Release Of Radioactive Iodine Research Articles

방사성 물질 흡착용 활성탄소섬유 시험방법 연구

The global demand for energy is escalating due to the increased power consumption for AI data centers, leading to the expansion of nuclear power facilities and a subsequent rise in radioactive waste generation. To address this, activated carbon filter systems have been employed in nuclear power plants to adsorb and prevent the atmospheric release of radioactive iodine, a byproduct of these facilities. However, the substantial annual discharge of activated carbon is causing challenges such as a shortage of waste storage facilities. To mitigate this issue, this study investigated the application of activated carbon fiber (ACF) in nuclear power plant filter systems. Adhering to existing standards for radioactive material adsorption, we established a suitable testing environment for ACF and conducted adsorption and removal tests. The results demonstrated a maximum removal efficiency of over 99.918% for radioactive iodine, indicating a performance comparable or superior to that of conventional activated carbon used in current processes. This research is expected to contribute positively to the diversification of materials used for radioactive material adsorption and removal in nuclear power plants, as well as the establishment of relevant standards.

Hydrothermal synthesis of melamine-based porous organic polymer for the advanced adsorption of iodine

The release of carbon dioxide into the atmosphere from the combustion of fossil fuels to produce energy contributes to severe climate change. Transitioning from fossil fuels to nuclear energy, which is free of carbon emissions, presents its own set of challenges, particularly the potential release of radioactive iodine in handling nuclear waste and in the instance of a nuclear accident. The ongoing research aimed to harness the advantages of porous organic polymers to capture iodine generated during nuclear fission by synthesizing them in an environmentally friendly and cost-effective hydrothermal process. Herein, a melamine-based porous organic polymer (MPOP-4), possessing reliable thermal and chemical stability, highly porous (SABET=195.48 m2/g), designed for iodine capture, is reported. The synthesis of MPOP-4 using melamine and uracil as basic building blocks showed high iodine vapor capture capacities in various media (6.30 g/g at 80 °C, 4833.15 mg/g from aqueous solution, and 1.98 g/g at 25 °C), accompanied by good regeneration ability. A significant abundance of nitrogen content, conjugated π-electron arrangement, and porous network make it an efficient iodine adsorbent. This study suggests the green nature (metal-free) of MPOP-4 and its ability to adsorb iodine.

N/O-Codoped Ultrathin Porous Biochar Derived from Casein for Fast Adsorption of Iodine.

The release of radioactive iodine into the environment poses a significant threat, as it can contaminate soil, water, and food chains, leading to detrimental effects on ecosystems and biodiversity. Hence, employing the adsorption method proves to be a simple yet effective approach for treating radioactive waste. N/O-codoped ultrathin porous biochar, synthesized from casein using NaHCO3 activation, emerges as a potential candidate for adsorption materials. The saturation level of I2 adsorption in 100 mg L-1 iodine-cyclohexane solution is 73 mg·g-1 at 20 min. The density functional theory (DFT) calculations and experiments attribute this phenomenon to the presence of graphite nitrogen (NG) and C-OH groups on the biochar surface. Furthermore, the pseudo-first-order model fits better with the experimental values, suggesting that the adsorption of iodine by the adsorbent is primarily physisorption-based. The Freundlich isotherm is suitable for iodine adsorption of biochar, owing to the abundance of adsorption sites within the porous structure, particularly at the edges, which enhance the adsorption activity. Significantly, the study highlights that NG adsorptive sites exhibit 1.5 times higher adsorption activity compared to C-OH adsorptive sites, underscoring the essential role of NG in iodine adsorption for electron transfer. Overall, these findings underscore the potential of N/O-codoped ultrathin porous biochar in effectively mitigating the presence of radioactive I2, showcasing its promise in addressing environmental challenges associated with radioactive contamination.

Survey on national practices regarding iodine thyroid blocking in 2016-2017.

Severe nuclear accidents may lead to a release of radioactivity, including radioactive iodine, into the environment. The thyroid gland in the human body needs natural or stable iodine to function properly and this iodine is normally absorbed in small quantities from food. Following a release of radioactive iodine from a nuclear or radiological accident, the body will absorb and accumulate the radioactive iodine in the thyroid gland. This increases the risk of thyroid cancer, especially in children. Since the thyroid gland cannot distinguish between radioactive and stable iodine, stable iodine can be taken to prevent the absorption of radioiodine by the thyroid in the event of a nuclear emergency. This is referred to as Iodine Thyroid Blocking (ITB). In 2017, the World Health Organization published revised guidelines entitled ‘Iodine Thyroid Blocking: guidelines for use in planning for and responding to radiological and nuclear emergencies’. The purpose of these guidelines is to support Member States in planning for and implementation of ITB before and during a radiation emergency. To enable the monitoring and measurement of the impact of a specific recommended intervention, a baseline should be established against which the impact will be measured over a certain period of time. With that in mind, a global WHO survey of national policies on ITB was carried out in 2016-2017. Here, an overview of some core findings of this survey is provided.

Lignin-based electrospinning nanofibers for reversible iodine capture and potential applications

The capture of radioactive iodine has recently attracted much attention due to the release of radioactive iodine during nuclear waste disposal and disasters. Exploring highly efficient, sustainable, and eco-friendly materials for capturing radioactive iodine has great significance in developing safe nuclear energy. We reported highly efficient, natural, lignin-based, electrospun nanofibers (LNFs) for reversible radioiodine capture. Abundant iodine adsorption sites, such as functional groups and the interaction between the intermolecular forces exist in LNFs. The capacity of the LNFs for the saturated adsorption of iodine was found to be 220 mg·g−1, which is higher than that of the majority of bio-based adsorbents studied. Moreover, the LNFs exhibited an excellent recycling behavior, and their absorption capacity remained at 84.72% after 10 recycles. Therefore, the results imply that the lignin-based nanofibers can act as a natural, sustainable and eco-friendly packed material for the purification columns in industrial applications. The results demonstrate that the novel, nanostructured, natural biomass, as an ideal candidate has the potential for practical nuclear wastewater purification.

Protection and safety of a repeated dosage of KI for iodine thyroid blocking during pregnancy

In case of nuclear power plant accidents resulting in the release of radioactive iodine (131I) in large amounts, a single intake of stable iodine is recommended in order to prevent 131I fixation to the thyroid gland. However, in situations of prolonged exposure to 131I (e.g. Fukushima-Daiichi natural and nuclear disaster), repetitive administration of iodine may be necessary to ensure adequate protection, with acceptable safety in vulnerable populations including pregnant women. Here we conducted toxicological studies on adult rats progeny following prolonged exposure to potassium iodide (KI) in utero. Pregnant Wistar rats were treated with 1 mg kg d−1 KI or saline water for 2 or 4 d either between gestation days gestational day (GD) GD 9–12, or GD13–16. Plasma samples from the progeny were tested 30 d post-weaning for clinical biochemistry, thyroid hormones, and anti-thyroid antibody levels. Thyroid and brain were collected for gene expression analysis. The hormonal status was similar for the mothers in all experimental conditions. In the offspring, while thyroid-stimulating hormone and anti-thyroid peroxidase (anti-TPO) antibody levels were similar in all groups, a significant increase of FT3 and FT4 levels was observed in GD9–GD10 and in GD13–GD14 animals treated for 2 d, respectively. In addition, FT4 levels were mildly decreased in 4 d treated GD13–16 individuals. Moreover, a significant decrease in the expression level of thyroid genes involved in iodide metabolism, TPO and apical iodide transporter, was observed in GD13–GD14 animals treated for 2 d. We conclude that repeated KI administration for 2–4 d during gestation did not induce strong thyroid toxicity.

PROBLEMATIC ASPECTS, COMPLICATIONS, MISCONCEPTIONS AND DEBATABLE ISSUES OF IODINE PROPHYLAXIS IN RADIATION EVENTS (REVIEW).

to consider and review the essence of emergency iodine prophylaxis during radiation events, physiological aspects of iodine metabolism in the body, properties of individual iodine prophylaxis agents that are recommended, and to justify the rationality of using some of them along with absurdity/inadmissibility of others; substantiate the creation of a unified preventive information strategy regarding the event in order to reduce anxiety and other negative psychological consequences among the affected population. The review was performed by searching the abstract and scientometric databases and printed publications. In the event of serious radiation events at nuclear power plants and industry facilities, radioactive iodine is highly likely to enter the environment. With the threat of radioactive iodine incorporation or with its incorporation that has already begun, it is absolutely necessary to carry out the emergency iodine prophylaxis. Such prevention should be carried out with stable iodine preparations such as potassium iodide or potassium iodate in special pharmaceutical formulas. Dosing of drugs in age and population groups should be carried out by specialists in radiation medicine and radiation safety in accordance with internationally recognized guidelines. The use of iodinecontaining food additives, iodine solution for external use and Lugol's solution is categorically unacceptable due to complete ineffectiveness, impracticality of implementation, and sometimes due to the threat of serious harm to health. Clear preparedness plans for possible radiation accidents and incidents, as well as successfullyimplemented appropriate preventive measures, including emergency iodine prophylaxis, are crucial for the effective and successful response to such events. Emergency iodine prophylaxis during radiation events should be carried out exclusively under the guidance of specialists in radiation medicine and radiation safety using special pharmaceutical formulas of potassium iodide or potassium iodate in doses recognized by the international scientific community. Other means of emergency iodine prophylaxis, including «handicraft»/home preparations, are absolutely unacceptable. Implementation of this protective measure should be accompanied by a coordinated information campaign in order to minimize purely radiation risks and to preserve the psychological well-being of the population.

De distributie van kaliumjodidetabletten: hoe goed is België voorbereid op een nucleair incident?

The distribution of potassium iodide tablets: is Belgium prepared for a nuclear incident? Potassium iodide tablets are protective in case of a nuclear accident with the release of radioactive iodine. After the Chernobyl disaster in 1986, there was an increased incidence of thyroid cancer in the affected areas. Disaster readiness was deficient, and the population was not aware of the possible protective measures. In Belgium, these potassium iodide tablets are freely available in any public pharmacy upon simply showing one’s identity card. We conducted a survey among the general population, pharmacists and school board members, showing that in Belgium too there is a need for more information. In addition, the survey revealed that in Belgium the distribution to the target groups should be improved. If a nuclear disaster occurs, it goes without saying that a proper organization of protective measures is mandatory. Unfortunately, in Belgium, so many years after Chernobyl, the necessary preparations for this have not yet been completed, while there are 5 nuclear sites within its borders. If the full potential of the potassium iodide tablets is to be exploited, a much better overall approach is urgently needed.

Lessons from Fukushima: Potassium Iodide After a Nuclear Disaster.

The release of radioactive iodine after a nuclear disaster, such as those that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan 10 years ago and Three Mile Island in Pennsylvania in 1979, increases thyroid cancer risk among people who are exposed. Certain populations are especially vulnerable, including pregnant and breastfeeding women, children, and neonates. Potassium iodide (KI) can effectively block radioactive iodine from being absorbed by the thyroid gland if taken immediately after a radiation release. This article examines lessons learned from Fukushima to enhance disaster readiness and nursing actions. Nurses should be directly involved in vulnerability assessments, emergency planning, and in ensuring the availability, accessibility, and distribution of KI within U.S. nuclear power plant emergency planning zones before a crisis occurs.

Transient release of radioactive iodine from the fission of UF4 in 2LiF-BeF2 salt.

In this study, the behavior of fission product iodine released from the melting process of a mixture consisting of UF4 irradiated with neutrons and 2LiF–BeF2 (FLiBe) salt was studied. The experiment showed that a large amount of iodine was released immediately during melting and captured by Ni metal foils. The transient release of iodine observed in this experiment is attributed to the redox reaction between the hot atoms of the fission product iodine that cumulated due to long-time irradiation. The effect of the redox status of the molten salt on the transient release of iodine was also investigated. Based on this investigation, it was proposed that the activity ratios of 131I to salt-seeking fission products in the fuel salt, as an effective diagnostic criterion, may be used for the surveillance of the redox potential of fuel salts in a molten salt reactor.

Международные и отечественные подходы к проведению йодной профилактики при аварии ядерного реактора

Purpose: Carry out a comparative analysis of the criteria and practices of conduct Iodine thyroid blocking (ITB) in various countries from the standpoint of WHO publication (2017) “Iodine thyroid blocking. Guidelines for use in planning for and responding to radiological and nuclear emergencies” (WHO Guidelines) and national Rules and requirements 2.6.1.2523-09 (NRB-99/2009) and other documents, including facility and territorial Emergency plans and instructions contained therein. Results: The WHO Guidelines, prepared using the GRADE method, determine the conditional recommendation in favor of conduct ITB in the event of a release of radioactive iodine: “During a radiation or nuclear emergency, the provision of ITB for people who are at risk of exposure to radioactive iodine should be implemented as urgent protective action as part of a justified and optimized protection strategy”. In the WHO Guidelines, such a recommendation is recognized as qualitatively low, and the strength of this recommendation is conditional, due to insufficient data on the use of stable iodine drugs. However, after studying the implementation of this protective measure, it was determined that the benefits of the intervention outweigh the disadvantages and associated costs. The article contains a selective discussion and opinion of the authors on a number of key issues of organization and conduct ITB. Conclusion: A comparative analysis revealed the similarities and differences between foreign and national practices of conduct ITB. The convergence of positions is necessary and aimed at harmonizing national and international criteria and practices. To date, there is no federal level document in the Russian regulatory framework that regulates the planning, organization and conduct of ITB in relation to people who are not associated with work at radiation hazardous facilities and do not live on territories served by the FMBA of Russia. Based on this, a range of priority important issues that need to be addressed has been identified.

Social uncertainties related to stable iodine intake in a nuclear emergency

Intake of stable iodine intake is considered as an effective countermeasure for reducing the risk of thyroid cancer in an eventual release of radioactive iodine following nuclear accident. However, there are a number of value and social uncertainties that are likely to impact on accident management. These include differences in public response as well as decisions made by emergency management actors during an actual incident. In order to explore these sources of uncertainty, this paper explored social uncertainties related to the potential administration of stable iodine. First, public understanding and compliance with the advice of authorities was studied by surveys, showing that less than half of the public knew when iodine tablets should be taken, or understood their protective role. There were also country specific differences in the level of expected compliance with authorities’ advice. Second, social uncertainties were identified through observations of emergency exercises; these were revealed to be mainly related to timing, public response, communication, effectiveness, cross-border issues and first responders. Third, studies on factors influencing communication about stable iodine were carried out and showed that public understanding and compliance with advice could be improved by communicating numerical and narrative information. Overall, the results indicate that enhanced focus on social uncertainties during the preparedness phase may improve the effectiveness of stable iodine administration in case of an emergency.

Cheap and biodegradable amino acid-based deep eutectic solvents for radioactive iodine capture via halogen bonds

Entrapment of hazardous radioactive iodine has attracted much attention due to the release of radioactive iodine during the application of nuclear energy, such as nuclear waste disposal and nuclear disaster. Deep eutectic solvents (DESs) are deemed as green solvents, designable solvents and solvents of the 21st century. Amino acids are cheap, highly biocompatible and highly biodegradable. Here, we for the first time develop amino acid-based DESs for iodine capture with high efficiency. Effect of structural factors (e.g., mole ratio, composition and composition) and external factors (e.g., mass, concentration and volume of iodine solution) on iodine capture is comprehensively studied. Cysteine:lactic acid (1:8) owns the highest rate and capacity for iodine capture, which shows similar efficiency with previous reports but owns lower cost and higher biodegradability. The high iodine-capturing efficiency of cysteine:lactic acid (1:8) is ascribed to the dominating halogen-bonding interaction (ca. 90%). This work opens a new route for the sustainable capture of radioactive iodine with high efficiency.

Efficient iodine capture by biocompatible PEG-based deep eutectic solvents: Kinetics and dynamic mechanism

Capture of radioactive iodine has been paid much attention due to the release of radioactive iodine from nuclear accident and metal fission. Deep eutectic solvents (DESs) are green solvents. Polyethylene glycol (PEG) possesses the merits of no toxicity, high biocompatibility, high biodegradation and low cost. Here, we for the first time design a series of PEG-based DESs for efficient iodine capture. PEG:thiourea+ethanol mixture owns the highest rate and capacity for iodine capture. Effect of mass, mol ratio, organic solvent, molecular weight of PEG and composition of DESs on iodine capture is investigated. W = W∞(1 − e−kx) is first fitted for DESs to capture iodine. Conventional, difference and the PCMW2D-COS UV–Vis spectra show that PEG:thiourea+ethanol interacts with iodine mainly via halogen bonds before 75 min and via induced force after 75 min. The iodine-capturing rate by PEG:thiourea+ethanol is slightly higher than that of the reported DESs with the highest efficiency while in the same condition. Although the presence of volatile ethanol in PEG:thiourea decreases the iodine storage efficiency, it would provide a new route of improving iodine-capturing rate and capacity.

A survey on emergency thyroid monitoring strategies and capacities in Europe and comparison with international recommendations

There are ongoing social debates about the risks and benefits of using nuclear reactors to generate electricity. Radiation accidents can occur for different reasons and even be caused deliberately as a result of terrorist actions, and these may affect from a few to thousands of people. After a major release of radioactive iodine as a result of a nuclear accident, large number of potentially affected people may require rapid assessments to determine the degree of thyroid contamination, especially children and young people given that their thyroid is a highly radiosensitive organ and particularly vulnerable to the carcinogenic action of ionising radiation. To date, there is no internationally agreed protocol for measuring 131I in the thyroid of affected persons, especially in children.To address this problem, the Child and Adult Thyroid Monitoring After Reactor Accident (CAThyMARA) project (https://www.eu-neris.net/projects/operra/operra-cathymara.html) focused on post-accidental 131I measurements in the thyroid, giving special attention to children and involved 15 institutions from 12 European countries. One of the Work Packages of the project had the objective to overview existing national plans and means for thyroid monitoring and to review international recommendations about radioiodine monitoring in the thyroid in case of a large scale nuclear accident. To achieve this objective, a questionnaire-based survey was carried out from May to October 2016. The survey results were based on the analysis of the answers of 31 institutions in 18 European countries, which included a wide range of questions related to emergency plan strategies, monitoring strategies for radioiodine in thyroid, dose assessment, etc. In addition, the peer-review literature in this area was reviewed and summarised. The results of the survey together with the current international recommendations about radioiodine monitoring in thyroid could provide important information on existing gaps, which can be used to develop new or update existing guidelines on thyroid monitoring after a nuclear accident.

Evaluation of volatile iodine trapping in presence of contaminants: A periodic DFT study on cation exchanged-faujasite

Using periodic dispersion-corrected DFT calculations, the effect of potential inhibiting species (H2O, NO, CO, CH3Cl and Cl2) on the adsorption of iodine species (I2, CH3I) has been investigated over different monovalent (H, Li, Na, K, Rb, Cs, Cu and Ag) cation-exchanged faujasite. We have found out that van der Waals interactions play an important role and can contribute up to about 50% of the total adsorption energy for the alkaline series. Both computed adsorption energies at 0 K and adsorption enthalpies for temperatures ranging from 298 to 523 K highlight the following points: (i) CO and H2O have been identified as the most important inhibiting species; (ii) Hard cations such as H+ or Li+ are very sensitive to water whereas soft cations such as Cu+ and Ag+ can strongly adsorb I2 and CH3I. Therefore, Ag-FAU appears to be the most promising adsorbent in presence of all contaminants, except CO which can inhibit the adsorption of I2. These findings can help to improve the filtering devices used in nuclear plants to avoid the release of radioactive iodine in case of severe accident.

The effects of iodine blocking following nuclear accidents on thyroid cancer, hypothyroidism, and benign thyroid nodules: design of a systematic review.

BackgroundOne of the most efficient radiation protection methods to reduce the risk of adverse health outcomes in case of accidental radioactive iodine release is the administration of potassium iodine (KI). Although KI administration is recommended by WHO’s guidelines for iodine prophylaxis following nuclear accidents and is also widely implemented in most national guidelines, the scientific evidence for the guidelines lacks as the guidelines are mostly based on expert opinions and recommendations. Therefore, this study will provide evidence by systematically reviewing the effects of KI administration in case of accidental radioactive iodine release on thyroid cancer, hypothyroidism, and benign nodules.MethodsWe will apply standard systematic review methodology for the identification of eligible studies, data extraction, assessment of risk of biases, heterogeneity, and data synthesis. The electronic database search will be conducted in MEDLINE (via PubMed) and EMBASE, and covers three search blocks with terms related to the health condition, intervention, and occurrence/location. We have no date or language restrictions, but restrictions to humans only. We will include studies comparing the effects of KI administration on thyroid cancer, hypothyroidism, and benign thyroid nodules in a population exposed to radioactive iodine release. The quality of the studies will be graded. If feasible, a meta-analysis will be conducted.DiscussionThis proposed systematic review will update the existing WHO guideline from 1999. New evidence on the efficacy of KI administration to reduce thyroid cancer, hypothyroidism, and benign thyroid nodules in the event of an accidental release of radioactive iodine to the environment will provide the basis for an update of the WHO guideline for iodine prophylaxis following nuclear accidents.Systematic review registrationPROSPERO CRD42015024340Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0106-3) contains supplementary material, which is available to authorized users.

Transport properties of iodide in a sandy aquifer: Hydrogeological modelling and field tracer tests

Summary The release of radioactive iodine into geological media from nuclear waste disposal is an issue that has to be considered since iodine is a biophilic element. 129I is, with 99Tc, one of the two long-lived radionuclides that have the highest mobility in radioactive waste disposal. Within this context, iodide retardation is still a matter of debate. A low value of the retardation factor is generally accepted in soils without organic matter, but the possibility for sorption cannot be completely ruled out. Since isotopic exchange with naturally occurring iodine is one of the main potential sorption mechanisms, site-specific retention parameters are needed. In the present paper, we study iodide transport in a sandy aquifer. A hydrogeological model was built to fit deuterium, bromide and iodide breakthrough data from in situ tracer test experiments. Within the precision range of the fitting, iodide is excluded from 2.5% of the effective porosity by anionic exclusion and presents a field retention factor (Kd) lower than 0.025 L/kg.

Superoxide Production by a Manganese-Oxidizing Bacterium Facilitates Iodide Oxidation

The release of radioactive iodine (i.e., iodine-129 and iodine-131) from nuclear reprocessing facilities is a potential threat to human health. The fate and transport of iodine are determined primarily by its redox status, but processes that affect iodine oxidation states in the environment are poorly characterized. Given the difficulty in removing electrons from iodide (I(-)), naturally occurring iodide oxidation processes require strong oxidants, such as Mn oxides or microbial enzymes. In this study, we examine iodide oxidation by a marine bacterium, Roseobacter sp. AzwK-3b, which promotes Mn(II) oxidation by catalyzing the production of extracellular superoxide (O2(-)). In the absence of Mn(2+), Roseobacter sp. AzwK-3b cultures oxidized ∼90% of the provided iodide (10 μM) within 6 days, whereas in the presence of Mn(II), iodide oxidation occurred only after Mn(IV) formation ceased. Iodide oxidation was not observed during incubations in spent medium or with whole cells under anaerobic conditions or following heat treatment (boiling). Furthermore, iodide oxidation was significantly inhibited in the presence of superoxide dismutase and diphenylene iodonium (a general inhibitor of NADH oxidoreductases). In contrast, the addition of exogenous NADH enhanced iodide oxidation. Taken together, the results indicate that iodide oxidation was mediated primarily by extracellular superoxide generated by Roseobacter sp. AzwK-3b and not by the Mn oxides formed by this organism. Considering that extracellular superoxide formation is a widespread phenomenon among marine and terrestrial bacteria, this could represent an important pathway for iodide oxidation in some environments.

Twenty-Five Years After Chernobyl: Outcome of Radioiodine Treatment in Children and Adolescents With Very High-Risk Radiation-Induced Differentiated Thyroid Carcinoma

After severe reactor emergencies with release of radioactive iodine, elevated thyroid cancer risk in children and adolescents is considered the main health consequence for the population exposed. We studied thyroid cancer outcome after 11.3 years' median follow-up in a selected, very high-risk cohort, 234 Chernobyl-exposed Belarusian children and adolescents undergoing postsurgical radioiodine therapy (RIT) in Germany. Cumulatively 100 children with or (without; n = 134) distant metastasis received a median 4 (2) RITs and 16.9 (6.6) GBq, corresponding to 368 (141) MBq/kg iodine-131. Outcomes were response to therapy and disease status, mortality, and treatment toxicity. Of 229 patients evaluable for outcome, 147 (64.2%) attained complete remission [negative iodine-131 whole-body scan and TSH-stimulated serum thyroglobulin (Tg) < 1 μg /L], 69 (30.1%) showed nearly complete remission (complete response, except stimulated Tg 1-10 μg/L), and 11 (4.8%) had partial remission (Tg > 10 μg/L, decrease from baseline in radioiodine uptake intensity in ≥ 1 focus, in tumor volume or in Tg). Except for 2 recurrences (0.9%) after partial remission, no recurrences, progression, or disease-specific mortality were noted. One patient died of lung fibrosis 17.5 years after therapy, 2 of apparently thyroid cancer-unrelated causes. The only RIT side effect observed was pulmonary fibrosis in 5 of 69 patients (7.2%) with disseminated lung metastases undergoing intensive pulmonary surveillance. Experience of a large, very high-risk pediatric cohort with radiation-induced differentiated thyroid carcinoma suggests that even when such disease is advanced and initially suboptimally treated, response to subsequent RIT and final outcomes are mostly favorable.