of the preliminary examination, they will be recategorized in their municipalities of residence at the time of the accident.

Page 13
FY 2013 target municipalities (as of September 30, 2013)

Page 14
Supplement 4
1    Age and gender of participants whose examination results have been confirmed

● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.

● Age shown is as of March 11, 2011.

Page 15
2   The presence/absence and the size of nodules

(as of September 30, 2013: Results have been confirmed for those examined up to August 23)

Page 16
3   The presence/absence and the size of cysts

(as of September 30, 2013: Results have been confirmed for those examined up to August 23)

Page 17
Supplement 5
Implementation status of the secondary examination by municipality

Progress rate (as of September 30, 2013)

FY 2011 target municipalities (The 13 municipalities nationally designated as evacuation zones)

FY 2012 target municipalities (Iwaki City includes only some districts such as Hisanohama)

FY 2013 target municipalities

※1 The number of examinees who underwent the thyroid examination at schools and other facilities outside the 13 municipalities nationally designated as evacuation zones.
● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.
● Age shown is as of March 11, 2011.
● Participants examined at their current schools are categorized in the municipalities where schools are located. At the completion of the preliminary examination, they will be recategorized in their municipalities of residence at the time of the accident.

26 Thyroid Cancer Cases Confirmed in Fukushima Children: Preliminary Results of FY2011-2013 Thyroid Ultrasound Examination

Thirteenth Prefectural Oversight Committee convened on November 12, 2013, releasing the results of the latest thyroid examination as part of the prefectural health management survey.

Please refer to this post for complete translation of the full results.  

A summary of the results is provided below:

Total number of children examined as of September 30, 2013: 289,960
Total number of children whose initial examination results are confirmed: 225,537
(up to the August 23rd, 2013 examination)
     
     Assessment A1  121,525 (no nodules or cysts found)
     Assessment A2  102,453 (nodules 5.0 mm or smaller or cysts 20.0 mm or smaller)
     Assessment B     1,558 (nodules 5.1 mm or larger or cysts 20.1 mm or larger)
     Assessment C         1 (requiring immediate secondary examination)

Secondary examination includes more detailed thyroid ultrasound, blood and urine tests, and fine-needle aspiration biopsy if warranted.
      1,559 are eligible for secondary examination
      1,148 have actually undergone secondary examination
        897 finished the secondary examination

In summary, as of September 30, 2013, 26 thyroid cancer cases are confirmed and 32 have suspicious biopsy results. (As of July 31, 2013, there were 18 confirmed and 25 suspected cases).

During the committee meeting, Shinichi Suzuki, the head of the thyroid examination, mentioned that one of the 26 confirmed cancer cases was not papillary thyroid cancer: This case is undergoing cytological reevaluation to determine the subtype of thyroid cancer.
During the press conference following the committee meeting, no information was given, as to the details of individual cancer cases, such as the presence of lymph node metastasis or the type of surgery done.

Shinichi Suzuki maintains that this thyroid examination was originally initiated to assess the baseline thyroid condition of Fukushima children, as there is no such epidemiological data available in Japan, with an understanding that it was not possible to obtain pre-exposure data. It is being conducted on an assumption that the effect of radiation exposure would not be obvious for at least four years after exposure, as was seen after the Chernobyl accident.

If these cancer cases were indeed screening effects, similar malignancy would have to be expected in other parts of Japan. As for the thyroid survey conducted by the Ministry of Environment in Aomori, Yamanashi and Nagasaki Prefectures, widely recognized as a comparison study, no cancer data is available from the cases of thyroid ultrasound abnormalities detected. Also it is not age- and gender-matched, and there is a question about the possibly uneven quality of ultrasound examination itself between the two studies. The MOE spokesperson indicated that abnormal cases are undergoing further examination, and more data might become available for comparison.

Fukushima Parks: One-hour Time Limit for Playing

These photos were taken by Akemi, a single mother who had voluntarily evacuated from Fukushima City to Kyoto, over 500 km away, when she visited her parents' home in Fukushima City in March 2013.

What the sign says:

For those using the park:
Due to the effect of environmental radioactivity, please be careful of the following points in using the park.

• Please limit the use of the park to 1 hour per day.
• Please wash your hands and face and gargle after using the park.
• Please be careful not to put soil and sand in your mouth.

For inquiry, contact Fukushima City Parks and Greenery Division Phone 525-3765


This is the park where the sign is posted. Akemi says identical signs were posted at three parks near her parents’ house. The sand pit is covered with blue tarp and weighted down. Akemi says this park used to be a green park. Akemi had sent her son to Kyoto by himself first, but while she was visiting him in Kyoto for a week in August 2012, the green park was turned into a regular playground. Was it part of the decontamination effort? Akemi says there is a child who walks through this park every day on the way to school.

This photo, taken from a slightly different angle, reveals a part of the body of a green and white heavy-duty excavating equipment visible in the upper left.

From yet another angle, the photo reveals what appears to be a construction site above the park. In fact, there is a house being built there.

Akemi got closer to the construction site to shoot this photo. The Radex radiation detector shows, "0.52 μSv/h."

Any park will have official air dose rates displayed after decontamination. The sign at this park states the measurement was taken on March 11, 2013, and the air dose rate is 0.186 μSv/h. However, Akemi's Radex registers 0.49 μSv/h, nearly 2.5 times as high as the official air dose rate.

Incidentally, Fukushima television stations show "Fukushima environmental radiation levels" as in this photo, accompanied by light and easy music, as if it were weather forecast.

*****

By the way, these signs have been posted at various locations in Fukushima City since April 25, 2011.

This is a translation of a Kyodo article dated April 25, 2011.

Signs posted at Fukushima City parks caution radiation levels exceeding the regulatory limit

Fukushima City installed sign posts at two of its parks on April 25th, where the atmospheric radiation level exceeding the national regulatory limits (3.8 μSv/hr) was detected, warning park visitors, "Please limit the use to about one hour daily," and the sandpit was covered with blue tarps.

Despite the distance of over 60 km from Fukushima Daiichi nuclear power plant, "Shinobuyama Children's Forest Park" had an atmospheric radiation level detected at the same level as the national regulatory limit. Usually there are many children's voices echoing at the park where many visitors flock to admire cherry blossoms, but there was hardly anybody there.

A worker at the Fukushima City Parks and Greenery Division said, "We have been trying to make it a good park." And a neighbor woman (age 78) said with tears in her eyes, "It is lonesome not to be able to hear children's voices. We never had such a quiet spring. This nuclear accident is just so disappointing."

A similar sign post was installed at the Shinhama Park in the central part of the city where the radiation level was 0.1 above the regulatory limit (of 3.8 μSv/hr).


*****

Rules imposed for the neighborhood park limits children’s playtime to one hour.

The radioactive fallout due to the accident is called "environmental radiation" as if it were part of nature.

Discrepancies exist between the official air dose rate after decontamination and the level detected by a personal radiation detector.

A house is being newly built right near a park with a daily one-hour time limit. (Incidentally, the real estate market is apparently "hot" in Fukushima City, as those who evacuated from Hama Dori, or eastern part of Fukushima Prefecture, look to settle there).

Certainly, there are individual stories and circumstances about their reasons to remain where children can barely be outside. However, seeing these photos makes you wonder about the consequences.

*****
Note: A photo of a sign from Sakabuta Park in Koriyama City, Fukushima, mentioned to be from April 2013, was deleted as of November 16, 2013 due to the following reasons.

• Current air dose levels are not consistent with what is on the sign.
• The photo was obtained from a tweet, and its original source is uncertain.

This oversight is deeply regretted.

Fukushima Doctors Planned to Distribute Stable Iodine to Every Fukushima Resident in Vain

Note: The original title, "Fukushima Doctors' Plan to Distribute Stable Iodine to Every Fukushima Resident Thwarted by NIRS and Yamashita" was changed to "Fukushima Doctors Planned to Distribute Stable Iodine to Every Fukushima Resident in Vain" on November 9, 2013, according to the further development of the story in "Prometheus Trap" series.


Asahi Shimbun's revealing "Prometheus Trap" series has been featuring previously unpublicized stories surrounding the Fukushima nuclear accident and its aftermath. Its latest series, called "Doctors Advance on Frontline," describes what was going on at Fukushima Medical University shortly after the Fukushima nuclear accident began to unfold.

Excerpted and translated from "Prometheus Trap: Doctors Advance on Frontline #18, #19 and #20," published on November 5, 6, and 7, 2013, respectively.

*****

Fukushima Medical University is located in Fukushima City, 60 km west of Fukushima Daiichi nuclear power plant. Fukushima Medical University Hospital staff was not uninformed and inexperienced about the care of radiation-exposed patients despite its designation as a radiation exposure medical care facility. The hastily set up decontamination station was ill-equipped and poorly-staffed. In fact, physicians on staff at Fukushima Medical University Hospital felt betrayed and overwhelmed that, instead of the "super team" of radiation specialists promised to come to take care of the radiation exposed individuals, the burden was heavily and mercilessly placed upon their inexperienced shoulders. Anxiety and fear mounted amongst the staff, with some, especially women, wanting to leave the hospital and evacuate with their children. 

Meanwhile, Fukushima Medical University’s own disaster response headquarters, located in the hospital president's office, began to consider the distribution of stable iodine to residents after the radiation levels at the entrance to Fukushima Daiichi nuclear power plant increased on March 12, 2011. Stable iodine saturates the thyroid gland with nonradioactive iodine to prevent the radioactive iodine uptake by thyroid gland, thus preventing radiation-induced thryoid cancer. Thyroid cancer incidence skyrocketed, especially in young children who rarely develop thyroid cancer, after the Chernobyl accident in 1986. Vice president of the hospital and pediatrician, Mitsuaki Hosoya, thought residents must be really anxious about the situation, considering that hospital staff evidenced fear of radiation. He thought they needed to establish a system for immediate administration of stable iodine to residents in case the need arose. They decided to have neighborhood pharmacies administer stable iodine, which would allow every Fukushima resident to take it. 

Vice president of Fukushima Medical University Hospital and pediatrician, Mitsuaki Hosoya

(Photo from Asahi Shimbun)

On March 13, 2013, the head of the hospital pharmacy contacted the president of Fukushima Pharmacist Association, who immediately agreed to cooperate and quickly faxed an instruction on how to make iodine syrup for babies and infants to 850 pharmacies in Fukushima Prefecture. The hospital pharmacist learned from Fukushima Prefecture that there were 240,000 stable iodine tables and 6 kg of stable iodine powder, and additional 500,000 were being ordered. The pediatrics department at the hospital already knew how many children had evacuated from areas near the Fukushima Dai-ichi nuclear power plant: these children would be needing the stable iodine the most. They had decided to tell the residents on television to go to the nearest pharmacy for the stable iodine distribution and administration.

The fax button that sent an instruction on how to make pediatric-dose iodine syrup to 850 pharmacies in Fukushima Prefecture. (Photo from Asahi Shimbun)

On March 14, in the midst of the preparation for the stable iodine distribution, National Institute of Radiation Sciences (NIRS) published a statement, forbidding the consumption of gargling medicine containing iodine as well as telling the public the stable iodine can only be taken at specified locations only if ordered. 

However, Hosoya was prepared to ignore this statement, thinking the danger of thyroid cancer weighed more than the potential side effects, if the need ever arose.

Also in the morning of March 14, 2011, Fukushima Medical University administrators began to look for someone who could explain the danger of radiation to the staff to calm their fear of radiation. Shinichi Suzuki, an endocrine surgeon, said Shunichi Yamashita, an endocrinologist at Nagasaki University, who conducted thyroid research in Belarus after the Chernobyl accident, was "the only person who could explain about radiation in an easy-to-understand yet scientific manner." An official arrangement between Nagasaki University and Fukushima Prefecture was made for Yamashita to come to Fukushima Medical University, upon an official request by Fukushima Governor,  to present accurate scientific knowledge of radiation.

Meanwhile, Fukushima Medical University was distributing stable iodine to the staff members in order to calm the fear, anxiety and confusion amongst them, especially in young women and those with children. Top priority was given to medical staff under age 40 who would be engaged in medical care of the radiation-exposed and personnel who were taking radiation measurements in the hospital. Next in line was staff in outpatient clinics under age 40, followed by female staff under age 40. The top priority group was given stable iodine beginning on March 12, out of 1,000 tablets in stock. By noon on March 15, 4,507 tablets were distributed as more stable iodine tablets came in from the pharmaceutical wholesaler. 4,000 tablets were received from Fukushima Prefecture on March 15, 2,000 more from the wholesaler on March 16, allowing distribution to Fukushima Medical University teaching faculty and office personnel. The timing of administration was left up to each work site, but many apparently took it as soon as it was distributed.

After a Hiroshima University professor from the acute radiation exposure medicine management headquarter set up by the Ministry of Education, Culture, Sports, Science and Technology told them there was a potential danger of Unit 4 exploding in the evening of March 15, a decision was made to distribute the stable iodine to children of the staff. Children were to be administered the stable iodine either "at the time of explosion" or "when the air dose rate is 100 μSv/h." 

Everyone at Fukushima Medical University was to keep secret the fact the stable iodine was distributed.

Although the hospital staff appeared to calm down after the distribution of stable iodine,  Fukushima Prefecture was not giving them permission for administration of stable iodine to residents as planned by the vice president of the hospital, Hosoya. He had to leave the decision to Shunichi Yamashita, who was to come to Fukushima Prefecture on March 18.

Nagasaki University Professor, Shunichi Yamashita

(Photo from Asahi Shimbun)

At 6 pm on March 18, Shunichi Yamashita did a presentation, along with two colleagues, Naoki Matsuda and Noboru Takamura, to about 300 staff members of Fukushima Medical University in a large conference room. Yamashita focused on the presumed necessity of stable iodine, insisting that it was not necessary to administer stable iodine: 

1) Prevention of thyroid cancer by stable iodine is a misunderstanding and nothing more than "Iodine belief." Japanese people's thyroid glands would only absorb 15 to 25 % of radioactive iodine, whereas Belarusians would absorb 40 to 50 % of radioactive iodine.
2) Exposure dose to radioactive iodine in the 20 km zone and west of the 30 km zone would most likely be below 1 mSv. As this is significantly less than Chernobyl, the Japanese government would not order stable iodine administration.
3) The stable iodine administration manual  should not be used as it contains many errors.

At the end of his presentation, Yamashita told the staff, "Please don't run away. Radiation exposure from this accident is a fate of Japan which promoted nuclear power plants despite being earthquake-prone.

Although Yamashita appeared confident, not all staff members were convinced: some physicians were obviously angry that the hospital administration arranged the presentation specifically for the purpose of calming down and soothing the hospital staff.

 (End of the excerpt)

*********
Commentary:

Significance of this story is multi-layered.

Why Fukushima Medical University Hospital was singled out as the facility to decontaminate and care for the radiation-exposed and injured individuals is a mystery. The hospital staff was overwhelmed due to inexperience and wondered why more experienced NIRS didn't handle the matter. Apparently, patients often were transported to NIRS after decontamination and stabilization anyway, leaving the mess of radiation contamination to be dealt with by Fukushima Medical University.

The fact that stable iodine was distributed to the Fukushima Medical University Hospital staff might be reasonable, considering they were expected to fulfill their duty on site, no matter how badly the patients might be contaminated. It could be considered not so much the privilege of being at the medical institution as the necessity for integrity of medical care structure and maintenance of moral needed to face difficult tasks. However, the fact the staff was sworn to secrecy could appear to make it all about privilege. If it is any consolation, at least the hospital staff was seriously considering taking care of the community, ascertaining easy access for every Fukushima resident to stable iodine. It is extremely unfortunate their effort could not be carried out due to an "order" by NIRS, the institution with the knowledge and expertise in handling radiation exposure. NIRS, incidentally, was the institution that funneled the data to UNSCEAR, the United Nations Science Committee on Effects of Atomic Radiation, on behalf of the Japanese government. Just what data NIRS gave to UNSCEAR is unknown as the full version of the UNSCEAR 2013 Fukushima report is not to be published until January 2014. Curiously, the chairman of the board at NIRS, Yoshiharu Yonekura, is not only the representative of the Japanese delegation to UNSCEAR but also the UNSCEAR rapporteur for the next two years, which seems odd considering Japan is the country that is the subject of UNSCEAR's report.

The fact that the hospital staff was not allowed to execute their plan to distribute stable iodine to every Fukushima resident has potentially significant implications for children.

As of July 31, 2013, there are 18 Fukushima children confirmed with thyroid cancer and 26 more were awaiting excisional biopsy (meaning surgery to remove thyroid tissue) to confirm the equivocal result of fine-needle aspiration biopsy (meaning thyroid cells aspirated suggested they could be cancer cells). The majority of over 360,000 Fukushima children were never given stable iodine. It is anybody's guess if these thyroid cancer cases would have arisen if the children would have been given stable iodine prophylaxis. For the time being, the Fukushima pediatric thyroid cancer cases are officially considered to reflect "the screening effect" due to mass screening of asymptomatic children with the use of highly sophisticated ultrasound equipments. In addition, it is "officially too soon" for radiation-induced thyroid cancer to be detected, as the Chernobyl cases had latency of 4 to 5 years.

Curiously, Fukushima Medical University is reluctant to release any extra information about these cancer cases such as estimated exposure dose for each case, citing patient confidentiality. Shinichi Suzuki has repeatedly stated that these cancer cases are the result of screening effect and thus unlikely to be associated with radiation exposure. The Japanese government also insists that Fukushima's thyroid abnormalities are from the screening effect, considering similar percentages of thyroid ultrasound abnormalities discovered in the Ministry of the Environment (MOE) survey of three other prefectures, Aomori, Yamanashi and Nagasaki. For clarification, the MOE survey was not exactly age- and gender-matched to the Fukushima cohort, and there is some doubt about the standardization of the ultrasound procedure itself. (Parents have noted the Fukushima Medical University examination is very short, possibly not finding every abnormality that might be detected in a more thorough examination. In other words, the amount of time spent conducting the ultrasound examination might not be consistent between the Fukushima and the MOE cohorts). In addition, it should be the rate of thyroid cancer being compared between the two cohorts, not so much so-called B assessment indicating nodules equal to and larger than 5.1 mm or cysts equal to or larger than 20.1 mm, as some of these findings can turn out to be benign conditions.

Is it medically acceptable to be drawing such conclusions when the first round of thyroid examination has not even concluded? Or, is it merely their wishful thinking for it to be a screening effect?

The truth is, we may not be able to draw any definite conclusion until the first round of thyroid examinations in all Fukushima children is complete at the end of this fiscal year. The overall findings might well establish a new baseline for the actual prevalence of thyroid cancer for future comparison, if the current finding did indeed represent a screening effect. However, medically speaking, we should reserve any hasty judgement  and simply observe and record what we find, yet provide appropriate and compassionate medical care including any necessary tests to assess general health conditions of those exposed, not just limited to thyroid examination.

Needless to say, Yamashita's statement, "Please don't run away. Radiation exposure from this accident is a fate of Japan which promoted and built nuclear power plants despite being an earthquake-prone country." is not only inappropriate as a physician but deeply disturbing as a human being. It could very well have been the beginning of many other "statements" he would be making from this day on.

For now, we await the upcoming announcement of the latest results of the ongoing thyroid examination on November 12, 2013.