RADIOLOGICAL AND NUCLEAR DISASTER: EVALUATION OF THE DISASTER: - PowerPoint PPT Presentation

RADIOLOGICAL AND NUCLEAR DISASTER: EVALUATION OF THE DISASTER: EVALUATION OF THE PROBLEM COL Patricia Lillis-Hearne MD MHA AFRRI Albert L. Wiley MD PhD FACR REAC/TS

DISCLOSURES � DR WILEY: NONE � DR LILLIS-HEARNE: NONE DR LILLIS HEARNE NONE

LEARNING OBJECTIVES � Identify the potential causes of radiation mishaps � Describe levels of authority in a radiologic or D ib l l f th it i di l i nuclear disaster � Distinguish between a radiologic and a nuclear Distinguish between a radiologic and a nuclear event � Identify where to go for further information on radiological disasters di l i l di t

ACR/ASTRO/AAPM Disaster Primer “A radiation disaster is a possibility for which we must be prepared Radiologists radiation oncologists and medical prepared. Radiologists, radiation oncologists and medical physicists will play a vital role as responders and as sources for accurate information for patients, the public and the medical community.” community. 4

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Where Do Accidents Occur? Where Do Accidents Occur? � Irradiation facilities � Nuclear reactors � Isotope production facilities � Materials testing (sealed sources) � Materials testing (x-ray devices) � X-ray and radiotherapy devices (medicine, research) � Unsealed radionuclides (medicine, research) � Transportation � Milit Military � ???? 6 S Source: REAC/TS Radiation Accident Registry REAC/TS R di i A id R i 6

What Causes Radiation “Accidents”? What Causes Radiation “Accidents”? Usually Human Error � Lost or mishandled sources � Medical misadministration � Bypassing Interlocks � Failure to use criticality control � Failure to use criticality control � Calibration/programming errors � Inadequate radiation protection programs, supervision/quality control, and training/written procedures control, and training/written procedures � Human factors 7 7

Reality: Reality: Major Radiation “Accidents” Worldwide Major Radiation “Accidents” Worldwide (1944 (1944- -Dec 2007); “Classification by Device” Dec 2007); “Classification by Device” Radiation Devices 319 Sealed Sources 210 X-ray Devices 83 Accelerators 25 Radar Generators 1 R di i Radioisotopes t 93 93 Diagnosis and Therapy 38 Transuranics 28 Fission Products 11 Tritium 2 Radium Spills 1 Other 13 Criticalities 20 Critical Assemblies 8 Reactors 6 8 Ch Chemical Operations i l O ti 6 6 Total 432 Source: REAC/TS Registry 8

Things To Consider Things To Consider � There are different types and extents of radiation injury, depending on the accident scenario depending on the accident scenario. � Whole-body irradiations (WBI vs TBI) (WBI TBI) � Partial-body irradiations (PBI) � Local radiation injury (LRI) � Internal contamination from radioisotopes � There may be acute and chronic effects There may be acute and chronic effects. 9 9

An Industrial Radiography Example: Location An Industrial Radiography Example: Location Yanango, 42 megawatt hydroelectric plant, located 300 km east of Lima Peru located 300 km east of Lima, Peru. 10 10

Device Device 192 Ir “gamma camera” with a 1.37 TBq (37 Ci) source 11 11

Dose Rates Dose Rates For a 30 Ci 192 192 Ir radiography source For a 30 Ci Ir radiography source Distance Distance Dose Rate Dose Rate [cm] [cm] [rad/ min] or [cGy/ min] [rad/ min] or [cGy/ min] Surface Surface 36,000 36,000 1 2,400 2,400 2 2 600 600 600 600 3 267 267 4 4 150 150 150 150 5 96 96 12 12

Medical Medical � 37 37- -year year- -old male put source in his old male put source in his pocket with 6 hour exposure pocket with ~6 pocket with ~6-hour exposure pocket with 6 hour exposure hour exposure � Initial symptoms of nausea / Initial symptoms of nausea / vomiting and one episode of vomiting and one episode of diarrhea diarrhea di di h h � Erythema on upper posterior thigh Erythema on upper posterior thigh � Admission Admission � T X X - IV fluids, 500mg Cipro bid, 8mg IV fluids, 500mg Cipro bid, 8mg dexamethasone tid, Naprosyn dexamethasone tid, Naprosyn- -like like pain meds pain meds 13 13

Medical Medical D+2 (Feb 22, 1999) Blistering, vesicular lesion with vesicular lesion with inflammatory halo D+5 (Feb 25 1999) Clindamycin D 5 (Feb 25, 1999) Clindamycin 300mg tid started & Cipro ↑ 750mg bid 14 14

Absorbed doses in Gy Absorbed doses in Gy Normalized to 30 Gy at the rim of the lesion (radius = 5 cm) Normalized to 30 Gy at the rim of the lesion (radius = 5 cm) LEFT 0 Absorbed dose Absorbed dose -2 2 di t ib ti distribution for di t ib ti distribution for f f horizontal cross horizontal cross- - -4 section at source level section at source level with source with source skin with source with source-skin skin skin -6 6 distance of 3 mm distance of 3 mm -8 -10 10 -12 -14 14 -16 15 -18 18 -12 -10 -8 -6 -4 -2 0 2 4 6 8 Gy at X cm depth 15

Moist desquamation on wife’s sacral region Moist desquamation on wife’s sacral region 18 March 1999 18 March 1999 16 16

Lymphocyte Kinetics Lymphocyte Kinetics Absolute Absolute 2100 2100 1800 1500 1500 1200 900 900 600 300 300 0 17 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 D D Days Postexposure Days Postexposure P P t t 17

D+28 19 March 1999 Ulcerative lesion 2cm deep D+28 19 March 1999 Ulcerative lesion 2cm deep - - continues to continues to expand. expand. 18 D+32 Increasingly painful. Morphine infusion started. Radiation D+32 Increasingly painful. Morphine infusion started. Radiation- - induced sciatic neuropathy. induced sciatic neuropathy. D+39 First febrile episode. D+39 First febrile episode. 18

Goiania, Brazil 137 Cs Accident September 13, 1987 19 19

Cesium Cesium- -137 137 20 20

Skin lesion initially diagnosed incorrectly 21 21

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Individual Monitoring Individual Monitoring � 112,000 people were screened � 249 contaminated people: 120 people had their clothes and shoes contaminated; 129 people had external and internal contamination 23 23

How Much Intake and How Much Intake and What Is the Dose (CEDE)? What Is the Dose (CEDE)? Step 1) Estimate the Intake Using Intake Retention Fractions. Whole Body Retention: Cs-137 o e ody ete t o Cs 3 At 190 days At 190 days about 18% of 6.00E-01 Cs-137 5.00E-01 remains in remains in ng action Remainin 4.00E-01 whole body. 3.00E-01 2.00E-01 2.00E 01 Fra 1.00E-01 24 0.00E+00 0 0 50 50 100 100 150 150 200 200 250 250 300 300 350 350 400 400 Days Post Inhalation 24

Assume Measured 1.48 MBq Assume Measured 1.48 MBq [40 uCi] of Cs [40 uCi] of Cs- -137 at 190 Days 137 at 190 Days Intake (Inhalation) = 1.48 MBq/0.18 = 8.2 MBq [40 uCi/0.18 = 222 uCi ] Step 2) Compare to Annual Limit on Intake (ALI). ALI = 7 4 MBq [200 uCi ] for Cs-137 ALI 7.4 MBq [200 uCi ] for Cs 137 (Gives 0.05 Sv [5 rem ] CEDE) So individual has 110% of ALI and 25 Dose of 0.55 Sv [5.5 rem]. [ ] 25

Initial Internal Initial Internal Contamination Measurements Contamination Measurements Range Range No. of Persons Bq Bq μ Ci/mCi μ Ci/mCi 10 4 -10 5 0.27 - 2.7 μ Ci μ 11 10 5 -10 6 2.7 – 27 μ Ci 15 10 6 -10 7 27 – 270 μ Ci 23 10 7 -10 8 270 μ Ci – 2.7 mCi 20 10 8 -10 9 2.7 – 27 mCi 7 10 10 27 mCi 1 Total 67 26 26

Results of Initial Cytogenetic Dosimetriy Results of Initial Cytogenetic Dosimetriy Range [Sv] No. of Persons Relative Frequency [%] 0 0 – 0 5 0.5 43 43 61 43 61.43 0.5 – 1.0 8 11.43 1.0 – 2.0 6 8.57 2.0 – 3.0 5 7.14 3.0 – 4.0 0 0 4 0 – 5 0 4.0 5.0 3 3 4 29 4.29 5.0 – 6.0 3 4.29 6.0 – 7.0 2 2.58 Total 70 100.00 27 27

Goiania Data Goiania Data 28 28

Acute Clinical Outcomes Acute Clinical Outcomes I ndividual Radiological Information (approximate) MF1 MF1 5 7 Gy (died) 5.7 Gy (died) DF 7 Gy (lived) Possibly spent more time outside (fractionated) MA1 10 MBq (270 μ Ci) intake, 4.3 Gy external (cytogenetics) IS 4.5 Gy (died) Probable very acute dose. AS 5.3 Gy (died) Probable very acute dose. LF2 LF2 1GBq (27 mCi) intake, 6 Gy external (died) 1GB (27 Ci) i t k 6 G t l (di d) GS 100 MBq (2.7 mCi) intake, 3 Gy, significant burn on shoulder Dr. PM 1.3 Gy, negligible intake (left source in bag) y g g ( g) 29 29

QUESTIONS? QUESTIONS? 30

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Preparedness Preparedness Preparedness and readiness We all know what we mean when we say it, but How do you evaluate it? How prepared is prepared enough? How do prioritize your resources? 32

Response Is Part of the Strategy “ The United States must be prepared to respond to the use of WMD against our citizens, our military forces, and those of friends and allies. We will develop and maintain the capability to reduce to the extent possible the potentially horrific consequences of WMD attacks at home and abroad.” - National Strategy to Combat Weapons of Mass Destruction (2002) 33