● このスライドは、非営利かつ個人的な目的に限り閲覧することができます。
The following presentation slides are shared with symposium participants exclusively for personal, noncommercial, educational purposes.
● このスライドの著作権は、講演の発表者本人に帰属します（図表等の引用箇所は除く）。如何なる国・地域においても、また紙媒体やインターネット・電子データなど形態に関わらず、スライドの全部または一部を無断で複製、転載、配布、送信、放送、貸与、翻訳、販売、変造、二次的著作物を作成すること等は、固く禁止します。
Copyright of these slides belongs to the presenter and/or the Radiation Medical Science Center for the
Fukushima Health Management Survey, Fukushima Medical University (except figures, tables, etc., cited fromother sources). It is strictly prohibited to reproduce, reprint, distribute, transmit, broadcast, loan, translate, sell,modify, and/or create derivatives of any slides, in any physical or electronic medium anywhere in the world.
● このスライド日本語版は国際シンポジウム事務局による仮訳です。正本は英語版となります。
The English-language slides, as shown during the symposium presentation, best reflect the author’s intent.
Japanese translations by the symposium secretariat should be regarded as provisional and for reference purposes
only.

2024年 福島県立医科大学『県民健康調査』国際シンポジウム
公立大学法人福島県立医科大学放射線医学県民健康管理センター
国際シンポジウム事務局（広報・国際連携室）✉ kenkani@fmu.ac.jp Tel: 024-581-5454(平日9～17時)
2024 Fukushima Medical University International Symposium on the Fukushima Health Management Survey
Secretariat of International Symposium
Office of Public Communications and International Cooperation, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University✉ kenkani@fmu.ac.jp, TEL: +81-24-581-5454 (Weekday, 9a.m. - 5 p.m. JST)Collaboration with International
Organizations
Lessons from Fukushima
May Abdel-Wahab, MD, PhD, FACR, FASTRO
2024 Fukushima Medical University International International Symposium on Fukushima Health Management Survey
Build Back Better together
Session 3.11: Sharing Lessons from Fukushima with Japan and the World
Saturday March 2nd 6:15-7:00 am CET

Outline• General overview of radiation exposure.

• How do patients, as well as local population concerned with radiation effects,
process information• Radiation risk assessment and communication• Examples of IAEA support during Fukushima• The IAEA Division of Human Health in collaboration with the Hiroshima
University, Fukushima Medical University, and Nagasaki University, among
others, STS projects in radiation, health, and society over the years• Rays of Hope initiative and the new STS projectCommunicating Radiation Dose

https://www.nirs.qst.go.jp/data/20130502.pdf

Adult dose compared to Background Radiation Level

Contextualize

Reasoning
tailored forpatients andreturnees

HEALTH RISKS FROM EXPOSURE TO LOW LEVELS OF IONIZING RADIATION BEIR VII PHASE 2:
https://www.nap.edu/read/11340/chapter/1

Classic Human Brain Anatomy and Physiological
Activities
Parietal Lobe: Sensory from Skin and Muscles
Multi-Sensory Processing

Initiation of Voluntary Muscles
Frontal Lobe: Orientation, Head and Eye Movements & Posture

Frontal Lobe: Problem Solving, Creativity, Emotional Expression & Behavioural Control
Cerebellum: Voluntary Movements, Posture, Balance, Co-ordination & SpeechOccipital Lobe: Perception, Eye Movements, Visual Memory & Association
Sciences, C.B., SPL. 2014.

Anatomy of Human Brain and Physiologic Activities

https://mi-psych.com.au/your-brains-3-emotion-regulation-systems/
https://quarterjack.tumblr.com/post/138626982205/triunebrain-humanbrain-brain-reptiles-mammals

Health Literacy

Socioeconomic
Access andUtilization

Culture/ Language

Age
Race/ Ethnicity

HealthLiteracy

Provider-PatientInteraction

Education

Self-careSensory/ Perception
Cognition

Adapted from Paasche-Orlow and Wolf (2007)

HealthOutcomes

Gender-specific differences doctor-patient communication
Male Physicians
Information giving
Biomedical
Psychosocial
Directive
Nondirective
Quality

Estimated pooled
gender effectsizes forcategories ofpatient-physician
communication
Base: 23 observational studies and 3 large
physician-report studies reported in 29 publications
met inclusion criteria and were rated

Female Physicians

Question asking
GeneralBiomedical
Psychosocial
Closed-ended
Open-ended

Partnership behaviours
ActivePassive
Socioemotional behaviour
Social conversation
Positive talkNegative talkEmotionally focused talkPositive nonverbal
Length of visit

-0.6

-0.4

-0.2

0

0.2

Effect Size

Source: Adapted from Roter, D. L., Hall, J. A., & Aoki, Y. (2002). Physician gender effects in medical communication: a meta-analytic review. Jama, 288(6), 756-764.

*Error bars indicate 95% confidence intervals

0.4

0.6

Communication and messages• KEEP IT SIMPLE:• Develop messages at a 6th•

grade reading level
Avoid jargon and scientificallycomplex terms.

• KEEP IT BRIEF:• Make messages for the publicbrief, concise and clear.

• KEEP IT TO THE POINT:• Follow the 27/9/3 rule.

In high-stresssituations, aspokesperson is judged
primarily byactions/non-verbal
communications before
audience members
ever listens to themessage
Risk Communication MythYou can’t anticipate what people
will ask
Truth
95 percent of all questions andconcerns of all stakeholders for
all controversies are predictable
and can be anticipated inadvance.

https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/EPA-Communicating-Radiation-Risks.pdf
https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/EPA-Communicating-Radiation-Risks.pdf ((Hyer & Covello, 2007)

The Influence of Background Behaviours
during Medical Encounters
Despite there is a clear trend towards open communication between doctors andpatients worldwide, distinct characteristics may affect the doctor-patient interaction

Variables to beconsidered to
improvecommunicationin the medical
setting

Backgroundvariables

Communication
content• Culture & doctor-patient
relationship• communicative behaviors• satisfaction• task vs. affective oriented
behaviors• compliance• personal characteristics ofboth patient and doctors• Characteristics of thedisease• phase of the patient's
illness

Patient outcomes• recall and understandingof information• health status• relationship level

Source: Adapted from Ong, L. M., De Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: a review of the literature. Social science & medicine, 40(7), 903-918.

Communication and Messages
Myth:Myth:
Communicating risk ismore likely to alarm
qierujigjpqwjiheqihihwqeih
peopleewq rather than calmthem.

Truth:

Truth:

This can be avoided if operated
properly. Educate and inform the public,
oihrowqrhyoiwqhyroerhoqi
outlining the whole picture. Make space
heowqiehhwqeiuhewqeoih
for them to voice their concerns, ask
eq questions and process the answers.

Wheeler, S. 2011.

The role of experts in post accident recovery:
lessons learnt from Chernobyl and Fukushima
Involvement and empowerment of the affected population to make informed decisions
Established places
for dialogue

Rapidly
implementation of
the projects toaddress theidentified problems

The development of apractical radiologicalprotection culture, enabling
the affected populations tomake choices and tobehave wisely

The use of acommonlanguage

The evaluation anddissemination of results

Source: Adapted from Gariel, J. C., Rollinger, F., & Schneider, T. (2018). The role of experts in postaccident recovery: lessons learnt from Chernobyl and Fukushima. Annals of the ICRP, 47(3-4), 254-259.

The need toperform
assessments

Risk Communication
Risk communication
systems

Dynamic listening andrumour management

PolicyCapacity

Communication
engagement withaffected communities

Internal & partner
communication &coordination

SciencePublic communication

WHO Risk Communication Training: http://www.who.int/risk-communication/training/module-b/en/index1.html
P. Sandman et al (1994). Risk Communication. Encyclopaedia of the Environment. Houghton Mifflin. pp.620-623.
http://www.psandman.com/articles/riskcomm.htm
Image: P. Sandman et al (1994). Risk Communication. Encyclopaedia of the Environment.
Houghton Mifflin. pp.620-623. http://www.psandman.com/articles/riskcomm.htm

Why Improve Communication?
• Ineffective communication (in emergency situations) canresult in negative consequences, i.e. public fear andconfusion• Quickly and effectively disseminate information
Policy• Technical facts• Individual Risk
• Safety Information

Capacity

Science• Close ‘Communication Gap’ between technical expertiseand public understanding• Increase public trust of official announcements and sourcesof information
Image: P. Sandman et al (1994). Risk Communication. Encyclopaedia of the Environment.
Houghton Mifflin. pp.620-623. http://www.psandman.com/articles/riskcomm.htm

The Impact of the Fukushima Accident: Big Data Analysis

After. 11th March 2011

Before. 11th March 2011

A comparison of the associated universities (green), topics (blue) and diseases (red) found throughassociation rule mining for ‘Nuclear Power’Source: Adapted from Lansdall-Welfare, T., Sudhahar, S., Veltri, G. A., & Cristianini, N. (2014). On the coverage of science in the media: A big data study on the impact of the Fukushima disaster. In 2014 IEEE International Conference on Big Data (pp. 60-66). IEEE.

The gap between residents’ risk perception and their actual
exposure doses have not changed, even 7 years after the accident
Residents’ perception that adverse health effects would occur from 1 mSv per year of radiation exposure

Comparison of Kawauchi residents' perception in 2014 and 2017
2017

8%

2014

31%

14%

0%

10%

24%

20%

Yes

30%

40%

Probably Yes

50%

43%

19%

45%

17%

60%

Probably No

70%

80%

90%

No

Source: Adapted from Sato, N., Orita, M., Taira, Y., & Takamura, N. (2018). Seven years post-Fukushima: overcoming the resident–specialist gap. Journal of radiation research, 59(4), 526-527.

100%

Patient satisfaction with Doctor-Patientcommunication during telemedicine
Research suggests that despite physical separation, communication during telemedicine
is not inferior to communication during in person consultations
5

Patient
satisfaction with
Telemedicine
versus In-Person
consultation

4

3

2

(n = 221)

1

Patient-centeredcommunication

Clinical competence

Source: Adapted from Agha, Z., Schapira, R. M., Laud, P. W., McNutt, G., & Roter, D. L. (2009). Patient satisfaction with physician–patient communication during telemedicine. Telemedicine and e-Health, 15(9), 830-839.

Interpersonal skills

Convenienceof carePatients’ Perspectives▪ Develop welcoming
ritual▪ Be present▪ Choose positive words▪ Nonverbal
communication▪ Ask open-ended
questions▪ Show empathy▪ Ask-Tell-Ask▪ Ensure buy-in throughshared decisionmaking▪ Leave on a good notehttps://www.physicianspractice.com/patient-relations/9-ways-improve-your-patient-communications
https://healthecommunications.files.wordpress.com/2011/11/trip-to-doctors-office3.jpg AND
https://healthecommunications.files.wordpress.com/2012/04/patient-visit-expectations.jpg

IAEA expertise (NA and NS)•

Department Nuclear Applications (NA)– Division of Human Health• NMDI, ARBR, DMRP, NAHRES, Directors Officeo Department Nuclear Applications (NA)▪ Division of IAEA Environment Laboratories• Radiometrics, Radioecology, Marine environmental
studies, Terrestrial Environmento Department Nuclear Applications (NA)
▪ Joint FAO/IAEA Division of Nuclear Techniques in Food andAgriculture• Soil and Water Management and Crop Nutrition Section• NAFA-Food and Environmental Protection Section

IAEA expertise (NA and NS)•

Department Nuclear Safety (NS)– Incident and Emergency Centre• Crisis communication• Emergency Preparednesso Department Nuclear Safety (NS)▪ Division of Radiation, Transport and Waste
Safety• NSRW-Radiation Safety and Monitoring
SectionPluso DGOC-Director General's Office for Coordinationo OPIC-Office of Public Information andCommunicationo MTCD-Division of Conference and Document
Services▪ MTCD-Publishing SectionCost

Government- based laboratories

High- throughput systems

Low

High

Cost and throughput relationship of measuring
radioactivity in food during a nuclear emergency

Single NaI detectors

Small community- scale initiatives

Low

Throughput
Slides Courtesy G DerconHighPublished Reports Examples

2015

2018

2021

2020

2022

2016

STS Approacho The interdisciplinary field of Science, technology and society

studies (STS) deals with how science (and technology) is made,communicated, and acted upon in social, political, and culturalcontexts.

o Communication strategy▪ Contextualize information▪ Deflect distractions to allow focus on critical tasks▪ Provide a single source of information and standard communication
protocols▪ Offload the need to retrieve, retain, and record information▪ Weed out extraneous information
Adapted after: Radiation Risk Communication in Fukushima from an STS Perspective Gregory Clancey, National Universityof Singapore, 2019https://www.healthcareitnews.com/news/5-point-communication-strategy-help-reduce-clinicians-cognitive-load

Timeline of STS Projects and Medical Physics (NA21)
NA9/16NA9/17NA21

NA9/24NA39

2013. JUL [Singapore]
Singapore Conference

2013. NOV [Fukushima]
FMU International Conference

2013. JUN [Vienna]
Technical Meeting 1

2013. OCT [Vienna]
Technical Meeting 2

2014. MAY [Vienna]
1st Consultancy Meeting2015. MAY and JUN[Fukushima]
FMU Training andWorkshop 1
2019. JAN [Fukushima]Consultancy Meeting

1 Year Extra-Budgetary Project2014. JUL [Fukushima]
FMU Technical Conference Meeting2016. MAR [Fukushima]
FMU STS Training
Workshop 2

2019. MAY [Fukushima]
Technical Meeting2022. JUN [Virtual}
Consultancy Meeting2014. DEC [Fukushima]
FMU Consultancy Meeting + STS
Workshop

2014. JAN [Vienna]
Technical Meeting 3

2014. OCT [Vienna]
2nd Consultancy Meeting2014. MAY [Vienna]
Technical Meeting 4

2014. NOV [Vienna]
3rd Consultancy Meeting2016. MAR [Fukushima]
FMU Conference

2016. APR
Translation of STS
Handbook to Japanese2017. AUG [Fukushima]Consultancy Meeting2019. DEC [Vienna]
Consultancy Meeting2020. OCT [Virtual]
Consultancy Meeting2021. NOV [Hiroshima]
Technical Meeting2022. NOV [Belgium]
Hybrid Technical Meeting2023. 1st Quarter [Virtual]
Consultancy MeetingInternational Network 2012 - 2022

CM and TM 2020:+ Brazil, Egypt, Ukraine
TM November 2021:+ Norway, Russia, Kazakhstan,Philippines
CM June 2022
+ Belgium (3 SCK CEN and 4
Academic)

International Network 2013 - 2022
Austria; 1%
Italy; 1%

Others; 12%

Israel; 0%

Cambodia; 1%South Korea; 1%
UK; 1%
Germany; 2%
Canada; 2%Japan; 53%
Malaysia; 2%
Thailand; 2%Singapore; 3%Belgium; 4%USA; 6%
IAEA; 7%

Professional Groups at Meetings
Science andTechnology
Studies80%70%

Medical and
Health Sciences
NuclearSciences

50%
40%

Other
30%
20%
10%

Jun.2022

Nov.2021

Oct.2020

Dec.2019

May.2019

Jan.2019

Aug.2017

May.2017

Jun.2016

Mar.2016

Nov.2015

Jun.2015

Dec.2014

Nov.2014

Jul.2014

May.2014

Jan.2014

Nov.2013

Oct.2013

Jul.2013

0%May.2013% OF PARTICIPANTS

60%

NA17 NA16 NA17 NA16 NA17 NA17 NA16 NA22 NA16 NA24 NA22 NA24 NA22 NA22 NA24 NA39 NA39 NA39 NA39 NA 39 1 Yr
EB
PROJECTS TIMELINE

30%

Humanities

25%

Natural Sciences

Social Sciences

20%

15%

10%

5%

Jun.2022

Nov.2021

Oct.2020

Dec.2019

May.2019

Jan.2019

Aug.2017

May.2017

Jun.2016

Mar.2016

Nov.2015

Jun.2015

Dec.2014

Nov.2014

Jul.2014

May.2014

Jan.2014

Nov.2013

Oct.2013

Jul.2013

0%May.2013% OF PARTICIPANTS

Major Professional Groups at Meetings

NA17 NA16 NA17 NA16 NA17 NA17 NA16 NA22 NA16 NA24 NA22 NA24 NA22 NA22 NA24 NA39 NA39 NA39 NA39 NA 39 1 Yr EB
PROJECTS TIMELINE

Training, Workshops and Conferences

Poster session discussion

Debate Panel at FMU TM May 2019

FMU Consultancy Meeting August 2017

Second Technical Meeting on Science, Technology, and Society
Perspectives on Nuclear Science, Radiation, and Human Health: The
View from Asia 2015

Publications
Project Outcomes

STS Curriculum Package“Health in Disasters: A Scienceand Technology Studies Practicum
for Medical Students and HealthProfessionals”

Non-IAEA Publications

Article Copyright © 2017 Authors, Source DOI: 10.1177/1010539516685400.
See content reuse guidelines at: sagepub.com/journals-permissions

New Medical Curricula
FMU, Hiroshima University and Nagasaki University
Radiation disaster medicine for medical
students at the Fukushima Medical
University, together with a science,technology, and society module
comprising various topics, such as publicrisk communication, psychosocial
consequences of radiation anxiety, anddecision making for radiation disaster.
Phoenix Leader PhD degree at the Hiroshima University, which aims todevelop future leaders who can address the associated scientific,
environmental, and social issues.

Training session held at FMU 2016
Joint Graduate School of Master’s degree in the Division of Disaster andRadiation Medical Sciences at the Nagasaki University and Fukushima Medical
University.
Source: Adapted from APJPH 2017 (29)2s: 99-109

Rays of Hope - Leaving no country behindGlobal Inequity in Access to Cancer Care

Difference in Equipment /Million Population2013-2021

Difference in Equipment Distribution / Million Population 2013 - 2021

Additional Staff needed by Region

Radiotherapy in global health” Abdel-Wahab M et al in "Radiology in Global Health: Strategies, Implementation, and Applications, 2e"Springer 2018

Practical Arrangements

Collaborating Centres

NIRS-QST
1

FMU

QST

HICARE

Comprehensive Approach Together with
the Country
Rays of Hope:•Supporting Access•Technical assessments and economic
evaluations;•

Equipment•

Capacity building – technology transfer &training;•

Sustainability Regional Anchor Centres•

Innovation through R&D

https://www.iaea.org/sites/default/files/19/10/milestones-document-2019.pdf

Innovation: Catalyzing education and training
State-of-the-art learning platforms and approaches that advance education and training
can accelerate the speed and scale of progress in the global fight against cancer

As innovative, cost-effective training tools, the IAEA’s virtual models are especially advantageous when the necessary medical
equipment is unavailable or has not yet been commissioned for clinical use. By enabling professionals in resource-challenged
contexts to train in an immersive learning environment, they help close global knowledge gaps.

Innovation: Generating novel insights
Global databases that generate novel insights for targeted action
can accelerate the speed and scale of progress in the global fight against cancer

WIPO’s 2023 Global Innovation Index

Data from IAEA DIRAC helped bring attention to an alarming trend: cancer cases requiring radiotherapy
are outpacing available technology.

Supporting Rays of Hope Anchor Centres
Anchor Centres – which serve as capacity building and knowledge hubs – can upscale global access tocancer care by advancing innovation at the regional and global level, together with the IAEA
To enable them to effectively perform thiscritical work, these Centres need supporton:- Education and training- Research- Quality assurance- Technology- Equipment- Resource mobilization

Rays of Hope - Regional Anchor Centres

New STS Project:
Medical Doctors’ Radiation Educationand Communication
Objective
Develop and train, radiation knowledge with relevance for medical personal, and patients.
Experience with radiation risk communication including teaching and training concepts canbe readily used.
Guidance manuals for building capacity will be developed and updated, based on Japaneseand international expertise.
Experience in Japan, Asia and internationally will benefit trainees from all participating RoH
countries, thereby supporting improved doctor – patient relationship in radiation therapy
communication and education.

Medical Doctors’ Radiation Educationand Communication

Scope
Train and apply radiation knowledge
for medical personal.
Respective communication skills
related to radiation exposure will betaught.
Focus on present conditions and whatis desired/ foreseen by population andlocal and regional stakeholders.
Medical communication should focus
on measures to enhance populations’general trust in medical services.

Conclusions
Successful risk communication must examine and compare the effects of risk
perception and tailor risk messages considering the person's cultural background.
It is crucial to understand how patients as well as local population concerned withradiation effects process information’s based on their specific and individual mind
set and their overall and universal processing of information’s in the human brain.
Efficient way to improve communication and promote mutual understanding
between concerned population, patients and doctors is via education andinterpersonal skills training.

Together, we will continue to build on past achievements and the experience of ourcolleagues from Japan and other countries world-wide including, while presenting
and evaluating our diverse experiences

Thank you!

● このスライドは、非営利かつ個人的な目的に限り閲覧することができます。
The following presentation slides are shared with symposium participants exclusively for personal, noncommercial, educational purposes.
● このスライドの著作権は、講演の発表者本人に帰属します（図表等の引用箇所は除く）。如何なる国・地域においても、また紙媒体やインターネット・電子データなど形態に関わらず、スライドの全部または一部を無断で複製、転載、配布、送信、放送、貸与、翻訳、販売、変造、二次的著作物を作成すること等は、固く禁止します。
Copyright of these slides belongs to the presenter and/or the Radiation Medical Science Center for the
Fukushima Health Management Survey, Fukushima Medical University (except figures, tables, etc., cited fromother sources). It is strictly prohibited to reproduce, reprint, distribute, transmit, broadcast, loan, translate, sell,modify, and/or create derivatives of any slides, in any physical or electronic medium anywhere in the world.
● このスライド日本語版は国際シンポジウム事務局による仮訳です。正本は英語版となります。
The English-language slides, as shown during the symposium presentation, best reflect the author’s intent.
Japanese translations by the symposium secretariat should be regarded as provisional and for reference purposes
only.

2024年 福島県立医科大学『県民健康調査』国際シンポジウム
公立大学法人福島県立医科大学放射線医学県民健康管理センター
国際シンポジウム事務局（広報・国際連携室）✉ kenkani@fmu.ac.jp Tel: 024-581-5454(平日9～17時)
2024 Fukushima Medical University International Symposium on the Fukushima Health Management Survey
Secretariat of International Symposium
Office of Public Communications and International Cooperation, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University✉ kenkani@fmu.ac.jp, TEL: +81-24-581-5454 (Weekday, 9a.m. - 5 p.m. JST)