The small size, portability and potential value of sealed radiological sources make them vulnerable to misuse, improper disposal and theft. According to IAEA, the confirmed reports of illicit trafficking in radiological materials have increased since 2002. For example, in 2004, about 60 percent of the cases involved radiological materials, some of which are considered by U.S. government and IAEA as attractive for the development of a dirty bomb. Although experts generally believe that a dirty bomb could result in a limited number of deaths, it could, however, have severe economic consequences. Depending on the type, amount, and form, the dispersed radiological material could cause radiation sickness for people nearby and produce serious economic, psychological and social disruption associated with the evacuation and subsequent cleanup of the contaminated area. Although no dirty bombs have been detonated, in the mid-1990s, Chechen separatists placed a canister containing cesium-137 in a Moscow park. While the device was not detonated and no radiological material was dispersed, the incident demonstrated that terrorists have the capability and willingness to use radiological sources as weapons of terror. A 2004 study by the National Defense University noted that the economic impact on a major populated area from a successful dirty bomb attack is likely to equal, and perhaps exceed, that of the September 11, 2001, attacks on New York City and Washington, D.C. According to another study, the economic consequences of detonating a series of dirty bombs at U.S. ports, for example, would result in an estimated $58 billion in losses to the U.S. economy. The potential impacts of a dirty bomb attack could also produce significant health consequences. In 2002, the Federation of American Scientists concluded that an americium radiological source combined with one pound of explosives would result in medical supervision and monitoring required for the entire population of an area 10 times larger than the initial blast. The consequences resulting from the improper use of radiological sources are not theoretical. Some actual incidents involving sources can provide a measure of understanding of what could happen in case of a dirty bomb attack. In 1987, an accident involving a teletherapy machine containing about 1,400 curies of cesium-137, which is generally in the form of a powder similar to talc and highly dispersible, killed four people in Brazil and injured many more. The accident and its aftermath caused about $36 million in damages to the region (Goiania) where the accident occurred, according to an official from Brazil’s Nuclear Energy Commission. In addition to the deaths and economic impact, the accident created environmental and medical problems. For example, 85 houses were significantly contaminated and 41 of these had to be evacuated. The decontamination process required the demolition of homes and other buildings and generated 3,500 cubic meters of radioactive waste. Over 8,000 persons requested monitoring for contamination in order to obtain certificates stating they were not contaminated. DOE has improved the security of hundreds of sites that contain radiological sources in more than 40 countries since the program’s inception in 2002. However, despite these achievements, such as removing dangerous sources from a waste storage facility in Chechnya, many of the high-risk and most dangerous sources remain unsecured, particularly in Russia. DOE officials told us that the program has barely “scratched the surface” in terms of securing the most dangerous sources in the former Soviet Union. Specifically, removing dangerous sources from 16 of 20 waste storage facilities across Russia and Ukraine remain unsecured while more than 700 RTGs remain operational or abandoned in Russia and are vulnerable to theft or potential misuse. In 2003, when DOE decided to broaden the program’s scope beyond the former Soviet Union, it also expanded the types of sites that required security upgrades. As a result, as of September 2006, almost 70 percent of all sites secured were medical facilities, which generally contain one radiological source. In addition, DOE’s program does not address the transportation of radiological sources from one location to another, a security measure that DOE and international officials have identified as the most vulnerable link in the radiological supply chain. DOE has experienced numerous problems and challenges implementing its program to secure radiological sources worldwide, including a lack of cooperation from host country officials. Finally, DOE has not developed an adequate plan to ensure that countries receiving security upgrades will be able to sustain them once installed. Since DOE began its program in 2002, it has taken steps to secure radiological sources in more than 40 countries and has achieved some noteworthy accomplishments. For example, DOE told us that it has (1) facilitated the removal of 5,500 curies of cobalt-60 and cesium-137 sources from a poorly protected nuclear waste repository in Chechnya, the location of continuing political unrest in southeastern Russia; (2) constructed storage facilities in Uzbekistan, Moldova, Tajikistan and Georgia so that sources can be consolidated at one site to strengthen their long-term protection; and (3) increased security at 21 sites in Greece prior to the 2004 Olympics, including providing 110 hand-held radiation detection devices for first responders. DOE secured, among other things, facilities with blood irradiators containing cesium chloride and a large industrial sterilization facility. According to DOE, it has neither the resources nor staff to comprehensively address and secure the tens of thousands of vulnerable radiological sources worldwide on its own. As a result, it has enlisted the support of regional partners and IAEA to implement programs to help other countries find, characterize and secure their most dangerous sources. DOE works with partner countries to identify sites where high- risk sources may be located and provides the equipment and training to conduct searches. Once the sources have been located, DOE enlists the support of IAEA or partner countries to transfer them to a secure facility. For example, DOE established a regional partnership with Lithuania to facilitate orphan source recovery efforts both in Lithuania and in neighboring countries. DOE purchased radiation detection equipment and trained Lithuanian specialists to initiate orphan source recovery efforts. Lithuania was able to identify 41 former Soviet military and industrial sites that potentially held high-risk radiological sources. Subsequently, Lithuania assisted DOE in initiating search and secure efforts in Estonia and Latvia, which resulted in the discovery and disposition of orphan sources. Despite these achievements, DOE’s program has not adequately addressed many high-priority sources. In 2003, the Secretary of Energy directed NNSA to expand its program to secure radiological sources worldwide, which increased both the number of countries targeted to receive DOE assistance and the types of sites to be secured. Expanding the program into many countries outside of the former Soviet Union—the initial focus and attention of DOE’s program—resulted in the addition of many medical facilities that contained lower priority sources that were now being targeted for physical security upgrades. As of September 30, 2006, DOE’s program had completed the installation of physical security upgrades at 368 sites in over 40 countries. However, a majority of sites secured do not represent the highest-risk or the most vulnerable sources. Of the total sites completed, 256—or about 70 percent—were hospitals and oncology clinics operating teletherapy machines used to provide radiation treatment to cancer patients. These machines generally contain a single cobalt-60 radiological source ranging from about 1,000 to 10,000 curies. In 38 of the 41 countries—or 93 percent—DOE had upgraded at least one hospital or oncology clinic. According to DOE, many of the countries that are included in its global program have medical facilities with radiological sources. As a result, these facilities were targeted for upgrades. In addition to the medical facilities, DOE has completed security upgrades at 47 research institutes, 35 commercial and industrial sites, and 30 waste storage facilities. Figure 1 depicts the countries receiving security upgrades, and table 1 provides a breakdown of the total number and types of facilities upgraded by DOE, as of September 30, 2006. Six national laboratory officials and security specialists responsible for implementing the program told us that although progress had been made in securing radiological sources, DOE had focused too much attention on securing medical facilities at the expense of other higher-priority sites, such as waste storage facilities and RTGs. In their view, DOE installed security upgrades at so many of these facilities primarily because the upgrades are relatively modest in scope and cost. For example, a typical suite of security upgrades at a medical facility costs between $10,000 to $20,000, depending on the size of the site, whereas the average cost to remove and replace an RTG in the Far East region of Russia is about $72,000 based on 2006 dollars. Officials from three of the four recipient countries we visited also raised concerns about DOE’s focus on securing radiological sources at so many medical facilities. For example, staff responsible for operating the teletherapy machines in hospitals in Lithuania and Poland told us that the cobalt-60 sources contained in the teletherapy machine did not pose a significant security risk. In their view, it was highly unlikely that the sources could be easily removed from these machines and that it would take more than one highly skilled and determined intruder to remove the source and transport it out of the facility without being detected or dangerously exposed to radiation. In fact, while emphasizing the importance of securing medical facilities, DOE officials stated that getting medical and security staff to buy into the need for improved security has been a consistent challenge for the program. Further, Russian officials told us that radiological sources in hospitals did not pose a comparable risk to RTGs or lost or abandoned sources. DOE has not offered to fund any security upgrades of Russian medical facilities since its funds are focused on securing RTGs, Radons, and orphan sources. According to five national laboratory officials and security specialists, completing upgrades at medical facilities also served to demonstrate rapid program progress because the upgrades are completed relatively quickly.