Management Of Radiation Accidents Research Articles

Radiation accidents and their management: emphasis on the role of nuclear medicine professionals.

Large-scale radiation accidents are few in number, but those that have occurred have subsequently led to strict regulation in most countries. Here, different accident scenarios involving exposure to radiation have been reviewed. A triage of injured persons has been summarized and guidance on management has been provided in accordance with the early symptoms. Types of casualty to be expected in atomic blasts have been discussed. Management at the scene of an accident has been described, with explanation of the role of the radiation protection officer, the nature of contaminants, and monitoring for surface contamination. Methods for early diagnosis of radiation injuries have been then described. The need for individualization of treatment according to the nature and grade of the combined injuries has been emphasized, and different approaches to the treatment of internal contamination have been presented. The role of nuclear medicine professionals, including physicians and physicists, has been reviewed. It has been concluded that the management of radiation accidents is a very challenging process and that nuclear medicine physicians have to be well organized in order to deliver suitable management in any type of radiation accident.

Medical management of radiation accidents: capabilities and deployment principles of the Bundeswehr Institute of Radiobiology

Radiation accidents are fortunately infrequent occurrences, but since their consequences can be very serious as in the Chernobyl and the Fukushima nuclear accidents, medical management of radiation accidents is of great importance. Besides several other tasks, medical management of radiation accidents is one of the key tasks of the Bundeswehr Institute of Radiobiology. Within a Task Force Unit for medical chemical, biological, radiological, and nuclear (CBRN) Defense, the institute provides designated personnel who will perform clinical investigations on the scene and will liaise with the institute, where different methods for biological dosimetry and dose reconstruction will be performed. The most important aspects of efficient medical management of radiation accidents are diagnosis of radiation-induced health damage, determination of the cause, dealing with contamination/incorporation, pathophysiological and therapeutic principles, preparatory planning, national and international cooperation and training. Military and non-military institutions have to work closely together when it comes to radiation accidents and since national resources are limited and could be exhausted, international networks can help to ensure medical treatment for radiation accident victims.

Quality Assurance in Military Medical Research and Medical Radiation Accident Management

The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within the scope of external quality assurance, but also in the exchange of special diagnosis data among international research networks. In summary, the acknowledged standard for a quality management system to ensure quality assurance is the very generic standard ISO 9001.Health Phys. 103(2):221-225; 2012.

Letter to the editor

Letter to the editor

CHARACTERIZATION OF THE RADIATION-DAMAGED PRECURSOR CELLS IN BONE MARROW BASED ON MODELING OF THE PERIPHERAL BLOOD GRANULOCYTES RESPONSE

Bone marrow failure is the major cause of radiation lethality in mammals. Since bone marrow is distributed heterogeneously within trabecular spongiosa encased in a cortex of cortical bone, it is very difficult to measure the extent of the radiation damage directly. However, indirect consequences of damage to marrow, such as reductions in peripheral blood cell counts, are easily measured. In this paper, the authors investgate a mathematical model of the granulopoiesis system that provides quantitative relationships between reductions in peripheral blood cells and the bone marrow precursor cells following radiation exposure. A coarse-grained architecture of cellular replication and production as well as a mechanism for implicit regulation used in this model are discussed. The model is based on previous investigations of rodents. The authors test how well the model matches, in the principal dynamic regime of hematopoiesis, experimental data on large animals as well as empirical data on humans following radiation exposure. Due to its ability to infer, albeit indirectly, radiation damage to bone marrow, this model will provide a useful computational tool in radiation accident management, military operations involving nuclear warfare, radiation therapy, and space radiation risk assessment.

Inter-laboratory comparison to validate the dicentric assay as a cytogenetic triage tool for medical management of radiation accidents

Abstract Radiation accidents with exposure of human beings can assume huge dimensions concerning occurring health impairments and essential medical resources such as personnel, patient care management and appropriate medical facilities. Particularly in mass-casualty events, a rapid sorting and allocation of victims to treatment is needed and their classification in medical treatment groups has to be conducted as fast as possible. For triage purposes several approaches can be considered. Clinical signs and symptoms are extremely helpful in estimating radiation effects on an organ-based level, whereas the assessment of radiation effects based on cytogenetic biodosimetry tools is the alternative approach. For both systems there are pros and cons with respect to the usefulness for specific applications, such as individual cases versus mass-casualty screening or whole- versus partial-body exposures. Among the biodosimetry tools the dicentric chromosome assay (DCA) is considered as the “gold standard” for biodosimetry after an acute radiation exposure. Recently, steady progress in standardization and harmonization of the DCA has occurred, in order to enable the validated performance of the DCA in the frame of cooperative response of biodosimetry networks during a large scale radiological scenario. Using the DCA in triage mode which allows the stratification of radiation exposed victims into broad 1.0 Gy categories only 20–50 metaphase cells per subject are scored instead of the 500–1000 scored for routine analysis. Our data show that there are significant differences between the dicentric yields after 1.0 Gy and 3.0 Gy γ-ray ex vivo exposure of blood suggesting this assay as suitable for the distinction between high and low dosed exposed individuals. These preliminary findings indicate the usefulness of the DCA also for therapeutic decision making.

C-reactive protein and serum amyloid A as early-phase and prognostic indicators of acute radiation exposure in nonhuman primate total-body irradiation model

Abstract Terrorist radiological attacks or nuclear accidents could expose large numbers of people to ionizing radiation. In mass-casualty radiological incidents early medical-management requires triage tools for first-responders to quantitatively identify individuals exposed to life-threatening radiation doses and for early initiation (i.e., within one day after radiation exposure) of cytokine therapy for treatment of bone marrow acute radiation syndrome. Herein, we present results from 30 rhesus macaques total-body irradiated (TBI) to a broad dose range of 1–8.5 Gy with 60Co γ-rays (0.55 Gy min−1) and demonstrate dose- and time-dependent changes in blood of C-reactive protein (CRP), serum amyloid A (SAA), and interleukin 6 (IL-6) measured by enzyme linked immunosorbent assay (ELISA). CRP and SAA dose–response results are consistent with ∼1 Gy and ∼0.2 Gy thresholds for photon-exposure at 24 h after TBI, respectively. Highly significant elevations of CRP and SAA (p = 0.00017 and p = 0.0024, respectively) were found in animal plasma at 6 h after all TBI doses suggesting their potential use as early-phase biodosimeters. Results also show that the dynamics and content of CRP and SAA levels reflect the course and severity of the acute radiation sickness (ARS) and may function as prognostic indicators of ARS outcome. These results demonstrate proof-of-concept that these radiation-responsive proteins show promise as a complementary approach to conventional biodosimetry for early assessment of radiation exposures and may also contribute as diagnostic indices in the medical management of radiation accidents.

Review of retrospective dosimetry techniques for external ionising radiation exposures

The current focus on networking and mutual assistance in the management of radiation accidents or incidents has demonstrated the importance of a joined-up approach in physical and biological dosimetry. To this end, the European Radiation Dosimetry Working Group 10 on 'Retrospective Dosimetry' has been set up by individuals from a wide range of disciplines across Europe. Here, established and emerging dosimetry methods are reviewed, which can be used immediately and retrospectively following external ionising radiation exposure. Endpoints and assays include dicentrics, translocations, premature chromosome condensation, micronuclei, somatic mutations, gene expression, electron paramagnetic resonance, thermoluminescence, optically stimulated luminescence, neutron activation, haematology, protein biomarkers and analytical dose reconstruction. Individual characteristics of these techniques, their limitations and potential for further development are reviewed, and their usefulness in specific exposure scenarios is discussed. Whilst no single technique fulfils the criteria of an ideal dosemeter, an integrated approach using multiple techniques tailored to the exposure scenario can cover most requirements.

Radiation Accident Preparedness: A European Approach to Train Physicians to Manage Mass Radiation Casualties

Mass casualties after radiation exposure pose an enormous logistical challenge for national health services worldwide. Successful medical treatment of radiation victims requires that a plan for medical radiation accident management be established, that the plan be tested in regular exercises, and that it be found to be effective in the management of actual victims of a radiological incident. These activities must be provided by a critical mass of clinicians who are knowledgeable in the diagnosis and management of radiation injury. Here, we describe efforts to provide education to physicians engaged in clinical transplantation. Following intensive discussion among European experts at the International Center for Advanced Studies in Health Sciences and Services, University of Ulm, Germany, an advanced training program on "radiation syndromes" was developed for physicians with experience in the management of patients with pancytopenia and multi-organ failure occurring in a transplant setting. The first European advanced training course using this educational tool took place at Oberschleissheim, Germany, on 28-30 November 2007. Small group discussions and practical exercises were employed to teach general principles and unique features of whole body radiation exposure. Topics included the biological effects of contamination, incorporation of radionuclides, clinical consequences of exposure to radiation, and approaches to medical management. Recommendations resulting from this initial educational experience include (1) provision of funding for attending, conducting and updating the curriculum, and (2) development of an educational program that is harmonized among European and non-European experts in medical management of mass casualties from a radionuclear incident.

Revisiting therapeutic strategies in radiation casualties

Nuclear/radiological threats have evolved and scenarios for terrorist attacks involving radioactive material have been identified as complex situations. Mass casualty scenarios may happen, and individuals may be exposed to intentionally hidden sources of high activity, resulting in delayed diagnosis and treatment of acute radiation syndrome (ARS). Moreover, ARS must be considered as an emergency in order to better anticipate delayed radiation toxicity. In this context, therapeutic strategies in radiation casualties have to be revisited and new pharmacological approaches developed. B6D2F1 mice were total-body irradiated (TBI) with a 9 Gy gamma dose and then received intraperitoneal doses of either early (stem cell factor + FLT-3 ligand + thrombopoietin + interleukin-3 [SFT3] +/- keratinocyte growth factor (KGF); stem cell factor + erythropoietin + Peg-filgrastim [SEG]) or delayed treatments (SFT3 +/- KGF, erythropoietin, or hyaluronic acid). Survival was monitored and bone marrow hematopoiesis evaluated at 300 days following early treatments. SFT3 anti-apoptotic cytokine combination administered early (2 hours and 24 hours) after lethal TBI induced 60% survival versus 5% in controls. Early SEG treatment may be an alternative to SFT3 in terms of survival (55%), but SEG benefit might be obtained at the expense of long-term hematopoiesis. SFT3 + KGF induced 75% survival. No effectiveness was observed, over antimicrobial supportive care, when administration of SFT3 or its tested combinations was delayed at 48 hours. As a potentially multi-organ failure, ARS requires global therapy, beyond the hematopoietic syndrome, which may include pleiotropic cytokines such as KGF.

Medical Management Principles for Radiation Accidents

The medical management of radiation accidents requires intensive planning and action. This article looks at the medical management of recent radiation accidents to derive principles for structuring and organizing the treatment of patients who may have radiation-induced health impairments. Although the radiation accidents in Tokai-mura, Japan and Lilo, Georgia were small-scale accidents, they illustrate important and characteristic symptoms and clinical developments. There are lessons to be learned and conclusions to be drawn for the military medical officers concerned with problems of medical management after radiation accidents.

Medical Management of Radiation Accidents, 2nd ed

Medical Management of Radiation Accidents, 2nd edRoger E. LinnemannAudio Available | Share

Medical Management of Radiation Accidents, Second Edition

768 Glossy Ibis Lane Kiawah Island, SC 29455 (The opinions expressed in this section are those of the authors and do not represent the official opinion or position of the Journal, the Health Physics Society, or the authors’ institutions.)

Biodosimety Assessment Tool: A Post-Exposure Software Application for Management of Radiation Accidents

The Biodosimetry Assessment Tool software application under development will equip health care providers with diagnostic information (clinical signs and symptoms, physical dosimetry, etc.) germane to the management of human radiation casualties. Designed primarily for prompt use after a radiation incident, the user-friendly program facilitates collection, integration, and archiving of data obtained from exposed persons. Data collected in templates are compared with established radiation dose responses obtained from the literature to provide multiparameter dose assessments. The program archives clinical information (e.g., extent of contamination, wounds, infection, etc.) useful for casualty management, displays relevant diagnostic information in a concise format, and can be used to manage both military and civilian radiation accidents. In addition, monitoring of diagnostic information of individuals using this program could potentially minimize the severity of psychological casualties by making a marked impact on the way that both radiation casualties and the worried well view their exposure, dose, and future risk for the development of disease.

How to cope with radiation accidents: the medical management

A concerted action, termed METREPOL, was accepted by the Commission of the European Communities and was started in December 1997. Its purpose was to develop a new approach to the medical management of radiation accident victims with respect to diagnostic procedures and therapeutic options, based on recognition and evaluation of health impairments after acute radiation exposure. The result of this interdisciplinary project is a manual entitled "Medical management of radiation accidents: manual on the acute radiation syndrome". The manual compiles recommendations for assessing the state and outcome of a radiation accident victim in the shortest possible time. Furthermore, it provides guiding support for the medical management of patients accidentally exposed to ionising radiation, based on a new strategic approach for the diagnosis of the acute radiation syndrome: the response category concept. This commentary outlines the background for the development of such a manual and the realisation of the response category concept.

Addendum to the radiation accident management plan.

HomeRadioGraphicsVol. 15, No. 2 PreviousNext LettersAddendum to the radiation accident management plan.L A ShratterL A ShratterL A ShratterPublished Online:Mar 1 1995https://doi.org/10.1148/radiographics.15.2.7761645MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1995 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 15, No. 2 Metrics Altmetric Score PDF download

95/00828 CRC handbook of management of radiation protection programs - Second Edition

Organization and Management of a Radiation Safety Office (Steven H. King and Rodger W. Granlund). Organization and Management of a Nonionizing Radiation Safety Program (Zorach R. Glaser). Organization and Management of a Laser Safety Program (Kelly L. Classic). Management of Low-Level Radioactive Waste (John R. Vincenti). Management of Monitoring Programs (R. Craig Yoder). Management of Radiation Therapy Patients (Donald E. Velkley). Management of Emergency Care for Radiation Accident Victims (Mary Ellen Berger and Robert C. Ricks). Evaluation and Control of Internal Radiation Exposures on the Basis of Committed Dose Equivalent (Kenneth W. Skrable). Properly Relating Radiation Protection Requirements to Relative Radiotoxicity and Risk (Allen Brodsky). Radiation Emergency Planning - Damage, Evaluation, and Control Procedures (Robert G. Gallaghar). Planning for and Management of Radiation Accidents (Sydney W. Porter, Jr.). Emergency Response Decisions in the Planning Process - Predetermined Conditions for Predetermined Actions (James A. Martin, Jr.). Accident Consequence Projection (Thomas J. McKenna and Joseph G. Giitter). Education and Training in Radiation Protection (Allen Brodsky, Phyllis L. Brodsky, and Kenneth L. Mossman). Education and Training for Radiation Protection in Nuclear Power Plants (Charles A. Willis). Requirements and Preparation for Passing the American Board of Health Physics Certification Examinations (Charles A. Willis). Education and Training of Radiologic Technologists (Dolores A. Thomas). Summary of Experience in Radiation Litigation (Vincent P. Collins). Legal Aspects of Health Physics Record Keeping (Donald E. Jose). Preparing for Court Appearances (Donald E. Jose). Radiological Controls Documentation in Radiation Injury Litigation (Gordon M. Lodde).

Management of radiation accidents and exposures

Management of radiation accidents and exposures

Treatment of radiation exposure and contamination.

For treatment of radiation accident victims, procedures for handling trauma patients must be modified to ensure proper care and prevent contamination of hospital facilities and personnel. The radiation accident management plan should be instituted in advance. Exposure and contamination victims are treated differently. Exposed patients have sustained either partial or whole-body exposure but do not carry radioactive material; contaminated patients have also been exposed, but they have radioactive material either externally or internally and thus are continually exposed to radiation until the contaminant is removed. The treatment area and personnel must be protected with use of isolation, clean transfer techniques, and appropriate attire. After clothing has been removed, the patient's medical condition is assessed, stabilized, and treated. Samples from the affected areas, eyes, nose, and mouth are obtained for analysis and planning definitive treatment. For external contamination, the skin is washed with normal saline or mild detergent. Treatment of internal contamination is based on the isotopes involved and may include saturation of the crucial organ, dilution therapy, isotope displacement, or use of chelating agents. After a survey to ensure that no residual contamination remains, the patient is transferred to a care unit. Effects of exposure are seen over periods ranging from days to weeks to years, depending on the total dose received. Knowing the dose allows clinicians to predict what effects may ultimately occur.

Book review

This is a multiauthor book with a total of 19 chapters dealing with radiation physics, the handling and transport of radioactive material, as well as historical aspects of nuclear accidents and the medical management of accident victims. The stated objective of the text is to provide a comprehensive publication of the medical management of radiation accidents. It is intended for persons with previous background knowledge such as physicians, health physicists or radiation safety officers.