Medical Aspects Chernobye Ofth L Accident

IAEA-TECDOC-516

MEDICAL ASPECTS CHERNOBYE OFTH L ACCIDENT

PROCEEDING ALL-UNION A F SO N CONFERENCE ORGANIZED BY THE USSR MINISTRY OF HEALTH AND THE ALL-UNION SCIENTIFIC CENTRE OF RADIATION MEDICINE, USSR ACADEM MEDICAF YO L SCIENCES, AND HEL KIEVDN I , 11-1 198Y 3MA 8

ATECHNICAL DOCUMENT ISSUEE TH Y DB INTERNATIONAL ATOMIC ENERGY AGENCY, VIENNA, 1989 PLEASE BE AWARE THAT ALL OF THE MISSING PAGES IN THIS DOCUMENT WERE ORIGINALLY BLANK MEDICAL ASPECTS OF THE CHERNOBYL ACCIDENT IAEA, VIENNA, 1989 IAEA-TECDOC-516 ISSN 1011-4289

Printed by the IAEA in Austria July 1988 IAEe Th A doe t normallsno y maintain stock f reportso thin si s series. However, microfiche copies of these reports can be obtained from

IN IS Clearinghouse International Atomic Energy Agency Wagramerstrasse5 0 10 P.Ox Bo . A-1400 Vienna, Austria

Orders shoul accompaniee db prepaymeny db f Austriao t n Schillings 100, fore for e chequa th f m th IAEf m o n i o n i r Aeo microfiche service coupons orderee whicb y hdma separatel ClearinghouseS I y N frol e mth . FOREWORD

On 26 April 1986, an accident occurred at Unit 4 of Chernobyl nuclear power plant resulting in the destruction of the reactor core. The causes of the accident as well as its consequences and impact mitigation are the focus of attention of Soviet specialists in radiation protection, nuclear engineering, radiation medicin ionizind ean g radiation dosimetry. Informatio presentenwas speciadat l meeting IAEs helthe Adby which have intensifie wordits k on radiation standardization and medical intervention planning for nuclear accidents. The Chernobyl accident and its consequences are a matter of interest for research workers from many countries. National committee radiation so n protectio givine nar g special attentio questione th o nt medif so - l assistancca injuree th o et d durin gradiatioa ndevelopmene accidentth o t d an ,f informatioo t d nan radiation control systems. Throughout the world, considerabled efforts are being made to solve the problem f furtheo s r developmen f nucleao t r engineering. 1988y Ail-Unioe Ma th ,3 1 Froo t 1 mn1 Scientific Centr Radiatiof eo n Medicine convene Conda - ference on Medical Aspects of the Chernobyl Accident in Kiev. This was the first conference on this subject with international participation held in the Soviet Union. There were 310 specialists representing Soviet scientific establishments and over 60 experts from 23 other countries and international organizations (IAEA, WHO, ICRP) participated in the Conference. The Conference was widely publi- mase cizeth sy db media alln I .foreig6 Sovie6 3 ,8 d nan t journalists correspondentsV , T radi d oan , including those representing leading scientific journals, were accredited to the Conference. Participants at the Conference discussed medical aspects of accident mitigation, including therapeutic, psychological, demographic, epidemiological and dosimetric problems. Future research on these and some other issues was considered in detail. Participants were given the opportunity to visit the Chernobyl site and the town of Slavutich, and t acquaintege o t d wit wore h th f som ko e specialized medical establishment Kievn si . These Proceedings include 29 reports presented by Soviet scientists during the four sessions as wel summaries a l discussionf so openind san g addresse . E.IMr .y sChazovb , Ministe Publif ro c Health Soviee th f o t . BlixUnionH . , DirectoMr , r Genera Internationae th f o l l Atomic Energy Agencyd an , Mr. V.A. Zgurskij, Chairman of the Executive Committee at the Kiev City Soviet of People's Deputies. EDITORIAL NOTE

In preparing this material press,the for staff Internationalofthe Atomic Energy Agency have mounted and paginated the original manuscripts as submitted directly from translators in the Soviet Union. Tfie views expressed papers,the statementsin the general madethe and style adoptedthe are responsibility of the named authors. The views do not necessarily reflect those of the government of the Member State or organizations under whose auspices the manuscripts were produced. thisin The bookuse of particular designations of countries territoriesor does implynot any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities institutions delimitationand the of or theirof boundaries. The mention of specific companies or of their products or brand names does not imply any endorsement recommendationor IAEA. partthe the of on Authors themselvesare responsible obtainingfor necessarythe permission reproduceto copyright material from other sources. CONTENTS

Opening Speech ...... 9 E.I. Chazov Addres e Participantth o t sConference th f o s e ...... 3 1 . H. Blix Address to the Participants of the Conference ...... 19 V.A. Zgurskij

GENERAL ASPECT HEALTF SO H PROTECTIO EVENE TH F TN O I A NUCLEAR ACCIDENT

Medical and sanitary measures taken to deal with the consequences of the Chernobyl accident ...... 23 G. V. Sergeev Sanitary and health measures taken to deal with the consequences of the Chernobyl accident ...... 39 A. I. Kondrusev The Chernobyl experience in the context of contemporary radiation protection problems ...... 47 LA. II'in Protection of health during a large scale accident ...... 65 A.E. Romanenko

RADIATION ENVIRONMENT AND RADIOLOGICAL PROTECTION

Theory and practice of establishing radiation standards before and after the Chernobyl accident ...... 1 8 . L.A. Buldakov, G.M. Avetisov, M.I. Balonov, Yu.O. Konstantinov Radioactive contamination of water ecosystems and sources of drinking water ...... 91 Likhtarev,LA. R.M. Barkhudarov, O.A. Bobyleva, V.A. Knizhnikov, V.A. Logachev, P.V. Ramzaev, M.N. Savkin, G.V. Sergeev Intake of radionuclides through food chains as a factor in the exposure of the Soviet population after the Chernobyl accident ...... 101 V.A. Knizhnikov, R.M. Barkhudarov, G.Ya. Bruk, A.P. Ermalitskij, A.I. Kondrusev, I.P. Los', N.Ya. Novikova, Eh.V. Petukhova, A.V. Pechkurov, O.G. Pol'skij, I.G. Travnikova, V.N. Shutov, V.P. Filonov Characteristic f radionuclido s e intak inhalatioy eb n ...... 7 11 . V.T. Khrushch, Yu.I. Gavrilin, Yu.O. Konstantinov, O.A. Kochetkov, U.Ya. Margulis, V.l. Popov, V.S. Repin, V.V. Chumak Sanitary-dosimetric monitoring of food products ...... 133 V.N. Bur'yak, N.Ya. Novikova, Z.A. Khulap, A.I. Tsvirbut Radiation monitoring of various objects as part of the Chernobyl accident management programme ...... 9 13 . O.A. Kochetkov, D.S. Gol'dshtejn, O.P. Osanov Personnel protection during a reactor accident ...... 145 V. S. Koshcheev, A. S. Korostin, S.P. Rajkhman Protective measures to reduce population exposure doses and effectiveness of these measures ...... 1 15 . G.M. Avetisov, R.M. Aleksakhin, V.P. Antonov, L.A. Buldakov, K.I. Gordeev, E.V. Ivanov, L.A. IVin, A.I. Kondrusev, A.N. Liberman, G.S. Perminova, V.M. Samojlenko Discussion G. Zubovskij.A ...... 5 16 . . / Waddingion: Brief summar ongoine th f yo g relatioprogrammn i O o nt WH f eo the public health aspects of nuclear accidents and the Chernobyl follow-up ...... 165 G.W. Anderson, E.D. Rubery ...... 168

DOSE EXTERNAF SO INTERNAD LAN L RADIATION EXPOSURE

Methodological principle r calculatinfo s g level f externao s internad an l l exposure th f eo population used in taking strategic decisions ...... 171 R.M. Barkhudarov, K.I. Gordeev, I.K. Dibobes, I.A. Likhtarev, U.Ya. Margulis, O.P. Osanov, O.A. Pavlovskij, B.S. Prister, M.N. Savkin, V.P. Shamov Dynamic f gammo s a radiation level formatiod an s f externano l exposure dose ...... 3 18 . V.A. Logachev, I.P. Los', V.I. Parkhomenko, M.N. Savkin, A.V. Titov Monitoring of internal exposure of the population in regions close to the Chernobyl nuclear power plant ...... 195 I.A. Gusev, I.A. Likhtarev, E.I. Dolgirev, I.G. Zhakov, B.A. Ledoshchuk, RamzaevV. P. Method r retrospectivfo s e determinatio f absorbeno d e humadoseth n i sn body resulting from external and internal exposure ...... 203 M.I. Balonov, I.B. Keirim-Markus, U.Ya. Margulis, O.P. Osanov Long term prognosi f individuao s collectivd an l e exposure populatioe doseth o t s n ...... 7 21 . O.A. Pavlovskij Discussion A. J. Gonzalez ...... 229

CLINICAL ASPECTS OF RADIATION EFFECTS

Acute effect f radiatioo s n exposure followin Chernobye th g l accident: immediate resultf o s radiation sicknes outcomd an s f treatmeneo t ...... 3 23 . A.K. Gus'kova, N.M. Nadezhina, A.V. Barabanova, A.E. Baranov, I.A. Gusev, T.G. Protasova, V.B. Boguslavskij, V.N. Pokrovskaya Transplantatio f bonno e marro victim n wi Chernobye th f o s l accident ...... 7 25 . A.E. Baranov Rehabilitatio f victimno f acuto s e radiation sickness ...... 7 26 . V.G. Bebeshko, B.P. Prevarskij, I.G. Khalyavko, I.V. Shimelis, D.A. Belyj Problem f evaluatino s g public health afte accidenn a r nucleaa t a t r power plant ...... 3 27 . O.A. Pyatak, E.M. Luk'yanova, V.N. Bugaev, V.P. Nedel'ko, A.E. Prisyazhnyuk, P.I. Burenin, V.E. Dashkevich, G.A. Zubovskij, L.I. Ivanyuta, A.G. Kolomijtseva, S.M. Makeev, A.A. Yakovlev Pseuchoneurotic disorders associated with the Chernobyl accident ...... 283 Yu. AleksandrovskijA. State of the pituitary and thyroid system in children at various times after exposure to radiation as a result of the Chernobyl accident ...... 293 E.A. Benikova, E.V. Bol'shova, . Zvonova,LA G.A. Zubovskij, F.F. Markov, E.G. Matvienko, N.G. Makhon'kova, V.A. Olejnik, N.T. Starkova, N.F. Tarasov, N.D. Tron'ko, A.K. Cheban, E.V. Epshtejn Medical care during the radiation accident (137Cs) in Brazil, 1987 ...... 299 G.D. Selidovkin Discussion P.V. Ramzaev ...... 9 30 . C.E. Brandâo-Mello: Medical aspects of the Goiânia accident ...... 310 T. Sharma: Shor lond an tg term cytogeneti genetid can c studiepopulatioe th f o s n after the Chernobyl accident ...... 311

POPULATION STUDIES, PUBLIC HEALT ALL-UNIOD HAN N REGISTER

Medical demographic consequence Chernobye th f o s l accident ...... 315 N.I. Omel'yanets, G.I. Miretskij, M.M. Saurov, F.F. Torbin Organizational, methodological and information aspects of the mass individual dosimetric surveys carriecontaminaten i t dou d areas followin e Chernobygth l accident ...... 7 32 . A.F. Tsyb, F.F. Stepanenko, V.A. Pitkevich, E.A. Ispenkov, V.K. Ivanov, E.G. Matveenko, M.A. Maksyutov, O.G. Pol'skij, R.N. Turaev, A.E. Romanenko, N.I. Omel'yanets, B.A. Ledoshchuk Database systema r fo s analytical approac studyino ht medicae gth l aspecte th f o s Chernobyl accident ...... 333 /./. Linge, K.K. Dushutin, . Zajtseva,LG L.N. Kovgan, S.G. Labuzov, A.A. Nigiyan, F.F. Khokhlov Preparatio Ail-Union a f no n distribution registe f persono r s expose effecte th f o dt o s radiation as a result of the Chernobyl accident, with a view to evaluating exposure doses and making a long term public health forecast ...... 345 A.F. Tsyb, A.N. Dedenkov, V.K. Ivanov, F.F. Stepanenko, F.F. Pozhidaev, V.A. Pitkevich, E.G. Matveenko, E.A. Ispenkov, O.E. Stadnik, O.G. Pol'skij, R.N. Turaev, A.E. Romanenko, N.I. Omel'yanets, B.A. Ledoshchuk, A.S. Sytnik, V.N. Bur'yak, V.A. Stezhko, G.A. Losev, P.V. Ramzaev, M.I. Balonov, Yu.O. Konstantinov Organizatio plannind nan f worgo k involve lone th gn di ter m clinical observatiof no children with a high radiation risk ...... 351 V.N. Bugaev, E.I. Bomko, E.M. Bruslova, A.I. Avramenko, L.A. Buldakov, N.F. Rubel' Discussion S. P. Yarmonenko ...... 365 Statemen Participanty b t s ...... 7 36 . Concluding Speech ...... 9 36 . A.E. Ramanenko Organizing Committee ...... 373 Lis f Sovieo t t Participants ...... 7 37 . Lis f Foreigo t n Participants ...... 1 38 . OPENING SPEECH

E.I. CHAZOV USSR Minister of Health

Dear colleagueI s Ladie d gentlemesan I nComrade 1 s

Two years have passed aince the tragic events on the Chernobyl Nuclear Power Plant, but up to now the pain experienced by our people does not subside and up to now many people e deeplar y concerne e questioth y b de consequence nth whae ar t s of thihealte th s r accidenhr countrfo ou l r d firsal fo an ytf o t f preseno d cominan t g generations. When answering these questions one should point out the unprecedented characte d compexitan r e situatioth f o y n resulted from the fire on the nuclear reactor and radioactive contamination of relatively large territory. Therefore when speaking about e liquidatioth e consequenceth f o n Chernobyf o s l acciden- ge e w t nerally use the terms " unprecedented " , " for the first titre in the world practice " , etc. A need emerged in the large-scale governmental measures unpracticew n makin i ne s wel , a e s a lth g - de d cisions, the use of all the medical experience to protect the population health in contaminated areas. One should admit that not everybod s read wa ymako t y e these decisions y nothinsa o t ,f o g their realisation. Only efficien d active secan tth - l e al wor f o k tions of the Government Commission on liquidation of the consequences of the Chernobyl accident made it possible to overcome the impact of the tragedy and to prevent its negative effects on population health« One must say definitely that we can today be certain that there are no effects of Chernobyl accident on human health, and e great th oe selfles tth o extent se du twor medicaf o k l specia- thef o m9 list wer39 ( ae give Governmene th n t award Medica. s) l specialist e firss th wer tn i erank f thosso o cam helo wh ee t e th p peopl n dangeri e , the e statioy th wer t a en durin accidente th g .

Much had been done during the evacuation of the population from contaminated areas. The scale of these works is unprecedented. Only in some days after the accident highly qualified exami- populatioe natioth f no n withi accidene th n t zons organizewa e d an d medical treatment of those with the diagnosis of acute radiation sickness began. Moreover, the thorough investigations of all the aspects of the desease permitted to reduce the group of patients o 145t fro«7 Worl23 m d medicine did t knon w suc a volumh worf o e k before. During the first few months after the accident the stationary examination was provided for 37,5 thousand people ( 12,6 thousand of them - children ). By the end of 1936, 696 thousand people (215 thousand of them - children ) were provided with necessary medical treatment. The Ail-Union distributed clinical-dosimetric register of irradiated individual createds swa t includeI . s more tha0 n60 thousan undew de no specia peopleth re ar lo ,wh dispensar y observation. Wit e purposth h f scientifio e d methodicaan c l guidance th f o e activitie d generalizatioan s e uniquth f no e scientific date th a All-Union Scientific Centr Radiatiof o e n Medicin e USSth Rf o e Academ Medicaf o y l Science d Speciasan l Research Institut- Ra f o e diation Medicine In Minsk were founded.

The complex of measures undertaken in our country allowed to protec healte th t Sovief o h t people fropossible th m e negativ- ra e diation effects e thorougTh . h medical examination reveat no d lsdi any deflexions in the health of population. Health protection bodies, special scientific centres and dispensaries continue observation of the population in contaminated areas. Today here, in Kiev the first scientific Conference on the Medical Aspects of consequ-

10 Chernobye enceth f o s l acciden beins i t g opened. More tha0 scin15 - entists and specialists of our country, engaged in radiation me - dicine and radiation protection, and over 60 specialists from 23 countries for the first time will discuss thoroughly all the comple problemf o x s nucleae causeth y b dr reactor accident e Sovi.Th - et medical specialists hav o reasonn e conceao t s l anythinn o g this subject. All the materials on the Chernobyl accident effects on human health are submitted to IAEA, and WHO since the first months afte accidente rth e materialTh . s were discussed several times at the expert meetings. Taking into consideration the fact that the Chernobyl accident has cast the light on various global problems of medical science and practice we are sure that the results of this discussion which will become available to the broad public e grea, th wil te b lcontributio e worlth do t nmedica l science. Our experience, which the world medical practice did not know, should become e scientistaccessiblth l al d physicio t an se - ans in the urorld. Today we must also say that the Chernobyl events manifested the solidarity of medical specialists of the whole worl e dange n fronth i d f o rt brough uncontrolley b t d distractive force of atom. We thank everybod o responde wh yr trouble ou o t dwero ,wh e with us during the hard months of struggling for life and health of Soviet people. We express our gratitude to dozens, and hundreds of scientists and physicians, representatives of international organizations and firms who offered their help. e SovieTh t Unio s sufficiennha t potentia o solvt l e without ssssistanc probleme th e s emerging froChernobye th m l accidentt .Bu we were gla recivo t d e offerth e s that were manifestatioth e f no natural impulse of the honest people of the globe, the manifestation of sympathy to our people. 400 years ago John Donn wrote: deate Th everf ho belittlen . yma .. " e toosm - ,en n sinca m % eI l mankindal tit f o y , don*t ever e bellask th r who t fo :" ,i m tolls", it tolls for you". 11 Chernobyl accident has cast the light on another global problem - the danger of mankind extermination in the case of nuclear war.Atomic energy is a two-faced Janus who can bring well- bein d prosperitpeoplee e worlan gth th n connectil i f do al s o t y - on with the development of atomic power engineering, but it also can be a cause of mankind extermination« One should remember that Chernobyl accident and medical-biological problems connected with it can in no way be compared with the consequences of modern nuclear alle warw y ,.wh Tha physicianss i t , people safeguarding the health and peace of the population of our planet, warmly welcome the Soviet-American agreements on nudlear missiles.

Dear colleagues! Our Conference is held in Kiev, the population of which had displayed selflessness, high consciousnes d organisatiosan n ni the complicated situation, connected wite Chernobyth h l accident.

Today, whe e wors nth e wiss over m i t ht ,le happiness , health d prosperitan r amiablou o yt e hosts d lik * expreso .I t e s deep gratitude to the Central Committee of the Communist party of Ukraine, to the Counsil of Ministers of the Ukrainian SSR, to the Executi- ve Committee of the City Soviet of People*s Deputies for providing exellent condition Conferencer ou r fo s woul.I d lik expreso t e y sm gratitud Generao t e s parl hi Directo . Bli- r H IAEe fo x. th A Mr f ro ticipation's well as to the representatives of WHO, all our foreign collègues whose participation will contribute to the success of our work.

12 ADDRESS TO THE PARTICIPANTS OF THE CONFERENCE

H. BLIX Director General International Atomic Energy Agency Vienna

littla w no e s Ii ovet year o r tw o tha e accidensag th t t a t Chernobyl occurred. s ther Whefirse wa th enI t timehelicopa n ,i - ter, shortly after the accident, Soviet experts were just brin- ginsituatioe th g n under control with great effor d greatan t skill« When I visited Chernobyl a second time in January 1587, the dest- royed reacto d beerha n embedde concretn undamageo i dtw d - an e re d actors had been decontaminated and were again in operation after technical modifications and changes in rules and procedures. The third undamaged reactor, adjacen e destroyeth o t d ones ha , now bee n operatioi n n since manyn o months I e expec se d o an ,t t this occasio w normanho l lif beins i e g restore largee th n ri d part

aree oth fa thas closewa t d evan dacuated e accidenTh . s verwa ty severe, but the wounds are healing.

No-one can deny that the costs of the Chernobyl accident -- n livesi , injur healtho t y , environmene damagth o t e d cosan t t to society — were high and they were the highest here in the Soviet Union and in the Ukraine and Byelorussia. Thirty-one people died, more tha0 sufferen20 d radiation injury, over 100,000 were evacuate d largan d e area f lano s d were contaminated. Radio- active fallout outsid e Sovieth e t Union necessitated protective measure mann si y contries.

What lessonworle th ds si drawing - from this acciden Ther? t e lessoe th simpls y i n sa o y wh — w fe t no thosthed e e an ar yar e - that nuclear power mus abandonede b t psychologicae .Th l fallout from Chernoby s considerabllwa d spreae an ovel worlde dal rth .

13 poiny Wma e t out f ,courseo , that many peopl opposo wh e e nuclear power do not oppose hydro power, despite the many dam catastrophes with thousand f liveo s stheo d lost r y opposNo . e coal-fired power,

despite the thousands of lives that are lost in mines and the environmental pollution and destruction that has been caused by fos- l fuelssi .

1 am not critical of this - our human reactions are not necessarily scientific. They are human. We have been sadly and gradually accustome o deatt d n coai h l mines, polluted industrial areas and the drowing of people by dams that burst. We have not been accustome o deatt dd injur an h radiatioy b y d pollutionan radioy nb - active fallout„We must do all in our power to prevent that we get used to it. But we must also avoid letting the spontaneous reactions lead us to act in an unwise and irrational manner. Many people are scared when airplanes take off. But they do fly, because e destinationth o thet t y ge wan o ;t t they know thae riskth t s e smal ar thad an lt alternative way f travellino s e alst ar g no o without risk.

No way of producing electricity is without some risk. It is

meaningles o examint s e onl e riskth y f nucleao s r power muse W t. compare these risks wit produche w thos f i a givee e n whicru n e w h quantity of electricity by coal or hydro, oil or gas- In a period when it is becoming evident that the environmental consequences e world*oth f s enormou f fossio e lus s fuel e catastrophiar s c regi- onally and globally - acid rains, dead forests and lakes, and probably a modification of the temperature of the earth"s atmosphere, it would be paradoxical to abandon nuclear power, which is not contributing to any of these ills.

The first lesso f Chernobyo n s noti l , therefore o stot e , th p nuclear power stations, but to reduce further the rists. The pub- s lesi sc li toleran f nucleao t r accidents tha f otheno r accidents.

14 This has to be accepted by the nuclear industry and regulators everywhere. Safety is never a static concept. Whether in cars, airplane nuclear so r powe d musr an plants tn alwayca t ,i stree sb - ngthened« These efforts go along two lines: to prevent accidents

and to reduce thej consequencesize s of such accidents as ne- an( vertheless occur.

Bach government f course,o responsibls n popula,i ow s -it o t e tion for the safety of its nuclear installations and it has all the legislative and executive power to exercise that responsibility. However, each government is interested in the nuclear safety in other countries as well and is interested in learning as much as possible from other countries experience. It is for these reasons that governments are making increasing use the International Atomic Energy Agency. The first requirement is a mutual openness d helpfulnessan .

An excellent example was set by the Soviet Union, when after the Chernobyl acciden producet i t n extensiva d e e caureporth -n o t ses and course of the accident and submitted it to international discussion with some 500 nuclear experts in Vienna in August 1986.

We regret today the untimely death of Valeri Legasov, who stood with several Soviet colleagues at the centre of this discussion which enable nucleae th d r worl learo t d n froe tragith m c experien- ceChernobylf o s .

Many measures have since been taken jointlIAEe o th t A t a y further strengthen nuclear safety. The Incident Reporting System allows governmen d nucleaan t r operator learo t s n from many smal- r accidentle d incidentsan s that occur. These lesson- s re hel o t p biggee ducth e ris f th eko r accidents. Nuclear Safety Standards ( NUSS ) are internationally accepted safety standards, and they hav w beeno e n Chernobye updatee lighth th f o tn i d l experience. A special advisory group consistin world*e th somf go f o es best expertise in nuclear power safety - including Mr. V.A. Sidorenko

15 from the Soviet Union - has worked out a set of b.asic and coherent safety principles which should gradually help to further strengthen safety. And a practice has developed under which Member governments

invite the IAEA to send and international team of experts in operational safet o examint y n reviea e e operationawth l safet n nuci y - lear power stations on their territory. We have sent some 25 such mission ( OSARTs ) saroun e worldth d , breakin e isolatioth g f no power plant operators, acquainting them with good practice n othei s r countries learnind an , g from y thathe sa glas wellt mm a o a t d I . the Soviet Union has invited such a team to come to a plant in your country, FranceUS e , ,th Japan jusd e Federaan tth , l Republic f Germano d manan y y other countries have done.

While international effort o furthet s r strengthen operational safety to prevent accidents was one important cosequence of Cher-

nobyl, others were directed at mitigating the size and consequen- f accidento s ce s that might nevertheless occur conventiono Tw . s were elaborate n recori d d tim n 1986earln i eo e y ,on notification to other countries in the event of an accident, to enable them to take precautions against possible transboundary fallout e otheth ; r onemergencn o e y assistanc o t efacilitat e outside assistance in case of nuclear damage.

One of the lessons taught by Chernobyl accident was that some common standards were desirable regardin e levelth g f radio s - atio t whicna h different type f fooo s de prohibite b wer o t e r fo d consumption: intervention levels. There were wide and unjustified variation e standardth n i s s adopte differeny b d t countrie- ma - s ny of them quite unnecessarily restrictive. The Codex Alimentari- us Commission of the U.R.* s Food and Agriculture Organization ( FAO ) and the World Health Organization ( WHO ) is expected to com p witu e h recommendations this summer.

16 Other important lessons to draw from Chernobyl are those with which your medical professio s i nconcerned IAEAe Th .*activitie 3 s n thesi t stare no area d t di swit h Chernobyl.

In the field of diagnosis of overexposures, the Agency has had a long-standing activity in biological dosimetry. A report on chromosomal aberration analysis for dose assessment was published immediately after the Ghernobyl accident. A new report is in preparation, as a result of the advice which the Agency received from a grou pn Leningrai t thame t n i dDecembe r 1987- jo t -I a wil e b l int publication by many authors, including several Soviet scientists. It will contain all the biological, biophysical, immunological, biochemical and haematological methods for dose assessment whic e presentlar h y available.

The Agenc s alsha y o worked very extensivel e fielth dn i y of medical handling of overexposed persons. A report on the general principles of diagnosis, prognosis and treatment of overexposed individuals is in print arid guidelines on the handling- of individuals subject to external irradiation and to internal contamination are in a very advanced stage of preparation« A documen skin o t n lesions produce irradiatioy b d s pube ni aboub o -t t lished; it includes substantial contributions by Soviet scientists as a result of the Chernobyl experience.

Let me also mention a very widely disseminated Agency publication e technicath , l documen " Wha n a Generao t l Practitio- ner ( M.D.) Should Know about Medical Handling of Overexposed Individuals". This is not a document for a specialist, but is

intende r non-specializefo d d medical practitioners bees ha n t I . up-dated after Chernobyl. This publication has been reprinted five times already 5,00d an , 0 copies have been distributed throughout the world. German, Italian and Japanese translations have been completed, and other translations are being prepared. It is

17 now being supplemented with additional documents directed to specialists.

mentioLastlye m t e enormouslle th n, y important epidemiolo- gica e lradiatio th stud f o y n effecte populatioth n o s n around Chernobyl which the Soviet authorities have launched, and in which they have invited international participation and advice. The IAEA and the WHO have been channels for this international co-operatio e scientifith d an n c community aroun e worlth d d will welcome the results of this study in an area in which we - for- tunately- have limited information.

We know the enormous work which has been performed by the Soviet authoritie d institutean s o trea t schecd e peoplan t th k e who received or were feared to have been exposed to radiation in the accident. Almost a million members of the public have had various examinations, and the new Ail-Union Centre of Radiation Me- dicine of the USSR Academy of Medical Sciences has been established her Kievn i e . close m y expressin b t e Le thanke y Sovieth gm o t st Ministry of Healt r holdinfo h g this All-Union Conference r havinfo d gan , invited more thae hundreon n d scientists from abroad, including a delegation froe IAEAth m . This will ensure thae conclusionth t s you draw will benefit the maximum number of people around the

world. Through the openness you demonstrate, the tragic experience of Chernobyl will expand our knowledge and help us to reduce harmful consequences of radiation. I wish you a very success- ful conference.

18 ADDRESS TO THE PARTICIPANTS OF THE CONFERENCE

V.A. ZGURSKIJ Chairman of the Executive Committee at the Kiev City Soviet of People's Deputies

Dear participants and guests of the Conference ! Ladies and gentlemen ! Comrades !

On behalf of the Kiev Executive Committee at the City Sovie f Peopleo t *s Deputie I heartls y welcom heru n Kiei yo ee t a v e Ail-Unioth n Conferenc e Medicath n o e l Aspecte Chernobyth f o s l Accident. Our city, which stands on the bank of the Dnieper, has been chosen for this grand scienbific forum, and, we concider it a higbot s ha h honou logicad an r l consequence th e o t too e Du . proximity of the Ukrainian capital to the hypocenter of the Che- rnobyl accident s largit , e scientifi technicad an c l potential, Kiev has become one of the first lines of overcoming the acciden- l consequencesta n thosI . e hard month f 198o s e leadin6th g experts of our city contributed much to curb the raging atom. Citizens of Kiev were selflessly workin o stabilizt g e situatioth e d nan to safeguard people" s health. All medical staff bore a great responsibility at that time acting all over accidental and neighbouring area e injured gives th s wa e o tile t nfirs W d th l. ai t e gratefu ar r colleagueou o t l s from Moskow, Leningra d othean d r e countrcitieth r f theio sfo y r tireless activit helpd yan . Sci- entist publid an s c figures from foreign countries have als- oof fered their assistence.

As you know, the All-Union Scientific Center of Radiation Medicine of the USSR Academy of Medical Sciences is founded for the development of long-term strategy of medical measures aimed at the mitigation of the accidental consequences, as well aa at

19 e totath l safet f nucleao y r engineering e precon. th Thes e ar e- ditione Kieth vr Conferencefo s n fact I e .participatio th , f no representative f internationao s l organizations, prominent fore- Sovied an n t ig scientist s wela ss masa l s medians attention will mak e presenth e t e mosConferencth f t o importan e on e t scientific workshops of the final quarter of our century. The public of Kiev have done their best for the success of your scientific an dn anciena socia ever-yound e an se tl n workca o thau s g, yo t Kiev arriveu Yo . e ddays th her t a ,e e calleknowth y nb d writer Michael Bulgakov " chest-nut trees and May on the boulevard". Yo e Dniepeuth wile se " whiclr s i marvelouh t shina s y weather" as the great Gogol described it. You will see numerous monuments

that are 15 centuries old, among them - Kiev -Pechersk and St. Sophi ae remarkablmuseumth f o e s ev thae e beine ar tth gn o now,

historical date, the Millenium of Russian Criatianity, the sym- bol of centuries-old development of our history and culture.

Succes o yout s r Conference r you fo d than ru an ,time yo k .

20 GENERAL ASPECT HEALTF SO H PROTECTION EVENE NUCLEAINA TH F TO R ACCIDENT MEDICAL AND SANITARY MEASURES TAKEN TO DEAL WIT CONSEQUENCEE HTH CHERNOBYE TH F SO L ACCIDENT

G.V. SERGEEV

Abstract

frontso tw Wor s carrien o :wa k t emergencou d y qualified medicad ai l was organize r thosfo d e suffering from thermal burn radiatiod an s n injuries, and wide-scale prophylactic measures were take o prevent n t exposuro t e radiatio s consequencesit d an n . Mor peopl0 e00 tha0 e 60 n(includin g 215 300 children) underwent extensive medical examinations. For prophylactic purpose n ordei d o diagnost ran s e more accurately various diseases whicd hha been identified durin e medicath g l surveys peopl0 50 7 e3 , (including 12 600 children) were examined in hospital. (This figure also includes people who made personal requests for such examinations.) No abnormalities associated with exposure to radiation were found. At the suggestion of the USSR Ministry of Health, more than 350 000 children and pregnant women were sent to sanatoriums, rest homes and pioneer camps in 1986-87.

The exposure dose to the population as a result of the Chernobyl accident durin e nexth g t 50-70 years wil t exceeno l d more than 20-30e th f %o dose from natural radiation.

The accident at the Chernobyl Nuclear Power Plant is the most serious one in nuclear pov/er development. The results of this really gigantic and effective work to eliminate the consequences of the accident have no equal. Therefore the experience has great importanc e Soviete worl th t onl th t r als no er d fo ybu , fo o scienc e and practice. The objective of our conference is to highlight medical aspects of the Chernobyl accident. We have to consider thoroughly e eventth featured an s s related wite accidentth h e effectth , f o s exposur e contaminatioth d an e f environmento n have W e. als o evat o - luat e wholth e e amoun d qualitan t f woro y k don medicay b e l person- e statth nel f e healtexposeeo , th f o h d o considet grou d an pe th r long-term objectives of medicine, bearing in mind the consequences of the accident. Government Medical Commission was established to coordinate the activities of all medical expert groups working on the elimination of the consequences of the accident at the Chernobyl Nuc-

23 lear Power Plant e leaderUSSe .Th th H f o sMinistr f Publiyo c mose Healtth t d prominenan h t scientist e fiel th f radiolo o dn i s - gical medicine, as well as representatives of a number of other organizations were include n thii d s Commisaion informes wa t .I d about the number of casualties, their conditions, the amount of specialized aid provided by medical organizations, the radiation level in the area around Ghernobyl, at the plant itself, and on the contaminated territories, about preventiv d sanitary-hyan e - gienic measures. Thus, the Commission was at the head of all medicad sanitarlan afflicteye th wor n ki d area. The Commission worked in two main directions: to provide emergency and adequate medical aid to casualties suffering from heat burns and radiation injuries, and to monitor large-scale versatile measures to prevent radiation exposure and its consequences . Operation Governmene groupth f o s t Medical Commission were established to elaborate and pass decisions. These decisions en- visage: - the urgent measures to provide first medical aid for the victim accidene th f d preventivo s an t e measure e personth r fo s- e plan th d rescu an tf o el teamsne ; - medical aid and preventive measures for the population at the accident site 0 kilomete3 , a i.e n i . r zone; - mobilizatio f extrno a force d meanan s - provido t sne e th e

cessary medical aids sanitary-epidemiological and preventive measure evacuatee th r fo s d population e populath r fo s -wel,a s a l tion effected by radioactive fallout; e participationth - e expertth f o ss from scientific research d medicaan l center- r countraf ou e f n o providinsth i y r fo d gai flicted area d elaboratioan s f sanitary-hygieneno , antiepidemic measures, norms, criteri d rule an af radiatioo s n protection.

24 The Coordination Scheme of the Government Medical Commission and other board establishmentd an s s givei s n Pigni « I «

Governmental Commissio e Liquidatioth n o n f Consequenceo n f o s the Chernobyl Accident

Ministries,departments, takine g th par n i t GOVERNMENTAL MEDICAL COMMISSION accident consequences liquidation. on the liquidation of consequences

Ministry of Health Ministr f Healto y h of Ukraine USSe _ o_ th fR

Republican medical Ministries of Health establishments of Union Republics Ministrr o y Health of ByelorussiaE SS n

Republican medical establishments Structural institutions of e Ministrth f Healte o USSyth Ef o h

Scientific-researc medicald an h - Republican prophylaxis establishments, medical subordinate to Ministry of Health establishments of the USSR

FIG.I. e schemeth Governmene n i th , e se n tca Medicae w s A l Commission coordinated the activities of the Health Ministries of Union republic d medicasan l organizations medil , al heae beinf -th o d t ga measurel ca aflictee th provido n st i d ai earea d ensuresan d cooperation with other ministries and state boards which carried out their tasks in the contaminated areas. Various decision differenf o s t significanc meanind ean g were not taken only on the basis of the received information. Its members visited the site to study the situation, to give consultative and practical aid, to take part in the consideration and solution of the problems together with the leaders of regional party,

25 Soviet and economic boards, However, we have to admit that the first s activitiestagit f o e solutioe problemth e s th f s o n wa s not always effectiv d operativean e , numbea wha n i tcasef ro d le s to contradictory opinions and dragged out the solution of some problems. e firsth tf o objective e On o estimatt s possibilite swa th e y e populatiooth f mose th livo t t n n i econtaminate d areas. In an unprecedented short period of time, taking into consideratio e growinth n g leve f radioactivo l e contamination o d nan the basis of Safety Standards established in 1976 (SRS-76), it was decided on the criteria for the introduction of emergency measures to protect the public. According to the Government Commission decision over 100 000 people were evacuated from the accident site. Further events prove importance th d f thio e s measur wels a es a l iodine prophylaxis s necessarwa t I . o solvt y e many urgent complex; problems. It should be pointed out that medical personnel at the plant was informed about the accident 15 minutes after the accidend occuredha t . First medicas givewa d n ai lbot medicay b h l per- e locasonneth lt a l surger d firs an d yteam ai t s which arriven i d 30-40 minutes. First of all, the casualties were taken out of the radiatio d destructionan n zone, then they were sanitize werd an de given symptomatic treatment. Those with axonal reaction were immediately evacuated. During the first 12 hours 132 people were taken hospitale tth o . Such serious situation demanded urgent involvement of medical experts of high qualification. The Moscow team of highly-qualified experts begahour2 wor1 s n it s- ki ac afte e th r cident. The? 2 y 0 casualtied examine35 an o 6 t 2 d gav d n dan so ai e April. Casualties were sent for inpatienf; examination and treatmen n specialli t y prepared clinic Kien Moscowsi d van totae .Th l numbe9 peopl49 f o re were hospitalized wit diagnosie th h "acuf o s - te radiation sickness".

26 All casualtie fult sgo l clinica radiatiod lan n examination ni dynamics, cellular composition of. bone marrow was defined. All these enabled constan d objectivan t e estimatio atate th f o f eno th provido et sicd kan e necessary adequate treatment. At firstbasie th clinicaf so n ,o l examinatio diagnosie nth s of acute radiation sicknes s confirme swa people7 23 r .dfo However, subsequent examinations analysie ,th dosf so e burdens according to the chromosome aberration rate and the estimation of clinical symptoms enabled to exclude 92 people from this list. Clinicians usemodere th d n arsena homf foreign-madd lo an e e medicines. Foreign scientists took par n treatini t patientse gth , hel- sendiny b pes du g equipmen medicinesd tan , sharing their experi- encd knowledgan e fiele th radiatiof o dn ei n injury treatment (Hammer, Gale, Champlin, Tarasaky and others). e faileW savo dt 8 people 2 e o wer,wh e mostly plant workers and fire fighters at the accident scene. 16 people from the total number of casualties do not work jet. This testifies to the fact that the methods and principles of treatment, elaborated by So- viet medicine, turned to be rather effective. Sinc firse eth Chernobyte th day f o s l acciden whole th t ene Ukrainiane oth f , Byelorussia d severaan R nSS l region Ruse th - f so sian Federation worked for medical aid in the most contaminated areas. There were engaged 2000 health teames, a considerable numbe f scientistro s from scientific-research institutes wels ,a s la engineers and technicians for dosimetry investigations (see Table I) e objectivTh medicinf o eintroduco t s ewa e public healt- hra diation observation evacueel .Al s froaccidene th m t zone were subjected to thorough examination and dosimetric tests in order to define their stat healthf o e , possible radioactive contamination of personal belonging and skin. The content of incorporated radioactive isotope defineds swa . High-sensitive body monitors

27 Table I. The number of specialists involved in medical aid and examinatio e evacueee populatioth th f o nd e regionan sth f o n s contaminate radiatioy b d n fallout

The organization :Health:Doctors:Low-grade:Students:Scientists :team : s :medica : l :and engi- ______\______\______^workers ;______;neers______Ukrainian SSR 297 2000 4000 1250 9 Byelorussia14 25QO R SS n450 0 Russian Federation 1518 1913 3695 - 938 The system of the USSR Ministrf o y Public Health 519 504 - 686 Total 1964 6932 12699 1250 1924

(BM) v/ere use r thifo d s purpos n Juni e e 1986 USSe .Th R Ministry of Public Health approve e establishmenth d f specializeo t d hospital n Kievi s , Mins Moscowd an k . Their main objectives wero t e

find out, register and observe in dynamics all exposed individu- e Chernobyresula th s a f o ts al l accident wela a s ,thei a l r treat- mend publian t c consultations All-Unioe Th « n Scientific Centrf o e Radiation Medicin e USSth Rf o eAcadem f Medicao y l Sciences wa s establishe o ensurt d e profound scientific investigatione th f o s outcome e accidentth f o s , coordinat l measureal e observd an s e different contingent e populationth f o s . More than 600 thousand people (including 215*3 th.children) were thoroughly examined. 37, . peopl5th e (including 12,. 6th children) underwent examinatio e hospitalth t a n s prophylacticsa s , obtaining more accurate diagnosi f variouo s s disease r becauso s e of their personal initiative. There were no deviations of the state of health connected with the exposure. This was the result of large-scale prophylaxis measures, which provee ratheb o t dr effective.

28 They were carried out by health services in coordination with other departments. First of all, these were sanitary-hygiene measures aime t radiatioda n safet maximud yan m decreas outef eo d an r inner public exposur vicinite e Chernobyth th n ei f yo l Nuclear Power Plant somn wels i ,a e s la region Ukrainiae th f o s n SSR, Beylorussia d Russiaan R nSS Federatio personnee th e d th nan t la accident scene. perioe th radioactivf n o dI e release sanitary-hygiene services together with meteorological services conducted monitoring of radioactive fallout t enable.I determino t d e regionth e s with high leve f lradiationo . Effective contro radiationf lo , radiation-hygiene services, monitoring foodstuff d drinkinsan g water were introduced in the aflicted areas. On 3 May 1986 the USSR Mi- nistr Publif yo c Health approved "Temporary Standard Permisf so -

sibl n drinkin± eI Conten•' g f wateo t d mairan n foodstuffs". Taking into account the annual consumption of different foodstuffs, the technology of their production, there were introduced temporary regulations governin radionuclide gth e contenl al n i t foodstuffs, fruit vegetablesd san , herb d severasan l medicines. In accordance with the guidelines the sanitary and epidemiological services, the USSR State Commission for the Agricultural Industry solved the problems of food supply. All these measures led to the substantial reduction of the intake of radionuclides with foodstuffs and public exposure. Tough measures were introduce controo t d possible th l e ways of radiation transfer from the zone of the Chernobyl Nuclear Po- wer Station and from the territories with relatively high level of radioactivity Ministre .Th Publif yo c Healt coordination hi n witMinistre th h Homf yo e Affairs Ministre ,th Railwayf yo d san the Ministr Civif o y l Aviation establishef dosimetrio t ne e cth d control posts. These posts carrie t dosimetriou d c controe th f o l transportation means (includin railwad an r gai y transport), vehi-

29 clés, footwear, dress accordin permissible th o gt e levels approved by the Ministry of Public Health. Medical personnel supervised decontamination of settlements, roads, different buildings, premise d meanan s f transportso d ,an t shouli pointee b ds rathe wa that t ou di t r toug d effectivean h . In addition to the measures, aimed at radiation safety of the regions near the plant, a special attention was given to better sanitary and epidemiological conditions. The problems of psycho-emotional tension and radiophobia wer r attentione focueou th als f sn o i o .explainee b The n ca y y b d the lack of immediate, adequate and commonly understood information about real radiological situation. Medical personnel was not always very well traine n thesi d e problems. Erroneous understanding of real radiological situation and alleged exceptionally hazardous influenc radiatiol al f o e n doses s shapewa y traditionadb l information abou consequencee th t f o s nuclear energy use for military purposes. At the same time the public had superficial knowledge of the fact, that not only the appearance of life, but the evolution of biosphere was accompanied by ionizing radiation« Therefore, the level of explanatory work and sanitary educa- e increasedpossibls b i o t t i tio d d mentiono neha t An « , that i t enabled considerable reduction of psycoemotional tension and the syndrom radiophobiaf o e judgee b n dca frot e .decreasI th m a f o e numbe f letterro USSe th sR Ministr Publif yo c Health receives fropopulatioe th m Ukrainiae th f no n SSR, Byelorussian SSR, Russi- an Federation and other republics. This work will be conducted in the coming years. e basiTh c knowledg f constaneo t presenc radiatiof o e e th n ni biosphere and its biological influence, methods of its measurements had not been brought to public notice and this is our serious mistake.

30 A special attention was paid to the health of the children. Their health was thoroughly monitored in that situation. Accord- ing to the proposed measures of the Ministry of Public Health more than 350 thousand children and pregnant women were sent to sanatoriums, rest home pioneed san r camp 1986-1987n i s « Prophylac- tic measures were carried out in schools and kindergartens under rigorous control. There were sent the necessary medicines, devices and different medical equipmen increaso t qualite eth - medicaf yo sa d lan nitary service» In addition 1000 people were employed at different organizations of the Ministry of Public Health. Large-scale, purposefull and long-term work gave qualitative and quantative results. Thus, the complex of prophylactic sanitary and hygiene measures enabled to avert the outbreaks of infectious diseases in the places of mass gathering of people, to reduce the radiation dose by 70$5 compared with the predicted one. What is the real annual external exposure dose majorite ?Th peoplf o y e eth hav t ego dose equal to that which the patients get during plain roentgeno- graphy. The analysis of the state of public health, including pregnant wome d childrennan , confirme absence dth deviationsf eo , which might be related with the influence of radiation. The num- diseasef o r d be deviationsan e e statth th healtf t n eo si no s hi regionse sam th thas ea n i t , which wer t contaminatedeno - in e .Th crease of the number of general diseases in several regions was due to better quality of medical examination and psychoemotional influence. Since the first days we have solved both the urgent problems of eliminatin medicae gth l consequence accidene e th th f sd o an t problems of the long-term program of public observation» The All- Union register of all persons subjected to radiation exposure was establishe ensuro dt long-tere th e m dynamic observatioe th f no

31 public stat f healtho e childree Th . grandchildred an n l peral f o n- sona subjected to radiation will be also included in the register. t I also contains information about radiation doses e evath , - luatio e statth f healthf o eo n s e casechangeit ,th f proo d s an s- viding medical service criterie e All-Unioth Th . r fo a n register and dispeJisary observation of different categories of the population are given in Table 2, the scheme of receiving information by the Ail-Union register and reverse connection with organizations which provide out-pebient observatio s i nshow n Tabli n « 3 e

Tabl . Criteri2 e r registratiofo a e All-unioth n i n n register and the levels of all-round observation of exposed persons as a result of the Cherriobyl accident

The ca- The character of I-3II thy- levee -or Th f o l e leveTh f o l thegory the observed roid bur- ganizationr sfo register of ob- persons den du- all-round obser- serva- rine vatiogth n tion first year af- e th r te accident (in rad) I 2 3 4 5 I Persons after They are ob- e countrTh y radiation sick- e serveth n i d level of re- ness.still sick clinical hospi- gister(speci- or with radia- tal N6 of the l registera s tion injuries, Ministr f Pubo y - at the Insti- as wel s sicka l - lic Health;ALL- tute of Bio- nesses whice ar h Union Scientific physicf o s closely connected Cente f Radiao r - the Ministry with radiation tion Medicine of Public injuries as a re- and other spe- Health,Ail- e accith sul f -o t cialized organi- Union Centre e elith den -r o t zations of Radiation mination of the Medicine of consequencef o s e USSth R Aca- e accidenoth f t demy of Medi- l Scienceca s

32 Table 2 (cont.) 3 4

Persons involved They are ob- The country at the accident serve n spei d - level of re- scene, evacuated cialized organi- gister(Scien- from the radia- e zatioth f no tific Research tion zond ean republic or Ail- Institute of also persons with Union Scientific Medical Radio- the doses of ra- Cente Radiaf o r - logy of the diation: tion Medicin of Academ- Me f o y adults 25 and the USSR Academy dical Scien- more of Medical ces) .republi- pregnant women Sciences registen ca r (at the time of the accidentd )an their children born aftee rth mord an e 5 accident new-born children, children, teenagers 5 and more All other persons They are ob- The country involved at the served at their level of regis- accident scene local clinicf so ter(Scientific irrespectivf o e Central republic Reasearc- hIn the radiation hospital level stitute of dose. (they are given Medical Radio- Evacuees froe th m consultations at logy of the radiation zone,as the specialized Academ- Me f o y well as other clinics in case dical Scien- persons wit- hra of necessity) ces) , republi- diation doses: registen ca r adults 10-25 pregnane th t (a t time of the accident d thei)an r children bor- naf accidene th r te t 1-5 new-born children, children, teenagers 1-5

33 Table 2 (cont.) 3 4

All other per- - ob The e yar Dynamic obser- sons, evacuated served at their vation at the froradiae th m - local clinicf so level of the tion zone irres- Central republic region (regio- pective of the hospital level register)l na , radiation dose. (they are given the data are Persone th f so consultationt sa sent to the controlled region the specialized republican with radiation clinic n cassi e and Ail-Union doses 5-10 of necessity) level- re f so pregnanl Al d an t gisten ri their children Scientific born after the Research In- accident in the stitute of controlled region Medical Ra- irrespectivf o e diolog£ ° y their radiation the Academy doses. of Medical New-born child- Sciences ren, children, teenagers irrespectiv f theio e r radiation doses controllee th n i d region. Children "born frofathere th m , o receivewh e th d radiation dose of 25 rad in the period of 3 months before conception Other personn i s They are ob- Dynamic- sob the controlled served at their servatiof o n region wit- hra local clinics regional rediation dose and (they are given gister children born consultations in from parentf so profile hospi- groups3 , 12 , . tal n cassi f eo necessity)

Note: evacuees are persons, who were evacuated from the radiation zone wels , a thoss lthein a o o lef n sincewh t r ow i t e 26- April 1986$ the personnel is observed at the clinics where they work and after work - at the local hospitals where they live.

34 Table 3

SCHEME OF RECEIVING INFORMATION TO THE ALL-UNIÜN DISTRIBUTED RESISTER AND REVERSE CONNECTION WITH ORGANIZATIONS WHICH PROVIDE OUT-PATIENT OBSERVATION

USSR Ministry of Health I All-Union Distributed Register f RMedicao I l Radiology,, Obninsk

Ministry of Health of RSSFR, Ukraine, Byelorussia. Enl isted Republ ican RICC * establ ishment Republican level of register Ministry of Health

Regional Hospital

Regional level of register

Central Region Hospital Central Region Hospital City Hospital y Hospt i C i fcai

Regional level of register

* Republican Information Computer Centre

It should be stressed that scientific forecast calculated by scientist abou possible th t e consequence accidene e th th f so t ta Nuclear Power Station for the population of this country and other region Europef so , which were partially afflicte radiatioy db n fallout, generally coincided IAEA d wit an forecase ,O hth WH f to experts» The predicted increase of oncological and genetic diseases, whic occu n resula hca s ra exposuref to , wilamount lno moro t e than a few hundredths of one per cent and cannot practically be distinguished from spontaneously occurring diseases radiatioe .Th n

35 doses receive Chernobye a resul th s da f o t l acciden e folloth n i -t wing 50 to 70 years will not exceed the dose caused by natural radiation backgroun mory b d e than 20-30%» However, in order to study the possible consequences of the exposur o takt d e an eimmediat e medical measures long-term "Comp- x ecologicale l progra o investigatmt e consequenceth e e th f o s Chernobyl accident approveds wa " - basie gi Th .e c ar clause t i f o s ve n Tabli n . Mor4 e e tha0 scientific-researc10 n h establishments participate in this program.

Table 4o The main scientific directions elaborated in the frame f "Compleo s x ecological progra o investigatmt e conseth e - quences of the Chernobyl accident"

The stud substantiatiod an y e regularitieth f no e forth -n i s matio f individuao n collectivd an l e absorbed dosea resul s a sf o t e Chernobyth l accident developmene Th . d substantiatioan t - ra f no diation forecast and dose burden.

The stud f epidemiologicalyo f clinica functionald an l , genetic and ecological aspects of public health under the influence of radiation resulted froe Chernobymth l accident. The creatio f automateno d syste o procesmt e resultth s f o s public examination in the regions which are cloae to the Cherno- byl Nuclear Power Station. The establishment of Ail-Union Dist- ributed clini dosimetrid an c c registe e exposeth f o r d persons ans operationit d . Experimental atudy of radiation and medical problems caused e Chernobybth y l accident. The development of hygienic measures to protect the public from ionizing radiation. The generalizatio e experiencth f no f publio e c health organizations eliminating the consequences of the accident at the Chernobyl Nuclear Power Station.

36 Mass media constantly covered the state and measures to eli- minat consequencee eth accidente th e firs f th o s tn e .I th day f so accident Soviet experts of the Ministry of Public Health met a number of foreign representatives on their request, answered their questions and gave necessary information about the problems they were intereste. in d The General director of the World Health Organization Mr.H.Male s senr wa detaile a t d information abou Chernobye th t - lac medicas cidenit d lan t consequences. Soviet scientists submitted the calculations of the collective absorbed doses especially for the population in the European countre IAEe th parth Af o o tt ymeetin expertf o g n Augusi s t 1986. e experiencTh Soviee th f teo experteliminatioe th n si f no accident s highlswa y estimated abroad e Sovie.Th t expert took part in the liquidation of the consequences of the accident in Brasil, which was reported by the press. Speaking about the huge amount of work done by the medical staff to secure the public in the face of the accident, it is impossibl paso t e s ove n silencri e some negative features- re e .Th lative prosperit runninn i y g nuclear plants befor Chernobye th e l accident played the definite role in the appeared complacency of several leaders of public health and medical organizations. There cleao n s r wa schem actionf medicao el al f so l organizationn si cas large-scalf o e e accident medicae .Th l personnel eve hosn ni - pitals had not adequate training in the field of radiation pathology. They did not know enough the methods of diagnostics and treatmen radiatiof o t n injuries numbea n ,i casef ro s thed ydi not receive information about the necessary methodological literatur thesn o e e problems, whicshelvee th s kep hn wa medio tf o s - l administratorsca l thi n explai.Al s ca n bot y flow hwa vice :th - takene b o t ,tim frod sha m Chernoby e expertMoscowo lt th d s,an had to go from Moscow and Kiev to Chernobyl.

37 Radiological servict enougno dosimetricaf d o h eha - ra d an l diometrical device n reservei s numben i d f caseo ran ; s there were simply no necessary devices. A lot of them, which were available in the arsenal of radiological equipment were out-of-date. Regardless of the existing planned training of experts to provide radiation control, additional courses of radiation measurement method medicar fo s l e organizepersonneb o t d lha d since the firs te accident th day f o s . The elimination of these drawbacks in the course of the ac- e los th f tim o sd demandeo ciden t ean d le t d more - effortex d an s penditures. Till the present time the Ministry of Public Health has done and continues its work in creating the conditions for e optiuth m functionin publie th f cgo radiation security system.

The measures taken at the Chernobyl Nuclear Power Station were constantly within eyeshoGovernmene th f o t t commission, Cen- tral Councie Committeth CPSe d Ministerf th o l Uan f e o e th f so USSR. The succesful wor medicaf o k l personnel would have bee- im n possible without constant help received from the local party, So- viet and economic organizations. In conclusion, it should be mentioned that all sorts of con- jectures about negative influence of the consequences of the Cher- nobyl accident on the public health should be disproved by real data have . W reasono en hido t s e them e participant.Th e th f o s conference - scientists and experts have an opportunity to study all materials and express their views on all aspects of the Cher- nobyl accident.

38 SANITARY AND HEALTH MEASURES TAKEN TO DEAL WIT CONSEQUENCEE HTH CHERNOBYE TH F O S L ACCIDENT

A.I. KONDRUSEV

Abstract

By the end of the first year after the accident, more than 20 million gamma background measurements had been made at population centres; 0 sample5000 0 f drinkino s g wate wated an r r from open reservoirsd an , 30 million different surfaces (transport vehicles, housing, ground, clothing, etc.), had been tested. Analyses had been made of 700 000 samples of milk and milk products, 120 000 samples of meat and meat products and more than a million samples of other food products.

Iodine prophylaxis was administered to 5 400 000 people, including 1 690 000 children.

Temporary whole-bod r externafo v ymS exposurl0 (5 v mS e 0 limit10 f o s r internafo v mS exposur l0 5 exposure d an e ) were introduce e firsth r t fo dyea r afte e accident th re ligh th f scientifio n ti , ce effect th dat n f variouo ao s s exposure doses and in view of the actual radiation conditions. The standard millisievert)0 r (3 1987-8 fo m reduces re 8wa 3 e o actua t dn th viei , f wo l reductio n exposuri n e levels achieve e a resullarge-scal th s a df o t e clean-up measures undertaken.

Accident at the Chernobyl nuclear power plant was a serious examinatio e physicianth r r countryfo nou f o s » Hygien a branc s a ef e practicscienco hth - d sa an f eo e nitary control have accumulated a good experience in prophi- laxis of hazardous radiation effect on the population as well as in radiation protection, including the control of construction and operation of nuclear engineering enterprises. The

schedul r saffo ee operatio f nucleao n r facilities use n medii d - cine, technology and research is developed and put into operation.

The existing system of sanitary legislative and regulating document s formeha s e ordeth d f necessaro r y measure populan o s - tion, including radiation protectio t nucleana r plan othed an t r nuclear fuel cycle facilities. In 1971 the USSR Ministry of Public Healt s adopteha h " dCriteri r decisiofo a n making about population protectio nucleaa n casi n f o e r reactor accident", worked out by the National Committee on radiation protection.

39 This document determined the necessity of different measures including evacuation froe areth ma neighbourin e accidentath g l site, dependin actuae th n lo g radiological situation. These Cri- teria were basith e f sanitaro s d epidemioan y l ogical works after e Chernobyth l accident.

However unique th , e characte accidente th f ro s scaleit , , have urged the USSR Ministry of Public Health and its sanitary- epidemiological services to organize and conduct complex coordinated measure spreventioe aimeth t a d populatiof o n n overdosage. These measures included:

- development, introduction and organization of strict contro temporarilf o l y permissible level externaf o s d interan l - nal irradiation as well as of content of radionuclides in drinking water and food-stuffs, permissible density of radiocontamination of ecosystems, houses, transport, different things used every day d skin,an : - organization of mass iodine prophylaxis; - introduction of severe regulations in behaviour of people on the territories were the doses enhancing established limits could form? - organization of the system of training courses for the population for the increase of the knowledge on radiation hygiene.

The specia e wholl th rol en i esyste f sanitary-epidemioo m - logical facilities was that of coordination of activities of various ministries and departments, which aimed at the realiza- above-mentionee th tio f o n d measures. Measures on prophylaxis and sanitary-epidemiological control werintt pu eo e actiofirsth tn i nhour s afte e accidentth r , r instancefo , iodine prophylaxiP personnelNP e 2 th 1 r n .I fo s hours iodine prophylaxis involved the whole population of the

40 tow f Pripo n . *Lateat e scal th rf iodin o e e prophylaxi s wideneha s d according to the actual situation, the complicated characber of radionuclide deposition and the duration of radionuclide release into the environment. Totally iodine prophylaxis involved about 5 400 000 persons including I 690 000 children. Already on the 30 April 1986 the decision was made about the exclusion froe ratiomth f milno k froe cowmth s kep n properti t conn yo - taminated territories.

Foe protectioth r f peoplno e involve e clear-uth n i d p process, e Ministrth f Publio y c Health introduce da derive dmSv0 limi25 , f o t i.e a leve. l which doet exceeno s d that recommende e ICRd th Pan y b d existing in Radiation Safety Standards—76 for people involved in emergency work» This level was subsequently reduced to 100 mSv per e thir r th yea pe dn i v r yea r particularlmS fo r0 5 o t yead an ry dangerous work» Strict radiological contro s establishei l o dt ensur e standardth e e observedar s . Sinc e firsth e t days afte accidene th r t vast sanitary-hygienic measures were undertaken, they were aimed at the ensuring of radiatio ne populatio safetth r e areasfo th y f no , neighbouring the Chernobyl NPP as well as the reduction of external and internal irradiation of the population of Ukraine, Byelorussia, Russia and other republics.

The establishment f sanitary-epidemiologio s c servicd ha e organized permanent intensive control of radiological situation on the territories with the enhanced radioactive contamination- Under control were also food product drinkind an s g water, This worconductes wa k d together wit e Statth h e Departmenf o t Hydrometereology, State Department of Agriculture, other Minist- rieDepartmentsd an s . On the basis of scientific data on the effects of various irradiation doses and actual radiological situation temporary dose limits for the population were introduced: 100 mSv (50 mSv r internafo fov r mS externa l0 5 irradiation) d an l . Taking into

41 account real decrease of irradiation levels as a result of complex measures, radiation standard 1987-193r fo s 8 were reduced up to 50 mSv. These levels as well as the fact that during the first postaccidental yea determinine th r g facto internaf o r l irradiation were iodine isotopes ( first of all I-I3I due to its uptake with drinking water, milk amd some other food stuffs ) on the 3 May USSe 198th R6 Ministr Publif o y c Healt s introduceha h " Temporard y dose limits of iodine concentration in drinking water and food products" . Later, taking into account the annual uptake of various food stuffs, their production technolog wels a ys cummulativ a l e peculiaritie long-livinf o s g radioisotopes y 198Ma 60 3 wer n ,o e adopted temporary permissible levels for the whole nomenclature f fooo d products, medical preparation d drugsan s .

For the provision of the system of radionuclide control in food products, the USSR Ministry of Public Health together with the USSR Ministry of Agriculture has worked out and put into operatio e standardth n n treatmentso , processin d prean g - paration for realization of products of cattle-breeding, fowling forage, forestr contaminaten o y d territories.

Moreover e USSTh R, Ministr Agriculturf o y accordancn o e e with the USSR Ministry of Health has formed the peculiarities of agricultur e territorieth n o e s with enhanced radioactive background .

Enterprise f sanitary-epidemiologio s c servic d controan e - lling organization e USSth R f so Ministr Agriculturf o y e follo- e directionth e mentioned th we f o s d document t makinsa g decisions connected with the realization of food products through state shops, public catering, markets.

42 The basis of this system of radiological control was the uniform method of immediate determination of volume and specific activity of beta-emmiters in water, food stuffs, plants and " soidirec y b l " measurement f "thicko t " samples. e complicateth Duo t e d radiological situation, significant fluctuation f radionuclido s e conten n fooi t d stuffs producen o d contaminated e necessitterritorieth o t e f preo ys du wela s-s a l cision measurements, regulations were adopted, accordin o whict g h the results of radiological control conducted by departmental service d organizationan s s wert considereno e - e ma basi th dr fo s king decisions connected wite realizatioth h f foono d products. These decisions were made only on the basis of data obtained by sanitary-epidemiological establishment controd an s l servicef o s

e USSth R Ministr f Agricultureo y . e mentioneth l Al d measures allowe o decreast d e significant- e radionuclidth y l e uptake with food - stuff ensurd ma an e s th e intenanc e establisheth f o e d leve f internao l l irradiation. Reliabl f anthropogenio y wa e e coverinth n o c t g pu forcs wa e transfer of radioactive substances from the NPP-site and highly contaminated areas. Strick control of radioactive contamination of transport, technique, footwear, clothes, linen etc. had been organized on doaimetry stations and sanitary posts according to the established by th USSR Ministry of Public Health temporary permissible ( control ) dose limits. ( That was already mentio- neG.Uy b d . Sergee s reporhi n . i v) t

Enterprise f sanitary-epidemiologio s c service, research institutions of the USSR Ministry of Public Health together wit e organizationth h e USSth Rf o sStat e Committe Hydrometen o e - orology and USSR State Atomic Energy Control had performed sys-

tematic control of radioactive contamination of air and soil. For radiometry and dosimetry 1000 posts and laboratories were formed, 3 500 specialists enlisted for these works, over 3 250

43 dosimetri d radiometrian c c instruments involve mo-6 s 1 wela d s -a l bile laboratories scale f Th work.o e s carriesanitary-epiy b t ou d - demiologic service accidenth n o e t impact mitigatio s reallwa n y large: by the end of the first afteraccidental year more than 200 000 000 gamma-background checks were performed in populated areas, as well as 500 000 examinations of drinking water and water from open aquatic basins, 30 000 000 measurements of surface samples ( transport, apartments, territories, clothes etc.). Me- asurement f moro s 0 samplee 00 tha0 f milo d n70 mils an kk products, 120 000 - of meat and products, over 1 000 000 - of different food stuffs were done. To provide sanitary-hygienic safety of the population additional efforts of sanitary-epidemiologic stations, situated on contaminated territories were desired. Thus, 3 interregional radiological departments, 7 radiological groups, 13 groups of individual dosimetry were additionally organized n BryansI . k region (Rus- sian Federation) research laboratory of radiation hygiene was opened. At 15 sanitary-epidemiological stations the staff of radiological departments was incresed.

Much attention was also paid to the training of specialists n radiometri spectrometryd an y r differenFo . t ministrie- de d an s partment sspecialist0 ove00 1 r s were prepare e basith f n o so d sanitary-epidemiological service. That gave opportunitth e o t y enhance the identification of radionuclides and control of their contents in agricultural products on all the stages of their production, laying-i processind nan n environmentas i welga s a l l samples.

A.t the same time at critical areas was introduced the enchan- ced contro f sanitary-epidemiologio l c conditio e mosth im tf o n portant objects ,l foofirsal f do t industry, public catering, trade, water supply of populated territories. Individuals ignoring sanitary-hygienic regulations were subjecte o severt d e measures

44 specified in statute of State Sanitary Control in the USSR. Thus, for the violation of sanitary-hygienic and anti-epidemiologic regimen, during 1986-198 70 official 00 ove 3 r2 s were fined, more than 5 500 were removed from business, 2 643 different objects stopped operating, administrative actions were brought against more 0 personstha00 n2 .

anxieto t e Du y prevailin e moo populationf th o d n i g , that expressed in inadequate estimation of the situation and fear of irradiation consequences, local public health organizations as well as radiological specialists working at-site had carried out a huge sanitary-elusidative work aimed at the reduction and preventio psychologicaf o n l tentio d radiophobiaan n , introduction of primary knowledge of personal protection and peculiarities of life on contaminated territories. Only in 1986 mobile agita- tingteams gavgues9 11 e t performances 0 lecture40 ,1 s were deli- vered as well as 1 500 debated, 91 question-and-answer parties, 115 articles appeare n locai d l papers broadcastsV T 2 radi6 , d an o , 92 documents on medical aspects of radiation protection were published. This wor beins i k g continued.

When speaking abou e largth t e work conducte y sanitary-epib d - demiologic service we should mention certain shortcommings that have revealed during this period, îîot every sanitary-epidemiologic enterpris whole s readth e wa e en th wore i y volum th n i k r fo e condition large-scala f o s e radiation accident. Normative documents regulating control of food stuffs were as a rule directed monitorine th r a backgrounf o g d conten radioactivf o t e substances, Radiological services had no sufficient reserve of dosimet- d radiometririan c c instruments. Durin e initiath g l period there o stricn s twa coordinatio activitf no n differeni y t - linksa f so nitary-epidemiological service. CHERNOBYE TH L EXPERIENC CONTEXE TH EN I F TO CONTEMPORARY RADIATION PROTECTION PROBLEMS

L.A. IL'IN

Abstract

Mean individual exposure dose o criticat s l population groups livinn i g the regions under strict control did not exceed the established temporary dose e firs limitth d secon r an t fo s d years afte e accidenth r v mS t 0 3 (10 d 0an respectively). The external gamma exposure doses to those living in the contaminated areas did not exceed 50 and 15 mSv, respectively, for 97% of the inhabitants. Internal exposur eo incorporate t dose e du s d radioactive caesium nuclides did not exceed 50 mSv for the first year and 20 mSv for the second year after the accident for 99% of the population; and for approximately 90% of those e regionlivinth n i gs under control, thes et excee doseno d ddi s 10 mSv for both the first and second year.

It was virtually guaranteed that the doses received by the majority of populatioe th e regionth n i ns under control were less than hale temporarth f y dose limits for the first and second years after the accident (for about 95% e seconpopulatioe oth th f n e firsdi th year) % tn i 90 nyea d . ran

Concentrations of radioactive caesium in the bodies of those living in e regionth s under control wer n averageo 5 time2- e se summe loweth f n o ri 198 7e summe th tha somn n f 1986i i nro ed casean , difference th s measures ewa d by factors of 7-10.

The implementation of the whole complex of measures brought about a 5 to 20-fold decrease in the thyroid dose commitment for children, a 1.3 to 2.5-fold decreas e externath n i e l gamma dose (dependin n occupatioo g aged an n ) 10-fola d an r greateo d r decreas n internai e l exposure doses.

Experience of large-scale work in the management of the acciden Chernobye th f Unit o a t 4 tl nuclear power plan stils I t l being thoroughly analyse generalisedd an d . Among numerous aspects particulaf ,o r interes signifid tan - cance is further improvement of the radiation protection system with regar majoa o t dr accident« The present report is intended to discuss a number of problems n thi,i s field stemmed froChernobye mth l events. This attemp s basepersonay i tm n o d l experience e gainehandth n i -d ling of the accident, especially at an early stage, and in scientific guidance of the biomédical aspect of the problem«

47 TABL . Schem1 E f developmeno e a large—scal f o t accidentP NP e , e mosth t adequate countermeasures

idene Ac t 1 t i i de i e Ac Exposure Main types 1 Protective measures phases stages t source f exposuo s i ie d theian * (according. 1 1 y icat 1 i p 1 bi ap O WH e tth o i 1 termino 1 1 logy) 1 1

(Radioactive! y notilicl e m 1i T a I ! cloud, 1 Externa1 l tion(+), protection Earl1 4 y2 o t p u ( p r ec i p i — I (total), 1 of respiratoiy hours1 ) tation on 1 internal 1 organs(-*- d bodan ) y I body 1inhalâ( t ion) j) ,+ iodin( e pro- 1 I 1 phylaxi s+-( ), 1 1 i évacuâ (•$-n , t) io 1 1 1 individual 1 i 1 decontaminat ion( +)

1 Radioactive1 External 1 Sheltering ( +- ) , 11 1 cloud, ! (total), 1 protection of res ;is 1 on so i 1 . 1 tract) 1 (+-), évacua t ion (•*-), 1 food 1 ividuad 1 Hi l 1 chain » 1 external t dec D ntaminstjci '!<-•-) , 1 ! and inter -1 limitin 1 acceso g s t 1 nal (ad 1 into controlled I i sorption1 ) areas(-t-) , 1 ood i 1 1 stuffs and water ! 1 CDIlt (-Vl tO )

t 1 Precipi— 1 External » 1 Migrât ion(-»-. -) 1 III i tation on 1 internal 1 food stuffs 1 (£-6 1 soi 1 , foo ougldr ! )th i ( conti ol (•*•), i weeks) t chain ( digestive 1 territory iJeconta— 1 ! ! tract) 1<4-1 10 , acces -Ifn) 1 ina s } 1 1 limitation^-)

IV 1 1 Pre— i cp i Ex ternal , 1 Food stuffs Inter- (1,5-2 1 tation oti 1 intei nal ! control <+ ) , mediate montht s soil, 1 (througS h territory üeconba- afte1 e th r food chaml digest i ve ! minatiDn< •+•- ) accident 1 1 tract) 1

NOTE - depend e * season.th , or s , tjhere accidenth . t tal:es place; (•* - > applicabl eved ean n necessary - applicable ) - + ( ; , but require cost benefit analysis.

48 It ahould be stressed, above all, that a great number of large-scale measures aimed at localizing the accident and eliminatin s consequencegit s were planne implemented an d e th n do basis of the system (previously developed in the Soviet Union) of radiological protection in the case of a nuclear reactor accident. An important link of this system is represented by the radiological criteria for decision making on measures to protect e populatioth evene reactoa th f o tn ni r acciden developes a t d e 1960 th y colleague m sn i y b (see m ed Tablsan 1 e/"!/) • Accordin emergenc e theso gth t , e B) criteri yd protecan A ( a - tive measures are all determined by the limits of predicted exter- l gammna a doee d thyroian s d dose r childrenfo s - r levedo .Fo , A l ses are 0.25 Cy and 0.25-0.30 Gy; for level B, they amount to respectively, Gy 5 2. d an .0.7y G Unles5 s leveexceededs i lA , the protective measure t involvno o e disruptiosd th e e th f no public living routine. If radiation exposure exceeds level A but does not reach leve decision, lB s (including evacuation) ahoule madth e b dn eo basis of the actual situation« If level B ia predicted to be reached, emergency measures, evacuatio populatioe th f no n from the exposure zone above all, are absolutely necessary. At an early stage of the accident, our general task was to avoid public exposure rangB withi A- y casee an prevennth ando , t n i , t whole-body gamma exposure for the population outside the evacuation zone from exceedin v ovefirse mS th r0 tlevega 10 yea f lo r after the accident. The decision to evacuate the population of the town of Pripyat was not taken when public exposure had reache r exceedeo d d poine rathe t leveth bu t, t lrA a whe e th n radiation situation predictions indicated such probabilities /2/. In practice, aa a result of the evacuation of the population from 0 peoplePripya00 5 frod (4 )tan 30-kma m zone roune th d plant, individual whole-body doses for most of the town's inha-

49 bitanta were about 15-50 raGy, and for part of the citizens (doctors, militiamen, municipal workers, i.e. thos speno ewh t long period f timso e outdoors) e averag,th e individual gamma dose amounte o 130-3t d vern w populatioi 0 fe ya mGy wa .t I n centres e 30-kth mf o evacuation zon eo continuou t that e ,du s variations in the radiation conditions, not all the inhabitants could be prevented from receiving doses over level A, but these did not reach leve . BecausB l timela f o e y iodine prophylaxis thye th , - childree th f roio % nd 37 fro dosr mfo e Pripya, Gy belos wa t3 w0. for 2% it was 0.3-1 Gy, and for less than 1?5 it amounted to 1.1-1.3 Gy« In the management of the accident, an emergency standar whole-bodr fo d y exposur s immediatel 0.2f wa eo v 5S y intro- 30-ke duceth mn i dzone . Wide-scale medical examinations covering about one million people revealed no case of acute radiation sickness among the population examined. Except for those damaged within the plant site durin accidene gth t (237 persons with diagnosed acute radiation sickness) o cas, n radiatiof o e n sicknes s establisheswa e th n i d participant accident-managemene th f so t operation. Thus, experience of radiation protection of the public and those dealing with consequences of the accident within the 30-kin

zone at an early stage and, the more sos in the subsequent period indicate determinine th s g par pre-sef o t t exposure regulations sa guidance for those responsible for decision making under complicated and difficult circumstances. In addition, of no less impor- n effectivtanca s i e e syste f strico m t controe observancth f o l e of these regulations. It was due to meeting the latter requirement that possible human overexposures were essentially prevented. The Chernobyl accident posed a number of most difficult problems o thas j t decision making relativ radiatioo t e n protection required not only a high organizational effectiveness but also hot recommendations e mai o extraordinar.Th t n e reasodu s nwa y characte-

50 riaticUnie reactoth - 4 t f o a r accident. Thes e knowassoe b ear o nt - ciated wito eventstw h : explosiv ecore breath e f containmento k e th , graphite burning, and resulta s ,a ,a 10-da y releas gasef eo d san aerosols containing great amounts of radioactive material into the environment/ 3/. The above factors together with sharp variations in the meteorological conditions in the accident area led to a considerable contamination of some regions«

Unde circumstancese rth generae ,th l assessmen- ra e th f to diological conditions, the organization and, if necessary, realizatio measuref no radiologican so l protectio populatioe th f no n and environment were all based on the results of an unprecedented wide-scale health and environmental monitoring.Immediately drawn into these activities were thousands of scientists, specialists of different civil offices and of the Ministry of Defense, as well as local subdivisions of the State Committee on Hydrome- teorology, radiological teams of sanitary and epidemiological stations under the Ministries of Health of the Soviet republics, radiological service of the veterinary and agricultural supervision, etc. In a short time, millions of radiometric and dose measurements were carried out and then analysed and generalized by local organizations, regional centressceintifie th d ,an c staff of the State Commission. n thiI s enormous work, though effectively performea a a d whole, many problem questiond san s arose, among which termn ,i s of further improvement of radiation monitoring, the following should be noted. First. All dosimetric and radiometric facilities available were used. Prom experience follows the necessity of their further unification, strict regulation possibln so e usage, redetermina- tio sensitivitf no y threshold limitd san referencn si emero t e -

51 gency, adequate indication instrumente th f o a s taking into acco- nature th d specifi t an e un c feature f radiatioo s n registered, as well aa simple usage and compactness. f significancO unificatioe th s scalee i th f thesf o sno e instruments accordin e accepteth o t g d syste f unitso m « Of particular importance are specific developmental efforts to improve methods of back-determination of absorbed doaes to the human body following externa d internalan l exposure have .W e once again seen thamethode th t f "dosiraetro s y without dosimeters" are very promising for the reconstruction of absorbed doses from external exposur L signalRL r eo differenn s i (e.g R ES y .b t materials, including samples of hair, nails, tooth enamel, clothes). Thus, determine r Institutou R signalt a dES y b e s from enamel, doseo t s three persons died from radiation sickness proved to correlate closely with the severity of damage. The Chernobyl accident demonstrated the importance of assessing doses to open parts of the human skin r instanceFo « resulte ,th s obtained withele multif hth o p - layer thermoluminescence dosimeters developed at our Institute /4/ r measurinfo g absorbed doae d low-energbetf o an sa y gamma radiation to the skin show that such dosimeters should be included into the emergency syste f personao m l monitoring. Second. Taking into account actual radiation hygienic conditions, the scope and frequency of control may be essentially changed. For example, ^ I is known to be the dominant and most "characteristic" radionuclide in environmental objects and foodstuffs within the first days and weeks after the accident. In a short time, methods of I measurement in environmental samples were detailed r casefo s when gamma-spectrometric measurements were impossible (because of an enormous number of samples and for lack of gamma-spectrometer n othe i farmt a sd rs an plac es where tentative conclusions about, say, milk activity were necessary). Methodological problems of mass thyroid gamma-exposure rate measurements had been solved for

52 those cases when portable gamma radiometers were used« Modelr fo s the calculation of individual thyroid doses from radioiodine inhalation, allowin r differengfo t living condition contaminaten i s d areas and patterns of dairy products consumption were developed, including necessary tabulated data and numerical values of formula parameters,

The Chernobyl accident therefore necessitated organizing and carryin a grea t gou t nambe f variouo r s measurement f actio s - vity in environmental objects and object samples, the human body included« In particular, lifetime ^ I, *Cs, and ^'Cs contenta were measured in more than 600 000 persons« The vast mass of data, with allowance for methods of estimation, made it possible to classif e populatioth y exposury nb e levels and thin ,o s basis, to take sanitary and hygienic, medical and organizational measures necessar r normalizinyfo e situatiogth mitigatind nan radioe gth - logical impact« The main conclusion from this experience is that the whole syste f madequato e radiatio radiometrid nan c monitorine th d an g scop f controo e l under condition majoa f o s r accident shoule b d further improved« s knowi t I n that, befor e Chernobyth e l accident USSe th R n i , n othei s wela s a lr countries only annual limit intakn o s f o e radionuclides with food were set. The concentration of nuclides in drinking water was also regulated (see Standards of Radiation Protection 76 /SRP-76/). Radionuclide contents of individual foodstuffs were not standardized« At the same time, a standard on * I was specified in case of an accident (so that the thyroid dos r childrefo e n shoul t excee no dmSv)0 30 d , This requirement t witwa me smil3 h k concentratio f 370no 0 Bq/1« After the Chernobyl accident, there arose a necessity for immediate settlin e problemgth s connected wit e assessmenth h f o t foodstuff activit sortind an y r prohibitingo g certain kindf o s food. Accordingly, standards were calculate d introducean d d imme-

53 1 31 I content diatel ^ foodstuff4 2 r f o sfo y medicinad an s l raw- materials, including dairy products (curds, sour cream, cheese, butter), leafy vegetables, meat, poultry, eggs, berries, with allowanc r theiefo r contributio diete th .o nt Subsequently ,y 1986 latMa n ,i e standard n so -^C d -*'san C

conten meatf o t , milk?and some other foods were introduced beca- f theio e r us increased relative contributio contaminatioo t n n f theso e products. These standards were calculate r permissifo d b le dose of 50 mSv for exposure of the whole body and internal organs over the first year after the accident« Temporary permissible level surfacf so e contamination (for premises, transport, equipment, clothes, shoes, personal protective means, and skin) were calculated and approved to prevent additional internal and external exposure of people and human- caused escap radioactivf o e e materials froe 30-kth m m zone» Moreover, corrected permissible levels of contamination were adopted for the ground surface, outer and inner building surfaces after decontamination* To improve control of agricultural produce activity 8 standard2 ^ s were formulated which regulated the orde treatmentf o r , processing d preparin,an r realizafo g - tio f variouno s livestock,, poultry, fodder r products,fu , etc« e mosTh t complicated regulation problems primarily dealt with organizing the radiation monitoring of roads, buildings, transport, house-hold articles, etc. To carry out such large- scale operations, safe but realistic, under the circumstances, standards were needed. Standard earln i y 198t yMa sse 6 were repeatedly reviewe n termi d makinf o s g them more stricd an t approaching the SRP-7S values, as the radiation situation was returning to normal. In particular, after the decontamination e constructioth d e "Ukrytiean th 2 f f Unitd o no an "1 s object (Unit 4 tomb) had been essentially done, we turned back to setting standard contaminatior sfo unif o n t premise t SRP-7sa 6

54 levels for beta-particles. At the 30 km zone "boundary, the SRP-76 standards for skin of workers were set as permissible level clothef so s contamination wholee th n ,.O experiencf eo standardizatio organizatiod nan radiatiof no n monitoring showed that even,e th eve f suctn o ni majo ha r accident, science-based measures allowed to prevent radioactive material from spreading ove30-ke rth m zone boundarie d considerablsan y decrease eth dange contaminatiof ro peoplef no , their belonging dweld san - lings by a massive and highly laborious decontamination operation. This, along with other practical, sanitar hygienid yan c actions, permitted a sharp reduction of adverse effects of the mose accidentth t f o importan e .On tema t -se problem o t s swa porary dos publie e th limi arean r i c fo t s with high exposure levels. Accordin Sanitare th o t g y Rule Nucleaf so r Power Plant Designing (SRNPP-79), suc limiha publif o t c exposure th n i e case of a design-basis accident was represented by an individual dose limit of 100 mSv» used as a temporary one for the first year after the accident. Later on, the WCRP introduced a mor secone e th stric r d fo yea tY standarrmS afte0 3 e f th ro d accident. These regulations forme basie r th deffectiv sfo e implementation of the whole tremendous complex of accident - management actions« An analysis of actual data, with allowance for all protective and preventive measures, suggests the following. Average individua criticae l th dose r fo sl population groups in the regions under strict control did not exceed the dos efirse limitd th secon tan r fo sd years afte accidene th r t (100 and 30 mSv,respectively). External gamma doses did not mSv5 1 ,d populatioe excee respectivelyan th 0 f 5 o d $ n97 r ,fo permanently living in contaminated areas.

55 Internal doses from incorporated radiocaesiut no d di m v oveexceefirsv e ove mS secone mS th r0 th r5 t0 d 2 yea dd ran year after the accident for more than 33% of the population, and in approximately 30% of inhabitants of the regions under control they did not exceed 10 mSv either for the first or second year afte accidente th r . In other words, due to the above efforts, doses to the majorit populatioe th regione f yo th n i ns under control proved lese tb o s than haltemporare highs th fa s ,a y dose limitn i s the first and second years after the accident (for about 95/5 of the population in the first year and for 90?» in the second year). n thosI e regions radiocaesiue ,th m contene bodth y f o t in summe r5 time 1982- s s 7 somn wa lowei ed personran s 7-1- 0ti mes lower tha summen i n r 1986, Finally, in 1937 the contribution of internal exposure to e totath l dose more clearly tendet exceno decreaso d -t d di d an e ed 20-30^. wholee th measuree n ,th O s taken permitte a 5-2d 0 fol- re d duction of expected thyroid doses to children, a 1.3-2.5 fold decrease of external gamma doses (depending on age and occupation), and a 10 fold and more decrease of internal doses. These measures include essentially: 1. Evacuatio populatioe th f no n fro 30-ka m m zone, including the tow f Pripyatno . 2. Formation of a 30-km circular zone around the plant site with hard restrictions and radiation monitoring to prevent an anthropogenic transfer of activity from the contaminated zone to "clean" areas« 3« Prophylactic use of stable iodine by those dealing with sequence accidente th populatio e f sth o y ,b f Pripyano d an t regionf o s bordering upo30-ke th n m zone.

56 4. Ban on whole milk consumption, restrictions on dairy cattle grazing or shift to uncontaminated pastures or fodder, foodstuff control sorting, processing, and utilization. 5» Deactivation wor population ki e n th centren i d san territory adjacen Chernobye th o t l plant» Sendin, 6 childree gth d pregnannan t women froe mth population centre healto st h resort e summeth n sri period 1986-1987. 7A packag» measuref eo substituteo st n som,i e areas, local food by food brought from elsewhere, Agrotechnica, 8 ameliorativd lan e measure agriculn so - tural land» As already noted, these measures together permitted a significant reductio populatio e dosef nth o o st n (both from external and internal exposures).

Thus, experience of regulating reference levels of environmental contaminatio d dosnan e participant e limitth r sfo s of an accident-management operation and for the population of affected areas showed an exclusive role of this component of radiation protectio determininn i n stratega g r accidenfo y t handlin providinr fo d gan reasonabla g y achievable decreasn i e exposure for different human cohorts. In addition, experience of the above and other measures clearly demonstrates that, with contaminated areas of throusands of square kilometres, external gamma exposure is a very difficult problem to deal with, especially after relative stabiliza- tio radiatiof no n conditions. Unlike more "controllable" internal exposure indicates ,a above th ey db estimates , methodf so external gamma exposure handling primarily decone depenth n -do tamination of the human environment. Population centres, forests, fields, and farms, in contrast to the plant site and bordering areasdecontaminatee b n ,ca d onl mechanicay yb l remova radiof o l — nuclides, withou y speciatan l solutions concerning active chemical components.

51 Amon complee gth d onerouxan s decontamination work mose ,th t difficult was the radiological protection of forests. Nevertheless, deactivation work taking into account particular features of the various areas is continuing«, It should be emphasized that further reductio gammn ni y dosara e e rateth n si area will be determined by vertical migration of radionuclid.es e soiinth l includin where us e e gth possibl deef eo p ploughing and other measures. Fropoine th mvief o treducinf wo gamme gy th dos ra a e rate, 1 -3 rr soil decontamination due to transfer of radionuclides ( Cs included) to the overground parts of plants should be considered as insignificant.

The proble e assessmenth f e possiblmo th f o t e radiological e impacacciden th e USS th f o Rtn o populatiot s beeha n n already discussed /2, 7/. The collective doae commitment for the entire populatio e countrth f o ns i yestimate0 man-Sv 00 e aboub 6 o 32 ;t td n analysibasea n o d f fielo s d material, with allowanc r effecfo e - tivenes e measureth f o s s take thoad an n e being carried out- .Ac cording to the dose-responae relationship without threshold and the ICRP risk factor r stochastifo s c effects /8/, cancer death excess may be expected to constitute hundredths of per cent of spontaneous values, the corresponding number of genetic defects e progen e firsth generationo th n tw i f t yo f exposeo s d parents being hundredth f thousandtho s r cent r datpe f Ou a.o - s shosa wa tisfactory correlation with more recent frequency estimates of expected late radiological effecte Chernobyth f o s l accident on the population of Western Europe /9/ and Northern Hemisphere /10/. The basic dat r calculationfo a e sUSS e th premad ar Rn i e - sented in a series of figures. It should be stressed that an analysis of actual and calculated data showed a log-normal distribution of individual doses, irrespective of the region (typical distribution ia shown in Pig. 1)« The distribution of the

58 USSR populatio obtaines nwa d accordin individuae th o gt l dose commitment (secomparison i ed Pigan ) .2 n witanalogoue th h s doses from natural background radiation (ignoring the technoge- nic background f intereso s i ) t /PigtI tha» individuae 3/ .th t l dose commitmen majorite USSe th th r R f fo tpopulatioyo n (about 250 million people) will not exceed 1 mSv.The calculations show (see Pig ) thadose .4 th te contributio thif no s populatioo t n e totath l collective dose commitmen populatioe th e r th fo t f no whole country (278.8 million people) will not exceed "\5?o. Con- sequently, the Chernobyl experience shows that the decrease of e loweth rindividuae leveth f o l l dose commitment dow zero t n o does not practically influence the collective dose commitment.

1.5

0.5

0 -

-0.5

n tu r\ O -1 - Q

-1.5

-2 n

-2.5 -1

Probits D Measured data point Calculated fit

PIG.l. Probability distribution of the individual doses.

59 3 a o (i.

0.001 0 1 0. 0 1. 0.1 100

Commitment Individual Doss, mSv PIG.2, Distributio USSe th R f populationo n accordin committee th o gt d individual doses.

A 1 Q",- nN •a 25

*• 0 20 Ï / o ^ v u 15 y. 10 -A u0 S K /

'i ' "i ' "i ' "i '"i ' "i '"i I I 0 1. 0.001 1 0. 0.01 0 10 10 1000

Commitment Individual Dose, mSv Distributio. FIG3 . USSe th R f ncollectivo e committed doses accordino gt the committed individual doses.

60 3 -i

4 - r ^ - 3 - ,-, J71 f 7 ' ' ' ' ^ / ' / / ' n ' / / / , / , / ^ / *; ^ ^ s ^ PI /N t> / / r ^ ^ ^ / ^ n / / / , 0 / s / X / X / X n / x O / / y y X y X / / / / / N, / N / X / X / X / X X /x 1 - n / X /\ / X / \ / \ / X / X / X 7X x X /x ; / ; / ; / / X /\ / X / \ / \ / X / X / X / X x X /x 0 / / \ / \ / X / \ / \ / / x / X X X U q \ X X ' P \ 0 - S 3 0 \ x x X U x X 3 X x B x \ X -1 - \ O \ \ en X ^—' o \ x x -2 -

I I t T 1 11 1 1 { [ 1 1 i 0.001 0.01 0.1 1.0 10 100 1000 Tot a

Commitment Individual Dose.v mS IX/\ Natural exposure |\\] Accident expoaure

PIG.4. Distribution of the USSR collective committed doses from natural and accident exposures.

t standI reasoo t s diacuso t n s this conclusio e n terranth i f o s discussion at the ICRP meeting (Gomo, Italy, September 1987), where arguments were adduce n favoui d settinf ro lowee th g r individuae limith f o t l dose commitment which shoul e condb - sidered as a biologically significant exposure level. r manFo y reasons, this approach more seemb eo t srealisti c than that in current use. One should also take into account thaoriginae th t l meaning e collectivth f o e dose concepte predetermineth n i e us s it s solutio f radiatioo n n protectio assesse th nn i -problem t no d san ment of late effects of accidental exposure, If, in the framework of our analysis, the lower level of the individual dose commitment ia taken to be 10 mSv (which constitutes only about 15% of the corresponding cumulative dose from natural background radiation), one may conclude the following. The ex-

61 pected fatal cancer excess will increase up to 0»23% of the spontaneous level (Pig« 5) (for a population of 7.5*10 men. vsrith a collective dose commitment of 2«2*10 man Sv), tte absolute number f predicteo d cancers decreasin a comparey J>Q%a b g d with initia- es l timates for a population of 280*10 . men.

1 -

/ z. -2 v v\ 4\A o 01 0 -3

-4 [A

-5 ~

-6 l T l l l l i T i T T III l H l T 0.001 0.01 0,1 1.0 10 100 1000 Total

Commitment Individual Dosev mS ,

PIG.5» Ratios of rad—induced to spontaneous cancer according to the committed individual doses»

Finally appears ,a s from these calculations presene ,th t epidemiological methods would fail to register the above malignant tumor excess. n conclusionI shoult ,i pointee db t tha ou dnumbea t f o r radiation protection problems illuminated by the Chernobyl accident hav t beeno e n touched upo n thii n s report o thesT « e problems which lost ye t hav t theino e r significance belongs radiophobia. There is a lot of work to do in this sphere.

62 REFERENCES

1. Dibobes I.K., Ilyin L.A., Kozlov V.M.. eal t

e adoptioTh urgenf no t measure proteco t s populatioe th t n ? in the event of an accidental release of radioactivity into the environment Handlin: .In Radiatiof go n Accidents (Proc. Int, Symp. Vienna, 1969), IAEA, Vienna (1969). 2. Ilyin L.A., Pavlovsky O.A. Radiological consequence Chernobye th f so l accidene th n i t Soviet Union and measures taken to mitigate their impact. Report at the IAEA Conference on Nuclear Power Performance and Safety, Vienna, 28 September - 2 October 1987, 48/33- N IAEO -A- 3« Informatio e Chernobyth n no l nuclear power plant accident and its consequences prepared for IAEA, Atomnaya ener- giya, 1986 b1,No.5. v , 301-32. ,pp Russian)n 0(i . Osano. 4 v D.P., Shaks A.I» Procedur d devic an er assessinfo e effece th g f exposuro t e to ionizing radiations. Certificat authorshif eo o 79100pN 6 (USSR) (in Russian). 5. Standard Radiatiof o s n Protection (SRP-76), Moscow, Atomiz- dat, 197Russian)n (i 8 . Sanitar. 6 y Rule Nucleaf so r Power Plant Designin R NPP-79)(S g , Moscow, Energoatociizdat, 1985 (in Russian). 7« The Chernobyl nuclear plant accident: a year later. Atomnaya 3-2, energiyaRussian)n pp (i 3, 1 N ,., 198864 . v , 8. Recommendations of the International Commission on Radiolo- gical Protection. ICRP Publicatio Pergamo, n26 n Press, Oxford, 1977.

63 PROTECTIO HEALTF NO H DURING A LARGE SCALE ACCIDENT

A.E. ROMANENKO

Abstract

The general principles applie n plannini d g measure o protect s e th t population covered fouhour4 2 r e speriods th followin ) (1 :e accidentth g ; 7 day(22- )s afte e accident6 weekth r2- ) s (3 afte ;e accident e th rth ) (4 ; subsequent period.

n ordeI o carrt r t medicaou y l examination providd an s e medical carr fo e beed ha thos no evacuatewh e thosd an d e livin n regioni g s with high levelf o s radiation, about 2000 doctors, 4000 intermediate-level medical assistantd an s more than 1200 senior student t medicaa s l institutes were involvede th n I . first period laboratory-dosimetri0 23 , c mobile mord teaman e p sthau wer t n se e 400 team f doctorso s , includin 2 specialize21 g d team r examininfo s g children and pregnant women. The epidemic control stations in these regions were supported by shift teams from epidemic control stations in other regions. A doctors0 tota33 intermediate-leve 0 f o l60 , l assistants 5 specia12 , l vehicles wern o aneo s dinvolved .

Over the whole period about 500 000 people were examined, including 100 000 children; more than 500 000 haematological and 54 000 hormonal studies were carried out, and more than 200 000 measurements of iodine and caesiu e bodieth f n maffectei o s d individuals were made.

Nuclear power engineering is the reality of the contemporary society. General Secretary of the GPSU Central Committee M.S.Gorbachev declaired thae worle futurth th t f do eeconom s i y hardly imaginable apart of its development.

At the same time notwithstanding technical and technological efforts made in every country to decrease the risk: of radiation accident t nucleaa s r power, plants, these risks cannot stile b l completely avoided.

e basith f co probleme on Thi s i s s thae necessitth t f deveo y -

lopment and planning of so called " secondary protection level " e populatioth r fo n under accidental conditions. The experience of Chernobyl accident shows us that questions of protection must be solved in spite of all the efforts and me- s thean y demand. These protective measures mus e planneb t d an d

65 finance complee th n i dx wite designth h , constructio d maintean n - nance of nuclear plants. Populated areas and industrial objects o lesn s m arounk tha plane 0 n3 th d t must als e speciallb o y pre- e maintenancth pare r fo d e under condition a radiatio f o s n accident. Som f theso e e measurei e sar - material basis for the systems of environmental radiation monitoring, including population control; - additional hennetizatio buildingsf no , both residentiad an l industrial, and construction of radiation shelters; - availability of iodine compounds; milk products; food stuffs for children; - material basis for the systems of information and communication; trainin populatioe th f o g n wite hel f speciath ho p l literature, aiming at the prevention of negative socio-psychological reactions organizatioe th s wel ,a s a l appropriatf no e behaviour of the population during the initial period of the accident.

Notwithstanding the experience of earlier radiation accident n differeni s t countie Ghernobye th s - se ls it acciden o t e du t verity has brought complicated problems connected with health se- e populatioth rvic r fo e f contaminateo n d areas. These problems demanded theoretical considerations as well as quick reactions and decision making. Ghernobyl has demonstrated that the complexity of problems connected with population protectio a transfrontie t a n r nuclear accidents require ample international cooperation aiming at ensu- ranc nucleaf o e r safet d populatioan y n protection. You know that in May 1986 M.S.Gorbachev have submitted a number of proposals to some international organizations ( IAES, WHO, woro safett t etc ou k) . y regim nuclear fo e r engineering.

Therefore, summine experiencth e Chernobyp gu th f o e l accident consequences liquidation e considew , t necessari r o shart y t i e

66 with the national and international organizations, dealing with different aspects of radiation protection.

That ia why in this paper we want to touch certain organizational, medical and socio-psychological aspects of the radiological situation that has developed as a result of the accident and some conclusions and recoraendations concerning health service. Complex measures undertaken for the mitigation of the accident consequences had required mobilization of considerable medical resources. f specialisto t lo A s were involve n examinatioi d "treatd an n - e criticath men f o t l population physicians0 00 2 : junio0 00 4 :r medical personnel senio0 20 1 ;r medical students. Durin e inith g - tial postaccidental period 230 dosimelry laboratories were set up as well as about 400 medical teams, including 212 specialized brigades for examination of children and pregnant women compiled of specialist n pediatryi s , obstetric gynecologyd an s , hematology, endocrinology etc. Sanitary-epidemiologic stations in contaminated areas were reinforced by shift teams from different regions. To- tally 330 specialists, 600 junior personnel, 125 specialised transport units were involved. Iodine prophylaxi n performes ml wa people,inclus 5 o t d - childrenn ml din 6 g1, . During the whole postaccidental period over 500 000 people were examined, including 100 000 children, over 200 000 tests on iodine and cesium in children were performed including 100 000 children 0 hématologie.00 0 Ove0 00 0 hormona 50 0 r00 20 4 5 d , an l iodine and cesium tests were performed. It is necessary to note that while organizing hématologie examinations, we must take into consideration people's attitude of mind based on the widespread conception that radioactivity is connected with hématologie and biochemical alterations.

67 Special attention was paid to medical care of children and pregnant women o wer,wh e evacuated durin e firsth g t days after the accident and placed to sanatoriums and boarding houses for supervision. e extremel n spitth I f o e y complicated radiological situati- Juln i yn o 198 e preliminar6th y e forecasth r workea fo wa tt ou d externa d internaan l l commitment populatio e firsn th dose tr fo s postaccidental year as well as a number of measures for the decre- f theso e e as project doses. e initiativOth n f sanitary-epidemiologicao e l service, activities of various establishment dealing with radiomonitoring were coordinated. During the whole postaccidental period scientific and applied sanitary - epidemiologic enterprises performed about 3 rain instrumental and laboratory tests of food stuffs, drinking water and environmental samples (only for Ukraine). Aresula s f thio t s sample activity actual internal population doses were 5 "to 15 times lower than those projected. Mass clinical examinations justif absense th y f significano e t health disorder e populatioth n i s f criticao n l areas compare e conth -o t d trol. n additioI e hugth e o t nwor k performe e organth praf y o sb d - ctical health service, wast research investigations were planned and organized. In Kiev All-Union Scientific Centre of Radiation Medicin s organizewa e d withi USSe th nR Academ Medicaf o y l Sci- ences; the Scientific Council on Radiation Medicine was founded.

A comple f technicao x l facilitie s beini s g developed, soft- Distributee th warr fo e d clinic dosiraetric registe f individuro - s subjecteal o ionizint d g radiatio s initiateni s wela ds speci a l - l subregistera e individualsth f o s , selecte r long-terfo d m control.

s usefui t underlino I t l e that accordin e generath - o t gdi l rectio e sociath f no l countrr policou e Ministrn i yth y- He f o y

68 alt n 198i h 5 bega e organizatioth n f totano l annual medical scre- e countryeninth f go *s population .

Our investigations have reveale e followinth d g peculiarity of large-scale radiation NPP accidents which may be useful for medical planning: patients with different form d stagean s f o s acute radiation sickness ; including combined radiation, mechani- cal and termal lesions may be found only among NPP personnel and members of resque teams. And the number of these individuals is, as a rule, limited. Foe populatioth r e areasth f o n, neighbourin e placth gf o e accident, non-stochastic effects are hardly problem, as well as acute radiation lesions.

As for long-term stochastic effects manifesting in excess

cancer d congenitaan s l defects- , ac the e e yfocuth th wilf e o sb l cident medico-social consequences assessment e e degreth Th .f o e latter is dependent on the chosen concept: threshold or non- threshold ? So it is first of all necessary to choose more ap- conceptso propriattw e th . f o Howevere , long-term followinf o g wast population cohorts is necessary after a NPP accident.

This provided favourable prerequisites for the development of dispensary controe populatioth f o l n contaminatei n d areas. It is clear that the programmes of medical screening were corrected according to the situation with the involvement of dosimetry and special tests. The peculiarities of the Chernobyl accident required special measures differin n mani g y aspects from many theoretica d praan l - ctical investigations performed by Soviet and foreign specialists concerning radiation protection unde e conditionth r a severs e nuclear accidents. Variet f accideno y t scenarios connected with their scale and developmen n timi t e present difficultie r emergencfo s y planning.

69 After the Tree Mile Island ( USA ) accident in the WHO Brus- sels meeting Report the accident time development scheme was recommended that consiste f threo d e phases: early, intermediated an , late. However, the Ghernobyl accident did not fit this scheme. t I seems reasonabl o considet e r these phase f developmeno s t of any accident with no regard for any peculiarities of every accidental situation. We suggest that the early period must be considered to be the initial, acute accidental phase, that lasts until e cessatioth l f uncontrolleo n d releases e casf th o e n I .

Chernobyl this initial period lasts till May 5, 1986 ( 9 days since the explosion ), then the releases stopped.

Intermediat ea perio phass i f variou o d- e s possible duration, when the accident liquidation works on the damaged reactor sit e ovethid ar ean rs guarantees cessatio f furtheo n r environmental contamination. Moreover, at the beginning of this phase the radiological situation is formed. This phase may last for several weeks or months,depending on the severity of the accident. Late phase - is the posaccidental or reconstructive period, whee graduath n l retur o usuat n l life takesy placema t I . lasr manfo ty years r medicofo , - socia d ecologicaan l l consequences require long-term scientific investigations which cause a number of peculiarities in the everyday life of the population in the accident area.

Ghernobyl accident and its impact mitigation has given us bas o suggest e t tha n accidentai t l planning health protection of the population is a prior necessity. Ample range of countermeasures mus e planneb t d performean d d ste y steb p p accordino t g the regular succession that depends on their significance and for the gradual involvement of necessary means. All the emergency measures must be planned for maximum scale project accident wit e maximuth h m radionuclide composition, otherwise population mae undeb y e ris th rf overdosage o k .

70 Taking these considerations into accoun wane w o recomtt t - men e followinth d g stagin e emergencth f go y plan:

Stag afte: y withie accident I da eth r1 n ; Stage 2:2-7 days after the accident; Stage 3:2-6 weeks afte e accidentth r ; Stage 4:1 ,5-2 months after.

The duration of the first stage is stipulated on the one hand e facbth y t that initial accidental a rulreleasee mos s th ea t e ar s

powerfu d fore ma.-joritan mth le projec th f o y t dose, includin- in g halation doses from radioiodin e thyroith n o e d gland, whice ar h

accumulated rather intens^ve-'- e otheyth aan -dro . hane effith d - ciency of iodine prophylaxis which rapidly decreases as a function of tirae.x l thesAl e require emergency measures unde e conditionth r s of unsufficient information concerning actual radiological situation. The duratio e stag s th i dependen f 2 ee o nprobabilit th n o t y of accident release cessation, radiological situation stabiliza- tion, necessity to finish evacuation and perform the initial consequence liquidation measures. 2 cove e Stageinitiad th r an 1 s ( acutl ) eaccidenta l period ( early phase according to WHO terminology ) and require special accuracy in planning and readiness of emergency means. Stages 3 and 4 correspond to the intermediate phase. Stage 3 is a period of iodine danger, that determine the characte f countermeasureo r s wela ss medicaa l l activities. Stage 4 completes the intermediate phase of the accident and determine e beginninth s e latth e f o gphase expedience Th . f thio y s phase detachmen s i subjectet e necessitth y b d o guarantet y e th e cessatio f furtheno r environmental contaminatio e handon e , th n o n

âë ~Iôd~înë~propnylaxi s i aimes o bloct d e inhalatioth k n dose du e to the transient character of this process. For alimentary dose decreas r exclusioo e n alternative counter-measure e usedar s .

71 and by the necessity to master the radiological situation within the shortest possibl ee othetimeth u ro , hand e latteTh . r demands beforehand preparations of material and methodical basis for large scale environmental, food chai populatiod an n n examinatione th n i s areas contaminated by long living radionuclides. Further periodization and planning of accident consequences liquidation measures depend on the season of the accident and on the number of other aspects. We consider further planning unreasonable as medical means involved by that time are numerous and enough for all reseach and applied activities. Moreover, time is no

longer pressing. The main tasks of stage 1 are: 1» Preliminary estimatio e accidenth f o n t severet d radiologian y -

cal situation. e injured. Emergenc2 th o t ,d ai y 1), Emergency measures on population protection.

4. Involvement of medical means into the accident consequences liquidation. Emergency measures are:

- Shelterin e populationth f go ,l childrenal firs f o t , pregnant women and nursing mothers in residential or industrial buildings wit e maximath h l possible henne tization e latteTh . r mus e takeb t n into accoune authoritieth y b t s while designing buildinge th n o s territories involved into emergency planning. This measur- ve s i e y effectivr doed t requiran no es e large eipences especiallf i y the populatio s i preparen urgentld an d y informed;

- iodine prophylaxis r childrenfo ,l efficienc e firsal Th f . o t y of this measure depende availabilitth n o s f iodino y e compounds n convenieni t forr rapifo m d distribution;

- in some cases evacuation of the population from the most contaminated areas or at least preliminary measures that make evacuation itself easyd fasan .t

72 Evacuation is considered to be the extreme measure and is performed only when radiation level causes the exceed of the quo- te of external dose limit for the first postaccidental year with regar r averagfo d e daily shieldin majorite popue th th r -fo f go y lation.

Assessment of other criteria within one day after the accident will hardly be probable. It must be noted that emergency evacuation without strict organization and preliminary preparations may cause higher body burdens than sheltering before organized evacuation. Countermeasure decision e assessmen e baseth sar n o d healtf o t h consequence wels a s detrimena l t connected wite introduceth h d Countermeasurea, which are determined by two dose levels: lower ( beneatchosee th t ni h countermeasur inexpediens i e- up d an ) t per (whe dose nth e exceedcountermeasure th , sit unnecessary)s ei » n cas I Chernobyf e numbea o e th o t r reasonf ro e fo du ld san interes populatiof o t n protection upper dose limits were decreased. Some of these reasons were on the one hand connected with the difficulties in stochastic effects estimation depending on the chosen conception - linear of threshold, and on the other hand - the complexit e developinth f o y g radiological situatio d difnan - ficultie estimatios it n e firssi th tn ni day s afte e accidentth r . Dependin e severit accidene th th n o g f d o yloca an t l conditions emergency plans must include the readiness and emergency developmen medicaf o t l establishments: clinics, specialized medical establishments, mobile mean o starst t healt placee h th car n si e of evacuated population residence.

These mobile means are: - radioiodine monitoring brigades; - brigade specialistf so pediatryn i s , obstetric d gynecologyan s , endocrinology, hematology etc., for data examination and forma-

73 tion of critical groups ( children, pregnant women, nursing mo- ; ) th s er - medical laboratory team r adulfo s t population examination; - specialized team f medicao s l radiologists, hématologist, etc. e to reinforc e personneth e f locao l l clinic hospitalsd an s ; - reinforcement teams for local sanitary- epidemiological stations; - brigade f specialisto s s witnecessare th h y involvemen- psy f o t chologists for elusidation of the events to the population. Main task: f e stago sar 2 e . Estimatio1 d specificationan f radiologicao n l situation. . Selectiv2 e monitorin f radio-iodino g n thyroii e d gland. 3. External doses forecasts formation. 4. Selective radiometry of food stuffs and environmental samples. 5. Medical treatment of injured and necessary aid to evacuated population. Continuation of radioactive releases may cause significant changes in radiological situation. That is why urgent specifica- e contaminateth tio f no d zone e borderdegreth d f contamio ean s - nation are the basis for adjustment of medical measure plans. One of the most complicated tasks of this stage is organization of selective thyroid monitoring, first of all for children and pregnant womens i stipulate t I . shory b d t physical half-life of radioiodirv d evean en shorter effective half-time, especially r childrenfo l thesAl . e demand urgent measure n complicatei s - con d ditions of sheltering and evacuation. Only beforhand preparedness

of material, methodica d organizationaan l l basi assury ma s e reliable and appropriate results that help to specify the radiological situation and selection of principles of further mass population supervision. The result f iodino s e monitoring - mus e ba analyseb t e th n o d sis of dosimetry, first of all, of local milk and milk products.

74 That help o assest s e ratith s f inhalatioo alimentard nan y contributions to the thyroid dose.

To have reliable data concerning forecasts for external doses both calculation and instrumental methods of radiometry must be actively used. f theI y excee e externath d l dose limi e first th quot r t fo e postaccidental yea e decisioth r n abou e necessitth t f evacuo y - atio s madei n . More complicated tas f thio k s stag s i controe f fooo l d stuffs, drinking wate environmentad an r l monitoring. This contro- ne s i l cessary for establishment of internal doses and forecasting as well as for the specification of radiological situation. As soo s mean a nd instrument an s r thifo s s contro e locatear l d n establishmentsi , subordinat o different e t ministrie depad an s - rtments s cleai t i ,r that coordinatio cooperatiod an n f theso n e establishments on mutual methodical and organizational base are necessary.

This complicated system of centralyzed collection, generaliza- tion and assessment of dosimetry data must be based on two methodical centres: establishments of the State Committee of Hydrome- teorology, responsible for environmental control, and establishments of Ministry of Health, responsible for food stuffs control, internal dose assessmen d forecastingan t .

Both centres cooperat o t controe e functioninth l e th f o g whole system. All these require beforehand preparations of material and methodical base, developmen f organizationao t l principle disd an s- tribution of functions and means among different ministries and departments. This was organized during the liquidation of the Chernobyl acciden e initiativth n o t f Ukrainiao e n Ministrf o y Health and by the Decree of Council of Ministers of the Ukrainian SSR.

75 Main tasks of stage 3 are: 1 . Specification and assessment of radiological situation and its forecasts. 2. Development of mass radiometry of thyroid radioiodine, clinical examinations of children, pregnant women and certain contingents of adult population. . Enlargemen3 e varietth f o f tenvironmenta o y l sample r radiofo s - metry; control of foodstuffs and drinking water, sanitary supervision of restrictive measures maintenance. 4. Preparedness of instruments and means for the control of long- living radionuclide e environmentth n i s , food stuff populationd an s .

For this s stagusefui t notei o et l : - it is necessary to establish organizational and methodical cen-

e basi th tref specializeo n s o s d research institutions e latTh -. ter must as well be responsible for preliminary development of uniform medical documentation, worked out according to the program d scal an f sinvestigations o e , read r computefo y r processing. - while preparing the means of long-living radionuclide control

s necessari t i o spicift y e presencth y conditiod an e f equipo n - ment, laboratories subordinat o certait e n ministrie d departan s - ments, as well as the programmes of investigations, distribution of functions e ordeth f ,centralize o r d data collection, analysis e resultsth f o , preparatio f reportso n , developmen f decisioo t n projects according to the situation. These preliminary measures may hel o o mastecorrect t p stag h d e situatioe 4t th an er th te th n no plans of consequence* liquidation.

e h maistagth 4t s Onnf i mase o etaskth s f controo s f o l radiocesiu m, forecastin f internao g l dose latd an es effects assessment. Integral par f emergenco t y plannin s i gdevelopmen f measuo t - res aimed at prevention or limiting of socio-psychological proses- ses, which accompan y radiatioan y n accident couldn^e W . t avoit i d

76 in the Chernobyl situation as well as it had not been avoided durin e Threth g e Mile Island accident. Basic reason of psychological tension, radiophobia and reactive conditions is inability for a man to detect radioactivity with the help of sense organs; as well as low level of radiological kno- wlege, identificatio a powe f o n r plant acciden a nuclea d an t r bomb explosion} missing of contradictory information. All these lead to rumours and fantasies, contributing to the development of tension and inadequate population reactions and behavior, for example, self restrictions in gre-en food stuffs. These condition e reasonth e f healtar so s h anomaliey ma d an s cause a variety of diseases of non- radiologie origin. That is why preliminary training and education of personnel e populatioth f e territories o wela th s f a lo n e involsb y tha-ma t ved inte acciden th of grea o s i tt importanc r prophylaxifo e - ra f o s diophobic reactions. Population has to know the potential danger of accidents, their character, acute and late radiation effects,

protective measure theid an s r effectiveness. Unde e conditionth r f actuao s l accident populatioe b o t s ha n methodically informed about measures take maid an nn sourse f risko s , protective activities and appropriate behaviour.Special attention shoul e pai b do trainint d f medicago l personne d enlightenmenan l t of intelligensia ,e maiwhicth n s i hsours f disturbino e g information. Important are the measures preventing deviations from the official information.

77 SCHEM A SEVER F O E E NUCLEAR POWER PLANT ACCIDENT DEVELOPMEN D ADEQUATAN T E COUNTERMEASURES

Phases of accident! Stages of eraer- Radiation Bourses ! r Typei f o s Gountermeasuree TerminologO WH ( genc) y y plan_____ radiation ! Early 4 hour(2 1 s Radioactive cloud External (to- Timely information(-O Sheltering after the explo- Body deposition tal) (+)»Respiratory organs protection sion from fallout Internal (in- (+), Body protection (+), halation) Iodine prophylaxis (+), Evacuation (+-), Individual decontamination

2 (2-7 days Radioactive cloud, External (to- Sheltering (+-)»Bod d respiraan y - - ac afte e th r Body deposition tal) tory organs protection (+), cident begin- from fallout, Internal (in- Iodine prophylaxis (+-), Evacua- ning) ground deposition, hallation,in- tion (+), individual decontami- food chain x testinal) nation (+), limited visiting External and of supervised zones ( + ), Control Interna- ad ( l of food stuff d drinkinan s - wa g sorption) . ) te+ ( r 3 (2-6 weeks after) Ground depositions External Migratio e populatioth f o n n Internal (in- Control of food stuffs (+), testinal) Decontaminatio e territorth f o n y (+-). Limited admittance (+-/

Intermediate 4 (afte ,5-r1 2 Ground depositions External Contro f fooo l d stuffs (+)e ,D Pood chain Internal (in- contamination of the territories testinal)

Depends on the season of the accident Applicabl) (+ ) necessard an e y ( +- ) Applicable though do not require cost-benefit analysis RADIATION ENVIRONMENT AND RADIOLOGICAL PROTECTION THEORY AND PRACTICE OF ESTABLISHING RADIATION STANDARDS BEFORE AND AFTER THE CHERNOBYL ACCIDENT

L.A. BULDAKOV, G.M. AVETISOV, M.I. BALONOV, Yu.O. KONSTANTINGV

Abstract

e externath f I l gamm e awhol th dos o et e bod r exposuro y e thyroith f o e d gland does not exceed 0.25 Gy, there is no need to adopt emergency measures which would temporarily disrupt the life of the population. If external exposure exceeds these level t doe e t dosexceebu sth no o st ef i d r 0.7o , 5Gy the thyroid gland from 131j exceeds 2.5 Gy, then ad hoc decisions have to be taken in accordance with the actual circumstances encountered. Doses of less than 0.25 Gy are virtually harmless to the individual, a dose of 0.25 Gy is considered potentially dangerous, and at doses of 0.75 Gy for whole-body r locafo y lexposurG exposur5 e 2. thyroi th r o ef o e d gland, radiation sickness r pathologicao l changee glan occuy th n n ma somdi i rs e cases.

External exposure doses to the population in the most severely contaminated regions of the Ukraine during the first year after the accident lay in the range 0.7-2.5 rem, and internal exposure doses - assessed from the results of 52 000 examinations - did not exceed 1 rem in 90% of cases. Only e anticipate th case0 d 23 di s n i d doses excee rem5 d .

The concentration of the main dose-forming nuclides, caesium-137 and caesium-134 n mili , k products, potatoes, vegetable fruid an s t producee th n i d contaminated region outside the 30-km zone was 0.5 x 10~° Ci/kg.

A syste f dosmo e limit d principlean a f theio s r application as well as radiation protection regulations based on public health legislation of the USSR and Soviet republics and approved by the USSR Ministry of Health in a number of official documents served a lega s a l basi r measurefo s s take publiy b n c health bodies under conditions of a radiation accident at the Ghernobyl nuclear power plant« These dosuments include above all the Standards of Radiation Protection (SRP-76) e maith , n Sanitary Rules (MSR-72/80)e th , Criteria for Taking Decisions on Measures to Protect the Population e Evena Reactoth f o n ti r Accident e Sanitarth d an ,y Ruler fo s Nuclear Power Plant Designin d Operatioan g n (SRNPP-79) e abovTh . e documents were drawn up taking into consideration radiation protection experience gained in the USSR, findings of Soviet and foreign scientists, ICRd IAEAan P , recommendationsy sa n ca e . w Now,

81 e l accidenstageth al tha f t o a e officiast th t l documents which regulate radiatioe th d n factor proved efficient with regaro t d sanitary and hygienic as well as medical measures aimed at locali- zinaccidente th g o prophylaxit , handlind an s f medicao g l consequences for workers and general public. At the same time, a number of theoretica d practicalan l aspect f standardizatioo s n appeared to demand further development and n somi , e cases, special experi- ment d epidemiologicasan l studies. The SRP-76, MSR-72/80 SRNTP-7d ,an 9 inclide sectionn i s which dose limit radiatiod san n protection regulation e providear s d for projected increase of personnel exposure in the management of a radiation accident. The above dose limits and regulations agree with those recommende e IGRd adopteth an P y b dn tnoa i d t countries. Their strict observation prevented participants in localiza- e accidenth tio f d no decontaminatio an t plane th tf no sit. d an e adjoining area from overexposure fraught with serious medical consequences. A tragic exception was the death of a few plant workers within the first minutes and hours of the accident when potential exposur e predictedb t e ye coul e othet Th .no d r measures were all carried out according to an emergency plan brought into 6 Aprilforc2 n eo s soo, a s informatioa n accidene th n d firo n an t e was received. The current SRP do not set standards for public exposure from routine operations of nuclear power plants. This seems reasonable since to guarantee human rights in this country also means to ensure entire protection of people against harmful effects of productive activity. But the SRP provide the public exposure limita- e regulatioth tio y b n r controo n f environmentao l l activity (water, air, foodstuffs, etc.), production processes which might result in radioactive contamination of the environment, doses from medi- l exposurca d technogenicallan e y increased background causey b d construction materials, chemical fertilizers, combustio f organio n c

82 fuel, etc regulatioe .Th contror no l procedur determines i e y b d standardization acts legally approve r co-ordinateo d USSe th R y b d Ministry of Health. In the event of an accident, taking account of its nature and scale, the Ministry of Health may set temporary dose limit d permissiblsan ee publi level th word sanitart r an ckou sfo y rules to provide living conditions in areas contaminated with radioactive material fulfio .T l suc hlaborioua important bu s t task, the Ministry of Health invited a large group of leading scientists and experts, including firs d foremosan t Nationae th t l Commission on Radiation Protection (NCRP). An analysis of this work will be given below, and now we should dwell on an early stage of the accident when all possible measures were being taken to minimize public exposure accordancn ,i e wit Criteriae th h .

According to the Criteria, if external whole-body gamma exposur r thyroio e d exposure doet exceeno s d 0.2 ther, 5Gy s i e no need to take emergency measures that involve the temporary disruption of the living routine of the public. If this level is exceede externat bu d l dos r thyroio e dreact dosno o hd e I from respectively, Gy 5 2. d an 0.7 ,y 5G decision s shoul made b d e with allowance for actual conditions. Emergency measures to protect the public (indoor shelter; restrictio f timo n e spent outdoors; rapid evacuation; prophylactic iodine distributionr o n o n ba ; restrictio contaminatef no d foodstuffs; shif f dairo t y cattlo t e uncontaminated pasture or fodder are recommended if external whole-body gamma dose reaches 0.75 Gy or thyroid exposure from radioiodin e numericaTh e . exceedGy l5 Criteri2. e svalue th f o s a are supported by the a posterior conclusion that doses belo wpracticalle 0.2ar y 5G individualn ya safr efo dos,a e of 0.25 Gy is believed to be potentially harmful, while a whole- body dose of 0.75 Gy or a thyroid dose of 2.5 Gy might result in isolated cases of radiation sickness or thyroid pathological anomalies e Criteri .Th closn i e e aar agreemen t with those adopted

83 in other countries, exceptions being rather rare. For instance, evacuatio recommendea n± whole-boda t da r thyroio y y G 5 d 2. dos f o e (Czechoslovakia), at whole-body doses of 0.1-1Gy and thyroid doses of 1-10 Gy (Hungary), at doses of 0.1-0.5 Gy to the whole- body and from 0«3 to 1.5 Gy to the thyroid and other organs (EEC Comission). n earla t A y accident.e stagth f o e Ministre e polic,th th f o y y f o avoiHealto t s d hwa publi c exposure abov e Criterith e a values and, in any case, to prevent the population beyond the evacuation zone from receiving 10 rera over the first year after the accident, i.e. levels much lower than those of the Criteria. Due to the measures taken, whole-bod e majority th dose r f fo evacueeso y s a tota ( 0 people t exceef abou00 o lno 5 s 5 remd 11 wa 2 td) di t i ; only in some population centres situated in areas most heavily contaminated froe plumth m e that doses happene reaco t d h 30-40 rem. Wide-scale medical examinations which involve0 people00 0 93 ,d includin 0 person00 6 69 gs thoroughly studied with dosimetrid an c laboratory methods, permitted the absence of acute radiation sickness amon e populatioth g e statedb o t n n conformit.I y wite th h Criteria, prophylactic iodine was distributed among 5 365 000 people Aresulta , thousand f hypothyrosio s s cases were avoided, whole- bod d thyroian y d exposures v/ere reduced.

s sooA s urgenna t step d beesha n taken,the efforte th f o s Ministry of Health were focused on sanitary and hygienic measures to minimize e publidoseth o ct s from externa primarily, d lan , internal source radiationf so . Wit hn viewi thigreaf o , s t importanc s prompwa e t determinatio f temporaro n y permissible levels (TPL), allowin changer gfo radiation i s n conditionso ,t regulate radionuclide contents of foodstuffs and water, contaminatio f variouo n s surfaces, etc. Because of a major part of 131 I in external and internal exposur n earla t ya e stage, temporary permissible radioiodine

84 content drinkinf o a g watenumbea perioe d th rfoodf an r o r d fo s managemene th accidene f o th f o t t were elaborated withi firse nth t dayy d 1986approveMa san 3 . Thesn o d e were supplemented with additional standards for staple foodstaffs on 6 May. To avoid excess external and internal public exposures, on 7 May 1986 the Ministry of Health approved TPL of radioactive contamination for various surfaces (premises, transport, equipment, etc.), clothes, footwear, skin, and means of personal protection. Subsequently, taking into accoun latese th t t dositnetric data Jun2 n e,o 1986 revised permissible contamination levels, based on established exposure standards, were introduce r groundfo d , road d oute,an r and inner construction surfaces following decontamination. activitI Allowin r yfo g reductio growina d an n g parf o t long-lived radionuclides y 198 Ministre Ma 6th 0 3 n Healtf o ,yo h approved the "Temporary permissible levels for the radionuclide

conten foodstuffsf o t , drinking water d medicina,an l herbs (total beta activity)' 1 which comprised nearly all foods consumed by the public. Since a great amount of fruit and vegetables grown in areas of potential contamination is usually processed, the "Temporary permissible radionuclid e levelth r sfo e contenf o t canned frui d vegetablestan " were establishe Septembe9 1 n o d r 1986. Use of livestock products, which might have been contami- natedproductioe th n i , drugf no producd san e manufactured from enzyme and endocrine raw material necessitated setting standards for finished articles- Therefore, the "Temporary permissible levels radionuclide th r fo e conten medicaf o t l preparations" were approved by the Ministry of Health on 22 July 1986 and the "Temporary permissible radionuclid e levelth r fo s e conten f endocrino t d aa e enzym w materialra e " were approve Ministre th y b dHealtf yo h together with the State Agro-Industrial Committee on 19 September 1986.

85 To improve control of produce manufactured at the enterprises under the State Agro-Industrial Committee, 28 standards zation documents were adopteabove th ey b dauthorit e Ministrth d an yy f Healto o regulatht e treatment, processing d preparinan , r fo g realizatio f variouno s livestock, poultry, fodder productsr fu , , etc. Changee radionuclidth n i s e composition, gamma exposure rate reduction sinc accidente e momenth th e a large-scalf o t d an , e decontamination operation all led to the new "Temporary permissible contamination levels for the skin, underwear, clothes, transport, machinery d mean,an f personao s l protection 4 Octobe(1 " r 1986) d "Temporaran y permissible contamination level r roadsfo s , populated areas, oute d inneran r construction surfaces following decontamination" (26 October 1936) in which lovver permissible exposure rate d betsan a contamination level r surfacefo s s were set. A packag f timelo e y measure d stricsan t observancL TP f o e reduce d preventean d$ e publidose70 th dy o b ct smas s diseases among highly concentrated populations resulta s .A , external doses e populatiotth o mose th t f heavilo n y contaminated e areath f o s Ukraine ovefirse th r t year afte accidene th r t were 0.7-2.5 rem. 0 peopl00 2 5 e anf o d % interna30 r fo l t excee m doseno re d 1 dsdi studied. Only for 230 persons dose commitments reached 5 rem. In the areas of the Russian Soviet Federative Socialist Republic which adjoin the accident zone, external doses over the first year were estimated to range from 0.5 to 5 rem. Prom the radiocaesium contene bodth y f o investigatet 0 inhabitants00 0 9 n i d , internal doses due to these nuclides were shown to average 1.5 rem over the first year. Average doses of total external and internal radiation to the population of all contaminated areas did not, therefore, exceed 10 rein established by the Ministry of Health as a temporary dose limit. s morA e specific informatio s obtainee radiationnwa th d an d situation e betterchangeth r ,fo d temporary dosee limitth r fo s

86 public were revised f 1987o d s compareen ,a . e Thusth y d,b with summe f 1986ro radiatioe th , n condition arean i s s affectee th y b d accident became far less serious« And the Ministry of Health set a doae limirera/yea3 f o t r totafo r l (externa d internallan ) exposure ove yeae rth r 1987« Large-scale expeditionary studies showe morda e than 10-fold reductio f gammo n f 1987o ae d backgrounTh « en e th y b d concentration of Cs and Ga (major dose-contributing nuclides) n dairi y products, potatoes, vegetable fruid san t produce n coni d - _0 taminated areas beyond a 30-km zone was 0«5»10 Ci/kg. Even the highest values registere potatoesn i d , vegetables fruid ,an t were 4-10 times lower than those of the TPL of 30 May 1986. e radionuclidTh e conten bakerf o t y product d cerealsan s also appea- refalo t d l belo e abov L th valuesw TP e r lac .Fo uncontarainatef ko d fodder highese ,th t mil mead kan t (primarily beef) contamination levels still exceede TP1e th d , particularl private-ownee th n yi d sector. However, according to a system of restrictions, such products were not allowed for sale or use at public catering establishments. Based on actual data, average dose estimates for all population areas did not exceed 3 rem/year, a standard established by the Ministry of Health. Moreover, internal doses from radiocaesium were 0.3-0.7 rem/yea lowerd ran , thus indicatinn ga improved radiation situation and high effectiveness of measure-s take reduco t n e intake radionuclidef so s with food. Thereforen ,i December 1987 the NCRP reviewed the TPL of 30 May 1986 and radiatioe th t fi no t L situationsuggeste TP L w TP ne w e ne d .Th were calculate e totath lr radiocaesiufo d m activity with allowance for routine daily consumption of principal foodstuffs. For all foods, the new TPL correspond to internal doses of no more than 0.8 rem/year, and actual dose commitments may appear lower by a morer o o facto.tw Comparisof o r y TPL-8f no Ma 0 d thos3 8 an f o e 1986 show sa 2-2 0 fold reductio majorite f valueth no r f fo so y foodstuffs.

87 It should "be stressed that TPL-88 provide the most strict

caesium standards as compared with other countries (e.g. for milk:

7 8 8 USA, 2.4*10~ , 1-10";UK 7 ; Finland, 2.7*10~, USSR, V10*~ Ci/1). Therefore followt ,i s thastandardizatioe th t d contronan l system adopte n thii d s country permitte n effectiva d e solutiof no sanitar hygienid yan c tasks Ghernobye causeth y b d l accident. Nevertheless n settin,i g temporary dose limit d permissiblan s e levels under variable radiation conditions, a number of unsolved theoretical problems arose, some of which require urgent research. Scientific foundation of dose limits and permissible levels is known to demand the solution of a complex of problems relative to modelling the migration of accidentally released radionuclides through various environmenta d lformatio an pathway n ma f o o nt s dose criticao t s l intakorgano t e f radionuclideo esdu y inhalab s - tion or ingestion. Also of significance is potential external exposure frotu a radioactive cloud or radionuclides deposited on various surfaces (soil, vegetation, buildings, etc.). Model description thesf o s e processe fairle ar s y well formalizedf .O great hel n solvini p above th g e problems were recommendationth e s presented in ICRP Publication 30 with supplements (Limits for Intake Radionuclidef o s Workers)y b s . However, since this Publi- cation is intended first and foremost for workers, many questions remained unsettled, e.g. those related to model coefficients and parameters applicabl r differenfo e e groupsag t . Special attention should be paid to experimental studies of parameters which describe the passage of various soluble and insoluble radionuclide-containin^ cotupoundd through the gastrointestinal tract. An important element r determininfo g permissible level f fooo s d contaminatio s stani n - dardisation of average daily and annual diets in different regions Experience of the Chernobyl accident has confirmed an opinion formerly expressed by the NCRP that such IGRP concepts as benefit- detriment analysis wit bodha mathematicf o y s proposed, linear relationship between dose and stochastic effects, and risk factors of late effects and weighting factors based on this concept lack scientific foundation and cannot be applied in practice. At the latest ICRP meeting in Como (Italy), the International Association on Radiation Protection (IARP) made critical remarks against the ICRP on these issues. Assessment of late stochastic effects of an acciden e basi th collectivf o sn o t e dose d rissan k factors derived from a linear relationship without threshold seems to be particular- y absurdl e abovTh . e issue requirl sal mosa e t thorough research and remain in sight of the NGRP and other experts concerned with the radiation factor regulation.

89 RADIOACTIVE CONTAMINATIO WATEF NO R ECOSYSTEMS SOURCED AN DRINKINF SO G WATER

I.A. LIKHTAREV, R.M. BARKHUDAROV, O.A. BOBYLEVA, V.A. KNIZHNIKOV, V.A. LOGACHEV, P.V. RAMZAEV, M.N. SAVKIN, G.V. SERGEEV

Abstract

The contributio f aqueouo n s component e individuath o t s collectivd an l e doses receive e populatioth y b de a resulacciden th s a nf o tt Chernobya t n i l 1986 did not exceed 1-2%. In the first few days after the accident, the total beta radioactivit 10~x 1 e wate s th ' Ci/L f wa ro y . Subsequentlye th , concentration of radionuclides in the water fell steadily and throughout 1987 was stable at 1-3 x 10~^ Ci/L. The highest recorded figure was 4 x 10~9 Ci/L in May 1986 caused by iodine-131 (for the Dnepr).

Pour main radio-hygienic problems causee Chernobyth y b d l accident may be settled as follows: - urgent assessment, study of dynamics and forecast of exter- l gamma-radiationa n change n differeni s t regione countrth f o s y cause passiny b d f radioactivo g e cloud radioactivd an s e fallout; accidental monitoring of radioactive contamination of rivers and open water basins used for drinking water supply, industrial and recreation purposes, with the aim of development of short long-terd an - m radio-hygienic measures; - mass radiological monitoring of all the links of food chain: soi - agricultural l product - sfoodstuf f component ratiod an sn i n general for population of territories contaminated with fission products; - mass measurement forecastd an s f externao s internad an l l irradiation levels caused by the accident. e above-mentioneAlth l d problems determinin e radiologicagth l situatio e countrth r n botn i e fo scaly th h f researco e medicad an h l measures, and resources necessary for solution of these problems are too ample to discuss in one paper« Therefore, in this paper we will present only important general points- .de Result e th f o s

91 tailed analysis of radio-hygienic situation will be given in coming paper heterogenie .Th c structur e radioactivth f o e e contami- natiohu^e th e f no territorie maie th n s i sfeatur e radioloth f o e - gical situation. Specifics of radiological situation in different regionss required different population protection measures. They are : - evacuation of population from the towns of Prip'at, Cher- noby d settlementan l f 30-kilometeo s r zone around ChernobyP lNP wher majoe th e r dose loads were determine y externadb l irradiation; - introductio standardf o n waten so foodstuffd ran s radioactive contaminatio d systeman n harf o s d contro theif o l r observa- e territoriesth tio n o n , wher majoe th e r doses were determiney b d internal irradiation. In this paper we stress the features of radiological sirua- tion connected wit e radioactivhth e contaminatio f aquatio n c ecosystems and sources of drinking water. e radio-hygieniTh c situatio aquatie th n o nc objecte th f o s country formed after the Chernobyl accident had a regional specifics. Thus, because of geographic situation the main water ba- e samP siteth NP e t e i ,tim e soutth th ef o o hmost - sin in te sar tensive fallouts (due to complicated weather conditions) were forme northern i d n direction. During the assessment of radiological situation in the northern par Ukrainf o t d nearbean y territorie Byelorussif o s d aan Russian Federation maie th ,n attentio qualite th pais o nwa dt y of water from small river d reservoirsan s o supervisiot d ,an f o n local water sources. During the examination of radiological situation in southern territories of Ukraine the main problems were connected with the assessment of status and providing of protective measures for large basins, producing wate drinkingr fo r , industria d techlan -

92 nological purposes, irrigation, used for fish-breeding and fish- ing, sports and recreation. firse Eveth tn ni yea r afte accidene rth t radioactive releases affecte large statue th dth ef so reservoir Ukrainef so e :th rivera Dniper, Dnestr, Souther Howeven. Bougal firse . th ret h t obtained data about the radioactive substances content and the radioisotope compositio watef no r allowe determino dt e thae th t hard supervisio large-scald nan e measures woul necessare db - yon ly for Dniper basin. Thus, on the territory of the Russian Federation that was affected by the Ghernobyl accident as a result of the meteorological condition 1986y Ma maie ,n th si n drinking water sourcr efo three large cities (Kiev as well) is the Desna. However all the territories with high fallout densit fissiof o y n product- si e sar tuated out of the basin of this river, beyond natural watershed, d smalan l rivers flowing there (Trubezgh, Snov, Iput', Besed*) are the Dniper tributaries above the Kiev reservoir. The small rivers in Byelorussia (first of all the Braginka) flowing through the contaminated areas are not the objects of drinking water supply. However the level of silt contamination, d enhancean d conten radioactivf o t e substance waten si r during 1986-1987, as well as negative results of radio-hygienic assessment of soil status over their basins required including of these factors into the "Dniper-river hydrosphere" system of radiological monitoring. The largese Dnipeth s i rt reservoi Ukrainef ro ; it's water is used by half of the republic population for various purposes. territoriee th n O s irrigated with water from this river mos- ag t ricultural products are obtained; about one third of wheat, sonic vegetables, rice etc. harves s collectei t d here. Becaus thesf eo e reason questione sth Dnipef o s r water quality monitoring, developmen forecasf o t r it*fo t s changes, perspective f possiblo s e

93 water usag variour fo e s purposes becam subjeca e f stato t e interest sinc firse eth t days afte Chernobye rth l accident. radioactive th s a r fa e s A contaminatio f drinkinno g water source y caussma certaia e n dange healtr fo r populatiof o h d nan also taking into accoun huge th te scal d certaiean n specificf o s necessary protective measures, which require participatio spef o n - cialists from different ministries and departments, the general supervisio s conductenwa Ministre th y b dPublif o y c Healt- Uk f ho rain it'd ean s local offices. Thus Ministry of Public Health of the UkSSR with assignment of the Council of Ministers of the UkSSR launched coordination of efforts of Ministries of Land-reclamation and Water Industry of the UkSSR; Ministry of Housing and Communal Services; Ukrainian administratio hydrometeorologf no d environmentayan l monitoring, d officean sanitarf o s d epidemiologicaan y l service concernin- la g boratory water quality monitoring. They also took par n providini t g of "Dniper-river hydrosphere monitoring program" launched later. Analysi f joino s t laboratory investigations show that maxi- m radiatiomu n watee levelth rn i s fro Kiee th mv reservoir were observed during the first days after the Chernobyl accident (total beta-activity had reached the value of I E-7 Ci/l). Next 10 days radiation level in water was unstable (5 E-9 - 6 E-8 Ci/l). Durin followine th g g period radionuclide concentration i n water was decreasing all the time: since 2? May till 20 July 1936 it was detected as I-2E-9 Ci/l; since 20 July till 20 November 198 fluctuate- 6 range th 3-7E-If eo n di O Ci/ld en d sinc e an , th e of November and during the whole 198? - stabilized at the level of I-3E-IO Ci/l. Totally during the period since the Chernobyl accident by means of sanitary and epidemiological services, research institutes, laboratories of all ministries and boards of the Ukrainian SSR territory only, more the 0 thousan30 n d water analyses from

94 open reservoirs, centralized water supply system d bore-wellsan s were conducted; among the mor- m e tha thousann3 d gamma-spectrometry and radio chemical analyses. s investigatedIwa t , thae leveth ttotaf o l l radioactivitf yo water during May-June 198 s determine6wa I-I3y b d I y contenMa n (i t contributio thif no s radionuclide inttotae th o l water radioactivit 80-90$s 3O/0o ywa t p Junn ,u i . - e Sinc secone th e d half o f June (according to disintegration of I-I3I- the level of total activit watef o y r froKiee th m v reservoi s determinerwa pree th -y b d senc relativf o e e short-livers: Sr-89, Ba-I40, Ru-I03, Ce-I4d Ian Ce-I44f Zr-95 (and their daughters), as well as Cs-I34 and Cs-I37 to minor extent. Radionuclide concentration in water (except I-I3I that had e establisheth d temporal content normative- t exceele no e d th d)di vels, determined in the SRS-76- Leve radioactivitf o l rivere th n si y Prip'a d Bragirücaan t , radiologicaly critical tributaries of the Dniper in the upper Kiev reservoir area during 1986 was about 10 times higher than typical values for the reservoir; during 1987 - 2-3-6 times higher. Radiological situation of the rest tributaries in the upper Kiev reservoir area (river f Uzhso , Teterev) durin l thial gpe s riod was more stable, however in some cases, after the heavy rains n June-Augusi t 1986 followed with washing down from surfaces- ,ra dioactivity of water was 2-3 times higher than is typical for Kiev reservoir level. Radio-hygienic situation in the Desna-river basin (the main Dnipe- mo r e tributarysame th th o e t t Kien levea p i s (u vs ) a lwa men accidenf o ts abou halwa e drinkinf t on tfo ti g water supply of Kiev) durin whole gth e perio mors dwa e stable highese .Th - tle vel of radioactivity (4 E-9 Ci/I) was registered in May 1986, mostly contribute I-I3Iy db . Since Augus Septembet- r 1986 radioactivity of this water basin was at the level of I E-IO - I fi- ll Ci/I.

95 Drinking e centralizewateth n ri d system watef o s r supply corresponde e pre-accidentath o t d l levels durin l thial g s period. Taking into account fluctuation Kief so v reservoir water radioactivity observe y 1986Ma n ,i d Dniper water suppl s closeywa d an d 5 millioth2. e n populatio f thio n s city durin summee th g r 1986 was supplied by drinking water from the Desna and bore-wells. The Dniper on the territory of UkSSR ia the totally control- le dreservoirx reservoirsi l ther Dnipee al e th ar n e i n ri sl .Al cascade: Kiev, Kanev, Kreoienchug, Dneprodzerzghinsk, Dniped an r Kachovkra reservoirs. Influence of the radioactive contamination of Kiev reservoi radiologicae th n o r l situatio s detectenwa d over aree Kanef th o a d Kremenchug l an val h reservoirs, howeve- Au n i r gust 1986 the radioactivity level was stabilized within 2 -9 E-IO Ci/I. Kremenchugh reservoir during the year played the role of a buffer in the cascade reservoir system (including to design of the dam, large dead volume of the reservoir). Water quality dynamic s showsi fig.In no . Afte high-flooe th r n 1987i d spitn ,i e of it's shallowness, water radioactivity leve n Kreiuenchugi l - re h servoi highet no rs ri decrease thaw no 5 n E-I d dan I Ci/1. In the rest of reservoirs of the Dniper Cascade, according to total beta-activity of water, it's quality is similar to the typical level, however content of Cs-I3T is several times higher, Sr-9 abou0- 0 time1 t I ( sE-I - E-I7 I - 2 Ci/1). Accordino t g the above-mentioned e possibilitth , f prolongatioo y f periono f o d the Dniper water usage for irrigation and first of all for rice cultivatio investigateds nwa Cs-I3e .Th 7E-I0 leve5. If o lCi/ 1 s adopte post-accidentawa e d durincontroa th an s l a de al gon l l period, according, to data of sanitary service, it was not excee- y regioan dewaten f i dno r usage. However radiological situation over water objects is determine t onl dcontenno y b y fissiof o t n product- watern re si a s .A sult of processes of sedimentation the major part of radioactive

96 Storage pools Iodine 131 Kiev Kanev KremenchuE

yii yiu ix x xi xn i n in iy y XI XII

\\\\\\\\[\\\M ioaioCesiume 4 v137113 , —————— « I Cerium , W4 Niobiu5 9 m Rubidiu} 10 m

FIG.I. Dynamics of water quality changes in aquatic objects.

substances, entering water surroundings, relatively soon falls t intbottoe ou th o m depositions, Radionuclide concentration ni these deposition 10-100s si 0 times higher thal waten al ni f o r reservoir cascadee th f o s . Especially rati e clea th f thes o s r i e radionuclide Kien si v reservoir, small river northerf so n parf o t Ukraine, nearby area Byelorussif o s Russiad aan n Federatione .Th constructed coffer-dams, special trap reservoid san r dams playee th d positive role in decreasing of spreading of silts from the Kiev reservoir and rivers Prip'at, Braginka et. al. Thus, ailt radioactivity in the tail-water of Kiev HPP in surrjner 1986 was 50-100 times les s0 kilomete 10 tha t na r distance frocoffer-dame th m .

97 Results of conducted radiological monitoring were the basis of measure securinr fo s e stablgth e water suppl townf o y Dnif so - per cascade, additional measures for cleaning of the open water supply objects, enhancement of the construction drinking water preparation objects. Accordin e fac riverside th t th o t gthal al t e territorief o s reservoir Dnipee th f ro s cascad widele ar e y use populatioy db n ni recreation purposes, departments of health protection conducted special target program for assessment of radioactive contamination of these territories. As a result of assessment of these additional doses, which wil accumulatee lb populationy b d recreae ,th - tion usag thif o e s territorie s permitteswa d without limitations (excluding, of course, territories around Kiev reservoir in 30- kilometer zone and nearby areas). According to requirements of sanitar ybeachee serviceth complee l th sal n ,preliminarf o x o y sanitary measures was conducted aimed at mitigation of small contaminated spots witradiatioe hth n level exceedin standare th g - es d tablishe r thifo ds s noteareawa t d.I that these measure e necesar - ssar r beacheyfo Kief o s v reservoi d somewherran Kanet a e v reservoir. Special attention was paid to local water sources in rural regions: pits, draw-wells, bore-wells n thes.O e territoriee th s measures to improve hermetization of these water sources, to prevent contamination with radioactive substances were conducted. DurinAugus- y gMa t l settlement 198al n 6i s situate tere th -n o d ritories, where high densities of long-liver fallouts were registered, centralized systems of water supply, using the water from underground well-protected sources were constructed. noteworths i t i p u mentioo t t yi followinge m th su n o T . Radiological situation in general, particularly aqua-environmental situatio reservoire th n majoe o n th rs- source- wa f o s drinkingr tefo r , industrial, technologica d recreatiolan n purpo-

98 ses, was satisfactory, in spite of the large scale of the Cher- nobyl accident. Radiological situatio aquatie th n no c objects, situaten o d the territor Ukrainef o y , Byelorussi d nearbaan y region Rusf so - sian Federation has strict heterogenic structure. Because of both

geographic feature Cherf so noby P sitlNP e situation d concret,an e weather conditions, aquatic objects of Ukraine were more sensi- consequencee tivth o t e e accidentth f so , though higher levelf o s radioactive fallouts were registered on some territories of Bye- lorussi Russiad aan n Federation. Highly effective were protective measures over existin- gwa ter sources and reserve ones; hydrotechnological measures prevention of radioactive contamination spreading; introduction of the hard radiological supervisio hygienid nan c normative radioacf so - tive substances conten drinkinn ti g wate d foodstuffsan r . Aresula s watee tth r component contribution into individual d collectivan e doses accumulated during Chernoby o 198t e 6du - lac t exceecidenno d ddi t I-2?S.

99 INTAK RADIONUCLIDEF EO S THROUGH FOOD CHAINS AS A FACTOR IN THE EXPOSURE OF THE SOVIET POPULATION AFTE CHERNOBYE RTH L ACCIDENT

V.A. KNIZHNIKOV, R.M. BARKHUDAROV, G.Ya. BRUK, A.P. ERMALITSKIJ, A.I. KONDRUSEV . LOS'LP , , N.Ya. NOVIKOVA, Eh.V. PETUKHOVA, A.V. PECHKUROV, O.G. POL'SKIJ, I.G. TRAVNIKOVA, V.N. SHUTOV, V.P. FILONOV

Abstract

In the first few days after the accident, a standard (of 1 x lO"'' Ci/L) was established for the concentration of iodine in milk, calculate o ensurt d e e thyroi thae th dos th to t e d gland woul t exceeno d d 30 rem. Temporary permissible e concentratiolevelth r fo s f radioactivo n e substances in 24 types of food, water and medical material were established and implemented on 30 May 1986. The highest concentrations of radiocaesium in milk recorde n 198i d 6x 10""' wer 5 ' 3- eCi/L . Unrestricted consumptiof o n that milk coul a dail do t yhav d intakle e f 3000-500o e 10~x 0 f o i C radiocaesium. Those individual d consumeha o wh sd suc10 h milk were identified.

The average level f radiocaesiuo s t exceer regiono mpe e d th ddi n emergency standards actuae Th . l concentration f radiostrontiuo s n mfooi d products did not exceed the temporary permissible levels calculated for this dose and in most cases were 10-100 times less as a result of the control measures which were implemented. Standards, monitoring and classification of foodstuffs were introduce o reduct d e internath e l exposure a factodos y b ef o r 10-30, down to levels which were not only in line with the temporary limits t alsbu o wite radiatioth h n safety standards (NRB-76).

The concentration of strontium-90 in all the main food products studied was relatively insignifican - namelt y about 0.3-3e radiocaesiuth f %o m concentration.

The intensive discharge of radioactive gases and aerosols from the damaged unit at the Ghernobyl Nuclear Power Station. (CNPS), whic e contaminatiohth continueo t d le days0 1 d nha , of the area with a complex mixture of radionuclides in different directions and at great distances from the CNPS. It has already become customar o distinguist y h three branchee th f o s W j radioactive trace: northern, southern, and western. 1 radionuclid e maith s n dosagwa e e e populatiofacboth r fo r n i n the first days and weeks. The presence of this radionuclide in milk was detected already on the second and third days afte e accident th re firs th tn I .weeks e concentratioth , f o n

101 I in some samples reached 1.10*" - l.lCf^Ci/l, The greens, including sorrel, spinac sprind han g onions, showed approximately the same level of contamination with ^ I. Withi distance neae nth th r f radioactiveo e tracp u e— to several dozens kilometers totae froCNPe th mth lS- amount of beta active substances contained in the water of some ill- equipped draw-wells reached 2.10~ Ci/I. However mosn i , t draw- wells, as well as in open reservoirs used for water supply, the conten f theso t e substance t excee n no watesi e d th ddi r j'Qt I conten1986f normao e d miln ,th len i t klevele th y .B and other foodstuffs had decreased. s showA y soinb d vegetatio lan n analysis e fallou,th f o t nuclides froradioactive th m e clou s followewa d theiy db r noticeable fractionation, which became especially apparent at distances upwards of 15-30 kilometers from the damaged unit. Thus ,a considerabl e increas concentratioe th n i es ~ f no ft? r 414 f ^ anradionuclided s (tenfol morer observeo ds e )wa th n i d northern branch of the radioactive trace. It should be added that the radioactive trace was patchy. When matters were tackled concerning the protection of the population from internal radia- -ol tion exposure after the decay of TI and its dropout from food chains e emphasi,th areae th s lai sn wa o d located within the zon f northero e n radioactive trace (upward kilo0 15 -f o s meters froe GNPS)th m . Inside this zone caesiue ,th m patches had covered the poor peat-boggy and sward-podzolic sandy and sandy-loam soils of the Polesye area, which are distinguished for their decreased capability to fix caesium. Temporary permissible levels contene (TPLth f f )o o t radioactive substances in 24 types of food, water, and herbs, becam , 198630 e y effectiv.Ma Wit f e accouno e du hs th a e f o t feasibilit masf o y s technical monitoring L werTP ee aime,th d at measuring the total beta-ray activity. During 1986-1987 radiological units of the sanitary-and-epidemiologic service

102 network under the USSR Ministry of Public Health had carried out several hundred thousand check-up measurements. The monitorin d rejectiogan n were performed als departmentay b o l service f enterpriseso s engage production i d f foodstuffso n , as well as by laboratories under the State Agro-Industrial Committe USSRe th .f o eApar t from these pooled data, this report contains the results of nearly 10,000 gamma-spectral and radiochemical measurements carried out by the Institute of Biophysics unde USSe rth R Ministr Publif o y c e Healtth d han Leningrad Institut Radiologif o e e Hygiene unde RSFSe rth R Ministr Publif o y c Health. e radionuclidTh e compositio soif d no vegetatio lan n ni the vicinity of the CNPS (to the north and north-east of the station s presentei ) Tabln i d . I e As shown by analysis of the data in Table I, radionuclides of ceriurn - Ce, and niobium - Nt> , constitute a considerable par f radioactivo t e falloue southerth n i t n areaf so the Gomel Region, locateclose th en i dvicinit CNPSe th ;f o y rutheniud u R an , Cs - m whild an es C caesiu - m account for a major share of nuclides in the localities situated to the north and north-east (Bryansk Region) of the station. e differencTh e between radioactive composition e soith lf o s and the grass is not substantial. This testifies to the decisive d secondaran rol r eai ye playe dusth y tdb radioe routeth n -i s active contaminatio herbaceouf o n s vegetation. The pattern of radionuclide contamination of staples of diet (Table 2) is somewhat different. Practically, as follows from Table 2, the radioactivity of milk and meat (the content of naturataket no s ni l int potassiu- o K account - m s )i determine amoune th radiocaesiumf y o tdb / Cs 1986n .I e ,th 1 *37 -^Cs ratio in soil, grass and all foodstuffs was 2:1« Appa- rently practicallu R ,migratt no d ydi e from soil into food

103 Ta"ble 1. Radi o nue 1 i de composition of soil and grass

Plac f samplo e . e Dat , e Object, Kadionuclide composition ; obtainin ; g

IWCe :I06R: u WGS-., ^ «*C95 : . W0la = 9°Sr , I3Ij

North of Gomel' July 1986 Soil 9,5 17,040,3 18,3 1,7 0,05 1,0 undetected region Grass 6,6 9,4 53,9 2 26,3, 5 3 1, undetecte 1 0, d

Sout f Cornelo h * July 1986 Soil 25,3 10,3 9,1 5,0 23, 7 10, undetecte0,06 d region Grass 3 8, 24,0 15,6 7,4 21,7 0,8 1,4 undetected

South of Mogilev May 1987 Soil 12,0 62,3 25,0 - 0,7 region Grass 6,0 64,5 26,0 3,0

West of Bryansk June 1986 Soil 8,0 2B,050,6 15,2 8,0 6,0 I,o 5,0 region Grass - 56,6 28,3 1,0

July 198? Soil 8,0 20,043,2 16,6 1,0 2,5 Or sa 1,0 61,4 23,6 7,5

Table 2. Radionuclide composition of foodstuffs established as a result of investigation conducted in northern areas of the Gomel Region in the summer periods of 1986 and 1987 (percentage of the total contamination activity)

Year of Radionuclides (percentage) Foodstuffs sampling 106

Milk 1986 - - 66.3 33.1 - - 0.5 Meat 1987 - - 71.1 27.4- - - 1.5 Root-crops 1986 - 0.57 65.0 32.0 3.11 0.72 1.5 Potatoes 1987 - - 71.5 27.5 - - 0.3- 1.0 Vegetables 1986 17.6 7.0 32.6 14.6 7.5 10.1 1.2 d fruian t 1987 - - 71.5 27.5 - - 0.3 1.0

Note: "-" - undetected.

104 chains. In the summer and fall of 1986, those food products which were expose direco t d t contaminatio r (sucnai froe h th m vegetabless a , frui berriesd an t ) along with radiocaesium, /06 , 1W revealed considerabl. Ge d an e u amountR f so n The content of strontium radionuclides - 90 Sr - in foodstuffs examined in areas located within all the three main branches of the radioactive trace, was relatively low - about 0.3-3 percent of that of Cs radionuclides (Table 3).

90 Table 3. Average Sr content in some foodstuffs ( n .10 Ci/1, kg). The data were reported by radiological departments of sanitary epidemiologic stations.

Milk White bread Potatoes Region 1985 1986 1985 1986 1985 1986 (II-IV (II-IV (II-IV quarters) quarters) quarters) USSR 2.9 17.0* 4.2 9.9 3.8 8.2 RSFSR 3.3 21.0 6.1 6.2 4-3 6.0 European part of the RSFSR (center) 3.4 50.0 5.2 13.0 4.1 11.3

Ukr.SSR 2.6 23.8 5.1 19.1 3.7 14.0 BSSR 5.4 55.0** 2.4 62.6 6.2 38.0

Note*. Without data for the Gomel and Mogilyov Regions of the Byelorussian SSR; ** According to the results of III-IY quarters.

dat e shows th A a y npresenteb USSR'e Tabln th i d , s3 e average leve contaminatiof o l f foodstuffno s ha s r S with 90 grown noticeably. In those areas of the RSFSR, Ukr.SSR and BSSR, which were contaminated with radioactive substancese ,th increas concentratios it n i e mucs nwa h highe abouy b n a tr-

105 go orde magnitudef o r . However, averag r levelS n efoodstuffi s s in these republics remained smal l- substantiall y lower than those levels which could cause an excess over the daily dose allowed by SRS~76. The average 90 Sr levels in some foodstuffs r III-TVfo quarter f 1986so , presenten i e Tabln i ar d , 3 e approximate agreement with the content of global 90Sr revealed in foodstuffs in 1964-1965, while the content of thia nuclide •fî? remain ss leve loweC s lcompare a re (Tablth - o t 4) ed

Table 4. Average content of Cs radionuclides in staple foodstuff d totaan s l daily die n 1985i td 198an * 6

Milk White bread Potatoes Daily di*ef -10 Region 1.10- Ci/1 Llo'^Ci/kg 1.10~(0 CiAS 1.10~f°Ci/day

1985 1986 1985 1986 1985 1986 1985 1986 (II-IV (II-IV (II-IV quarters) quarters) quarter I)

USSR (as a whole) 0.05 17.8** 0.06 0.74 0.05 1.2 0.1 1 11.2 RSFSR 0.04 33.4 0.07 0.31 0.05 0.2 0.12 20.6 European parf o t the RSFSR (center) 0.06 93.8 0.05 0.44 0.05 0.23 Ukr.SSR 0.05 9.7 0.12 2.0 0.07 1.14 0.13 9.2 BSSR 0.28 245.4*** 0.08 3.7 0.18 19.7 0.56 164.7

Note: *1985 columns presens levelsC t; 19S6 columns present s levelsC Withou* * d ; an e Gomes tC th d bot datan lr hfo a Mogilyov Regions of the Byelorussian SSR; *** samples were taken predominantly in areas most heavily contaminated with radioactive substances; **** temporary permissible levels (TPS , 1986),30 y effectiv, Ma SES-7f o d standards a e6an f so C countriesthEE e 270.10~d an 0 ,33 <°Ci, respectively.

106 The data presente Tabln i d testif4 e considerabla o t y y increased * Cs content, as against the 1985 figure, in all foodstuffs produced after the accident, especially in milk. Increased level of this nuclide in foodstuffs was observed in all regions of this country, with its most pronounced growth BSSe prevalence th R th n wherei o t e Polesyf ,du eo e type soils, the level of global Cs in milk was several fold higher in comparison with the country's average figure. At the same time, in 1986, the country's average daily diet, as well as that in the above-mentioned major regions, showed radiocaesium levels

yo •> substantially lower than those allowed by SRS -76. The Cs intake in the most heavily polluted areas is characterized by the data presente Tabln i d . 5 e

The data presente Tabln i d sho5 ee actua wth l levelf so Cs and Cs intake with the diet by the human body. It shoul notee b d l dcase al average tha n sth i t e radiocaesium levels eacn i h district exceeno d d di tnorma l values abrupn .A t decrease contene ith n f radiocaesiuo t diee th t n tooi m k placn i e August 198 s compare6(a same th Julo e t df o yyear) , whics i h accounted for by the introduction of a more stringent norm for Cs conten miln i t k (1.10 Ci/-19 instea f 1.1o d 0 Ci/1). Durin—?g the first post-accident year - till June 1987 - the average intake level in the areas polluted with radioactive substances abouy b n ordes a t wa magnitudf ro e lower tha nore nth m which allowed the internal exposure level of 5 rem. This is explained by the fact that, due to rigorous control, the actual levels of radiocaesiura concentratio n foodstuffni t exceeno d ddi s L thcalculateTP e thir fo d mosse th doset r part.Fo , these levels were 10-100 times lower. The role playe y productdb animaf so l origi havins na e th g Cs-accumulating property is represented in Table 5. The rigid norm prescribe Augusf o milr s fo dt(a k 1986) reduce conte th d -

107 Table 5- Actual average levels of Ca and Cs daily intake with diets by the human body in one northern and three southern districts of the Gomel Region.

Food routes of Cs intake 1986, 1986 1987, humae bth y n body July August* June

Daily intake of Cs by the human body with foodstuffs, with due account of the monitoring Q and rejection 0 Ci/da1 . y,n 6.36 2.04 1.53

e th Dail y b ys C intak f o e human bod s percentaga y e th f eo level allowed by TPL as of May, 30 1986 (percent) 19.3 6.2 4.6**

Contribution of some foodstuffs into the daily Cs intake by the human body (percent) Milk 75.5 23.5 15.7 Meat 19.6 61.2 40.8 Pish - - 3.4 Fruit and berries 4.6 14.4 19.2 Potatoes 0.1 0.3 16.2 Vegetables 0.03 0.01 3.1 Bread and bakery products 0.09 0.3 1.3 Other products 0.03 0.2 0.3

NoteAugusn I * : t 198 e temporar6th y permissible e leveth f o l content of radioactive substances in milk was reduced tenfold 1.1o t 0- yeae Ci/1On r * afte* ; accidene — flrth t (before May, 1987 average )th e conten radioactivf o t e substancen si the diet amounte abouo t d t 1.10 , whicCi " h agrees wite hth annual internal exposure dose received by the whole body — 0.5 rem.

108 ribution of milk to the total internal exposure dose. However, in "natural" conditions, i,e» without rejection, in the areas contaminated with radioactive substances, milk may account for upwards of 75 per cent of radiocaesium taken in by the human body with food. As shown by calculations, with the level of contamination of milk reaching /1:2/. 10 _ o Gi/1, it accounts for r eve(o n e intak% morecontaines G th 90 f f )o eo dailn i d y diet. It was established that, in actual conditions of this or that populated humalocalitye intaks C th ny eb bode ,th y 43? depends on how thoroughly the recommended protective measures are carried out, rather than on the density of fallout of this particular nuclide. The actual levels of the radionuclide humaintake th ny eb body could als influencee ob e facth t y db (not taken into account in Table 5) that the traditional diet structure,which had been taking shape in these areas for many decades, was frequently upset: using their own discretion, people restricted the consumption of meat and dairy products, believing that these foodstuffs mostlys C accounte e th r fo d humae intakth ny eb body. As to their contribution into the population Cs exposure level (wit rejection)o hn , foodstuff arrangee b e y th sma n i d following order: milk, meat, fruit (stone fruit, applesd )an berries (currants, gooseberries, wild berries), potatoed an s vegetables, fish, mushrooms, bread higA . h radionuclide content was detected in tea, and a number of lots were rejected« In 1986, in areas located in the immediate vicinity to the GNPS, as well as in the most heavily contaminated sections of "caesium patches", the inspection bodies had to re- ject, along with milk and meat, up to 20-30 percent of samples of cultivated berries, stone fruit, table greens d abou,an t 10 percent of fruit. Potatoes remained "clean" both in 1986 and throughout 198?. As shown by the examination carried out in 1937, the entire produce gathered from personal plots fully

109 complied with the requirements. Among the products which still continue to be rejected there are certain percentages of mild meatan k wels , a wils la d berries, mushroom d fishsan , some samples of which showed Gs contents exceeding the TPL several tenfold highese .Th t concentration radiocaesiuf so m _

110 Correct calculatio internaf no l exposure doses, basen do m one-tim contena C e t measurements, requires informatioe th n no intake dynamics takn ca e pattere e stoc.On th f o kthif n o s dynamics with the aid of the data presented in Table 6.

B7 Table 6. Dynamics of Cs content in milk, on a per-unit basis, with the concentration recorded in July 1986 take unia s tna

Area Year, July Sept. March May June Sept. month 1986 1986 1987 1987 1987 1987

Gomel Region: - south 1.0 0.72 2.09 0.69 0.57 - north 1.0 0.46 0.42 0.29 0.34 Bryansk Region 1.0 0.73 0.43* 0.39 0.62 0.41

Note: * The average value for the stable fattening period (November 1986 - April 1987).

The data presented in Table 6 reveal the general trend toward graduaa s l purificatio milf no radioactivf o k e substances. Reduced contamination of second-harvest grasses, observed range th ef o fattenind towarden e th sg period (September 1986), accounte decreasee th r fo ds conten C d perio e milkn th i t n .dI of stable fattening of cattle in the regions where hay, gathe- rearean i d s polluted with radioactive substances, a mad p u e substantial percentag fodderf o e , milk showed increased contamination levels (southern Gome e areath lf so Region) . During the same period in the Bryansk Region, due to the use of "clean" fodder contaminatioe ,th milf no k with radioactive substances felnoticeablyf of l n earl.I y summe f 1987o r , after fattening on winter crops, Cs content in milk slightly increased.

Ill The relationship between the density of Cs contamination e contenofth soi d f thio an tl s radionuclid n mili e s i showk n Tabln i . 7 e

Table 7. The relationship between the density of Cs contaminatio n differeni n t regions contenit d n an si t milk take n thesi n e regions from privately-owned cows n summei fald f 198an o rl 7

Region District Contamination density (Ci/km2) at v/hich Cs content in milk is 1.1Q-* Ci/1

Gomel Vetka 4.9 Khoyniki 3.0* Mogilyov Cherikov 5.2 Bryansk Novozybkov 4.4

Note: * This value could be affected by unauthorized supplies y froe 30-koha mfth m evacuation zone aroun e CNPSth d .

t I shoul notee db d that Tabl present7 e s dat r milfo a k from privately-ovmed cattle. Milk from publicly-owned cattle which is on fodder from cultivated paatureland and, besides, receives greater amounts of cleaner concentrated fodder, in the same area is, as a rule, 2-3 times cleaner than milk from private cows grazing on roadsides, in the forest, etc. Milk from publicly-owne dradiocaesiu L cowsTP e , th whic t mme h contenb requirements, coul receivee b d e areath n 198i dn si 7 o with the contamination density of 10-15 Ci/km . It is likely that in the future, as caesium is fixed in the soil, clean milk will be also available from cows fed on fodder from more heavily contaminated areas. The content in soils of various assimilable form caesiuf o s shows i m n Tablni . 8 e

112 Table 8. The content of mobile forms of Cs in different type soif o s1986-198n li percentagea s (a 7 )

percentaga s (a s C f Formeo f so Region Soil type total content) Exchange* Accessible** Tightly for plants bound

Gomel Sward-podzolic 15.0 28.5 71.5 Sandy (1.6-27.2) (1.4-46.5) Peat -boggy 6.3 14.9 85.1 Mogilyov Sward-podzoloc 27.2 33.0 67.0 Beat -boggy Sandy (16.0-38.5) (18.1-47.9) Bryansk: Sward-podzolJc, (Novozy'b- sandd yan v Distko - sandy-loam — 15-31 69-85 rict) Tula (Plavsk District) Chernozems — 8-18 82-92

Note: * The part of caesium displaced by 1n ammonium acetate solution pare caesiuf th o t * ;* m displace hydrochlorin 3 y db c acid and 1n ammonium acetate solution.

The data presente Tabln i d mak8 e possiblt i e conco t e - lude tha substantiaa t l proportio radiocaesiuf no s stili m l radily accessibl plantsr fo e . This proportio approximatels i n y equa thao lt globaf o t l caesium e detecte th e soi th n i ln i d 1970s s show.A analysiy nb datf so a obtained, o thern s i e clear-cut relationship betwee capabilite nth f caesiuo y o t m pass from the soil into vegetation (fodder grasses) and the typ soilf o proportioe s welth ,a s la assimilablf no e caesium available in the soil (Table 9). This may be attributed to the fact that the major part of caesium fallout covering unplovved soil lies in its upper- penetratet ye t no deepee moss th d ha t rt laye i layer r- s

113 «p transfes C Tabl . 9 re coefficient n "soil-grassi ) (K s " and "grass-milk" links of the food chain, in summer period e pre-accidenth f 198o sn i d 1987 6an d an , t period (1970), Ci/kg/1 /Ci/kg

Sampling Grass/soil K Milk/grasK s sites 1970* 1986 1987 1970* 1986 1987

Gomel Region 0.5-4.5 0.83 0.25 0.35 0.31 0.34 Mogilyov Region - 1.5 0.7 - 0.27 0,30 Bryansk Region (5 western districts) - 1.8 0.26 - 0.22 0.34

Note Accordin* : o "Globat g l Caesium-137 Fallou Man"d an t - . M.: Atomizdat Publishers, 1974 A.N.Mareyy "b , , R.M.Barkhudarov, N.Ya.Novikov e Pavlovsn 197i ,th 4n i k District, Tula Regione th , grass/soi s 0.00wa 2K l (for chernozems).

(on natural pastures, by the fall of 198? more than 80 percent

•C3!? d remaine ha e uppe s th C n ri d o f2-c m e soil) layeth f .o r On the other hand, the role played by agrotechnical measures (amelioration, fertilizer application, lime pretreatment) should not be ruled out, either, for it is these measures that result in decreased Gs mobility in soils (Tables 10 and 11).

Table 10. Coefficients of transfer of Cs into foodstuffs depending on agrochemical measures taken in 1987, Ci/kg/Ci/km2

Fallout Agrochemical Potatoes, K Vegetables,K density, measures n n Ci/kni n. I0~8 n-IO~8

Less than Conducted 0.06 0.05 15-0 (0.092-0.007) (0.007-0.00 More than Not conduc- 0.06 0.007 15.0 ted (0.018-0.003) (0.022-0.004)

114 -> Table 11. Gs transfer coefficients in the "soil/grass" fooe linth d f chaiko grass/soiK ( n ldependin) e th n go type of pasture

Area Numbef o r K, grass/soil , Ci/kg/Ci/kg farms examined Pasture type ?arm category Natural Cultivated Priva- te Public- owned awned

Gomel 0.41 0,26 0.39 0.15 Region 112 (0.75-0.16) (0.51-0.04) (0.78-0.15) (0.36- 0.03)

The obtained data, partially presented in Tables 10 and 11, mak t possibli e o drae t conclusio th w n that, coupled with agrotechnical measures, the cultivation of pastureland lead ten-fola o st d reductio contens C f no n agricultura i t l produce. In 1987, the grass/soil transfer coefficients were considerably lower as compared to the corresponding 1970 figures highee Th . r 1986 coefficient (Tabl- re ) doe9 et no s presen a trut e e degretransfeth f eo caesiuf o r m frosoie th ml Intgrasse th oe likel .Th y explanatio thas ni t fodder grasses were contaminated with caesiu r rathem ai froe rth m than soil, as well as due to the secondary dust formation. This also account face th t r tha fo sn 198 i tmilk/grase 6th s coefficient was lower than usual (0.22-0.2?) because non-organis C c from the air is assimilated by the cow's body to a smaller degree than that passing through the root system of the grass d incorporatinan g into tissue plantsf so .

The coefficients of transfer of Cs radionuclides from the soil into some other agricultural crops, cultivate Polesyn o d e type Bryanse soilth n i sk Region, wer s followa e s Aci/kg ^ : grain - 4.8. 10 9 ; potatoes - (1-2). 10 ** , cm ')' cucumber - s6.1 0tomatoe; - s (1-4).10 -11

115 Essentiall same n sandyth o e y above soilth ef so typ n i e all areas, the Cs transfer coefficients are at the same time much highe y severa(b r l order magnitudef o s ) than thosn o e heavy-loam chernozem soils characteristic of southern areas of the Tula Region. Outsid northere th e n e brancradioactivth f ho e trace o larg,n e contaminated areas, comparabl o thost e e described above, have been revealed. Further investigatio s needei n predico t d e th t route radiocaesiuf o s m migratio n fooni d chain Ukrainiann i s - Byelorussian rate Polesy f "purificationth o e d ean thesf "o e chains. Also important is the problem of rehabilitation of soil within the 30 km zone, where, along with radiocaesium, alfa active go nuclides - ^Pu and Sr - may be significant as far as protection against internal exposure is concerned. firse th tn I post-accident weeks, radioactive iodins ewa the major facto internaf ro l radiation exposure. Late, on r internal exposure levels were determined by Cs and Cs. n areaI contaminatios G s wher e th e n densitA Y7y exceeds 2 10-15 Ci/km , it will be impossible, for a long time to come, to receive milk conformin e standinth o gt g radiation safety norms and good for use without being processed. In areas with maximum densities of Cs radionuclide fallout , the intak f theso e e radionuclides with local agricultural pro- humae ductth ny b s bod y (without dairy products), starting froautume th m f 1987 no (6-8)s wa ,Ci/dayf .1C , which corres- annuae pondth o lt s internal exposure dose — approximatels y 100-150 mrem. Startin complet, g ? froe autum98 th m1 ef no contro f o l foodstuff f vegetablo s e origin (wit e exceptioth h mushroomf o n s and wild berries) received from products grown within the "caesium patches" became unnecessary.

116 CHARACTERISTICS OF RADIONUCLIDE INTAKE BY INHALATION

V.T. KHRUSHCH, Yu.I. GAVRILIN, Yu.O. KONSTANTINOV, O.A. KOCHETKOV, U.Ya. MARGULIS, V.I. POPOV, V.S. REPIN, V.V. CHUMAK

Abstract

Internal exposure of all organs other than bone tissue by inhalation of a mixture of radionuclides virtually ceased by the end of the first year after e accidentth . Comparatively intensive fallout froe radioactivmth e plume took e towplac th f Pripyat o nn i e e 'evenin th lat durind n i e an ge nigh th gf o t 26-27 April 1986 densite Th . f contaminatioo y n certaii n n streete towth nf o s by iodine-131 at the time evacuation began was estimated to be of the order of (1-706 Bq/m10 x )2 (30-2000 pCi/m2). This give a valus f intako e y b e inhalation of (0.3-20) x 106 Bq (10-700 yCi), which corresponds to an absorbed dose to the thyroid gland in adults of 0.2-14 Gy (20-1400 rad). The actual results of measurements were significantly lower than the maximum estimate.

The main contributio e predicteth o t n d 50-year dose equivalent commitmen r bonfo t e tissu s i efro m transuranium elements exposurd an , e during the first year corresponds to about 1/4 of the maximum permissible dose for occupationally exposed persons.

INTRODUCTION

Aa resuls f passino t f radioactivo g e cloud ove e townth r , it* a inhabitants were affected by the following radiation factors: - external beta-gamma-radiation froe cloudmth y - internal irradiatio resula s na f radionuclide o t s inhalation from the cloud; - external beta-gamma-radiatio f nuclideo n s contaminating horisontal and vertical surfaces ; - internal irradiation by inhalation of secondary aerosols, coming from contaminated surfaces; - internal contamination as a result of radionuclide intake with contaminated food-stuffs.

The effect of the latter may be excluded by means of organizatio f providinno e populatioth g n wit " hclea " rfoo d products. Thus inhalation intak f radionuclideo e s durin e passinth g g

117 f radioactivo e clou y presenma d r somfo te population groupe th s major factor, causing subsequent internal irradiation. Knowledg f dynamico e releasef o s s frodamagee th m d reactor to the atmosphere together with the information about meteorological condition radiatiof so n transport that were changing, allow relativelsa y accurate descriptio radionuclidf no e concentration alternation neargrounn i s layerr ai d , though onl casn i y e of rather large-scale averaging. This approach can be hardly considere suitabla d e metho realistir fo d c assessment inhalatif so - on uptake role as a factor of internal irradiation, for the application of this large-scale averaging to the concrete territory may lea mord mistakeo t dan e 0 times)1 ( s e secon.Th d possible source of quantitative information is the practical results of measurement of radionuclide concentration in inhabited areas. This relatively correct information exists for large cities ( Kiev, Minsk etc.). It is evident, that the results of individual measurements e mosar t informative e measuremen.Th dosf o t e rate from thyroid e simplesglanth s a d t kin individuaf o d l examination, allowino t g assess the commitent absorbed dose in this organ were conducted for hundred f thousando s s inhabitant f contaminateo s d areaf o s Russia, Byelorussia and Ukraine. Authors of this paper had no possibility to summarize the hu?e array of data, which will be acces- sed for many years. Here we discuss the results of individual investigations which were conducted directly by the authors and which are directly connected with the subject of this work - the

inhalation uptake. l Pither al e result rsf ar eto f investigatiso - individualf o s on s from Pripiat Chernobye th - * l ÏÏPP personnel town o werwh , e evacuate relativele th o t d y clear regions approximatel 5 day, 1 s n aftei y e accidentth r .

118 Estimated maximum assessments.

In case of absence of data about radionuclide concentration in nearground air layer the evident relation may be used: , V / W • Q = U where U - expected inhalation radionuclide uptake during total tim f fallouto e (y/Cq B , ; i) - Qmeasure d contamination densite th f o y area, Bq/ m2 (Ci/ m2 )j W - 0.33E- 3m/ sec - respiration rate of a reference man; V - radionuclide deposition rate on surface, m/sec. This formula f courseo , e area,th e use shoulr b s fo dt dno which were contaminate a resul s a df loca o t l rains, fallin- gdu ring the radioactive cloud passage. In literature the "dry" deposition rat s i consideree d usuall V»0e b .o 05-0t y m/sec5 .00 .

Observations of average daily concentration and fallout intensity, conducted since May till August 1986 in Kiev show that deposition rate for 1-131 was in the range of 0.003-03 m/sec', r isotopefo f cesiuo s m- 0.01-0. 3 m/sec, isotope f cerio s - u m- 0.006-1. 3 r m/sec1-13fo s e assume1A w . d deposition ratd an e f overestimateo e consideb o t t i r d level V=0.001 m/sec. Thuse th , followin e gassessmen th formul e user b fo y d f ma possiblao t - in e halation uptake of 1-131: a <= 1/3 ' Q Using the data concerning the maximum density of 1-131 contamination, régis ter n April-Mai d y 198 e followin6th g assess- e obtaineb ment y ma s d accordin o thit g s formul e tabl. ) se 1 ( ea

Table 1. Density of the 1-131 contamination of some town n April-Mai s y 1936

City Gomel* Done tsk Kiev Minsk Mogilevk s Pin Poltava Q,kBq/m2 2400 7.4 480 15 59 780 18 U,kBq 810 2.5 160 5 20 260 6 U/ALI 20 0.07 4 0.1 0.5 7 0.2

119 According to SRS-76 the ALI for 1-131 aerosols is considered to be 3.7E4 Bq (1.0 /Ci}« In assumption that inhalation of one ALI 1-13f o 1 aerosols lead irradiatioo st thyroif no d mGy5 glan1 f ,o d the assessed commitment absorbed dose wil e aboub l t r 0.3fo y 3G e largesth r tfo Gomecity d abou mG Kievy- an l 0 5 temphasize .W e th e maximu assessmente m e naturth f o e ^ stak no whicd e ai hint o consideratio f factorso t lo na , decreasing actually observed valuef o s individual doses. Assessmen lattee th f ro t wil givee lb n below.

General characteristic discussee th f so d individual examination results.

Absenc peroraf o e l radionuclide uptak r everfo e y examined individua d beelha n additionally confirmed wit e resultth hin f so dividual inquest concernin behavioe th g r regime sinc momene th e t accidene oth f t tilbeginnine th l examinationsf go . Resultf so this inquest show that in spite of relatively low statistics of the examination, collected data about behavior regime are typical for the evacuated population of Prip"at, excluding a small group of those o wer morn wh ,i e e extreme conditions becaus f theio e- in r dividual resons. The following experimental data, obtained with various me- y differenb thod d san t group investigatorf o s e discussear s d further: 1) commitment adsorbed dose in thyroid gland caused by iodine isotope0 evacuate21 r fo s d inhabitant Prip'atf o s , includin5 g7 kids; data were obtained on 3-10 May 1986 due to measurement of gamma dose rate froe thyroith m d gland, selectively intercompared

with the results obtained with two-channel "iodine" spectrometer}

) commitmen2 t adsorbed dos thyroin i e d0 adult 65 glan r sfo d from Prip*at, mostly the NPP personnel, who remained in the regime simila commoe th o rt n populatioe regimth f o e n - durinpe e gth

120 riod before the evacuation? however the professional factor sho- totalle b t uldno y exclude; d

3) results of radiometry of excrete samples from 64 persons who wer businesn o e s trip n Prip*ai s werd an te evacuated wite th h inhabitant e towreturned th an nf o s d o Leningrahomt ( r e fo ; ) d 4 of them the detailed radiochemical analysis ( 16 nuclides ) of excrets was conducted; 4) results of examination with whole body spectrometers and radiochemical analysi f Sr-9 o salpha-emitterd 0an n excreti s f o s 189 individuals evacuated from Prip"at, who stayed not nearer than. Chernobyl and used only "clean" food; 5) the data about 75 persons who were evacuated from the most contaminated settlements, wer e comparisoeth r usefo d f inhao n - lation and peroral radionuclide uptake;

Dynamic f radiatioo s n condition n Prip^ai s t since the beginning of the accident till the evacuation of the population.

According to the measurements of gamma dose rate, conducted by Korobeyniko n aboui v 0 fixe3 t d points wite intervath h 3 l2- hours e locatioth , Prip*af o n te damage closth o P unit - eNP d(3 t 6 km) determined to the great extentjheterogeneous time and spatial picture of the development of the radiation conditions over Prip"at. Behavior regim peoplf o e e differed too. knows Ii t n that primary t affecreleasno d tdi e Prip*at . Further "tranquil" flo radioactivf wo e substances froe th m damaged reactor unde cale th rm meteorological conditions caused the relatively momentary passage of the rare radioactive streams witrathee th h r small cross- section, which contaminatee th d earth surface.

* urgent examinatio thif no s grou conductes wa p y db V.L. Korobeynikov.

121 Relatively more frequent fallouts froe radioactith m - ve streams in the Prip" at zone happened in the evening and 7 April2 - ,t 6 a whe2 nigh f n o t people were sleeping in their flats. The density of contamination of some streets with 1-131 up to the moment when the evacuation was laun- - 200 0 030 . ( ^Ci) - 2 2 /m m / Bq I0~x ) 6 0 7 - 1 ( s chewa d According to these values the inhalation uptake estimated using the discussed formula were ( 0.3-20 ) x I0~6 Bqd 0-700y#Ci)

and thyroid dose ( for adults ) - 0.2-14 Gy C 20- 1400 rad ). Practical results of measurements were sufficiently less than the maximum assessments.

Results of the individual examinations.

The practical result f 1-13o s 1 incorporation measure- e mentioneth l al ment r d fo sgroup s cause e followinth d s di g tribution of the individual absorbed doses (the iodine short-livers were taken into account).

Table 2. Individual adsorbed doee distribution r examinefo d groups

Numbe / r fractio f thoso no wh e belongs to the certain dose interval , Gy Examined group 0.15 : 0.15-0.75 : 0.75-1. 5 i 1.5- 3.0

210 évacuants 140 (66.6* 5 (31*6 3 )(1.4 ) * ) 2 (195) 75 kids, average dose- 41(54.7*) 31(41.3*) 2 (2.7*) 1(2.3*) 0.25 Gy 135 adults 99(73.1*) 34(25.1*) 1(0.3*) 1(0.36) average dose- 0.14 Gy 650 individuals from the HPP personnel 416(64.070 2H(32. 9*) 17 (2. 695) 3(0.5*) average dose 0.21 Gy

122 Higher individual doses for the personnel in comparison with e adultth s from evacuated populatio e explaineb e y th nma y b d characte f theio r r professional activity before measurements. It is noteworthy that among the examined there were individuals e iodinus t eno drugs d di d . an whd di o Relative contributio f perorano l radiation uptak- e to inte th o tal food-chain uptake may be compared with the inhalation before the conductment of any sanitary and hygienic measures according to results of 1-131 incorporation measurements for inhabi- o settlementtanttw f o s s whic t unde go he primar th r y radioactive cloud. Non f theo e m used iodin e eresult e th th drugy b f o s( s individual inques . ) Thit s contingen divides wa t d groupinto tw o s separately for each settlement. Individuals belonging to group 1 e locaus t l no milk d di ; grou usep2 d this milk. Evidently, assumption of the fact that pure inhalation uptake is a dominant for individuals from group 1, at least does not understate the role of this factor in rural conditions. Commitment thyroid dose for both e characterizegroupb y ma s d wit e followinth h g e datse ( a table 3). lable 3. Commitment thyroid dose Settlement :Group:Average dose: D1/D2 inde: /numbex f examinatedo r : rat ( cGye ) /

2/317 236+-34

9 +- 1 4 / 4 1 1/ 2.2+- 0.6 +-11 9 5 2/15/

Represented data show, that the contribution of inhalation consumption into the total food-chain uptake was less than Jofi>. s noteworthi t I y that data ontained from this groups relato t e the postaccidental period ( not more than 10 days after the accident ) when the food-chain uptake even of 1-131 was not expresse n fuli d l scale.

123 The first excrete samples from those who had been on business trips came to the laboratory on the 4-th day after the acciden „ Contaminatiot f feceo n s with different radionuclide- re ( s late e 4-to Zr-95t d th afte y n h e accidens da o )a th fol r s wa -t lows ( see table 4).

Table 4. Radionuclide content in fecal samples e 4-to th afteny e accidenhda th r t

"îTuclide :Sr-89: Y-91 : 2r-95: Mo-99:I-1 31 :Te-132 : Cs - 134* Cs-137 :Ba-140

Content, 5 1. 0.1 1 0. 5 1 1. 0.1 4 1 2. 5 5 1. relate4 1: o dt

Kuclide :La-140;Ce-141 : Pr-1 43 ;Ce-H4:Pm-147:ffd-1 47 : Pu-239:Am-241+Cm-242

2 ' 2 0.016 1 °' 9 0.02' 1 ? 2 * 2 related't 9 * 1 3 * o2 Zi-95

Certain enrichment ( related to Zr-95 ) of the feces with

Sr-39, Y-91, Ba-140, Ce-141, Ce-144 in comparison with the nuclide compositio e sampleth f o n , Apri3 takes tha2 n wa to l n 1936 froe radioactivmth e environth e d streaan -P mNP froe mth mental contamination is possible. Content of Mo-99, Te-132, Cs-134, Cs-137 was the same. Relative content of j-1 31 in fecea was significantly less. Difference in radionuclide composition apparentl causes y wa bot y e b processed th h f radionuclido s e tra-

nsfer from respiratory organs to body liquids and the different relative content of radionuclides in various radioactive streams, passing ove e towdeterminind th r an n e actuath g l inhalatio- nup take. The second reason should be considered the main one.

•# Zvonova I.L« , Korelina N.F. and Shvydko IT.S. took part in e obtaininth processind gan f thesgo e data.

124 e averageTh d result e radionuclidth f so e composition determinatio e twenty-four-hourth n ni s mas excrementf so s fro4 m2- examined individual e showsar n fig.1ni e eliminatio.Th n rates examinatiof o 1-ae y th tda n o 4-t( n aftey haccidente da rth ) for each examined individual wer continuoue Th assume , 1 s da s curve show decorporatioe sth n ratmixturr efo nuclides4 f eo , estimate accordancn di e witlune hth g TCRe r modeth Pfo f o l aerosol standarf so d dispersion ) (AMAconcretelum 1 D r eacfo yh nuclid d relatean e 1(oo t d4-te nth h day). Isotope Sr,Mo,If so , Cs and Ba in these estimations were considered to belong to the dissolution class D, the rest to class - W. Taking into account the fac proximatenesf o t I^Re th P f modelso , possible deviation dispersioe th f o inhalef no d aerosols beyon standare th d d value, the conditional character of the nuclide classification on dissolution classes - the reliability of the results, shown in fig.I may be considered satisfactory. Therefore, for all the 64 exami- d individualne commitmene th s t effective equivalent doses were

1,0

CALCULATION 2 0,1

O o 0,01

r 0 0,0 1234 5678I I 0 1 9 Time froe accidenth m t beginning (days)

Fig. 1. Observed and estimated dynamics of the total beta—activity of feces.

125 estimated, usin e e methoreversth gth f o d e calculatioe th f no primary inhalatio r everfo n y radionuclide accordin e IGRth Po t g model.

The contribution of the thyroid dose into the total dose was calculated separately, usin ge contaminatio th dat f o a f o n e thyroith d gland with 1-131 obtained with gamma-spectrometer precalibrated with the phantom. Correction on the alternative short-livers contribution into the dose was made according to the estimated composition of the fuel. The result f assesseo s d thyroid dose f thoso werso ewh e examined depending on the time spent outdoors ( referring to the results of inquest - for the period since the accident till the departure from Prip* at only) are shown in fig.2. The indi- d follodi d wan iodint no vidualed di prophylaxi o wh s s were detected also.

0 2 6 1 2 1 3 4 0

Total time spent outdoors (hours)

. Thyroi2 Fig. d dos - etota l time spent outdoors curve.

On fig. 2 curves 1 and 2 were plotted with the method of linear regressio d corresponnan e followinth o t d g relationship betwee e thyroicth n e tim!th e dos d spenan e t outdoors: D=0.1t

126 t follono d anwdi d prophylaxi d D=0.0lan d r di thoso fo t swh e respectively» Dose D is represented in Gy, time- in hours. Hence, according to the represented relationships, the practical effective- e iodinth nes f o se prophylaxi e observeth r fo s d e groupb y ma s characterized with the protection coefficient of 10. Those, who during their stay indoors had the windows opened and those e intermediatth wh n i o ee evacuatiopointh f o t n were affected with releases were not taken into exerption represented on the fig.2. These individual e highesth d ha st radionuclide content. This phenomenon may be explained under the assumption that the contribution of the mentioned additional factors into the equivalent dose is the major one. Experimental points should be shifted rightward on the time-axial ( as it is shown in fig.3) to arran- e averaggth e e linear relationship betwee e quantitth n f radioo y - e nuclidtimth ed spenan e t outdoors. Pig.3 show e estimateth s d

0,005 -

0 43 12 16 20 Total time spent outdoors (hours)

Fig . Commitmen3 . t equivalent beta—dos - etota l time spent outdoors curve.

127 individual effective equivalent beta-doses mainly formed by thyroid dose, multiplie e standarth y b d d weight facto f 0.03o r . In general these data are in satisfactory conformity with the above-discusser results of thyroid 1-131 contamination measure- 0 individual65 d an 0 ments21 respectivelyf o s . In assumption of the significant uptake of radionuclides by those who had their windows opened, protection factor ( for 5 hours of 36 spent outdoors before the evacuation ) may be con- e otheth sidere n e abourO b han » e o 3 explanatiot dt th d f thio n s fact with the model of different radioactive streams, passing ove e towth r n during some period s trustworthf a timo s s i ee th s a y first one: According to this explanation all the experimental point n fig.i s 3 shoul e consideredb e uniforth s a dm excerption; this is non-linear relationship between the accumulated dose and time spent outdoors e actuath ; l inhalation uptak s causei e d by the individual reasons ( interaction between individual and actual radioactive streams). According to represented data about the content of alpha- emitter n fecei s e ratith sf commitmeno t equivalent alpha-and beta-dose ( accordins o IGRt g P model) shoul1 o t e aboub d 6 5- t for lung tissue and 3000:1 - for lower colon. More accurate assessments ( for commitment alpha-beta-doses in skeleton particulary) could be made referring to alternative experimental data. The trans-uranium elements were extracted from the urine samples of 82 individuals using the sedimentation method. Total alpha-activity of the samples was compared with the minimum detect ible activity e twenty-four-hou(MDAth n i ) r quantit f urino y e ( approximatel . ) Conteni pC y f 5 trans-uraniuo 0.0t0. / 2Bq m radionuclide f examined o 9 sample4 % 0 n s lesi 6 s ( wa ss) than . EstimatioMDA f trans-uraniuo n m conten n wholi t e th bod t a y day of measurement was conducted according to Langham model,

128 dose calculation- according to IGRP lung model in assumption that the dispersio f aerosolno s characterizeswa d wit- mi h0 1 AMA f o D cron e fractio.Th radioactivityf no , transferred from lungo t s body liquids according to the results of aerosol particle dissolution tess assumedwa t . Maximum conten f trans-uraniuo t m elements in whole body was 780 Bq (21 nCi), average value - q (2.B 0 7 10 nCi). Extrapolatio date th a f froo nmomene th m f o t analysis to the moment of the inhalation shows that average body content corresponds to inhalation of 1200 Bq ( 32 nCi) trans-uraniuf o m element e for aerosolth f mo n i s s with AMAf o D 1D micron. Assessmen commitmene th f o t t equivalent doss conwa e- e followinducteth r fo d g trans-uranium nucline composition: Cm-242- 3505, Cm-24 , Am-2412# 4- - 156, Pu-239, Pu-240-8.3^, Pu-238-3.2?S. Pu~241 activity approximately 40 times exceeds total alpha-activit mentionee th f o y d plutonium nuclides. Aestimatioe resula s th f o t alpha-dosf no e cause nucy db - s ascertainewa t i m A dd an tha lidem C t f 8C9o sf isotope o S s transfer from the intermediate chamber to bones and 10^- to liver. Plutonium isotopes distribution was assumed in accordance with ICRP Report 30. Estimated values of the commitment equivalent alpha-dose for bone tissue for the above-presented inhalation uptake of 1200 Bq are as follows: 73 mSv ( 7.3 rem) for the first year afte inhalatione 1 rem th r(3 r firs )v fo yea0 mS 1 td 0 ran ,31 870 mSv (87 rem) - for 50 years. Red bone marrow dose is 12 times lower than bone tissue dose. Strontium content in urine was determined for another group individualo2 f8 s using sedimentation metho Sr-89( d extrad )an - ction metho Sr-90)( d . Concentratio thesf no e nuclide urinn i s e was approximately equal. For 37 individuals strontium content was less than the sensitivity threshold of the method (0.4 Bq/ twenty-four-hourr pe i 10pC s quantit urinf o y Sr-3n o ed 9an

129 Sr-90). Averag notef o m desu isotopecontene th f o f strontito s - organisme th 0 nCi examinee n u(2 i th m )q f B s abouo wa 0 d 74 t maximue anth d m valu 3 nCi) (7 270- e e representeq .0B Th d average content corresponds to the coramittnemt equivalent red bone marrow dose of about 0.3 mSv ( 0,03 rem) for 50 years. Compared with the contributio e otheth rf o nfactor internaf o s l irradiation, this dose may, evidently neglectede ,b . Average radionuclide content ( for the group of 65 individuals) accordin e resultth o t f gexaminatioso wholee th n -no body spectrometer in May 1986 is given below.

In table 5 data about nuclide composition in bodies of those who died due to acute radiation sickness are presented.

Tabl « Radionuclid5 e e compositio e bodieth n si n 5 examinate6 f o d individuals Tîuclide Nuclide content Related to Zr-95 The same for those ( kBq) content who died of acute radiation sickness Sr-89, Sr-90 0.74 0.13 0.14 Zr-95 4.1 1.0 1.0 ttb-95 3.7 0.9 1.0 Ru-103 7.0 1.7 2.0 Ru-6 10 2.6 0.63 0.7 Cs-134 9.0 2.2 2.3 Cs-137 18.0 4.4 6.7 Ce-141 1.4 0.34 0.8 Ce-144 1 .4 0.34 0.7 Trans-uranium 0.1 0.025 0.020 elements

Compariso radionuclide th f no e composition (tabl wit) 5 e h the discussed results of fecal analysis leads to the conclusion of the relative body enrichment with Cs and Ru isotopes. During the estimation s assumewa t i s d tha s isotopetC s belon dissoo t g - lution class D, the rest - to class Y. According to the lung mo- deICRPf o l , reconstructio radionuclidf no e inhalation uptak- re e ferrin s contentit o t g , determine y 198Ma 6n i dlead o rathet s r close values of doses for various aerosol dispersions ( AMAD 1-10 mi-

130 cron). The corresponding averaged assessment of the equivalent dos human i e n organ se followinleadth o t s g results r lungfo : - s 21+-3 mSv (2.1 rem) for the first year and 30 +- 5 mSv (3.0 year0 5 rerar sfo )afte e inhalatioth r e maith nn( contribution is from Ru-106 and Ce-144: 30-90?S) i for the whole body - 0.3 mSv (0.0 f 8thi0 yearso 5 rem % sr 35 dosfo s accumulate), wa e d during the first year. Assumptio e factth f , o n tha l averagal t e assessments obtained from different e groupcombinedb y ma s , e followinleadth o t s g characteristic of commitment inhalation irradiation of the " critical" l organadultal r fo s evacuated fro e mtabl , se Prip ( 6) e t *a

Table 6. Expected irradiation of the critical organs cause inhalatioy b d n uptake sinc e accidenth e t tilevacuatioe th l n

Q Commitment equivalent orgam nre dose / v S , 1-st year Ha If-century "Thyroid glanS0.14-021 / H-2Ï 0.14-021 / 1 ^F~21 Lung tissue x 0.026 / 2.6 0.035 / 3-5 Whole body 0.0006 3/ 0.068 0.000 / 0.08 8 Red bone marrowXX 0.0064 / 0.64 0.1 / 10 Bone tissu x ex 3 0.077. / 3 7 0.38 / 7

Note x :Trans-uraniu m elements contribution into commitment equivalent dose is about 15S&« » x Mainlx y from trans-uranium elements.

It is noteworthy that assessments represented above were conducte r actuallfo d y detected nuclides only and, excludine th g thyroid dose, the short-livers contribution was not taken into consideration becaus f theio e r total désintégratio e begith y -nb nning of the monitoring» Evidently, the actual dose, accumulated

first of all by respiratory organs should be overestimated. To conduct this assessment the knowledge of the actual short-livers compositio s i nnecessary totae Th .l energy release nucleth f o -e

131 r fuea f RBMK-100o l 0 reactor durin e 6-1th g 5 day f sustaio s n decreases 3 times ( both for beta-particles and totally for beta-gamma-radiation). The same factor should be used for an upper assessmen a lun f o gt tissue dose.

Conclusions.

1. Internal irradiation caused by inhalation of the radionuclide mixture for all organs except bone tissue was accumula-

ted durin e firsth g t year afte accidente th r . 2. The thyroid gland may be considered as a critical organ; average thyroid dose was about 1 MPD for professionals. e trans-uraniuTh . 3 m elements mak a maie n contributioo t n the commitment equivalent half-century dose in the bone tissue; the first year irradiation correspond o theit s r uptake about 0.25 MPI for professionals. . Thoug4 e estimativth h e assessments were rather tolerant upo e possiblth n e varianc e inhaleth f o ed radioactive aerosols dispersion, there are a lot of vague questions related to the role of other physico-chemical properties of the inhaled substances. These properties need experimental detailization under the modeled conditions of the radioactive releases, e.g. high temperature in accidental reactor.

132 SANITARY-DOSIMETRIC MONITORING FOOF O D PRODUCTS

V.N. BUR'YAK, N.Ya. NOVIKOVA, Z.A. KHULAP, A.I. TSVIRBUT

Abstract

monitorine th Mos f o t g measures implemente e regionth n i f greatesdo s t radioactive contamination were mea r carriemild fo an t k t productou d s (36%) and water (45%). The efficiency of the control measures carried out during the firs monthw fe t s estimateswa 80-90%t a d d subsequentl,an 90-95%t a y .

Radiation-related situation, arizing afte accidene rth t ta the CNPP necessitated substantial extention and strengthening of the system of sanitary-radiation monitoring, which is usually carried out by bodies of the State Sanitary Inspection and also by special departmental services. As it is known, the cardinal task facing the bodies of sanitary-radiation monitoring is to avert human exposure e leve,th whic f o l h could exceed permissible sanitary standards. This task may be accomplished by systematic monitoring of radioactive contamination of environmental objects and foods, and should the necessity arise, by the control of radionuclide content in a human body. The character, structure, and scop monitoringf o e rulea dependene s ,a ,ar n specificito t a f o y radiocontamination source, potential validity of various objects, influencing radionuclide humaintake th ny eb body . The alse yar o affecte naturay b d l conditions, orientatio agriculturaf no l production, composition of diet and by other factors. The system of State Sanitary Inspection (SSI) existing be- foraccidene th ea consequenc s twa long-standinf o e g experience accumulate n supervisini d radiatioe gth n situation detenoiney b d global releas productf o e nucleaf o s r explosion radioacy b d san - tive wastes discharged intenvironmene th o variouy b t s enterprises. The SSI ensured operative and dynamic control of the environmental objects, sinc s activiteit extensive bases th y wa n o d e networ radiologif o k e unit sanitarf so y epidemiologic stations,

133 that allowed not only to accomplish the principal task, i.e. to control exposure of residents, but also to reveal regional special features in arising radiological situation, as well as to assess significance of various routes and pathways of radionuclide intak humaf eo abovne bodyth el forme.Al e th e basi th dr sfo model reflecting transfe radionuclidef ro e environmenth n si - tbe fore being ingested by the human body, with special reference to regional pecularities. The acciden CNPe th P t provea t severa d exise th tria -r lfo ting syste Gosagroprof o m m (State agro-industrial complex)e .Th accident led to a rather intensive radio-active contamination of large areas, not only surrounding the CNPP but of the distant ones as well. In the resultant situation it seemed likely that unecceptally high doses of radionuclides, primarily of iodine- -* d cesiuman coul^ - ingestee b d humay b d n body, includin- up e th g take by food-chains. Though emergency decisions in the first post- accident period were made proceeding from the measured dose rate of external gamma-exposure, the monitoring of foods was initiated maximalle oth n y possible scale o principa.Tw l e b problem o t d sha solved here: the major one was to carry out sorting of food, and the second - to obtain data for correcting long-term prognosis of internal irradiation. Pood sorting was based on the Temporary Permissible Stan- dards for radioactive contamination of foods, which were introduced according to accident-associated levels of population exposure, and subsequently the standards became more rigid« Taking into accoun accidene seasoe th th tf no t (early spring), the peculiaritie agriculturf so n contaminateei d regions- fo e ,th cuattentiof o s initiae th n ni l perio s radiomonitorindwa f go milk and greenery. Later the assortment of controlled food-stuffs widene d finallan d y covere f loca o whole t th dl se e products e .Th first task - food quality control - was provided by the measure-

134 f beta-activito m e samplessu th e l mentth al « f f so yo Y/it e th h purpose of obtaining trustworthy and unified mass estimations of volum specifid ean c activit watef yo food-stuffsd ran alle ,th - union express-method of direct measurement of beta-emitting nuclides in "thin-leyer" sourse was developed. The method was oriented on the existing in our country stock of serial radiometric instruments and allowed to conduct radiation control of food-stuffs

_q witcontaminatioe hth n exceeding; 5*10 J water Ci/kgfo rd ,an - I*IO~ Ci/kg without sample concentration (evaporation, ashing, etc.) methoe .Th d took into accoun average th t e real composition of nuclides in the measured samples, characteristic for the concrete period. Together with alteration radionuclidn si e compositio correctioe th n instrumenf o n t counting coeffitient s conswa - ducted. The used means of measurement were checked in the system of the USSR Gosstandard, and the involved personnel was trained base radiologicaf th o e n o l department sanitary-epidemiologif o s - l stationca veterinard san y service thesl .Al e organisationad lan methodical measures allowed to efficiently unfold the reliable syste radiatiof o m n contro f food-stuffo l practicay sb l establishments of the Ministry of Public health of the USSR and of the Uni- on republics, along with establishments of the State agro-industrial comple d othexan r departmental services. In addition, the samples were analyzed by spectrometry and radiochemical assays to determine a spectrum of radionuclidea, to reveal regularities in ingestion of individual nuclides via food chains by human body, and also to have ancillary control of quality of radiometric screening and, should the necessity arise, to correct the expert estimates. Major radionuclides causing internal irradiation in the first post-accident period were * I d radionuclidean cesiumf o s . Later levee ,th radioactivf lo e contaminatio foodf no s reduceswa decado t bot f short-livee o y hdu d radionuclides and owing to altered predominant pathway of conta-

135 mination, since the superficial pathway was replaced with the soil one, which by the end of 1986, and, particularly in 1987 practically completely determine e contenth d f radionuclideo t s n locai l agricultural produce e dat .spectrometrTh f o a y showed that by the middle of 1987, radioactive contamination of food en- tirely depende n -^'Co d d partiallysan n ,o ™Ca e vien th .I f wo above mose ,th t recent Temporary Standard foof so d contamination e orientear d solely towards radionuclide cesiumf so . Under these condition role spectrometrif sth o e d radiochemicaan c l methods of control became more important since they prove t onlno dy more accurate techniques but also provided data for correcting long- term prognosis in case of internal irradiation. Table I presents the scope of radiometric studies of princi- l food pa wated san n 1986-1987ri , conducte territore th n o d f o y Byelorussian SSR by the Ministry of Health. It should be mentioned here that the control was focused on the areas with the most intensive radioactive contamination r thi.Fo s reason e samples,th , which values exceeded the levels of permissible radiocontaminatio foodsf no , canno regardee tb meaa s n- a d en indicato e th r rfo

tire volume of agricultural produce in the republic. Information Of Tabl demonstratesI e , that radiation monitoring e covereth l al d

Table I. Quanity of radiomonitoring of food stuffs and water in Byelorussia 1986-198n i R SS n 7

; ; : : Milk : Milk :Meat and Vegeta- Frui Grain: t ,Othsi r Water Total ; products ; neat bles ; bread \ ! : products 1 •

Total 332718 II5225 124988 89374 37838 34970 147453 799048 I6II6I4

Exceeding 43302 6438 10235 6282 1315 606 I2104 8760 89342 permissible

13 5,6 8,2 7,0 3,5 2,3 8,2 1,2 5,5

136 regions wher levele th e radioactivf o s e contamination could, probably, be exceeded, as well as the adjacent areas. The bulk of radiation control was focused on meatdairy products (36/5) and water Systematic contro locaf lo l agricultural produce botn hi publi d privatcan e sectors provide possibilite th d specifo t y y those populated area d farmssan , where radiocontaminatio f somno e kind productf o s s (primarily meaf ,daird o an t y products) exceeds the permissible levels. Depending on the degree of radiocontamination, the decisions were made whether to impose a ban on the consumption of given products, or to process this batch of food into some other kinds (whole milk into butte othed ran r dairy products). Furthermore, ther s deviseewa complea d organizaf xo - tiona d agrotechnicalan l measures aime reducint da levee gth f lo radionuclides to the permissible value. Informational and sanitary educational work of radiologists and hygienists among different sectors of population and economic executives proved an important element in the system of radiation monitoring. The entire complex of measures implemented to control radioactive contamination of foods, promoted sharp decrease in significance of peroral intake of radionuclides, (including the major radioisotoped an oneI J s II Icesium)f so formation ,i dosf no e bur- denr populationfo s . Effectivenes stepe th sf o stake n withie th n

first months may be evaluated as 80-90 %t and in the subsequent period it reached 90-95 %• The estimates presented are based on the direct measurements of radionuclide content in foods, human lackine bodyth n ,o g correlatio r overwhelminnfo g majorit- re f yo sident o followeswh d restrictive measures, between radionuclide bode d densitleveth an y n i lf territoria o y l radiocontamination.

137 The matetial of sanitary-dosimetric monitoring, accumulated within the post-accident period, allows characterization of dynamic changes in radioactive contamination of foods, with the view of being abl furtheo et r perfec d optimiztan e servicth e contf o e - rol. Specifically, the level of radioactive contamination of livestock products (milk, meat) remains rather high, and for this rea- e scopth f contro o en so l over thes modifiee b e o t product t dno s si in the nearest future. At the same time, the level of radioactive contaminatio graif no n crops, vegetables areae th , snearll al n yi faile reaco t standardizee s hth d values d thu ,an seemt si s expe- dien o rais t issue th ereducinf o e volume th g radioactivf o e - emo nitoring with subsequent transition to random checking. In view of e abov th radiatioe th e n monitoring service shoul equippee db d with gamma-spectrometric instruments on a large-scale.

138 RADIATION MONITORING OF VARIOUS OBJECTS A CHERNOBYSE PARTH F TO L ACCIDENT MANAGEMENT PROGRAMME

O.A. KOCHETKOV, D.S. GOL'DSHTEJN, O.P. OSANOV

Abstract

Permissible levels of radioactive contamination were based primarily on an experimentally established relationship for contamination in the region aroun e Chernobyth d l power plant e gammth : a exposure dose rate measured close to a contaminated flat surface, 1 mR/h, is equivalent to 10 000 beta particles/cm2»min. From this relationship t i follow, s thae th t established contamination limit of 0.1 mR/h roughly corresponds to the limit for contamination of the outer protective clothing worn by staff at nuclear power plant s laia s de radiatio th dow n i n n safety standards (NRB-76), namely 800 beta particles/cm^»min.

Experience in establishing radioactive contamination standards and in organizing radiation monitoring made it possible to reduce significantly the adverse effecte accidentth f o s .

The acciden e nucleath t a t r powe ro radioactivt plan d le t e contaminatio f environmentao n l object extensivn o s e areaf o s Kiev, Mogilev, Gomel and some other regions, particularly e Chernobyth zon m f k o e 0 withi3 l e NPPth n . This necesaiated organization of large-scale radiation monitoring of contaminated roads, buildings, transport facilities, articles of daily use, clothes, and human integument etc., in order to prevent o reduct r o e substantially transmissio f contaminatinno g radioactive substances into the areas adjacent to the CNPP, and, therefore to obviate additional exposure of residents. To carry out radiation monitoring on such a large scale it was mandatory, in the first place, to introduce safety standards, which had to be realistic for the arising situation, and als o deplot o y sufficient amoun f radiotnetrio t c equipment, solving at the same time numerous organizational problems. The situation was complicated by the fact, that under the above conditions it appeared impossible to utilize the permissible levels of radioactive contamination r surfacefo s f variouo s s objects,

139 working clothes, additional individual means of protection, specified by SRS-76. Primarily, it was necessary to go over from the existing SRS-76 where permissible levels of contamination p were calculated at a number of beta-particles on I cm /I min

to estimating the doee rate of gamma-radiation from the surveyed objects. The latter, was mostly governed by the following considerations: - dose rate of gamma-radiation could be measured much fas- ter compared to estimating radiactive contamination in partic- 2 /minm ; c ) ( s le - measurement of radioactive contamination in beta-partic- 2 les ( cm /min) in the event of augmented gamma-background appea-

red rather difficult; - the amount of instruments for measuring radioactive con- 2 taminatio f variouo n s object n beta-particlei s /minm s c ( s)wa insufficient.

t I shoul e noteb d d here, that SRS-76, like similar documents in other countries, failed to specify such standards for majority of objects, exposed to radioactive contamination specifically for clothes of residents, articles of daily use, surfaces of buildings, roads, transport facilities, etc. At the same time, radiation hygiene has already accumulated sufficient experienc d knowledgean e , that enable e expertth d s from the Institute of Biophysics under the Ministry of Public Healte USS th o elaboratt Rf o h e promptl e verth y n i firsy t days after the accident the "Temporary Permissible Levels of Radiati- on Contaminatio r varioufo n s objects" which were approvee th y b d Chief State Sanitary Doctor of the USSR on the 7th of May 1936 e Tabl. ) se ( 1 e

140 Table I

Temporary permissible level radioactivf so e contamination for various objecta Rate of exposure dose of Contaminated objects gamma-radiation, mR/hr

Integuments, underwear,towels, bed-clothes, clothes,footwear, individual means of protection O.I

Surface f buildingso s , internal

surface f transporo s t facilities 0.2

Outer surfaces of transport facilities 0.3

While defining the permissible levels of radioactive contamination presented in the Table 1 , as a basis, there was taken experimentally determined relationship of radioactive contamina- e are th tiof CNPP o an ni , wher e exposurth e e dose rate f gainmao s - radiation I mR/h, measured in the vicinity of contaminated surface correspond to the specified by the SRS-76 values of permissible contamination of CNPP personal working overalls equalling 2 800 beta-particle /mim c n . ( ) sThi s valu f permissiblo e e level established by the SRS-76 implies 30 year length of service for the personnel. bore Furthermore b n mini no t dd e specifiethaha th t ti , d by SRS-76 permissible level of 100 beta-particles ( cm2/min ) for density of skin radiocontamination was established on the basis of radiobiologic studies taking into account both direct irradiation of the skin basal layer by the substances deposited alsd e portioan th o , of radioactivit nno e contamination penetrating the skin. If length of exposure to radioactive nuclides r equalyearpe r , sh the 170e abov0 th n e standards hav r prinfo e -

90 9Q cipal fission product t lesno s Y stha yfol 0 excep , n1 dSr t reserve, and for 13^'C7 s it is even 30 fold« For Sr9 0 and 90 Y,

141 this reserve amounts only to 2-3 times, but their percentage in the composition of contamination substances was rather small.

Therefore s warrantewa t ,i implemeno t d t temporarilyr ,fo the period of elimination of the accident consequences, the level f permissiblso e contamination, presente e tableth n n O .i d the whole, this document provided the legal basis for preventing the transfe f radioactivro e contamination froe zoneth m , where the work was carried out on elimination of the accident consequences. Parallel to this, the established values of permissible contamination levels were utilized as a principal criterion in assessing the effectiveness of large-scale decontamination works« Particular attention was given to the control of radioactive contaminatio f transporno t botCNPPe th m hzon k ,f leavino e0 3 e th g d alsan o whe t entereni l largal d e Europeae citieth f o s n part of the USSR. e tadiatioTh n monitorin s carriewa g t besideou d milie th s - tary personnel of the Soviet Army by the units of civil defense, with active participation of researchers and under-graduate students from the institutes with suitable orientation« The stations of radiation monitoring organized on the roads worked together witposte th h Statf o s e Traffic Inspection. Moreoverf ,i the necessity arose, additional control stations were set up. n additioI o radiatiot n n moniborin- e roadsra th e n th ,o g diation contro s organizewa l larga n o de scal n populatei e d areas which were affecte radioactivy b d e contamination aprea- ding from the zone of CNPP.

Radiation monitoring in the populated areas was instituted on the basis of local bodies of sanitary inspection together with territorial organs of civil defense, which received large scientific and methodological assistance from corresponding republican and Ail-Union bodies as well as from research institutions. Proceeding from the results of the all-over radiation mo-

142 nitoring decisione ,th s were mad residente eth whethet no sr ro of inhabited areas could stay in the settlements located in the vicinitm zone k CNPe n thosth 0 .I 3 P f o ye case- de ss whewa t ni emed saf alloo t e w populatio stao t nn thei i y r homes w regu,ne - lations were introduced governing the every-day life of residents. Special attentio s pai systematino wa t d c contro f fooo l d and water contamination. The results of radiation monitoring served as a basis for taking necessary sanitary-hygienic measu- l regional ren i s s with increased level radioactivf o s e contami-

nation. Implementation of the planned measures was strictly su- pervise y locab d l authorities and, particularl bodiee th y sb y of the State Sanitary Inspection. zonn CNPf radiatioe to o e th P0 Withi 3 e th nn monitorins wa g conducted primaril military yb y personnel, participatin elin i g - mination of the accident consequences, and also by researchers from the Institute of Biophysics under Ministry of Public Health USSe experty b s welth a Rs a lf o s from some other researc- in h stitutes. The radiation control in the zone of CNPP was in addition, carried out by the radiation monitoring service, reinforced substantiall y specialistyb volunteereo swh d from other NPP.n I this zone, major attention was given to training of personnel, engaged in mitigation of the accident consequences,, It ±s noteworthy to mention, that in different areas within the 30 km zo- CNPPf o e ,n differntiated permissible level f contaminatioo s n were established depending on radiological situation, character d tim an concretf o e e works performe eliminato t d accidene th e t consequences, and also taking into account how the personnel useindividuae th d l mean protectionf so . Thus r instance,whe,fo n the work was conducted directly on the construction site of the CNPP in May-June of 1936, and the rate of exposure dose of gamma-radiation reached dozens and hundreds mR/hr, it seemed unwar- ranted to limit the permissible levels of radioactive contamina-

143 tior workinfo n g clothe d individuaan s l mean f protectioso y nb the value of O.I mR/hr. For these reasons the decision was made to establis value mR/h5 permissibla th h f s o era e- levera f o l diocontamination for overalls if the work was conducted under the above conditions. e coursth f radiation o eI n situation being normalizede ,th permissible level f contaminatioo s variour fo n s objects wer- re e peatedly revise d madan d e more rigid, gradually approachine th g value SRS-76f so . Specifically completinn ,o constructioe th g n of the sarcophagus, having carried out the major part of decontamination works, and restarting the first and second power units CNPe becamt th i P t a e possibl reture o premiset eth - n po ni f so e standardunitr th we o st radiocontaminatiof o s r surfacefo n s o establishe SRS-7y db n beta-particlei 6e th t a d /mim An c n. ( ) s

border of the CNPP 30 km zone the permissible levels of radioac-

tive contamination for working clothes corresponded to the levels specified by the SRR-76 for the integument of personnel» n generalI e experiencth , e gaine n standardizini d g radioactive contaminatio alsd n organizinan ni o g radiation monitoring while eliminatin e consequenceth g e CNPth Pf o saccident , shows th.at even in the event of such a large-scale accident at the NPP, the scientifically substantiated measures, taken in time, provided the possibility to prevent transfer of radioactive substan- ceclothesy b s , transport facilitie othed an s r objects beyond the limits of 30 km zone. Due to the above measures, the risk of radiocontamination of humans, their property and houses was substantially reducedl thatal d , an ,togethe r with various sanitary-hygienic actions contributed to sharp decrease of the accident negative consequences.

144 PERSONNEL PROTECTION DURING A REACTOR ACCIDENT

V.S. KOSHCHEEV, A.S. KOROSTIN, S.P. RAJKHMAN

Abstract

In organizing individual protection and thé provision of protective clothing and equipment for accident teams, particular attention must be paid o protectiot e respiratorth f o n y organs systeA . f disciplinarmo y barriers, personnel airlock gate d transpord an san s t processing point - swit h obligatory monitoring of all movements of staff and equipment - is described.

Individua lunifiea protectio s i n d ma syste f no f socialmo , technical, medica d organizational-and-psychologicaan l l measu- s aimere t ensurina d g vital activity s wel a ,s shapin a l d gan maintaining the professional adaptation of man to labour activity under adverse circumstances emergencyn a n I . , this system acquire a specias l significance. The radiation situation, which, arose as a result of the acciden e Ghernobyth t a t l JTuclear Power Station (CNPSd an ) the resulting necessity of enlisting help of large number of the station's staff and the Soviet Army personnel with a view to eliminatin s aftermathgit , calle r takindfo ga packag f meao e - sure o ensurt s e individual protection. These measuree th d ha s following for an object: excludo t - r reduco e permissiblo t e e level radioe th s - active contaminatio f skio n n and, whic s i mosh t important, the intake of radioacbive substances through the respiratory organs wit accoune e radiatioth hdu f o t n situation and the nature of work aimed at eliminating the accident's aftermath; preveno t - e spreath t f radioactivo d e substances through contaminated working clothe speciad an s l footwear; - to ensure timely cleaning of working clothes and other means of individual protection (MIP), contaminated with radioactive substances e establisheth o t , d permissible levels;

145 - to evaluate service and hygienic properties of prospective MIP with a view to solving matters of the advisabilit f theio y r putting into practice; ensuro t - e individual protectio populatioe th f no n resi- ding in areas with increased levels of radioactive contamination; - to conduct sanitary-and-educational work dealing with various aspects of radiation safety and application of means of individual protection, etc. Naturally, individual protection of the personnel under condition f eliminatioo s aftermate th n accidenf a no f o h f o t a scope such as that which occurred at the GNPS has its own peculiarities, distinct frowore th mk whic s conductehi t da nuclear stations under normal conditions and during repair. On the whole, the following is characteristic of emergency situations, irrespectiv f theio e r specific features: hig- h intensit unfavourablf o y e effects; - the necessity of carrying out important and complex jobs when thera shortag s i e timef o e ; - ultimate physica d psychophysiologicaan l l exertiof no the working personnel; necessite th - providinf o y personneS NT e gth l with means of individual protection and organization of their use wit greaha t numbe personnelf o r . In the course of elimination of the aftermath of the accident at the CHTS, carried out on the basis of a thorough analysi e situation th standardf o f so t se procedured ,a san s was worked out and largely implemented. These documents specified individual protectio personnee th f no d populationlan . Besides meanw , ne protectio f so n were introduced, with high protectiv d servican e e propertie d minimasan l loads acting upon the human body.

146 Particular emphasi places testine swa th n d puttino dgan g to use of self-contained filtering MIP with air blow - the most effective and promising type of means of individual protection as far as human activity in emergencies is concerned. meanf o individuaf e so us e Th l protection e ,specia th suc s ha l protective geawelderr fo r d insulatinsan gH typesuitK3 f ,so yielded good results. Apar te CNP th froe tes St th a mt o thatt t ,pu were servicth e e propertie f expendablo s e working clothes made of non-wolen heat-resistant material, suits equipped with self- contained cooling systems, etc.

e introductioTh a syste f no f sanitary-checkin o m g routine n importana s wa t elemene individuath f o t l protectioe th f no personnel and prevention of the spread of contaminants. A rigorous system of barriers, sanitary "sluice gates" and check points, vehicles- "treatment stations with compulsory control over the transport of people and equipment was introduced. Radioactive decontaminatio workinf no g clothes, footwear, means of individual protection, uniform, etc. is of paramount importance in the system of individual protection. It was establishe a radioactivcase d f th thao e n i t e discharge contaminants stic workino t k s clothes much more firmly than under normal conditions or during repair at nuclear power stations, and it is much more difficult to cleanse working clothes of such substances explainee .b Thibasicalle y th sma y db y different nature of contamination which resulted from the discharge of radioactive substances frofourte mth h power generating unit, A decontamination routine was worked out, "based on the redox method, which largely settled the problems connected witdecontaminatioe th h MIPf no . The question of protection of the personnel from penetrating radiation shoul discussee db morn i d e detail shows .A n testine b th ya sui f tgo provided wit leaha d shieldingn ,i cas f one-wao e y radiation wite energth h y exceeding 120KeV,

147 the attenuation ratio is 1.1 -j-1.4. In case of arduous jobs involving movemen workersf o t duratioe ,th wearinf no g such n outfia s reducei t y 15-2b d 0 percen s comparea t d with organic clothing e samth e t .A time e exercisth , e stress abruptly rises due to the increased vveight of this outfit - 20 kg (with 11 kg being the normal weight). To ensure reliable protection of personnel from penetrating radiation with such intensity as that taking plac t nucleaa e r powee us r o stationst s ha e ,on a protective outfit weighin gn othe I mor . re kg wordstha 0 n20 , the projection of personnel against penetrating radiation is just a matter of time. The problem of psychophysiological selection of personnel for work under marginal conditions is prominent among the problems of ensuring medical protection during elimination of major accidents. Question staffinf so g nuclear power stations with operating personnel,whose mental state and professionally significant psychophysiological qualities enable theo t m reliably and efficiently perform their duties under distress conditions, should be tackled along with matters of functional rehabilitation aime achievint a d higga h leve generaf o l d lan professional working capacity. The experience, e coursgaineth eliminatiof n o ei d f o n the aftermat accidene e GMPSth th f o ht , a t urgentl y demands that a package of measures be worked out with a view to ensuring reliable Individual protection of the personnel of the nuclear power station and population living in its vicinity in case of an accident at a nuclear reactor. In working out these measures, a differentiated approach mus problee e takeb tth o f nt o m protectio f fouo n r categorie f peopleo s . These are: Firstly, emergency teams from among the nuclear power station's personnel, which wil directle lb y involve n tacklini d g problem eliminatioe th f o s d localizationan n accidenca f no , should one occur;

148 Secondly, medical personnel renderin victimo t d f gai so an accident; And, finally populatioe ,th n residin n proximiti g e th o t y nuclear power station, whicr otheo som n s exposei hy ri ewa d e exposeeffece b th y f radioactivo ma o tt d r o e discharges. A scientifically substantiate meanf o individuaf t so se d l protecbion shoul recommendee b d above r th eac fo edf o hcatego - ries. Pull and effective realization of these recommendations will require a physiological-and-hygienic substantiation and, besides, emergency protective means. Specifically, there will be a need for unified MIP kits to be used for arduous emergency jobs; quantity productio prospectivf no e MIP, includine th g self-contained filtering MIP with air blow; general-purpose front whicP partMI hf s o woul restrict dno viewine tth g angle; expendable working clothes mad non—wovef o e n material, etc» organizinn I individuae gth l protectio packind nan p gu protective means for emergency teams, particular attention shoul givee d"b protectioo nt e respiratorth f no y organsn I « emergencies, it is advantageous to use either the PM-2 respirator, which ensures protection against radioactive aerosols and gaseous iodine, or the TP-7 filtering protective mask with canisters fitted with anti-aerosol filters and the pano- ramic mask of nflM-80 type. potentiae th n vieI f o w l dange catchinf ro g fir y equipb e - ment and resulting high smoke content in rooms, the MIP emergency kit se furnisheb hav o t e d with insulating respirators heat-resistanf o t se r P6JI-1 o a 8 d - )an H tM K clothin ( r fo g firemen (TK-800). Special emphasis should be put on the protection of skin. The emergency kits should contain a set of film MIP, insulating suit sC fil PV r rubberizemad o mf o e d fabric, as well as hose protection means coupled with self-contained sourcer supplai , f 1 f( o sy\- \\ß

149 Wit a vieh protectino t w e personneth g e lb o whict s i h evacuated from the hazard zone, besides the main, working clothes d speciaan l foot?/ea r persona(o r l clothin personnee th f o g l working within the free-access zone), use should be made of other means of individual protection, such as general-purpose respirators of PM-2, "Lepeatok-A" or "Lepestok-Apan" type, a protective film cape wit hooda h , special foobwea d rubbean r r gloves. Along with this, the U1C -JÎA mine-type survival pack shoul providee b d n casi d e ther neea evacuatior s fo di e n from smoke-screenea d area. Unlike the evacuation kit for the station personnel, the medicar fo t ki l P workerMI s should also include body linen, cobton working clothes and a film semi-cloak r/ith a hood (instead of the cape).

r "betteFo r populatioe safetth f yo e evacuateb o nt d from areas in the vicinity of the station, a unified MIP packing casbees eha n proposed .A principl f domestieo c storagf eo thes e developedb eo t mean s sha .

Besides e long-terth , m measures, aimed t improvina e th g syste f individuao m l protection, should also include th e developmen f technicao t l training aidd equipmenan s exerr fo t - cising control over work in marginal conditions with the use of MIP r thiFo .s purpose ,a serie therr neea f fo s o sdi e teaching aids (films, lectures, instructional wall sheets, etc.) and training centers where the personnel could be taught direc- meane th individuaf o sf o e us tion r l fo sprotectio n under acbual-use conditions.

150 PROTECTIVE MEASURE REDUCO ST E POPULATION EXPOSURE DOSES AND EFFECTIVENESS OF THESE MEASURES

G.M. AVETISOV, R.M. ALEKSAKHIN, V.P. ANTONOV, L.A. BULDAKOV, K.I. GORDEEV, E.V. IVANOV, L.A. IL'IN, A.I. KONDRUSEV, A.N. LIBERMAN, O.S. PERMINOVA, V.M. SAMOJLENKO

Abstract

Basic measure o protect s e populatioth t n from radiation aftee th r Chernobyl accident included ) monitorin(i : f radiatioo g n conditiond an s exposure doses to the population; (ii) temporary or permanent evacuation of certain population groups; (iii) iodine prophylaxis; (iv) limitation of the intake of radionuclides with food products; (v) decontamination of land and buildings d (vian ); educational worsanitard an k y instructione th o t s population.

More than 5 000 000 measurements were carried out on different objects. In some population centres external doses exceeded level A, reaching 0.3-0.4 Gy, but nowhere did they reach the upper level B. More than 0 farm700 0 s were decontaminatef o * nr a tota 0 d f 00 abouan o d l 0 20 t contaminated soil was removed from large areas, taken away and buried. In 1987, as a result of these effective measures, the contribution to the dose from internal exposure averaged only 10-30%.

The overall effectiveness of the protection of the population living in e zoneth f radioactivo s e contaminatio e expresseb n ca n e n termi dth f o s conservation of 7000 man-years of normal life.

As a result of the accidental releases of radioactive products froe reactomth e Chernobyth r f unio 4 t l plant larga , e territory of the country (not only the regions closely adjacent to the place of accident but also those removed from it by hundreds and even thousands of kilometers) have been exposed to radiation. The central part of Ukraine, the south-eastern region f Byelorussio s somd an ae regione th f o s Europea e nRSFS th par f Ro t adjacen e placth f accideno o et t t have been most heavily exposed generae Th . l numbe f populao r - tion living within the above mentioned territories makes 17»5 million, including 2.5 million of children younger than 7 years old.

151 The situation arisen required an urgent developmen d realizatioan t numbea f no f organizational o r , radiation-hygienic, medical-biological, agrotechnica d othelan r measures. In addition to the measures for immediate protection of the population living in the towns of Prypyat* and Chernobyl m zonk 0 e3 aroune plantth e s necessar t th wa da t ,i d en solvo t y e complex and diverse problems of protecting the population living at large territories with the increased radiation contamination levels. Such large-scale tasks on radiation protectio e populatioth f no n were being e solveth r fo d firs worlde t th tim n i e. The purpose of the present paper is to give a general characteristics to the principal measures for decreasing radiation doses to the population taken in the course of eliminating the consequences of the Chernobyl accident and to estimate their efficiency. The comple f principaxo l measure radiatiof so n protection included : 1. Control of the radiation situation and radiation doaea to the population. 2. Temporary or permanent evacuation of the population and remova s group it f somr summel o f sfo o e r health-improving rest. 3. Iodine prophylaxis. Restrictio. 4 radionuclidf o n e intake with food. 5« Decontamination work. Carefu. 6 l medical examinatio populatioe th f no n exposed. 7. Explanatory and sanitary-educational work.

The possibilit creato t y e such condition f lifo sd ean activitie populatioe th r contaminatee sfo th t na d territories which would help to restrict the radiation doses within the established dose limits: of O.I Gy for

152 the firs secone tth yea r 0.0d d fo ran yea 3y G r afte accidene rth t surve efficiencs da y criteri measuree th f ao s performed. As it is known,radioactive products were being released from the damaged unit for a long time. It occurred at different meteorological condition mose sth t importan whicf o t h (for the formation of a radiation situation at particular territories) were wind direction and velocity and also availabi- lit unavailabilitr yo precipitationf yo r route ai th f eo t sa mass movement transferring radioactive products« The main factors which determined radiation exposure were: external gamma radiation of the cloud radioactive th f o d an e fallout; intakf eo radionuclides with inhale r and,ai d mostl iodinr fo y e and cesium isotopes, with food of the local origin.

These factors vary in their character duration arid f intensity. Gamma radiation of the radioactive cloud and fallout creates the dose of external radiation. The contribution from radiation of the cloud into the total dose of gamma radiation for the first year after the accident was about 10 per cent, cenr pe twit 0 9 h froradioactive mth e fallout. e isotopeTh f iodine^penetratino s humae th gn body l firswital f ho t contaminated milk, concentrate in the thyroid, relatively small in mass, and create there a significant dose of internal radiation. In 2«5 months after the accident this factor due to decay of iodine-131 practically lost its significance. It was a "cesium" factor that became the most long-term and determined internal human irradiation. Being an analogue of potassium cesium enters potassium metabolic chains and thus accumulates in the human body. Cesium enters the body by the same route potassiums sa e mai.Th n source radiocesiua f so m

153 intake into the body are milk and meat. After entering the body cesium as well as potassium uniformly distributes in the soft tissues. Contrar firse radiatioo th tw to yt n factors, i.e. exter- l gamma-radiationa d radioiodinnan e cesiut mac dost no e instantly. Cesium haa a certain accumulation period in the body which depends of the person's age. If a man constantly consutr.ps food containing radioactive cesium its balance in the body can be achieved at the following time periods: for a child yean o1.5-n i fo - r 2yea0 months1 rmontha 4 chilr n i , fo s- d adultr an haln fo di fa yea- s morer ro . Eliminatio f cesiuo n m from the body has the same rate as its accumulation. Elimination rat n childrei e n exceeds tha adultsn i t . Thus, averagly elimination half-life of the accumulated cesium will be: 1? days for a yea0 1 yeare rchila on day0 chilr ,4 f o 60-10d fo s dan 0 days adultr fo 25-6f o s 0 years old. The surveillance system operating before the accident coul t providno d a timele y assessmen radiatioe th f o t n situation aroused by reason of the greatly increased amount of measurements required and the objects requiring control^ shortage of measuring devices and very uneven character of contamination n thes.I e emergency condition necessare th s y for- Ministre th ce f Academ e so HealtUSSRe f yth o th f ,f f o hyo o Sciences of the USSR of the Ministry of Defence of the USSR, State oth f e Committe Hydrometheorologf o e othef o d ry an organizations were throw participato nt n medicali e , ecological- hygienic and radiometric examinations and measurements beginning from the first days after the accident. The most contaminated regions were fixed to the leading medical organizations« Technical equipment of the field teama consisting of physicists, dosimetrists, radiochemicists, hygienic workers, radiologist d othersan s mad possiblt i e r the efo carro mt t ou y

154 at the populated areas the estimations of gamma radiation levels and radiation contamination to make a detailed analysis of radionuclide compositio contaminatee th f no d environmental object d food-stuffssan measuro ,t radioactivea e contenn i t the human bod d als yestimatan o ot e conditioth e humaf no n health. Totall thit ya s stag worf o e k more tha millionn3 f so measurements have been made for the purpose of obtaining a true picture of radioactive contamination in various objects (air, water, food, soil, vegetation, etc.) contene ,th f o t incorporated radionuclides in the human body and the doses of external irradiation. A prompt collection and analysis of data about the radia-

tion situation at the contaminated territories and a direct control of external and internal irradiation made it possible to forni without dela ytrua e radiationatioe th f no n situation aroused and reliably predict future development of events.

s turit Tha nn ti gav possibilit e th e realizo t y e substantially time du e a variouann i d s protective measures including making decisions about evacuation of the population from this or that locatio affectee th n ni d area. atage Ath tf evacuatioeo importann na t role belongeo t d

the "Criteria for making decisions about measures taken for protection of the population in case of a. reactor accident*1 which were developpe adopted an d n 1983i d , i.e. long before the events considere thesf o de ehereus "Criteriae .Th " procee- ded from the consideration that protection of the population from external irradiation and inhalation intake of radionuclides at the time when a cloud of the accidental release was passing over require mose th dt urgent measures e measureTh « f o s preventing consumption of milk contaminated by levels of radioactivity exceedin permissible gth e standard were less urgent.

155 The experience aquired from the Chernobyl accident demonstrated a working capacity of the above mentioned "Criteria" which established two levels of irradiation, A and B (0.25 and 0-75 Gy, respectively) comparable to the recomtnentdations by IGRP, WHO and IAEA. The dose values of external irradiation exceeded the level "A" and made up 0.3-0.4 Gy only at some small populated localitie thet bu sy never achieve e th valued s corresponding to the higher level "B". The wide range of contamination levels forced the use of a zone making conception necessar r developmenyfo systee th f mo t of radiation safety. The zonea which have been marked included: a 30 km zone later transformed into a zone of evacuation, a zone of control with the threshold values of contamination density for plutonium-239, atrontium-90 and eesium-137 0-1; , 2 Ci/k5 1. respectivel , md an 0 3. regiond yan s expose loweo t d r level contaminationf so e area.Th s with contamination densities by plutonium-23 d strontium-99an 0 higher thaestablishee th n d thresholds were withi 30-ke nth m zone fro knows mi whict ni s ha the population was evacuated. Large territories with an increased contamination density by radiocesium were outside the 30-km zone. Locate thest a d e territories were abou 0 populate60 t d areas where people continued to live but lived in the conditions of a rigid control over food-stuffs of the local origin up to their withdrav/e and replacement by clean food imported from other regions of the country. These territories were called zones of a rigid control. The number of evacuated localities from the zone of evacuation was 185 with the total population of 135 000 includin towe Prypyat*f th gno . Por the sake of prophylaxis all the children and pregnant women who lived at the 30-km zone and in other regions of the Ukraine, Byelorussia and the Russian Federation exposed to increased radiation levels were directed by centralized order to

156 summer health resorts in 1986 and in 1987« Temporary removal of children and pregnant women helped significantly to decrease the rediation effects on these critical population groups» It was especially importan firse th tn i tyea r afte accidene rth t whee nth dose externaf so l gamma irradiation rapidly increasede th r Fo » sake of illustrating the range of this measure it should be noted thatotae tth l numbe childref ro pregnand nan t women remover dfo summer health res Ukrain198e n i tth 6Byelorussid n i ean a alone 0 individuals00 4 17 o madt p .eu

As one of the protective measures iodine prophylaxis playe importann a d firse t th rol tn i eyea r afte accidente rth , especially for children. Effeciency of this measure realized stablf o e us e e iodinebth y r examplfore , fo potasf th mo n ei - sium iodide pills essentially depende time radioiof th o e n o d - dine intake into the human body with the inhaled air or foodstuffs iodinf .I e prophylaxi populatioe th f so especialld nan y of young children (of three and less years old ) viras performed within the first 3-5 days from the beginning of consumption of the contaminated food then continuoue eve th spitn ni f eo s intake of radioiodine with diet its content in the thyroid was absorbeminimue th d man d dos withis ewa n 0.1-0. 0.03-0.05Sd 2an v n childrei adultsd nan , respectively iodinf I . e prophylaxis swa performed later (on May 10-15) its effeciency was significantly lower whole& s .A , iodine prophylaxis performe earliet a d r time (fofirse 5 daysth r t3- ) provide decreasa d absorbee th f o e d thyroie doseth n i ds averagel time0 1 lated y n an 10-1syb (i r 5 times4 3- days y .b )- This is especially true of the children living at the 30-km zone and in Prypyat* as they received iodine for prophylaxis by the centralized order and at the earliest time. Direct measurement radioiodinf so e contenthyroie th n n thiti i d s population group showed tha absorbee th t d dose f internao s l irradiatio thyroiexceet e no th d f dno d di 0.0 . 3Sv

157 The base of restricting radionuclide intake into the human body was laid by an introduction of the temporary guidelines for their permissible content in the foodstuffs. The guidelines were developed for those radionuclides and media which at a given stag bringinf o e e consequencegth e accidenth f so t under control determined human irradiation. Thus, immediately after the accident the guidelines of permissible content of iodine-131 in milk, milk products and in leafy vegetables have been introduced. These guidelines supposed that the radiation dose to the thyroid in children would not exceed addition I . temporare Gy th n3 0. y guideline permissiblf so e content of iodine-131 in meat, poultry, egga berries and drug materials have been introduced« The guidelines operating earlier were supposed to restrict radioiodine intake into the human body. The guidelines adopted on May 30 1986 regulated a permissible content of cesium radionuclides in food, water and other media. These guidelines were suppose o proceet d d frooi the fact that at any set of foodstuffs the maximum dose of internal irradiation would not exceed 0.05Sv per year. Durin firse gth t period followin accidene th g t whee th n main doseforming radionuclid internaf o e l irradiatios nwa iodine-131 its principal "supplier" into the human body, especially into tha childref o a lesset o t s mil rd nwa kan degre fres- e h leafy vegetables (sorrel, lettuce, spring onions, etc). The content of iodine-131 in milk was within the rang hundredf o e thousan- s d hundred hala sn fi Bq/ d 1an casef o specifie th s c activit 7 kBq/1e 3 mil f th o s y t kwa .A same timmaximue th e m permissible conten f iodine-13o t n i 1 milk which provided unexceedin thyroie th dose o th t edf o g (0,accordin) 3Sv introducee th o gt d guideline kBq/17 3, s .swa Therefore the measures directed at a decrease of radiation thyroie doseth o st d from radioiodine together with mass iodine

158 prophylaxis include constanda t radiometric contron i d lan cas exceedinf eo guidelinee gth rejectiosa agriculturaf o n l products and their direction to special treatment« An active measure used for a decrease or even exclusion of radioactive intake into the human body was transfer of the population and first of all children to the consumption of foodstuffs of agricultural origin imported from other regions of the country. When milk contaminated by radioiodine to the extent exceeding the temporary permissible levels was processed to butter, cheese or soft cheese the level of their radioactivity decreased by 2.5-3 times compared to the original product. Treatment of milk was also continued latter to prevent an intake into the human body of significant amounts of radiocesium n thi.I s cas n eliminatio5 ea 7 d an 0 9 n, effec98 s wa t per cent when milk was processed into butter, cheese and soft cheese, respectively. Witaccoune th h meaf o t n daily consumptio f thesno e5 time product3- n y whicsb ma s y hi sb less than tha milf o t decreaska radioiodinf eo e intaks ewa up to 8-15 and of radiocesium - by 4-50 times. A subsequent period when the main radiation dose of internal irradiation was formed by radiocesium and its leading intake was as before determined by milk and meat radiometrical control and if necessary rejection of these products were increased excludo .T intakn ea cesiuf eo m radionuclides into the human body in the amounts higher than the established one splannea d cattle slaughte prohibites rwa d and beginning from the autumn of 1987 the cattle before slaughte s transferrerwa r 1-1,fo d 5 cleamonthe th no st ration « During 1986-1987 the population living at the zones of rigid diea d controd fe consistinrula s s ewa la milf mead go kan t products imported from other region countrye th f so .

159 rapie th Dudo t eaccumulatio radiocesiuf no fisn mi h from stagnant ponds, in mishrooms and wild berries these products were subjected to an obligatory dosimetric control. Agrotechnical and reclamation measures carried out at the affected territories by the Gosagroprom have been actively used for decreasing the probability of biologically harmful radionuclides getting inthumae th o n body throug fooe th dh chains and thus for lowering dose burdens to the population. These measures included: insertio mineraf no l fertilizer sufficienn si t amounts (especially potash fertilizers) soil liming, deep ploughing with overturning the upper layer, use of cultivated and reclamated pasture r cattlfo s e beeding, e changtypf th o e f eo agricultur necessarf i d an e y chang lanf o e d tenure. In July 1986 methods for calculating the levels of external and internal irradiation of the population living at the territories affected by the accidental releases from Chernobyl were developed. These methods together v/ith experimental dat radiation o a n parameters have been a use s a d basrecommendationr fo e returninf so g childre pregnand nan t placee wometh f theio so t n r permanent residence, additional evacuation of the population from the localities where it was impossibl o providt e othey b e r means unexceedine th f go established (for 1 year) dose oimit of 0.1 Gy and choice of place r buildinsfo g temporar permanend yan t settlements. To decrease external gamma irradiation a wide range of decontamination wors bee contaminatee kha nth carriet a t ou d d territories. Accordin Ministre th o gt Defencf yo e which ful- filled the main work decontamination measures were taken at p the area of about 7000 km . More than 600 populated localities have been decontaminated and about half of them repeatedly (in order to achieve a maximum decrease of the contamination levels). During decontamination the most attention was paid to

160 social buildings (schools, nursery schools, etc). Buildings which after triple treatment were not decontaminated to the permissible standard alsd san o contaminated ramshackle buildings of low value were disassembled and buried. More than 70 000 homesteads were predecontaminated, contaminated soil s removewa d from large territoriesf o a r 0 00 d abou ,an 0 20 t soi s takelwa n awad buriedyan . Much decontamination wors kwa done on the roads and at the roadside areas: decontamination of surfacing (more than 25 000 km) and dust fastening along the area of 43 000 km. Dust suppression was made at the total 2 are morf ao . em k tha 0 n5 Asphalting and covering the contaminated areas with gravel, broken stone, sand or clean soil made it possible to achieve a decreas f gammeo a radiation dose rat abouy b e times0 1 t . Decontamination of homesteads was made by cutting off the upper laye soif ro l dow o 10-1nt Thi. 5cm sdecreasa measuro t d ele e gammf o a radiation dos e4 times rat3- y eb .

Decontamination of roads with hard surfacing by daily mechanized washing decrease levele th d radioactivf so e contaminatio abouy nb times2 t . Natural-soil roads were gradered down to 10 cm , they were also asphalted, concreted and covered with broken stones resula s .A decreasta theif eo r radioactive contaminatio abous nwa t three-fold. Explanatory and sanitary-educational work waa an important part in the complex of measures directed at normalizing the moral situation at the affected territories. The aim of this givo e objectivt wor th es kwa d timelean y informatioe th o nt population abou e locath t l radiation situation, abou maie th tn factors determining the situation and about potential risk of registered and predicted levels of human irradiation, especially irradiatio pregnanf no t wome childrend nan e leadinTh « g soviet scientist d expertsan s spoke befor people th e e explaining them

161 all necessary recommendations directed at the maximum decrease of radiation factors. All the questions received competent and comprehensive answers» As far as it was possible all mass information means have bee s explanatornit user fo d y worke ;th press, radio and TV» Their task was to exclude any attempt of minimizin exaggerato rise t th gt k no fro e han d frot mon i ean d m the other. In the latter case it could lead (and unfortunately sometimes it did) either to the lack of confidence in the information whic s supplieh wa streso t r subsequene o ds th wit l hal t inadequate responses, suc panis ha c (for example, urgent departure for a long time with children to other regions, refusal to use foodstuffs even of proven reliability; sometimes abortions, etc»). But along with this it should be emphasized that the majority of the population did not leave the places of their permanent residence and as a whole maintained the place. Experience obtained from this explanatory work demonstrates thapopulatioe th t n quietly appreciate e situatioth d e th n ni majority of localities where the necessary explanatory work had been conducted by competent experts from the first days after the accidennumbee th neurotif d ro an t c responset no s swa increased. Thus, the control of radiophobia (fear of irradiation) is mose th t on f importano e t whol e linkth en s i comple f protecxo - tive measures« It can be put even more definitely: harm to health from radiophobia sometimes (fortunatel t oftenyno s )wa dead essentiaan r l compare negligible th o t d d mainlan e y undetected possibility of any late effects of irradiation. o shot e larg th wm t itselThieai se e st th fpapeno d di r complex of work carried out in a purely medical aspect of

radiation protection. It is an independent part of work though almost the leading one in the problem of protecting people exposed to radiation. We only want to note that various

162 types of medical examinations were carried out on a mass scale (about one million people and 700 000 of them including 0 21childre600 n were examined carefully using dosimetrid an c laboratory measurement analysis)d san . Childre whon i n a m radiation dose from iodine radionuclide e thyroith o st d could v exceewerS 3 e 0. dsubjecte constano t d t medical survey. Efficiency evaulatio whole th ef o ncociple f prophylactico x - end protective measures carried out for the first two years after the accident makes it possible to believe that they resulted in a decrease of radiation doses to the thyroid aversely by 5-20 times, external irradiation doses by 1,3-2.5 times dependin d internaoccupation go an e ag ld irradiationan n doses from radiocesium by 10 and more times« Analysis of the radiation situation performed with an accoune protectivth f o t e measures allowo statt s eu s with confidence the following: singla t no e - cas radiatiof eo n injur bees yha n founn i d the population exposed to irradiation; - average radiation doses to the critical population groups did not exceed the main temporary dose limita for the first and the second year after the accident established by the Ministr Healtf yo h (0. 0.0d respectively)1, an 3Gy ; - doaes of external irradiation to the population permanently livine contaminateth t ga d territorie t exceeno d dsdi 0.05 Çy and 0.02 Gy for the first and the second year, respectively; - doses of internal irradiation from incorporated radio- nuclidee th cenr f t pe exceeo f cesiut so no 9 9 d dr mdi 0.0 fo y 5G populatio regione th n i ns under controe firsth tn i lyea d ran Gy for 92 per cent in the second year. Comparing to the summer f 198o e conten6th f cesiuo t m radionuclide bode f th o y n i s residents of the controlled regions decreased in summer of 1987 averagel somn 5 i time e2- d persony san b y 7-1y sb 0 times;

163 effectiv o t n 198i e - 7du e measure e contributioth s e th o t n dose from internal irradiatio averagels nwa y 10-30$.

REFERENCES 1. Long-term radiological effects of the Chernobyl accident in the USSR (material of the Soviet delegation in UNSCEAR used for preparation of the document A/AC—82/P,46! "The assessmen f long-tero t m effectChernobye th f so l accident"), Moscow, 1987. 2. Radiation Safety Standards (RSS-76/87) and General sanitary principles of operation with radioactive materials and other source ionizinf so g radiation (GSP-72/87)« Moscow, Energoatom- izdat, 1988. 3. L.A. Ilyin, O.A. Pavlovaky "Radiological Sequences of Chernobyl accident in the USSR and measures taken for its mitigating". IAEA, Report, 1987, 29, 4, 20-28. 4. L.A. Ilyin, G.M. Avetisov "Population radiation protection decision criteria in case of reactor accident". Medical Radio- logy, 1983, No. 5, p. 92. 5. "Temporary permissible levels of total content of radionuclides 1 ^1d 4-^CCaan foon si d product drinkind an s g water (TPL-88): USSR Ministry of Health, 1987, December 15.

164 DISCUSSION

G.A. ZUBOVSKU (USSR) In accident impact mitigation radionuclide diagnostic specialist greaf o e tb helpy sma . This service involves highly qualified staf wels fa contemporars a l y equipment,an avais i d - lable in every town. It has to be the centre of gamma-spectro- metr evacuater fo y migratind an d g population. Tha hely o tma t p increas qualite th e publif o y c health servic d decreasan e e th e level of radiophobia.

J. WADDINGTON (WHO)

BRIEF SUMMARY OF THE ONGOING PROGRAMME OF WHO IN RELATION TO PUBLIE TH C HEALTH ASPECT NUCLEAF SO R ACCIDENTS AND THE CHERNOBYL FOLLOW-UP First of all, priority is being given to the effectiveness e servicth f o en offe ca whic membe o O rt hWH r states following any future accident, based on experience gained after Chernobyl, when althoug organizatioe hth emergencn a d nha y roo operatin i m - on work quickly. After first indications of enhanced radioactivity levels on 26 April 1986, the system was essentially of an ad hoc character. The continuency plannin progresn i w gno beins si g carried closn i t e ou cooperatio faca n ti interd n an wit O -hWH IAEd an A secriat meetin beins i g g held next week. Followin interie gth m repor dosn to e commitment published O lasbyWH ts assiste yearha O ,WH d UNSCEA gaininn i R g datr fo a their own reports to be published later this year. A detailed report gas also been issued by WHO on the position throughout Europ relation i e cesiuo nt m depositio publis it d c nan healt h consequences. After Chernobyl, ther widespres ewa d confusion among member state measuren so s impose controo t d l foodstuff d thisan s contributed to public scepticism and disbelief. The systematic de-

165 rivatio f recommendeno d derived interventio- be nw levelno d ha s

en completed and has been approved by WHO*s Executive Board. PAO have concentrate e developmenth n o d n essentialla f o t y simple system suitable for international trade whilst WHO has, clearly duta , o safeguart y d public health. d WHan ThesOO approache beinFA ew no g e lookear s t a throd - organizationo tw e th d ugan h s wil e puttinb l g forward proposals on derived intervention level r foodstufffo s o Codet s x Alimenta- riu n 1989i s , base a figur e firs mS5 n th o f d o vtn ei year. A "milestone" working group was held in Geneva in November 198harmoniso t 7 e public health measure n relatioi s o nucleant r accidents. As a direct folling-up, an important meeting will take place in Netherlands in October, To look in detail, e situatioth e neat a th r n ni fiel ( dclosa nuclea o t e r accident), covering medical care, sheltering and evacuation. In relation to sheltering and evacuation, in particular, there are important psychological dimensions and this will be a major centre of focus. Indeed the psychological aspects involved in nuclear accidents and the public perception of relative risk from different energy option e becominar s g major elemente th f o s WHO programme. e lighth f Chernoby o n ti WH, is O l experience, lookint a g iodine prophylaxis with a view to issuing detailled guidelines by the end of 1988, The second workshop to develop these will be hel n Brusseli dmonthso tw n i "s time. Scientifi medicad an c l aspects will be coverd, the application to specific population groups, possible adverse side-effect practicad an s l aspectf o s storage and distribution. Detailed public health guidance related to the far-field including transfrontier consequences wil e develope- b l me a t a d

etin n Switzerlani g n Januari d y 1989-

166 Finally, Mr.Chairman, I would like to refer the question of epidemiological follow-up. This was examined at two successive meetings hel n Mai d ya detaile 198 d 7an d report issued. Out- side the Soviet Union, a number of important studies are in progress, includin gPolisa h programme inte effectth o f iodino s e prophylaxi d Europeaan s n Community (Eurocat) stud f congenio y - tal malformations. The International Agency for Research into Cancer (IARC) s i collaborating wit e Europeath h n offic f WHo a stude On i y of childhood leukaemia incidence using cancer registries in 15 European countries. Leukaemia has been selected as it appears relatively soon afte particularla ra i exposur t i d an ey sensitive of radiation exposure. The background level is low, and varies rather little in comparison with other cancers, and there are known variables which strongly influence risk. It allows the possibility of including several countries which do not register all cancers but which do register childhood cancers»

Data wil e centrallb l y analyse IARy b d C with particular reference to spatial and temporal variation and estimated levels of exposure from Chernobyl, by region, in collaboration with UNSCEAR.

Although, outside the near field area, it will be very dif- ficul o detect t effectsy an justifiee t b e stud n th , ca y: as d heln ca o determint p t i 1) uppen a e r e growtleveth n lo h of risk;

2) knowledge of the variation in childhood leukaemias will be useful in future evaluation of clusters; 3) exposure, following the accident, while low in absolute terms, représent a stea p increase multituda f o , e comparablo t e background in several countries.

Of course, the greatest interest is in the area close to the acciden n boti t h thiothed an s r epidemiological studiee w d an s

have t hearaboulo a d t this today«

167 At policy level e Worlth j d Health Organizatio n Europi n e has given high priorit o epidemiologicayt l studies firse Th .t consultatio n epidemiologo n y following Chernobyl asked WHOo t examine the flasibility and practical usefulness of establishing a steering group and clearing-house« s beeha n t I emphasized that suc a bodh y shoul t seeno do t k put undue pressure on any country either to carry out particular studies or in their detailed design. It would be a sound box for new ideas and a register of what was going on and the results. Above all t ,i mus t represen meetina t f scientifio g c mindd an s not develop an unnecessary complicated burocratic structure,Its meeting must be set up progmatically, depending on optimal needs and timing. A second international consultation on epidemiology following Chernobyl is accordingly being organized by WHO and IARG, to take place in the Autumn of 1938.

G.W. ANDERSON (Canada), E.D. RUBERY (United Kingdom)

Epidemiological follow-u e mosth tf o pexpose d individuals (100,000 Plus )f greao wil e b lt valua sourc s a ef reassuran o e - ce to the general population.

s probabli t I e that there will nevedetactabla e b r - in e crease in cancer or other diseases in these most exposed individuals. Reports should therefore be regular and frequent

/ year1 = n o; i (r( )3.e o reduct r e anxiet l concerneal n i y d people.

Collaboration wite proposeth h d exper t e grouWorlth f o pd Health Organization will provide valuable assistance wild an ,l increase the general credibility and acceptance of the results.

168 DOSES OF EXTERNAL AND INTERNAL RADIATION EXPOSURE METHODOLOGICAL PRINCIPLES FOR CALCULATING LEVELS OF EXTERNAL AND INTERNAL EXPOSURE POPULATIOE OFTH N USE TAKINN DI G STRATEGIC DECISIONS

R.M. BARKHUDAROV, K.I. GORDEEV, I.K. DIBOBES, I.A. LIKHTAREV, U.Ya. MARGULIS, D.P. OSANOV, O.A. PAVLOVSKIJ, B.S. PRISTER, M.N. SAVKIN, V.P. SHAMOV

Abstract

The significanc e factor f th eaco e f o h s involve n internai d d an l external exposur e populatioth f o e varn nca y considerabl a functio e s ya th f o n specific exposure conditions or the time which has elapsed since the accident e radionuclid f th I dat n . o a e compositio e fallouth f e o nar t available, dose rate dynamic e calculateb n ca s n accordanci d f o w ela wit e th h radioactiv e mixtur th deca r f interestfo yo e . After four year e reductioth s n in the dose rate follows the law of caesium-137 decay in soil, and the effective period of removal of half the radioactivity from the body is Teff1/2 = i4 years (Biophysics Institute of the USSR Ministry of Health) (according to other data 7 or 5 years).

In the first year after the accident, the effective dose equivalent to the human body was determined by strontium-90 and strontium-89. The EDE for subsequent years and the integrated 50-year EDE will be governed almost completely by strontium-90.

presene Th . 1 t "Method f Calculatingo s " were use r calcufo d - latin radiatioe gth n level whico t spopulatioe th h n living near Chernoby s exposewa l whicd an d h were require r substantiatefo d d developmen realizatiod an t f variouno s measures directea t da maximum decreas f humao e n irradiation« In this connection we used approaches baaed on theoretical considerations, accumulated experience and direct experimental data obtaine e examinatioth y b de radiatio th f no n situation under consideration and supposed to take into account the local speci- ficatio f humao n n irradiatio o proceet d nan d froe criticamth l (by their radiation sensitivity) population groups. It should be noted that the dose assessments obtained are of conservative nature and essentially represent an upper estimation of the dose commitments.

171 o providT . 2 strica e t consideratio conditione th f no d san the characte f radiatioo r n exposur dosee th ef external o s , contact and internal irradiation have been calculated. External irradiation includes:

- gamma radiation dose from the radioactive cloud (Dc^) formed during the period of its passage and track formation and as a result of an effect of a flow of flying radioactive fallouts and gases; gamm- a radiation dose frodepositee mth d radioactive

fallouts (a track of the radioactive cloud) (Dtr) ; beta-ra- humae y th dos no t eski n froenvironmentae th m l radioactive contamination (D , ). locae Oth f l populatio s evacuaten wa suppose s i t bu do t d return back (reevacuation) the dose of external irradiation froradioacitve th m e fallouts wil correspone formee lb th y db - ding doses received before the time of leaving (t^) and the doses received after coming back ^2)» In this case the time internal (t^-t^) will be a duration of the evacuation. Internal human irradiation is essentially determined by - the dose to thyroid (Th) formed by the radionuclideg of radioactive iodine concentrate thyroide th n i d ; - the dose of lung irradiation due to inhalation of radioactive products; dose gastrointestinaf th eo - l irradiatio o exposurt e ndu e to radioactive products penetratin e th bodinhalatioe y th gb y n or oral routes of intake and eliminated through the gastrointestinal tract ; - the dose of soft tissue irradiation due to accumulation of the radioactive cesium getting into the body mainly with food ; - the dose of bone tissue irradiation due to strontiuia-90 being accumulated in them.

172 3. Depending on the real radiation conditions and (or) on the time elapsed after the accident the significance of each of the above given factor externaf so internad lan l human irradiation can be different. This fact should be taken into account and provide priorities in the dose calculations.

4. The doses of external irradiation were calculated with the use of connections and coefficients presented below«

4»1 • The radiation dose from the cloud (Dci) is estimated by three independent methods. firse usee Th ton direce s th dat f tao measurement summaf so - ry gamma doses by the dosimeters UKC located beforehand (before the accident) around the Chernobyl plant at the distance of 1.5-50km a measura constane th f eo t control. If the time of taking off readings from the dosimeters a s i , D counted an ) d, accidenfroe momene th t mth ( f o ts i t a read.« dose registered by the dosimeter then the dose froca the cloud

(Dcl<) wile lb

Dcl - Dd - »thread) > where

Dtir read 6~ )aDmi a radiation dose froradioactive mth e fallouts for the period beginning from the moment of acciden-

s . Actuallwa , a , t o t t yreleas l p ta u d ean 7...10 days (determined after the passage of the cloud).

The second method is based on the doses to the thyroid determine direcy b d t measurement radioiodins it f so e conten adultn i t s who neither consurnpted mil r usekno d iodin s prophylaxisa e . Accordin date th a o gt obtaine generalizationy b d dose th se froca the cloud in this case can be estimated by the equation:

Dcl = 0.01Dth , where dos~ o ttieh t t eD tby^oid measured within 5-10 days aftee th r accident (inhalation component).

173 The third method is based on calculations of predictional estimates of the radiation parameters around plant for various types of accidenta: Dcl = °'1PV ft=15) where aftey accidente da th r — 15 . e th n mR/radsn o n i i h y ,R , D

The estimations made by these methods show that the dose from the cloud will be not more than 20 per cent of the fallout dose formed on the 15— day after the accident. It is assumed that the dose from the cloud will be 10 per cent of the annual dose from the fallouts as a maximum estimate of its value-

4.2. Irradiation from the track. The data of actual observations over the variations of the dose rate at the height of 1 m from the ground surface and predicted dose values for the next years are given in Table 1.

Tabl. 1 e

time after I dose dos\ ratr ee ai absorbe e th n i d the acciden givee tth no t moment :p u : ,P mR/h

1 day 3 0• 43 4 n 2,5 0.57 7 n 1 .7 0.72 15 n 1 .0 0.9 1 month 0.55 1 .2 3 n 0.22 1 •7 1 year 0.074 2.5 3 ri 0.039 3• 4

r practicaFo l purpose analitican sa l expression describing the variations of the dose rate in Table 1 at the time t >15 days has been assumed: Pv'(t)= 7.5'Py (D+15)'t~n P valu e isolin- th e5 r 7. extrapolateefo y da 1 o t d P/(D-f15) = 1 mR/h where th P/(D+15) - dose rate on the 15— day; o t - time moment, day.

174 actuae th r l ?o mixtur = 0.6*1.-value n th ef o e 3 with D+15 (on the 10^ of May). If the data on radionuclide composition in the fallouts are availabl variatione th e dose th e f ratso e calculateear e th y b d law of radioactive decay in the given mixture. Beginning from the 4— year a decrease of the dose rate follows the law of diminishing cesium-137 in the soil with e Institut th date th f year6 o a 1 y f = Biophysics(b se o T. i / u-P-fJ * r )o 5 year othe7. y (b s r literary data). o providT n assessmena e annuae th f lto radiation dose equivalent to the whole body the following attenuation coefficients have been assumed: transfe- r froexpositionae mth dose l th doae o absorbet e d 0.87- r ;ai e inth dee- p penetratio cesium-13f o n 7 intgroune th o d (begins from the second year) - 0.6; screenin- snoe th 0.7w- y ;gb - behavioural conditions witaccoune hth screeninf o t y b g building time th e d spensan t indoor d outsidesan : for those living in the town: 0.4; for those living in the country: 0.75- The summary coefficients for the first year are 0.24 and 0.46 for those living in the town and countrye inth , respectively secone th r d .Fo year : 0.1d 5an countrysidee th tow e d th nan 0.2 r fo 7 , respectively.

4.3. Skin irradiation by beta-rays. The radiation dose soio t d planski e e ltan th o ndu t contaminatio s estimateni d

Bf (skin)(rem/d) = 1.5'10'V

radionuclide supposes Ii tth f o d tha e» tE mixtur e wily lb abou MeV1 t .

175 5« The doses of internal irradiation were calculated with connectionf o e thus e s (links coefficientd )an s presented below. 5.1» Irradiatio thyroide th f no . If direct measurements are not available irradiation of the thyroi s estimatei d date radioactivth f ao y b d e conten n mili t k s assumei cenr t I f gamma-radioactivipe o td o Jun 0 t 9 tha 1 ep u t - o iodine-131t e du miln ts i y kwa neithef . I r direct measurements nor data on iodine-131 content in milk is available an approximate upper estimatio radiatioe th f no e thyroine th dosth o n et di critical population group (children obtainee b ratie n th ) ca o y b d

Dth(rem) = 100 P* ( mR/h ) .

This method of the dose estimation is very approximate and

cannot be used for clinical purposes. 5.2. Irradiatio lungse th dose f lunf Th n.o eo g irradiatio inhaley nb d radionuclide obtainee b followine n th sca y b d g ratio :

5*3« Irradiatio e gastrointestinath f no l tract n estima.I - ting irradiatio gastrointestinae th f no l trac consideree tw d only the lower small intestine (131) as a part mostly subjected to irradiation. An approximate estimation can be obtained by the equation:

Dp (LSI) = 10,4 Vß (lungs)

5«4- Irradiation of the whole body due to cesium intake with food . 5-4*1. The first year after the accident. During the first year cesium intake with foo determines i d contaminatioe th y b d n penetratin routey gb s other than plant roots calculatione .Th s assume retentioe :th n coefficien pasture th n o te plants wite th h o biomas kg/1 f 0.4-0.2s o mi ; cesium conten grasn i t s i s

176 described by a two-component exponential model with half-lives of 3 days (70$) and 50 days (30#) :

q (t)=0.2/0.7exp(-0.231t)+0.3exp(~0.014t)/. G^ CO 6~ - fallout density, 10~6 Ci/m2

Duratio pasture th f no e x monthsperio lais si i n s i dy i d ,ha during the last three months of the pasture period. Grass consumption by a cow is 50 kg/day, the half -life of cesium-137 in the body of a cow - 30 days the fraction eliminated daily with litrr pe milf eo 0.01 r kmilo 3 (averag0.1k- 3 e daily railkyiel- d 10 !)• The calculation of cesium content in milk before the cattl transferres i e stale th lo t dfeedin s performegi e th y b d equation: (2)

where qj - daily intake of cesium-137 into the body of a cow equal to q o-50 Cq_°- initial contamination of the grass); S 6

constan- jbiologica\e « th f to l half-lif radionuclide th f eo e 0.02- w 3co dayA a bod 2=°-e , if s nth 4-,=0.231yo ^ , « 01 .

During the stall feeding cesium concentration in hay is assumed as a constant, equal to the mean grass concentration during haymaking and is determined by the equation« 3 7 _>,-£/0- 0. _\e, r * ,l^ 2 0. . ) (3 - (1-e -r . — 0 -r > = )+-rq~ (1-e e *h L >*1 **• J

where t - average period of haymaking. For the first year cesium-134 content in gross and milk is calculated with an assumption of the ratio of its concentration in the fallouts to the concentration of cesium-137 remaining 1:2- 1:1.5«

5.4.2. The second year after the accident. During the second yeafactoe rth r which determines food contamination will be radionuclide intake throug soile hth radioecologicae .Th l

177 characteristics of the Ukrainian-Byelorussian Polesye, the region whic s mostlhwa y contaminate accidente th y b d , determine higa h degre cesiuf eo m resula mobilit s a thaf e to d th tyan coefficients of its transfer from the soil to the plants exceed by tenfold similae th s r value othen si r regioncountre th f so y (for example, by 1.5-15 times for milk). Therefore in estimating the doses in this or that region one should use transfer coefficients which correspond to the soil characteristics and were obtained for the conditions of the cesiura-137 world fallouts assuming that availability of the local cesium is similar to wore th thaM f to cesiu t leas(a m t w datobtaibefore ne ar ae -th e ned). In this case an average annual content of cesium in milk is sufficient for the practical purposes and can be obtained by the equation:

) (4 qm(Ci/l m »6soiK )= l

whercesiu- eK m transfer coefficien milkn i t , Ci/1/Ci/km2; (3-5'10~9) o ~ cesium conten soiln i t , Ci/k. m

Cesium content in the daily diet of man is determined by the similar method using the link coefficients for the diet recalculatiny whola b s r a o e g from cesium conten miln i t k assuming that r milpe k0 7 determineo t p u s daile th cen yf o t intak f cesiueo m inthumae th o ne th bod n i y BSSR and up to 30 per cent in the UK SSR. During the second and subsequent years the ratio of cesium-134 to cesium-137 vari es accordin differencee th o t g thein si r half-lives n futur.I e

the elimination process fro soie mth l (du mano et y factors: radioactive decay, washing out by the surface water, etc.) shoul alse b d o taken into accoun half-livee th t s bein4 1 g (or 7*5) and 1.75 years for cesium-137 and cesium-134, respectively«

178 5«4«3- Determination of cesium content in the human body. Cesium contenhumae th e n ti th bod f o y d towarden e sth year when contaminated food has been consumpted is mainly determined by the intake in that particular year. If cesium content daile th yn i assumee dieb constans n i t ca d t wit(i t h sufficient accuracy beginning from the second year) then cesium accumulation describee b followinbode e n inth th ca y y b d g dependence:

Q(t) = %i- (1 - e-*^) (5) ^e wherdail- , q^ ey intake wit diete th h , Ci/dayj coefficien- f absorbtiof o t n frogastrointestinae th m l tract ; equa1 o lt à - constant of the effective half-life of cesium in the human body, equal to 6.3*10 -3days 1 and 7.l6»10~3days~ r cesium-13fo 1 cesium-134d 7an , respectively (adults) childrer .Fo biologicae nth l half- life is determined by the equation:

fS = 12.8(t) (6 1/2-e-t) days achildf o e wherag ,- yearset .

The empirical ratio for an adult giving average annual cesium content in the body in the conditions of a chronical constant alse intakb on usedeca «

) (7 Q(t 120q= ) r Ci/body

where qr - daily intake of the radionuclide with food, Ci/days.

If radionuclide content in the diet varies its content in the body is described by the following equation:

^ Q(te- = )

The final form of the equation depends on the specific form of the variation function of cesium content in diet or in maimila s nka componen diete th particulan .f I to r during the first year whe cattle nth feedins ei pasturet ga whed san n

179 cesium content in milk varies cesium intake into the human body may be described by the equation (2) adjusted to the diet a wholesa .

5.4«4. Assessment of the dose equivalent due to cesium radionuclides. The dose equivalen sofe th t o t tissue certaia r fo s n time internal, T, is a product of the integral of body content for that dose perioth e y ratb d e coefficient:

JE ) (9 -

where d - dose rate coefficient, rad/day/Ci/body; duratio- time T th e f periono d considered, days; Q(t)- body content, Ci/body. e dosTh e rate coefficients used with calculations are: 2 dQ(for cesium-137) = 3.6 10 rad/day/Ci/body 2 dQ(for cesium-134) =6.1 10 rad/day/Ci/body.

Table 2 gives an example of internal irradiation calculated for the first year on the condition cesium-137 fallouts were 2 1 Ci/km with the contribution from cesium-134.

Durin secone gth d year irradiatio bode s th determineyi f no d by cesium intake with food conaumpte than i d t yea d partiallran y in the first year. Contamination of the diet during the second year is due to the intake of radionuclides into agricultural products trough the roots and therefore contrary to the first year contamination diee levelth t f wilo s essentialle lb y different depending on the local soil characteristics which influence cesium transfer int plante locae oth th food lf san d o origin e .Th differenc coefficientf o e s linking cesium-137 contendiee th t n i t

soie th l n awilwholi sa (2-20)-10~e d lb ean ^ Ci/dier tpe

9 2 1 Ci/km d 0.2-10~an 2 Ci/die Ci/km1 e r th ,tpe valua r fo e

180 Table 2.

time befor| remova* lto Doses, 1 ,y Ma mre o t m p (u 1987) • # • • other re- * • • 1 gion* s : 2 : 3 : 4 : 5

10 days 9«0 240 249 560 310 20 days 18.3 240 258 560 302

a Noteyea- dos r 1 rfo e : from intak o removat e o othet l r regions ; - 2dos e formed , befor1981 y 7Ma e froe intakmth e after coniing back; - summar; 2 3 e factor d th an yo t 1 dosse du e - dos4 e receive e absencth n f i dremovao e o othet l r places; - 5dos e exclude e removath y b dotheo t l r places conte Th . - ributio e summar f th milno o t k y intak s i 30-7e r 0pe cenr differenfo t t region s importani t (i sshoul d an t d be taken into accoune recommendations)th n i t .

Ukrainian-Byelorussian Poleay a mea d ne wholan e th valu r e fo e country, respectively. If to accept a sufficiently moderate value of the link coefficien e tsecon th (5*1e dos r th dfo e , 0yea) r aftee th r accident due to intake of that year will be 0,19 rem/year and the summary dose - 0,29 rein/year» t I shoul notee b d d tha l thesal t e calculations were madr fo e the adult population, a critical group for cesium. The levels of radiation dose o childret s e somewhanar r tolde fo lowe t r bu r ages theachievn yca e giveth e n values.

5-5« Irradiatio e humath f no o strontiut bode du y m intake. During the first year after the accident the effective dose equivalent (EDE) is determined by strontium-90 and strontium-39. n subsequenI t year e integrath s l committed ED Es alsi o practically completely determine atrontium-90y b d .

181 6. The next stage of dose calculations was based on the data of direct measurements of iodine and cesium content in the human body, on selected individual dosimetri reae c th control n decreaso d lan e dynamic dose th e f so rat n everi e y populated locatio e contth n -i n rolled zone. The detailed recommendations to the calculational methods were considere d approvean e dth y NCRb f do P Ministr Publif yo c Health, USSR, Improvemen absorbee th f o t d dose calculation methods is directed now towards the maximum individualizatio dose th e f radiatioe burdensno th r Fo »n doses from iodine-131 this paper includes a credibility analysis originae oth f l informatio specificatiod nan conditione th f no s for radionuclide intake into the body. For the doses of external irradiation the data presented here include detailed distributio individuaf no l radiation doses accordin occupatioe th o gt - nal-age basgroupe datf th e o individuaf n ao so l dosimetric control being accumulated and results of the profound examination of the dose field within the controlled area. For the doses of internal irradiation from absorbed cesium radionuclides we present a scientific analysis of the efficiency of some radiation-hygienic measures.

182 DYNAMICS OF GAMMA RADIATION LEVELS AND FORMATION OF EXTERNAL EXPOSURE DOSE

V.A. LOGACHEV, I.P. LOS', V.I. PARKHOMENKO, M.N. SAVKIN, A.V. TITOV

Abstract

Fro e firs aftemy th e accidentda tth r , gamma radiation fields throughou e countrth t y were systematically observe datd an da collected an d analysed. In the first stage, the availability of such dynamic data for each population centre made it possible to obtain reliable estimates of external exposure doses to the population up to the time of evacuation, which, in the majority of centres evacuated, did not exceed 0.1 Gy and in the others did not exceed level B (0.75 Gy) taken as the upper level.

The decontamination measures carried out made it possible to reduce the exposure a factodos y b ef 1.3-2. o r n comparisoi 5 n wit e anticipateth h d doses r differenfo t occupationa e groups ag maximue d Th an .l m reductio s notewa nn i d children.

The external gamma-irradiation from the fallout is one e maioth fn radiological factore accidentath f o s l releases from IV powe e Chernobyr th uni f affectino tP NP l e populationth g . Accordin assessmeno t g t conducte e Sovieth y db t specialistse th , external irradiation contribution into the total dose did not exceed 50$ during the first post-accident year, and about 60?5 for the whole life period. Determinatio f doso n e loade datbases th awa sn o dabou e th t gamma dose rate dynamic n towni s d theian s r economical areas, con- sidering the behavior regime of the population. Systematic observation ovee gamma-radiatioth r nwhole fielth en i d country , regular collection and analysis of the information were launched on e seconth aftey e accidentda dth r . Data about gamma dose ratd ean it's dynamics, obtaine aviatioy db terrestriad nan l survey, were e mosth t important factors, which were taken into consideration while decision making about evacuatio e populatioth f o n d nan taking measures concerning liquidatio e accidenth f no t consequences and population dose reduction.

183 Accordin thio gt s factor radiologicae ,th l situatio it'n ni s progress may be divided into two stages: sinc) accidene momene (I th th e - f o t ty 1936 Ma til ;0 l1 198y sinc) Ma 6(2 0 til1 e- l today. First stage» Dose field formatio s determinenwa dynamicy db s of releases from the accidental power unit, as well as by the meteorological conditions in the Chernobyl NPP zone and the direction of the air mass movement, transporting the radioactive pro- nearesductse th n .I t zone three radioactive traces were being formed: western souther northernd nan . Inside each trac nuce th e- lide compositio radioactive th f no e fallout heterogenis swa d an c densit surfacf o y e contaminatio s spot-likenwa . That rulea s ,a , led to stepped increase of gamma dose rate. Odose-rate n th Fig I . e dynamic severan si l settlements- ,si range tuateth en i dIT-2 2 kilometers aroun Chernobye dth P sitlNP e differenn i t azimuthal direction showns si . Influenc radioacf eo - tive clou d streamdose-rate dan th n so e dynamic clearle b y sma y seen on this figure. Doses, e irradiatioformeth y b d n frocloue mth d were assessed using data abou e totath t l gamma doses obtained with dosimeterf so IKS type (placed around the NPP site before the accident at the distance 1.5-50 kilometers), and the fallout gamma dose, formed durin 5 dayg1 s afte accidente rth . Assessment showed thacloue th t d dose did not exceed 20% of the fallout dose during the mentioned period. This assessment is in satisfactory agreement with the result theoreticaf so l estimation value th ed obtainesan d froe th m correlation between the inhalation uptake of radio-iodine by thyroi radioactive d th glan d an d e cloud dose. Dynamic datr everafo y evacuated settlement made possible th e reliable population dose assessments. Thes majorite e th dose r fo sy of evacuated settlements did not exceed o.I Gy, and for the rest were less than level B (0.75 Gy), adopted as the upper limit in

184 , mR/h 250 a) North of Chernobyl NPP 200

150

100

- - Kriuki 50 Chikalovichi - - Dovliady __ Radin 0 26.428.4 30.42.05 4.056.058.0510.?) 12.5 14.5 Dat measurementf o e s

3i:R/h 50 ) Soutb f Chernobyo h P NP l 40

10 St.Krasnitsa Glinka Cherevach

26.428.4 30.4 2.05 4.05 6.05 8.05 10.5 12.5 14.5 Date of measurements

Fig.I. Pjrnamic f gamma-doso s e settlement th rat n i e s where the evacuation was carried out.

185 the "Criteri decisior afo n makin populatior gfo n protectio- ca n ni f reactoso e r accident". Second stage. Dose rate during this period mainly depends on radionuclide composition of the fallout. Certain influence on the gamma dose rate dynamics has the sublimation of the volatile radionuclides while soil hearting, secondary wind transport, precipitation, snow shielding of gamma-irradiation, vertical migration of radionuclides in soil, etc. On Figs 8 dos.2- e field dynamics durin firse gth t year after the accident in the regions, situated to the north from the Cher- noby sitP showns lWP i e . Dose-rat relates ei Ci/kI o t ddensim2 - surface th f to ye contaminatio soif no l with Cs-I37. Figures show that dose rate decrease since 10 May 1986 in the absence of snow gooe layeb dy rapproximatema d with Vey-Vigner degre witw la eh degree indices of 0.6-1.3»

mfî/h

10" t-

• *?t *m

id"

10,-3

Time afte e accidentth r , days

Fig.2. Dynamic f gamma-doso s e ope th rat nn i eare a (Braginsky district).

186 P/A* mR/h 2 Ci/km

• •l » *

IG" 10

Time afte e accidentth r , days Fig.5- Dynamics of gamma-dose rate in the open area (Khoiniksky district).

P/As mH/h -> Ci/knT S l • l

10"

3 iO 10 Time after the accident, dajrs

Fig.4. Dynamic gamma-dosf so eopee ratth nn ei are a (Narovlyansky district).

187 mB/h Ci/tan

10"

r-5 l o ïîr

Time afte e accidentth r , days

Fig. 5« Aynamics of gamma-dose rate in the open area (Vetkovsky district).

I P/As

Ci/tan

10 Time after the accident, days

Fig.6. Dynamic f gamma-doso s e eopen th rat a i eare a (Chechersky district).

188 I PA.« fflJS/h0 Ci/km^

-i 10

. i l i x t

10"'

tO"J I_____• ...' ' !_____'. ! i '______i__! i 10 iO2 10-

Time afte e accidentth r , days

Pig.7. dynamics of gamma-dose rate in the open area (Kormyansky district).

l P/As

lu-

MA * 1 I I 1

lu'* 1 10 10*

Time after the accident, days

Fig.8. Dynamic gamma-dosf so e ope th rat nn i aree a (Novozubovsky district).

189 Influenc heterogeneite th f eo gamma-emittine th f o y g radionuclide composition inside the northern trace is illustrated by fig. 9, where the outdoor dose accumulation dynamics during the yea s presentedri figuree s showi th s n Bragir n.A o ,fo n region the first hal annuaf o f l dos accumulates ewa d durin firse gth t month5 0, Khojnikr ,fo y regio month6 1. n- , Narovlja region- month5 2. , Novozybkovo region -3«! month.

(I year)

1,0 -•

0,5 --

- Braginsky district • - Novozybkovsky district Q - Narovlyansky district _ Khoiniksk A y district

6 D A OUQSf 5 0 iI I 0 \ 9 0 » 0 M D J O Î O

Pig.9. Dynamics of dose accumulation in the open area during one year.

Deviation of the experimental curve from the Vey-Vigner law durin wintee gth r period 1986-1987 connectes ,wa d witgammae hth - shielding snoe effecth w f layero t Februarn .I y 198 shielde 7th - ratig in o reache value th d3-4f eo . Afte snoe th rw meltine th n gi April, dose rate increased rapidly and experimental points approache theoreticae th d l curve again. Certain decrease of dose rate was caused by effect of the vertical migratio radionuclidef no soile th .n si Accordin - da o gt ta of Institute of Biophysics (USSR Ministry of Health) the ver-

190 ta cal migration may be satisfactorily described with the following equation:

a A h//! e0."l 3 °' A_/ + h 0

where q(hvolumetricae th ) - l soil activit depte th , h n yo

Ag-Cs - isotope contamination density, Bq/nr ;

h0 - 0.01 meter; _\ - migration depth, m. Depth of migration depends on physico~chemical properties of the radioactive fallout, soil type, humidity and some other factors and is about 1.3 cm, average. This may lead to the dose rate attenuation of approximately 2 times, compared with surface activity distribution. Comparison with data, obtaine autumn i d n 1986, shows that afte sprine rth g freshe 1987f o t , suffio thern s e-wa cient migration of Cs-radionuclides. It was also noted that migration of other nuclides, particularly of Ru-106, had a higher rate. The important characteristic of the gamma-radiation field is the energy compositio direce th d dispersef an tno d gamma-radiation out- and indoors. Relative percentage of some energy groups into the dose rat summen ei r 198 presentes ?i Tabln i d . eI Attenuation facto gamma-rayr rfo s with actual energy composi- concretr fo timber 8 fo d e1 an rbuildings 2. tio s nwa . First-year external dose assessment for the population inha- bitin e contaminateth g d areas permanently e estimateb e n th ca , y b d empiric relationship:

) (2 s (Cs-137A k = j )D wherirradiatio- I D e n dose; ,Gy 2

A (Cs-137 )surfac- e contamination density, Ci/k; m s empiri- k c factor, presente Tabln i d . 2 e

191 Table 1. Relative contribution of the different energy ranges into the gamma dose rate. Measurement Different energy group contribution into the gamma Average place dose rate gamma- ray 0-150 150-300 300-450 450-600 600-750 750-900 900-1050 energy , keV keV keV keV keV keV keV keV Inside 8.7 22.9 12.3 14.5 27.8 11.9 2.0 0.28 milk farm Territory 6 . a7 s ide 19.5 10.7 17.0 31.6 12.2 1.5 0.30 milk farm Inside timber house 12.324.1 14.4 16.4 22.4 9.2 1.3 0.24 Inside concrete house 13.127.4 15.0 14.7 18.7 8.8 2.4 0.23 In the private yard 7 . 9 18.5 10.9 16.8 32.0 12.7 1.5 0.30 Fores0 5. t 15.0 9.1 15.0 38.1 15.7 2.1 0.36 Meadow 5 . 0 14.4 8.9 13.8 38.4 17.2 2.4 0.37 Arable land 9.5 22.1 13.1 14.3 27.1 12.3 1.7 0.27

Table 2. Empiric coefficients for external dose assessment

Region : Bragin Narovlja Khojniky Vetkovo Novozybkovo : Checherak : Kormjanak

K • IÖ~5 1.8 E-3 I.I E-3 1.5 E-3 0.9 E-3 0.8 E-3

It is noteworthy, that at least 70^ of individual doses are leas than above estimated. Second-year dos assesses ei followss da : D = 3.6 - I0~5 P (3) where D - the second-year dose, Gy; P - dose rate on I June 1987, mR/h. Aindividuals% t 30 leas r fo t , dose e lessar s than this value. Significant effect was obtained due to decontaminating works, conducted in I986-I987« Decontamination was conducted on the ter- ritoties of kindergartens and hospitals, other social and industrial building housed san meany sb removinf so mose gth t contaminated places with further covering with sand, grave partialld lan y with asphalt. Large works on decontamination of street and roads,

192 dust suppression, modernizatio settlementf no s were being conducted. In Table 3 is presented the ratio: dose rate in different zo- s insid ne settlemene th e t afte decontaminatioe rth n dose rate over meadows, characterizin primare gth y contamination.

Tabl . Dos3 e e rate reductio n settlementi n s aftee th r decontamination. P decont . / P meadow Zone Object June 1987 September 1987 Living In-doors 0.34 0.28 Yard 0.69 0.74 Kitchen-garden 0.74 0.74 Public Street 0.72 0.35 School, kindergarten In-doors 0.09 0.08 Yard 0.40 0.40 Hospital Office In-doors 0.13 0.14 Club Yard 0.66 0.47 Shop Industrial Milk farm In-doors 0.26 0.52 Yard 0.67 0.64 Garage yard 0.65 0.30 Area Meadow 1.00 1.00 Arable land 0.70 0.70 Forest 1.07 1.04

It follows from Tabl tha, maximue 3 e th t m dose rate reduction s achieve territoriee wa th n o d schoof so l yards, kindergartend san other social places. Conducted decontamination measures allowed to decrease the dose, compared with expected dose, 1.3-2.5 times for different professional and age groups of population; the maximum reduction was noted for children. On Pig. 10 relative level of average dose differenr fo s t professiona- sa e groupe th ag n d si lan e settlemenm showns ti ; dat s obtaineawa personay db l dosimetry. Obviously, the critical groups are the forestry workers and far- mers; thier life regime is connected with the maximum time spent outdoor non-decontaminatee th n so d territor settlemene th f yo - tiu

193 0.75

- dwelling house made of stone

0.00 - wooden dwelling, house schoolchildren pensioners machine- workerf o s operators forestry, employees cattle- field- nerdsmen breeders crop growers

Fig.10. Ratio of dose of rural population external exposure to gamma dose in the open area for different professional and age groups (May-September 1987).

dustrial area. However dose critica e loadth n so l contingent does not exceed forecast assessments, given durin stage g th f deveeo - protective lopinth f o g e measure r populatiosfo n radiologica- lse curity.

Thus, it may be concluded, that the whole complex of experimental data concerning external irradiation control confirmed cor- rectnes timelinesd san operativf so d long-teran e m radiological situation forecasts and proper decisions.

194 MONITORIN INTERNAF GO L EXPOSURF EO POPULATIOE TH REGIONN I S CLOSO ET THE CHERNOBYL NUCLEAR POWER PLANT

I.A. GUSEV, I.A. LIKHTAREV, E.I. DOLGIREV, I.G. ZHAKOV, B.A. LEDOSHCHUK, P.V. RAMZAEV

Abstract

In the first month and a half after the accident, the dose burden on the population was determined by radioactive iodine deposited in the thyroid gland. Later e dosth , e burde s governewa n y caesium-13b d d caesium-137an 4 . The measurements made are generally reliable. Departures from the norm in extreme cases (in the event of marked differences from the standard body build) were no more than 50% of the actual activity (at levels above 150-200 nCi).

Since effectivo thern s i e e metho f measurino d g nuclides incorporated intbodiee th o f childreno s s necessari t i , o develot y p special phantoms simulatin e humath g n bod t differena y t ages.

Ae resula Chernobys th f o t l acciden a largt e ammoun- va f o t rious radionuclides were released into environment. During the first 1,5 months after the accident the main population loads were determine radioiodiny d"b e uptake thyroiy n"b d gland. Prac- tica le assessmen th tas n ko f thyroio t d irradiatio beins nwa g solve determinatioy b d thin i I s * orga f cone o nb thay -ma t sidered as a point source. Broad applicatio f thyroio n d function radioisotope diagno- s wel a s othe a ls si r radiometers correca t a , t organization of the works, allowed to obtain ample data about thyroid irradiatio populatioe th n ni f near-sitno e regions. Specialized spectrometers (counters) of whole body (WBG) were a numbeuse n r i countrdf area o ou r f o sy durin e accigth - dent perio laterd necessite an d Th . f prompyo t estimatiof no 1-54 TV7 'd fCs an significann s i C ' t contingent transfeo t d f le so r transportable WBCs int e regionoth f examinatioo s s welna s a l to the usage of medical radiodiagnostical equipment from radiological departments of clinics and research institutes, SRP ra-

195 diometers (instrument, used for geological survey) and singlechannel counters with scintillation detectors of various type. Several hundreds of operators, who had had little idea about specificity of incorporate radioactive mixture measurements, were urgently trained and involved into the works. The questions of graduation of the instruments were solved in different way wer d mose san eth t acute ones metrologicas ,a l support of these estimations in the field of dosimetry was insufficient. Applicatio variouf no s type f equipmeno s r measurementfo t s of incorporate radionuclide conten human i t n body, necessitated verificatio datf no a obtaine 198n i dd 1988 6an . contrasn I internao t l irradiation contro enterprisesn lo , the actual situation urged to examine population contingent differenf o s groupse ag t , including newborns.y wh Tha s i t in our study we had to use fantoms of youngest children (2-3 years old), yers- teenager adultsd 14 )an - 0 .(1 s Character of cesium radionuclides irradiation was taken y -jr-} into account during the study» ''Cs is monoenergetic gamma- radiator with the energy (output) 661,6 keV (84-,6?a), and "^Cs has basic lines 569,4 (I6#), 604-,? (9896), 795,8 (86#), 801,9 (8,7%) e measurement-Th s showed, that there wer o othen e r nuclides beside the mentioned ones in the examined individuals (semi- conductor detector control). resolutet Gamma-line5 no keV 60 (5^e s C d )ar ^ 9dan f o s by scintillation detectors with cesiu e m2 keV th 66 lin t f .A o e actual situation of contamination the process of identification was hampered by "•?Zr and "•?Nb contributions (usually clothes

contamination). Division of instrument gamma-line,consisting

I57 of lines 605 ke"CsV ()I5/î and 662 keCsV () into its structural parts led to the errors due to the vagueness of pedestal form under these line cesiun si m isotop n spectrumsu e majorite .Th y

196 of instruments, like earlier, in our situation were graduated

-transitioe th d an graduatioo f nt Cs y b n coefficienr fo t cesium isotope sum was made with the help of calculated or empiric factor»

Therefore, volumetric source jerrycan4 ( s s) witGs ^ h were used. They were measure identican i d l geometry with analogous sources of -"Cs. Thus was estimated graduation factor for ^ Cs and *'Cs. These nuclide ratio was assumed to be 1:2 for *'Cs (according to precision gamma-spectrometry). Tabl giveI e maie th sn fantom parameters, filled with wate- SO r lution of IL'^'Gs7 , used for calibration.

Tabl Fanto. I e m parameters

Panm to Immitated age, Height, Weight, Median ^Cs ac- years cm kg thickness, tivity, cm Ci

FE 2 84 11,6 8,2 I,H5 FV 17 I?0 70 14,2 1,89 FP 10 IJI 27,6 10,2 2,755

Commo usee nth d featur l instrumental f o e registratios i s n of cesium isotopes gamma-irradiâtion by scintillation detectors. These detectors were in all the cases but one, Tl-activated sodium iodide crystal differenf o s o tt m sizem 0 2 : x fro 0 2 m case on e n organiI . mm c2 scintillatin10 x 3 20 g plastis cwa used as a detector. eighn I t instruments multichannel amplitude analysers were

used. However, due to the above mentioned irresolubility by scintillation detectors of gamma-lines o fM I' J Cs1*5 and 9Cs, and laboriousnes f spectruo s m hand-processing, imperfectiof o n software, all the spectrometers work in the regime of summary gamma-activity measurement» These measurement conductee sar n di one or two energy windows under visual control of operator»

197 The rest of the instruments may "be considered body monitors, using spectrometry qualitie detectorf o s registrind san g gamma-irradiâ thin i thar so n ttio window selectively, without visual control. Table 2 gives main technical characteristics of the mentioned spectrometers, plus stationary instruments for radioisotope diagnosis (gamma-chambers Fo-gamm gammad aan - chronograph RIH-5M), which in 1986 were temporarily adopted for incorporate cesium measurements. The minimum time of measure- s "Quicha ) s kment Bod0 (1 sy Monitor" average ,th e tims i e 60 3, and the maximum - 600 s.

Table 2. Main technical characteristics of whole body counters

Type of Geometry of measurements Detector size, number Type of pulse r "ioo t nI nun analyser

V/BM I.I Fixed chair 150x100 I Nokia 4840 2 V/B2. W » P03xI02 I Nokia 4900B 5 V/B2. M ii 63x63 I Nokia 4840 6 WB5. M Scanning 156x100 4 Nokia 4900 WBM-K Fixed chair 63x63 I Al- I024-95 SV/BMChZchSO Scanning 63x63 2 AI-1024-95 HIX-5M Couch, H=I,4 m 63x63 I Singlechannel LFO-IV Couch,. H= 0,4-5 m 400 I SJnglechannel QBM-I Sitting 282000 2 Singlechannel PO-gamma Couch, H=0,45m 260x8 I Singlechannel SSH Couch 500x400x20 2 Singlechannel VWB-3-I Fixed chair 150x120 I Nokia 4840 Y.'BK-0-4 Scanning 150x100 4 Nokia 4900

All the mentioned instruments can be divided into 5 groups accordin e applieth o gt d geometry: Examine. I d subjec sittins i tn arm-chai a n i g fronn i r f o t detector. This geometr properte th s f autocompensafcioha yo y n of adult body thickness.

198 2. Iso-sens itive geometry of longitudinal scannind by a de- e subject d bottoth an tectof p o m« to re th pai n o r e examine3Th - d subject lies unde e detectorth straigha n o r t couch. 4. The examined is sitting on a chain between two detector blocks. 5. Measurements in the so-called "North" geometry, when the subject is sitting on a chair with his feet on a pedestal highm c forewart s tors 5 pu d ,detecto1 hi s an t i o , se d s i r agains s loweit t r part t thi.A s geometr boda y a sory surf o t - rounds detecto t evea nd distributioan r f radionuclideno e th n si

body this method gives only insignificant errors 4 instrumente Th s were graduate boty db h total body acti- vitthin (i ys cas gives ewa numbena graduatiof ro n factors differenr fo t ages)activity b d ,an y concentratiog 1k r npe bodf o y weight»

Tabl givee3 maie sth n operational characteristice th f o s used instruments cleas i t rI . that minimum detectable activity differ signiSIcantly, depending on the type of instrument: from severa (fixei nC l d instruments 20-10o )t (mobili 0nC e instruments). We know that the balance of lOOnCi in the body during the year forms the dose of JO—4-Omrem/year for a given mixture of radionuclides for an adult,i.e.one fourth of background dose. Table 4- shows the results of study of simplest radioinetre characteristics, which were user incorporatefo d d cesium measurements e measurement.Th s were performed o wit tw e hel f hth o p investigator d take ha measuree o nth swh d quantit radio-cesiumf o y . e resultTh s show that measurements wit e simpleshth t radiometers (mininum detectable activity about 500 nCi) are quite reliable.

199 Table 3. Operational characteristics of whole body monitors.

Type Gamma-dose rate>pAR/h Instrument JAM, Characteristics Error, out of doors in-doors background, nCl % pulse/s FS FP FV

WBM-I-I 3,49 6 1,09 1,04 0,91 6 WBM-2-2 0,72 I 1,34 1,05 0,97 6 WB5 M2, 25 20 1,9 20 0,89 0,6H 5I, 9 TOM 5,6M 11,6 5 I,oo l,oo 0,98 6 WBM-5 2 K 14,150 5 70 1,19 1,02 0,8? II SWBMChZchSO 150 22 2,6 90 0,91 0,91 0,86 10 FO-gamm8 2 a 10,150 7 50 0,92 0,95 1,36 12 LFO-IV 150 20 5^,5 100 0,77 0,73 0,87 8 HIX-5M 250 JO 31,2 1000 1,34 1,35 1,07 75 Q3M-I 30 1,49 0,89 0,72 SS 5 R1 24,15 2 35 1,29 I.II 1,02 9 WB1 3. M 15 15 0,62 4 0,97 0,83 0,80 8 TOM-0-4 15 15 6,4 3 0,96 0,80 I,o 7

Table 4. Results of selective radiometre tests.

Typf o e Tester Graduation, factor Background Results of instrument measurements

SHP I I. 5,5-IO~"V

1.2 il 0,75

HOT I.I 0,59'IO~3 «Ci h 73 pulse a 0,85 >R kg

Robotron 2 1. I,2-10~ i 100/C 4 s 1,6 pulse s 1 kg pulse

CTRM-OI I.I 2,I'IO~^_//Ci min 2,5 pulse s I pulse

NK-350-A I.I 4,2 pulse s 1,08

200 Conclusions : resulte Th . cesiuI f o s m isotopes mixture measurementn i s human bodreliablee ar y . Deviation extremn i s e n a case ( s unstandard figire}could be no more than 50$ °f real activity (at the levels of no more than 150-200 nCi). USSe 198n th 2I «R n 6therei , unfortunately o sufficin s ,wa - ent ammoun f instrumento t r incorporatsfo e activity measurements. That had led to additional effort fordaptation of various medical instrument e studyth r .fo s 3- The fact of absence of special methods of incorporate nuclide measurements in children urges the development of human body fantoms for different ages.

201 METHOD RETROSPECTIVR SFO E DETERMINATIOF NO ABSORBED DOSES IN THE HUMAN BODY RESULTING FROM EXTERNAL AND INTERNAL EXPOSURE

M.I. BALONOV, LB. KEIRIM-MARKUS, U.Ya. MARGULIS, O.P. OSANOV

Abstract

n ordeI o estimatt r e absorbeth e d dos o surfact e e tissue n peopli s e working in a contaminated area, a calculation method has been developed based on area integratio e modifieth f o n d response functio a poin r fo nt beta-gamma source. Practical testing of the method in real conditions confirmed its usefulnes r prognostifo s c evaluations.

The main contributio e dos th s madi e o bett ny b e a radiation wita h limiting energy of 1.0-3.5 MeV and by gamma radiation with an effective energy 0 KeV2 f .o

The population centres studied were divided into town villaged an s d an s e inhabitantth s were divided into seve e groupsag n .

Preliminary data from an analysis of the radiation burden of the population in regions adjacent to the Chernobyl power plant zone show that the evacuation of the population from the 30-km zone and other steps taken to organize living arrangement n thesi s e regions brought abou a radicat l dron i p the levels of population exposure.

The issue of retrospective estimation of a dose burden acquires particular importance in the event of accidental or accident-induced human exposures, when informatio e leveth n lo n of radiation effects is essential for taking organizational and medical measures aimed at minimizing the consequences of expo- surnormalizind an e e situationth g e cas f th acuto e n I . e exposure, eve f personi n s injure personad ha d l dosimeterss i t i , sometimes needed to reconstruct distribution of dose burden on a body expose externao t d l irradiation. Ingestio f radioactino - ve substance n substantiai s l quantitie necessitaty ma s e prompt determination of their body content and distribution. If during an accident or radiation incident, dosimetric monitorin lackins gwa r provego d insufficient- re e tas f th o ,k constructing dose burden becomes much more complicated, though

203 it is not hopeless. If no personal dosimeters are available, the human dose burden induce y externab d l irradiation riot infrequ- determinee b entl n ca y y techniqueb d f dosimetro s y without dosimeters. Specifically done b en usinca t ,i g traces lef y irrab t - diation in materials« In numerous cases there are formed free long—lived radicals^ whose concentrations can be measured later. n factI 197n i p attemp n 3a mads reconstrucwa o tt e dosee th t s received by humans killed during atomic bombardment in Japan« The researchers employed a signal of electron spin resonance (ESR) produced by specimens of skeleton bones. In 1977 loA.Alekhin, I.B«Keirim-Marcus, Cel.Kraitor et al.suggested to utilize radioluminescence (RL) for estimation of doses in specimen hairf so , nails, skid clothenan personf so s exposed to radiation durin n accidentga . Subsequently R techniqu,ES e s alswa o employe sucn i d h cases, To tissumeasure th , e eRL specimen s weighing 10-10e ar 0g submerged in a dish with appropriate solvent, and then lumines- cence produce dissolutioy db sampla f no estimates i e PEMy b d . n ordeI determino t re specimen th e samR th eES f weigho s e ar t introduced into resonator of radiospectrometer, where ESR signal, dependen presencn o t fref o e e radical samplea n si s i , measured. e measurementTh s performed showed that sensitivit f techo y - nique influences i s levea backgrouna y f b do l d R signalES d ,an technique appears more sensitive than RL. In radiospectrometers employed, the minimal dose, registered for specimens of white cotton fabric equalled about I Gy. For other fabrics of clothes, hair and protein-based biological samples the dose appeared 3-15 fold highe d sensitivitran y was, correspondingly, lower. Following irradiation, free radicals gradually disappear, particularl protein-basen yi d specimens. However dosee n ,th ca s be determined even afte lonra g post-accident periodt i s ,a happened in the case of P» While recharging a radiation

204 source Luch-I he failed to notice that a gate of output window in container with a source 1,5 X 10 Bq Co remained open» beaA gammf o m a radiation affecte mid-portioe dth thighss hi f no . Only 4 months later P. referred to a specialized clinic, where examination revealed radiation injury of the lower extremities» The ESR and RL study of material of the trousers which P. wore that y enableda d researcher reconstruco st e topographth t dosf o y e along perimeter of thighs. After making & correction for reduced

leve radicalf o lmateriae th n si , l . wit. h T-ry 0 0 1/2=2 mondose ,th e maximal value posterion so r surface thighe th f sso were measured d thean y e equalleth 40+1n d o an righe y 0dG th g tle 52+1n o y 0G left. Certain experienc bees eha n already accumulate applyn i d - ing the above techniques in similar cases. Since radioactive contamination, of all patients was very high the efforts to determine a level of irradiation by clothes also ended in failure. Then technique of dosimetry without dosimeter utilizeds swa . This techniqu bases ei measurinn o d R gES signal from enamel and was employed in 1984 in Japan for retrospective estimating the level of exposure in atomic bombardment victims. Later this method has been modified and improved. In our institute E.D.Kleshchenko and K.K.Kushnereva have mastered this method and with its aid they measured in June of 1986 the dose rat n threei e patient d dieha do froradiatioswh e th m n sickness estimatee .Th II+d an valuecorrelatey 2 G 6 } 6 s d with severity of injury. Since ESR signal from enamel seems to be preserved fairly wel d allowlan s estimatio dosef no s startin thi, gGy s froI mO. technique appears rather promisin reconstructinn gi volume th g e of dose burden for the period of occupational activity of the persons examined. It shoul pointee db initiae th t tha n dou i t l period after the accident at CNPF, the persons enrolled in management of its consequences in buildings and on the construction site, deve—

205 loped reddening of skin ("nuclear sunburn")» sensation of burning (irritation) of eyes, caused by intensive beta- and low- energy gamma radiation impac superfician o t l and, particularly, open body e area necessitth e .Th f so y aros clarifo t e y contribution of these components into the dose absorbed, and to determine effective energ actuaf yo l radiation s alswa ot .I mandator o yt develo procedura p basie th radiometrif so n eo spectrometrid can c data for measuring the dose in skin of persons staying in contaminated area. To disclose distribution of absorbed doses in skin, the use was made of multilayer thermoluminescent dosimeters designed by D.P.Osanov and A.I.Shax. Effective energy of emitted radiation s evaluatewa y measurinb d g depth dose distributio y setnb f o s thin-layer detectors, placed in tissue-equivalent containers. Major contribution to this dose is made by beta-radiation with boundary energy ranging 1.0 to 3.5 Me v and gamma-radiation with effective energy 20 KeV, which cannot be measured by standard personal dosimeters. Individual doses in skin were measured in persons engaged in decontamination of the NPP territory, construction site and

buildings alsd ,n an personneo± l repairing mobile facilities, etc. The results obtained showed that dos beta-radiatiof eo skinn ni , 2 measure n conformiti d y with SRS-76/8 a laye mg/c0 n i 710 r m after o layea rmg/c7 multipln i , m e fol6 case e founs db wa shigheo t d r than individual dos gamma-radiatiof o e n determine y standarb d d dosimeters. This is indicative of the fact, that in a number of cases skin was exposed to overdoses and appeared a critical organ. Proportion, of dose, accumulated in the lens is approximately 2-3 times higher than the dose of external gamma-radiation. These findings provide basie r th introducind sfo g additional measures of personnel protection.

206 To asses dosee sth , absorbe body b d y superficial tissues of persons workin contaminaten go d territory, V.P.Kryuchkod van D.P.Osanov have develope measuremenda t procedure base aren do a integration of modified function of impacts of beta—, gamma- radiation point source. Testinprocedure th f go e under real conditions (cit Pripyatf yo ) confirme feasibilite th d apps it -f yo lying for prognostic assessment, This procedure was utilized r estimatinfo absorbee th g dskie th dospersonnef n o n ei - in l volved in management of the accident consequences and in other kindcontaminatee th worf so n ko d territory e derive.Th d results suggest that in situations arising in a post-accident period, whic e similahar theiy rb r characte thao rt t observable after the accident at CHPP, the doses in organs and tissues located close to the surface can sometimes exceed in dozens of times the equivalent absorbed doses in depth of human body. This circumstance implies the necessity of including beta-radiation dosimeters intG emergencoID y system supplementin witt i g h measures aime protectint da bode gth y open area d eyesan s from impacf o t beta- and low-energy gamma-radiation. At the first stage after the accident at GNPP (approximately till the end of May, 1986), iodine radionuclides appeared the major factor responsible for internal irradiation of population, living on the territory affected by radioactive contamination» These nuclides could be inhaled from a passing plume (inhalation pathway) or ingested with milk and dairy products of dairy- productive cattle grazin pasturen go contaminatea n si d zone, or they could be comsumed with contaminated from outside vegetable othed san r food items (oral pathway). The above circumstances influenced the scope and trends in dosimetric and medical survey of population. Medical teams from the Ministr Publif yo c USSHealte th R f measureho d thyroid conten radioactivf to e iodin larga n ei e contingent evacuate- dbe

207 yond the 30 km zone and also in residents of some populated areas in the UkrSSR, BSSR, RSFSR, where radiation levels were increasede founb o t d , thougs unnecessarwa t hi tako t y e decision evacuation ,o residentsf no . Particular attentio gives nwa n to pédiatrie contingent, assigne groua o t increasedf po d radiation risk. To avoid any delay in mass surveillance of population, the body conten radioactivf o t e -^I measures jwa d predominantly yb simple techniques, i.e. by determining gamma-radiâtion exposure dos nece th ratk t a surfacee , employin r thifo g s purpose serial dosimeter d radiometersan s DRG, SRP d DP-5,an • Dat phantof ao m spectrometry were used in estimating a scaling ratio of the measured gamma-radiation exposure dos j e thyroi^I rat o t e d content For inhalation pathway of exposure an equivalent absorbed dose inducee thyroith n beta-radiatioy i db d f iodino n e tils it l complete elimination was measured according to routine formulae, based on data of individual measurements of dose rate, and9 therefore, presentet ,i difficultieso n d . While assessing dose burden correctioa 5 mads presencr nwa fo e airbornf o e e iodine radioisotopes, other than *31j t dependin n e lengto gth f o h post-accident period«, Accordin YoT.Khrushco gt inhae th -l a t he lation route of exposure to radioactive contaminants predomina- residentr tefo d Pripyaf so largd tan e cities, wher ingese eth - tion of contaminated food was ruled out. As regards the population living on the territory with the formed radioactive trace, even withi relativelna y short perio timf o d e (till evacuation beyon boundariee th d 30-kf so m zone), principae ,th l componenf o t total absorbe dthyroie th dos a n ^51ei dingestewa „ ^ d orally mostly with milk« This is confirmed by the observation that the leve thyroif o l d exposur ruran ei l contingents wit proporw hlo - tion of milk in their diet never exceeded 30 % even by excessive values.

208 For retrospective assessment of dose burdens after oral intake in addition to estimated thyroid iodine content, it is also mandatory to be aware of ancillary input parameters, exerting substantial influenc finan eo l valu totaf eo l individual dose in the thyroid: e.g. length of stay in contaminated territory, date when cattle grazing began, duration of consumption of dairy products o solv.T e this proble calculatioe th m n formulae wer- ede veloped on the bases of the following assumptions: (V.T.Khrushch, Yu.I.Gavrilin, Z.S.Arephyeva) - milk and dairy products were consumed only till the moment when thyroid radiation content was measured! - consumptio milf daird no an k y products continued after measuring thyroid iodine content; - consumption of milk received from cattle grazing on contaminated territor s stoppeywa certain o d n dates prio measurino rt g thyroid radioiodine content; - consumption of milk and dairy products was started followin gcertaia n perio cattlf o d e grazin contaminaten o g d pasture and was ceased immediately after completing measurements? - consumption of milk and dairy products was started following a certain period of cattle grazing on contaminated pastures stoppet no s dwa afted an r estimatio thyroif no d iodine content»

The choie of a suitable model for calculation of thyroid c dose for every individual resident was made on. the basis of data, provide localy db , sanitary epidemiologic station locad san l authorities. The data were also supplemented with results of interviews. To simplify calculations numericae ,th l value parameterf so s were tabulated. These parameters are used in each calculation mode varyinr fo l g time intervals betwee beginnine e nth th d gan end of consumption of dairy products and milk, grazing of cattle on pastures dated ,an s when thyroid iodine conten s measuredwa t .

209 Calculation of these parameters was based on characteristic ointakI f* • rat ef e o wit milw hco k following single contamination of pasture, with varying patterns of grass and vegetable cleaning from iodine^.(O.I to 0.3 day ) and decreasing I conten whicmilk/(fron , i t ) 0.3o h t y wer78 da me0. selecten i d conformity with thes A evalues , providin additionae th g l conditions are satisfied, that -^Ij maximal concentrations in cow milk are always reached after 3 days of cattle grazing. Large sizes of contaminated area did not allow researchers to measure iodine content in all residents during May. The task of retrospective appraisa f thyroilo d dos thin i e s contingent emerged in the course of mass health examination of population in the autumn of 1986. The values of mean and individual doses were assessed in the first place, by comparing results of interviews with non-examined person d san residents with estimated iodine contenthyroide th n i t , supplementing them with dat n radioactivao e compositio fall-outf no thin si s area, exter- l gammana - radiation exposure dose rate, concentration ni milk, age-related distributio dosf no n surveye i e ^ residentf so this region, including also social factors. The surveyed populated areas were devided into rural and urban theid ,an r residents were groupse assigneag 7 :o t dunde r I year, 1-3 years, 3-6 years, 6-H years, 11-15 years, 15-18 year d ove syearsan 8 r 1 . Withi homogenouna groue sag majorin i p - ty of populated areas the distribution of residents with respect to thyroid s doscloswa e lognormalo t e have .W e received weighted- mean by number of persons examined relationships between dose in various age groups and dose in adults, obtained in 6 cities and 12 villages of the RSFSR. These results suggest that influence absorben o e oag f d dos mors i e e pronounce urban i d n areas than n rurai l ones. Probably attribute,e b thiy sma relativelo t d y higher consumption of milk by adults and adolescents in rural

210 areas than in cities, since they have their own cows. Utilizing mean relationship dosef so varioun si groupe sag becomet ai s pos-

sible to estimate a mean dose received by residents Of any age, if thyroid radiometry was carried out in one age group within populatio givee th nf no cit villager yo . To extrapolate dosimetric data to rural residents, where in May 1986 radiometry was not performed, there was explored a correlation of dose, with IJI-j- concentration in consumed milk and with gamma-radiation exposure dose rate in the vicinity of settlements locate zonesn di , user cattlfo d e grazing. According to data of I.A.Zvonova (oral communication), both correlation^ appeared statistically significant. For the territories covered by iodine prophylaxi followine sth g linear regression equations were derived;

D (1-7 yr) = 5.6 5m (D+I04D+20) , gv B (1-7 yr) = 1.9 R(D+I5), Sv

where B(I-7 yr) - mean thyroid dose for pédiatrie contingent

age7 years (D+IO+D+201- dm C" , ), MBq/ - 1mea n concentratiof no in milk within 10-20 days after the accident; P(D+I5), MR/hr gamma- radi mean io a nt areae leveth sn li clos settleo et - ment 5 days1 s afte accidente rth . f dat thyroiI l aoï d radionuclide conten e lackingar t e ,th individua estimatee lb dosn ca e d wit accurace hth y acceptable for goals of prophylactic examination by mean dose for residents of corresponding age in the given populated area with similar behavior patterns and dietary habits after the accident. When such comparison cannot be made then a concrete person or a group of persons with lacking data on direct measurement of I •* thyroid content may be regarded as exposed to mean individual dose, characteristi personsf o c , livin n thago t terri- territore th n o tor r yyo with similar leve f contaminatiolo y nb iodine radionuclides (iodine leve milk)n i l n eac.I h concrete

211 person the value of mean individual dose can differ severalfold from the actual one. To make assessment of individual dose value more accurate ,utilizee b ther n ca e d dat averagn o a e daily consumptio locallf o n y produced milmead an kn time s perioit f o d actual consumption by residents of the given populated area. Valu dosf eo e burden D(Sv) assigne givea o t dn individuan lca be calculate y relationdb :

|)3' ,^ b( - [I D = D V 9

mea- wherD n dosresidentr e efo givee th nf so settlemen t territore th f o r y (o with similar contamination patterns), rad, average-dail- V y individual consumptio locallf no y produced milk in April-May 1986 till its consumption was actually stopped, I/day; V - locally produced milk mean consumptio persony nb a livin territorn go e giveth f no y individual's residence, or on territories with similar contamination patterns, I/day; Q - average daily individual length of locally produced milk consumption, days; t> - mean proportion of radioiodine ingested with milk, $ - mean length of locally produced milk actual consumption by persons living on the territo- f individual'ro y s residenc othen o r reo areas with similar contamination patterns mea- , nb days j_ proportio; radiof no - iodine intak body b e y through other pathways (inhalation, injes- ted with vegetables, etc). Statistical analysis of thyroid radiometric data and results of interviews with over 3000 residents of Bryansk region, made by G.Yu. Bruk and N.P.Korelina revealed that for ESFSR districts contaminated with radioactive products ^ — 0.8. For other region s^ 1- coefficien werd an e ascertaine> t - tba e th n do

fielf o s d si studies lengtf .I milk0f ho an( 3Q consumptio - ex n ceede 0 days2 d shoult ,i regardee db s equallinda days0 g2 .

212 Model r calculatiosfo f individuano l thyroie doseth n i sd under various conditions of population's everyday activities on contaminated territories and its consumption of dairy products necessare th wels a ,s a l y tabulated material with, numerical values of parameters, used in formulae, are described in "îfenua r estimatinfo l g thyroid radiation dos radioactivn i e e iodine isotope intak humay eb n body"(Ed L.A.Ilyiny .b , academi- USSe th ciaR f AMS)no . Another possibilit asseso yt s individual dose accumulated in the thyroid is based on a correlation between ^Ij intake by the body and its cesium content measured on later dates, for instance August-Septemben ,i r 1986. Statistically significant linear relation0,7-0.9= £ )( s between body iodin cesid ean - um conten founs i tchildrer fo d n older tha yearn7 adultsd san , who in May 1986, on the whole, stopped consuming locally produced food items and observed these restraints throughout the summer. In this case dose D (Sv) induced by radiation in the thyroid could be estimated from the formula:

D = k(T)ACs age-dependen- ) wher(T k e t coefficient. Reconstruction of thyroid individual doses by these techniques is of limited accuracy. Nevertheless, selection of groups for medical follow-up, carried out on its basis, makes it possibl derivo t e e considerably nore precise characteristics, than those obtaine utiliziny db g mean value thir sfo s districr o t settlement. Radioactive cesium appear n essentiasa l facto populaf ro - tion internal exposure in a zone of radioactive contamination.

Since isotopes of both. ^57cs and ^^Cs released into the environment have large half-life retaineperiode ar d human san i d n lona "bod r g fo ytime becamt ,i e possibl summer—autumn ei 198f no 6

213 to estimat efficieny e"b t techm qu.ese contenth f thesto e nuclides ilargna e population involving ove0 thousanr10 d residents. This work was continued in 1987 as well. Individual and collective doses of internal exposure were assessed by findings of a single multiplr o e radioraetry. Schem sucf eo h calculations should include a function of radiocesium intake after the accident. I.A.Likh- tarev, ru.O.Konstantinov,, V.S.Repin have suggested to approximate the dynamic radiocesiuf so m intak two-stea y eb p functione .Th first step having large amplitude and lastng for about a month implicates ingestion of cesium with milk, meat, early vegetables in May 1986, prior to imposing rigid restrictions on consumption of local products. The second step with smaller amplitude reflects continuing chronic incorporatio smalf no l quantitie botf so - hra dioisotopes together with food. Amplitude ratio for each district s determinewa basie th datf s o n radiatio n do ao n monitorinf go food items. In fact, for the Ukraine as a whole, the ratio of d step 2n takes swa d 2:1s na an .t 1s This calculation scheme also took into account evacuatio f somno e residents beyon zone th de of intensive radioactive contamination. The calculations utili-

d valueze radiocesiuf so m half-lif e bodth y whic, n 2 ei T-j/ - h were obtained by O.V.Lebedev and co-workers in long-term, WBC-aided surveillanc residentse th f eo , evacuated fro radio-contaminama - te d1986y .zonMa n ei Practical applicatio abovedescribee th f no d techniquer sfo retrospective estimation of absorbed radiation doses in humans exposed to radiation effects following the accident at CNPP provided the possibility to classify the involved population contingent termn si radiatiof so n level d proceedin,an g from the data derived, to institute sanitary-hygienic and organizational measures directed towards normalizing the situation and minimizin radiatioe gth n impacts.

214 Preliminary analysis of population exposure in the areas close to the OWPP zone shows that evacuation of residents beyond the limits of 30-km zone supplemented with measures introduced to govern behaviour and everyday activities of population ensure dramatic decrease in levels of population irradiation.

215 LONG TERM PROGNOSIS OF INDIVIDUAL AND COLLECTIVE EXPOSUR EPOPULATIOE DOSETH O ST N

O.A. PAVLOVSKIJ

Abstract

e Fopurposth r f evaluatino e e long-terth g m consequence f radiatioo s n contamination following the Chernobyl accident, it was decided to divide the e Soviewholth f o et Union int oa numbe f regionso r . Calculations were made wit a hspecia l software package. The collective dose commitment to the country's population due to caesium isotopes will amount to 117 000 man-Sv, of which the first year accounted for about 27%. Thus, the main contribution to the aggregate dose will be made in the second and subsequent years, i.e., a period when the formation of dose burdens to the population can be effectively influenced by strict monitorin f agriculturao g l products, agrotechnical measuree th n i s contaminated area thoroughgoind eve y an ab n g reformatio e economyth f o n . Man f theso y e measures have already been e USSRtaketh n i .n e wholeOth n e averagth , e individual dose commitmen e country'th o t t s population will be about 1.2 mSv, which, given an annual level of background radiation in the USSR of 1 mSv/year, adds only 2% to the natural background dose. In view of all the measures taken, the main contribution to the population dose commitment comes from external gamma radiation from the radioactive products released durin aboud fro% an e accidenm38 th tg- % ? - t internal exposure resulting from the consumption of contaminated food products,

Due to specific circumstances which influence e radiatioth d n situatio Soviee th n ni t Union following e Chernobyth l acciden a prolonge( t d releas f gase o eaerosold an s s from the damaged reactor and variable meteorological conditions), nearly the entire territory of the country was contaminated to a certain extent asseso T .e long-ter th s m radiological impacf o t the contamination, the territory of the Soviet Union was split into five regions: - Byelorussia1 ; 2 - Horthern Ukr&ine, including the Uherkassy, Chernigov, Chernovtsy, Ivano-Frankovsk, Khmelnitsk, Kiev, Rovno, Ternopol, Transcarpathian, Vinnitsa, Volynsky, and Zhitomir regions; 3 - Central region of the Russian Soviet Federal Socialist Republic (RSPSR), including the Bryansk, Ivanovo, Kalinin, Kaluga, Kostroma, Moscow, Oryol, Ryazan, Smo- lensk, Tula, Vladimir Yaroslavd an , l regions;

217 Remainin- 4 g Europea Soviee n th par f tto Union wite th h Asian part of the Ural economic region; 5 - Asian part of the Soviet Union.

The population size and density, the number of newborns in 1986, the proportion of the urban population, and the area five th eacr e f fo regiono h givee s ar Tabl n ni . 1 e

Table 1. The population size and area for the 5 regions Soviee ofth t Union*'

Population Newborns Urban | Area, ^Population size, n 1986i , population, * 6 ;'^density, Region m k 0 1 106 106 relativ* e "persons per size '. : kn2 i 4 *

1 10.0 0.17 0.63 0.208 48.2 2 21.9 0.35 0.54 0.269 81.4 3 29.8 0.51 0.82 0.485 61.4 4 139.7 2.47 0.69 4.533 30.7 5 77-4 2.12 0.57 16.696 4.6

USSR 278.8 5.62 0.65 22.191 12.6

"^Figure f 1986o s sa .

Because of great importance of the ingestion pathway, informatio stapln no e foodstuffs (grain, potatoes, vegetables, meat, milk) produced in each of the regions was analysed, and their averaged productio squarr npe e kilometr s estimateewa d (Tabl . Table2) alse2 o give capitr s pe dat n ao a food production regione ith n s under consideration comparee b o t , d wit capitr hpe a consumption rates for 1986 averaged over the country /1/: Meat 62-5 kg/year Milk 332 I/year Vegetables 103 kg/year Potatoes 108 kg/year Grain 3 (breadkg/yea13 )r

218 productioe TablTh . e2 staplf no e foodstuffe th n aI 5 regions of the Soviet Union ^

• * * * Agricultural Production | Region j—9 produce io ka(i) j 103 kg(l)/km2:.kg(l)/man • * ** Milk 1 7.0 33.7 700 2 11.8 43.8 537 3 9.2 19.9 308 4 54.5 12.0 390 5 19-7 1.2 255

Meat 1 1.1 5.1 106 2 1.9 7.0 86 3 1.4 2.8 46 4 9.9 2.2 71 5 3-8 0.23 49

Vegetables 1 0.97 4.7 97 2 2.73 10.1 125 3 1.79 3.7 60 4 17.5 3-9 125 5 6.73 0.40 87

Potatoes 1 13.4 64.6 1340 2 15.6 57.9 711 3 10.9 22.5 367 4 35.0 7.7 251 5 12.3 0.73 158

Grain 1 7.0 33-9 703 2 16.8 62.4 767 3 10-2 21.0 342 4 119.0 26.2 850 5 57.0 3.4 737

*)Figure f 1986o s .sa

A comparison suggests a marked redistribution of foodstuffs among the regions, which has only in part been taken into account at the present stage of predicting the radiological situation in the Soviet Union.

219 The input data used for the prediction related to: - Variation in the gamma dose rate in each or moat of the

160 administrative territorianitl a of the Soviet Union u (regions, territories, autonomou d Soviean s t republi, /) 2 / c according to the information of the State Committee on Hydrometeorolog Sanitare th d Epidemiologicad yan y an l Service USS(SESe th R f )Ministro Healtf yo h (regional and republican SES); - External doses over different months in 1986 for each regione Soviee th moar th o f n o ttsi Union; r concentrationAi - totae th lf so radioactiv e materiad lan individuaf o l radionuclides; - Ground deposition densities of the total radioactive material and of individual radionuclides; radiocaeaiud an I - m11 concentration1 milkn i s , meatd an , vegetables ; - Diet patterns in different republics and agriculture production in each of the 160 administrative territorial unita ; - Variation in the overall population size and in both the rural and urban populations within the Soviet republics frota 195 o 01986t ; - Global contamination levels of agricultural produce due to caesiu d strontiuman m isotopes over 1964-1986 withie nth regional and republican boundaries.

e calculationTh s were made usin ga specia l packagf eo programmes, the basic methodological principles and results being presented below. 1. External exposure during the cloud paasage

e contributioTh thif no s pathwa insignificants yi e b y ma t I » seen from Tabl countre thatth 3 ewholea r s ya ,fo , gamma exposure froplume mth e make totae 1.3p su th $lf o collective external

220 dose arear Fo « s Chernoby e closth o et l plant contributet ,i p su to 2$ due to doses received by the evacuees from a 30—km zone around the plant» Whenever there was information on air concentratio time-integrater no d concentration, gamma doses froe mth plume were calculated with the convential procedure using dose conversion factors from /3/* Wit euco hn h data availabler ai e ,th concentration was derived from the ground deposition density value meany sb relationshipf so sSoviee base th foreigd n tan o d n scientists' finding Chernobye th n so l accident dose th e n .estimaI - tion indooe ,th r gamma shieldinr g fo facto o tw s assume rwa e b o t d country houses and ten for cities. The proportion of the urban to rural populations was also taken into account for each of the 160 areas concerned.

Table 3. External exposure of the public from the plume and fallout

• • * Region * rroorj * • *\ 1 • 2 *; 3 ; 4 Î ; ; 5 1 •

Plume

Collective dose, 10 man'Sv 0.97 1.09 0.17 0.26 0.00 2.49 Average individual doae, mSv 0,097 0.050 0.006 0.002 0.000 0.009 Fallout Collective dose, 103 man«Sv 53-4 48.3 32.8 53.9 6-2 194.5 Average individual dose v cS , 5.33 2.20 1.10 0.39 0.08 0.70

0 7 3 9 7 6 1:37C 87 7 contribution, 1 6 4 7 ^

221 Externa. 2 l exposure from deposited radionuclides

As shown by calculations, this pathway, like internal exposure due to intake of contaminated foods, is a ma^or contributor to exposures, accounting for more than 50% of the total dose to the Soviet population over the first year after the lifetime th acciden r almosf o fo % ed t60 dosetan n thes.I e calculations, the dose for the first month was assumed to be determined by a mixture of radionuclides whose gatnma dose rate decreased following the power lav/, with an exponent close to 0,75« For longer periods, the dose rate was assumed to be associated only with ^Cs and CB and to change with time according to a biexponential dependence which describes a two—compartment model of the vertical migration of the above nuclides in the soil /4/. For T "3*7Cs, this corresponds to half-times of gamma dose rate reductio years0 3 thref no "faste d ,th ean d "slow"an " components being proportional to 0,6 and 0»4» respectively« With no data available on the ground deposition density of caesium isotopes, the relationships from /5/ were used. It should be noted that external exposure of the Soviet population in the first year afte accidene rth t constitutes 26.7%lifetime th f o e dosef .O this 26.7/5, 20.2% is accounted for by I and other short-lived isotoperemainine th d san g 6.5% distributes i d almost equally

lifetime th Csbetwee) r .3% Fo e(3.5% ^C d dosed nan san , 137

the1 main part will naturall whosys C belone o contributiot g 137 n to the total external dose from deposited radionuclides varies with regio moro nt frod averagee% an m60 tha % nS0 sr fo abou % 70 t the country as a whole (Table 3). When estimating short- and long-term exposures from 137Gs, account was taken of variations n botoverali e th h l populatio e relativnth sizd ean e e th siz f eo urban populatio individuan i n l regioncountrye th f o st shoul .I d be stressed that decontamination played an important role in reducing external gamma exposures, particularlr arean fa yi t sno

222 froChernobye mth l plant e decontaminatio.Th morf o n e tha0 n60 population centres removae ,th buriad lan f contaminatelo d aoil, the suppressio dusf no t over large areas asphaltine ,th r go covering of contaminated sectors with gravel chippings, sand, or fresh earth designatioe ,th exclusiof no n restrictione zoneth , s s impose n productivo d e activity d othe,an r similar measures enabled average public exposures in these regions to be reduced threer o o factoa »tw y b f ro

3« Internal exposure from inhalation

e contributioTh f thino s pathwa considerablet no s yi e ,th [nain part being played by I. Calculations were made for a mixtur iodinf eo e isotopes , -^CsTe d ,,an 'Ce . Dose factors correlatin e thyroi th dose o gth other t e o d r organs wit hunia t of intake were obtained from /6/. In the absence of direct

r , Cs measurementd an , r concentrationCs ai f so , I r sfo 1 1 1 1 *\A "1 *ï 7 these were estimate groune e basith th f dso n o ddepositio n density values e calculation.Th s show intak inhalatioy eb accouno t n t r aboufo te tota th 3.55 f l5o collectiv e effective dose equivalent commitment for the country as whole, with region— dependent variation broaa n si d range (from 1»4 8.5$o $t e Table du ;se ) e4 to specific climatic condition protectivd san e measures taken.

4-i Internal exposure from ingestion

This pathway is the most "controllable", thus permitting changes in the dose commitment . Of the main isotopes contributing to exposures, I, 134cs and Cs were chosen since they coul positivele b d y found, especially withi firse nth t months after the accident, in agricultural produce over the whole country.

223 Tabl - eEffectiv4 e dose equivalent commitmento t e du s inhalation and ingestion

Î Region • • USSR Intake : : : 1 : 2 :" 3 : 4 -• 5 :

Inhalation Collective dose, 103 man-Sv 1.5O 1.09 O.80 1.06 0.01 4,46

Individual dose, mSv 0.15 0.050 0.027 0.00 O 8 O.OT6

Ingestion Collective dose, 103 man-Sv 50.5 30.2 8.35-? 0 0.72 125.1 Individual dose, mSv 5.04 1.38 0.29 0.25 O.01 0-45

131I contribution,^ 2.2 11.0 4 6. 6.9 3 2. 8-4 137Ca contribution, % 80,5 72.3 63.2 73.9 80.6 75.5

I appeared in the milk of cows which grazed on pasture as early as two or three days after the accident» At that period, I contamination of milk in southern Byelorussia, northern Ukraine, and the RSFSR regions adjoining the accident area amounted to 0»04—o«4 MBq/1, i.e. tens and even hundreds times as establishee higth s ha d standard (3»7 kBq/l)» However, milk from cows kept in stalls was far less contaminated. In each of the contaminated regions, hundreds of milk samples were analysed every day. This provided detailed information on changes in the contamination of agricultural produce both in individual regions and the country as a whole. An analysis of the data obtained confirmed the log-normal I concentration distribution in milk

and showed thaintegrae th t l of"IjCOncentration o mil n ni t kpu sale through the centralized system was about 170 Bq*y/l for the Gomel region, about 230 Bq«y/l for the Mogilyov region ("both in

224 Byelorussia) , 100 10 morr ,o d ,ean times lowe other fo r r regions and republics. At the same time, e.g. on 17 May 1986, the I concentration exceede kBq/7 3* dr 20-30 1abovfo e th milf ^ o e n ki regions of Byelorussia. Due to the measures on milk control in the regions close to the Chernobyl plant, the ratio of the time-inte- grate concentratioI d miln i ncentralizen ko de th sal o et ground deposition density proved to be 4-10 times lower than in regions with no measures taken. Accordingly, the I contribution to the collective effective dose equivalent comiritruent froni internal exposure average dcountrye 6.4th r $fo , varying from 2.255 to 11# for individual regions (Table 4). The calculation of doses resulting from radiocaeaium intake within the first year after the accident is similar to that given estimato T . I eabov intaker fo e caesiuf so m isotopes, datn ao contamination levels of milk, meat, and vegetables in all regions Soviee ofth t Union wer eshows usedwa nt I «that , wit hgeometria c concentratios C e ratie th meath f milo n f n i o k (Bq/le th o )t 1 "37 ground depositio ncountre densitth a r s ya fo y 1 2 (kBq/ f o m) whole, the ratio in the most heavily contaminated regions was close to five for milk put on sale through the centralized system. The collectiv Soviee e d th dose an r ts fo sC populatio o t e ndu 13J 7Cs make up 13?» and 20J5, respectively, of the total dose over the first year after the accident. To predict the immediate and late health effects of caesium isotopes seems to be more difficult. The coefficients for 137Cs transfer to the main types of agricultural produce used in the present paper were obtaine n 1964-198i d 6 from analysee th f so monitoring data on fallout contamination of the Soviet territory caused by nuclear tests. From these studies, the half-life of

137 J Cs in milk was found to be 8.4 years for the Soviet Union, i.e, the "clean" soil component of the decontamination model for caesium as a chemical element is 0.06 year" . Accordingly, the

225 integral intakes of CB and Ce were assumed to be 2.5 and 12 fold intakes of these nuclidea for the second year after the accident e calculatio.Th collectivf no e doses also allower fo d populatione growtth n i h differenf o s t region countrye th f o s , but the diet pattern was taken to be the same as in 1SS6. The latter assumptio y resulnma n somewhai t t underestimated values sinc cleae th e rSoviee trenth n ti d Unio n receni n t years sha been for increased consumption of meat and dairy products and a rather marked decreas annuae th n lei consumptio potatoef o n s and bread. The collective dose commitment for the Soviet population due to caesium isotopes is estimated to he 117 000 man»Sv, of which only about 2jfo is attributed to the first year. It follows thamaie th tn contributio thio nt s dose wile secon madth e lb n dei and subsequent years after the accident, i»e, during a period when public exposures can be effectively regulated by strict cont- agrotechnicay b foodf o d l san ro l measure n contaminateso d land, including even the restructuring of farms. The above measures, moa whicf o t e beinhar g implemente Soviee th n ti d Union, have considerably reduced doses to the public, the average values for the firs moste th yeat n heavili r y contaminated Gome e areath lf so Kiev, Bryansk, and Mogilyov regions being 10-15 mSv, with less A T 1 7 "11* than 505& caused by internal exposure from CB and Gs. Only in 0.5-1$ of those examined did internal doses exceed 50 rnSv. capitr pe e a Th dose commitmen Soviee th r t fo tpopulatio n will total about 1.2 mSv which, given an annual natural radioactivity backgroun mSv/yea1 Soviee f o dth n ri t Union, only means n approximata % excess2 e . This figur r thres abouo i eo etw ttime s the dose received by the populations of Italy, Hungary, Sweden, and other western European countries affecte release th y b de from Chernobyl /6-9/.

226 Allowing for all measures taken, the major contributor to the dose cocaiaitment for the Soviet population, (see Table 5) is external gamma radiation from deposited fallout (about 60$), with about 3S5Ü» being due to internal exposure from contaminated foodstuffs noteworths i t .I y that thosn i , e population centres where o protectivn e measures were taken becausw absolutlo f eo e levels f radiatioo d foonan d contamination ratie ,th f internao o t l external exposures over the first year after the accident sometimes approached 10. Meanwhile, in all population centres where food was controlled and those foodstuffs which did not meet the established standards were rejected above ,th e rati s « clos1 owa o et

Tabl « Collectiv5 e r capitpe d a ean effectiv e dose equivalent firse th tr yea fo sd lifetim ran e

Effective dose equivalent Exposure ——————————— 3———— — :——————————— — Percentage pathway collective, 10 Jr capitaman-Spe v* ,

first yeartlifetime ifirst year:life- first 'nfetime « *

Gamma radiation from cloud 2.49 2.49 8.8.9 9 2.52 0.76

Inhalation 4«46 4.46 16.016.0 4.51 1.37 Gamma radiation from fallout 32.0 194.57 18 698 52.6 59.6 Ingestion 39-9 125.1 H3449 40.4 38.3

Total 98.95 35 326.5 1171 10O 10O

s showItwa n thacomplee th t prophylactif xo d protectivan c e measures taken reduced individual external dosea by a factor of two or three and internal doses to the public by a factor of 10 or more as compared with the values predicted. The agrotechnical as well as sanitary and hygienic measures to be taken in future are

227 likely to reduce dose commitments for the populations of individual regions and of the Soviet Union as a whole as compared with the values « give5 Tablen d i nan 4 s

REFERENCES

USSe 1Figuren .Th Ri n 1986si . Financ Statisticsd ean , Moscow, 1987 (in Russian). 2. USSR: Administrative Territorial Division of Soviet Republics Januar1 n o y 1983« Izvestiya Publishing House, Moscow, 1983 (in Russian). Kocher. 3 , U.C. Dose Rate Conversion Factor Externar sfo l Exposure to Photons and Electrons. Rep. ORNL/NUREG-79, Oak-Ridge Natl. Lab. Ridgek . Oa , 1981 ,TN . 4-* Moiseev, A.A. Caesium-137, Environment, Man. Energoatoniizdat, Moscow, 1986 (in Russian). 5. Israel, Yu.A. et al. Environmental contamination in the Chernobyl plant accident zone. Meteorol. Gidrol«, No. 2, 198? (in Russian). 6. Dosisfaktoren fur inhaleition oder ingestion von radionuclid- verbindungen. ISH-Heft 63; ISH-Heft 78, april-november 1985- 7. Hungarian Atomic Energy Commission. The consequences of the Chernobyl nuclear accident in Hungary. Budapest, July 1986. Swedis. 8 h National Institut Radiatiof eo n Protection. Chernobyl- its impact on Sweden. SSI-86-12, 1986. 9- Chernobyl and consequences in Central Europe. Radiation Protec- tion Dosimetry. Special issue. Vol. 19, No. 4, 1987«

228 DISCUSSION

A.J. GONZALEZ (IAEA)

One common them f thio e s afternoon discussio s bene nha th n logi r establishinfo c g intervention levels after unanticipated situation involving radiation exposure has actually occured. Followin e Chernobyth g l accident a temptationther s wa e , by various authorities o lint , k such intervention levels with e dosth e recommende r radiatiofo d n protection planninr fo g anticipated situation. Ther s noti e , however conceptuay an , l link between intervention level dosd s an se wa limits t i s a , shown during the discussion, and it will be worthile to record this message since the confusion still exists in many places» As you properly stated during the morning section, Mr.Chairman, the main logic for settling intervention levels is just common sence. Common sence for balancing the benefits expected from the intervention against the harm such intervention would unevoidably produce.

229 CLINICAL ASPECT RADIATIOF SO N EFFECTS ACUTE EFFECT RADIATIOF SO N EXPOSURE FOLLOWING CHERNOBYE TH L ACCIDENT: IMMEDIATE RESULTF SO RADIATION SICKNESS AND OUTCOME OF TREATMENT

A.K. GUS'KOVA, N.M. NADEZHINA, A.V. BARABANOVA, A.E. BARANOV, I.A. GUSEV, T.G. PROTASOVA, V.B. BOGUSLAVSKIJ, V.N. POKROVSKAYA

Abstract

The effect of penetrating radiation evenly distributed over the whole body was the main cause of the development of general clinical syndromes typical for the dose range 100-1600 rads (1-16 Gy): bone marrow, intestinal and transitional forms or combinations of these syndromes.

Accordin o gammt g a spectrometric measurement f bloo o surind an d e samples and posthumous examination of organs and tissues, the maximum concentrations of radioactive iodine-131 in the body were 1-5 mCi (for various patients) e figurecaesium-13r th fo ;4 s13 werd an 7e 2-2.5 mCid ,an contaminatio y cerium-14nb ceriuf i t excee(abouo mC no % 0 d m95 3 td4di activity was in the lungs). Other nuclides did not exceed their MFCs. For plant personnel on site at the time of the accident, the average exposure dose to the lungs was 0.2 Gy, to the thyroid gland 2.5 Gy, and to the whole body about 0.0. 5Gy

A whole-body dose of 0.7 Gy may, as a general guide, be regarded as the minimum dose causing insignificant but consistent and individually significant changee blooth n di s picture whic e characteristihar f acuto c e radiation sickness of the first degree. Variant 1 of a diagnostic programme designed to ensure a uniform approach to the diagnosis of first degree acute radiation sickness has been established.

Of 21 patients with acute radiation sickness of the third degree (dose range 4-6 Gy), 14 survived. All patients with acute radiation sickness of the fourth degree died except for one. Generally, death resulted from a combination of clinical syndromes, primarily the intestinal and bone marrow syndromes with total or subtotal skin damage.

Recovery of haemopoiesis was extremely active: in 84% of cases, the normal blood pictur s re-establisheewa years2 1/ d1 . afteo t 1 r

Indicator f fitnesso worr fo sk returned afte 9 week8- r patientn i s s with first and second degree acute radiation sickness and were high one year after exposure. Some who suffered acute radiation sickness are now working at the Chernobyl plant. Their doses in 1987 did not exceed 0.6 rem.

The information on conditions of irradiation and clinical records of acute radiation sickness (ARS) in victims of the Cher- noby P accidenlWP t have been first reporte e IAEth Ao dt expert s in August 1986 (I) and included in the report No. 25 INSAG IAEA (2).

233 Prognostic evaluation outcomee hemopoiesie th th f o sf o s s injuries were give A.Ky nb . Guskov A.Ed aan . BaranoCone th -t a v ference of the Royal College of Patologists in Great Britain in AprQ. 1987. Authors data are included in a special Annex of UKSCEAR Repor n earlo t y effect radiationf o s , which - shoulfi e b d nalize 198n di d presente8an Sessioe N Generath U o f t dno - lAs semblytime th el furthe.Al r analysi clinicae deptn th si f o h l aspect situatiof o s n earlier declared grou patientf o p s goinswa g . Somon e result thif so s analysi presentee sar d below. Earlier formulated opinion abou relative th t e significance e oth separatf e component combinef so d radiation influence (1,2) was fully confirmed by clinical-anatomical, labaratory and cardio- logical analysi wels s a pathologically-anatomicas a l d biophylan - sical postmortem investigations. patiento Exceptw r fo ts (N24combinatioe th ,d 25)ha o f ,no wh acute radiation sickness therma(ARSf o d )an l burns otherl ,al s were mainly affected by general whole—body uniform gamma—beta irradiation actioe .Th penetratinf no g radiatio whole-bode th n no y was the main reason of the development of clinical syndromes of S suc bone-marroAR s ha intestinad wan l syndrome d theisan r combinations, whic characteristie har dosr cfo e range I-I y (1006G - O rad)I6 . Less penetrating dept,e onlth skinf o ho yt , beta irradiation (T.G. Protasova, T.I. Davydovskaya) at the doses at least 10 to 20 timeg higher than average whole-body dose became the vase causth t f radiatioo e n injurie skie morth n n i f seo tha2 n1/ patientse oth f . These injuries significantly aggravate clie dth - nical cours sicknesf o e d greatlsan y influence outcomese dth - .So metime backgroune th n so shallof do w radiation injurie isoe sth - lated center morf o se deep local radiation injuries (LRI) have arisen as a result of local application or contact with the objects contaminate radionuclidey b d t clothewe se r th suco s s ha boots.

234 No regular correlation was found between the radionuclide content measured during life, post-mortem investigatioe th d nan clinical manifestations. As was formulated earlier (1,2), the action of incorporated nuclides has not brought about the evident contributio clinicae th o nt l picturprodromae th f eo l phasf o e ARS for the given irradiation situation. According to the results of gamma-spectrometric measurements of blood samples (I.A. Gusev, A.A. Moiseev), of urine (R.D. Drut- man, V.V. Mordasheva post-mortef o d )an m sample organf so d san tissues (I.A. Gusev, Y.I. Popov maximae )th l conten radiof o t - active iodine-I3I in the organism was: for one patient (No. 24), iodine-I3I- 5 mCi caesium-137,-134 - 2 laCi, for another patient (No. 25), iodine-I3I - I mOi, caesium-137,-134 - 2.5 mCi. Conta- minatio cerium-14y nb highet no s r4 wa than 30/

For the NPP personnel, who was at the place in the moment accidente oth f meae , th nlunge th dos sf o eirradiatio n fro- min whol, ternaGy thyroif o e5 , bod2, l Gy d- - yemitter 2 0, s swa about 0,1. 5Gy

235 followine Ith n internage datth e tabl th n a o eA l irradiation of patiente from NPP personnel, who died as a result of irradiation due to the accident, are present. In several reports (1,2,8,11,12) the clinical characteristics of main syndromes of ARS in the prodromal phase, syndrome combinations with each othe witd ran h local radiation injuries were presented.

Table A. Doses of internal irradiation for the persons, who died as a result of Chernobyl NPP accident

Patient Thyroid Lung dose, Whole body dosey ,G No. dosy G e, Gy Internal External

24 30 2,5 2,0 1,7 25 6 2,0 1,0 4,7 17 I 0,4 0,2 10,0 3 0,3 0,3 0,2 12,0 4 1,2 0,4 0,1 11,0 26 0,5 0,3 0,1 12,0

Notes: I. The doses are given for the time of death. 2. The data are given only for the patients with the highest value intenraf so l doses. 3» In the last column doses of e^rbernal gamma exposure are presented.

Here we are demonstrating once again Pig.I (from report (2)), which shows those relationships and. the frequencies of lethal outcomes in the different groups of affected persons. As the figure patiente th l showe4 nearldegreS severe al 3- AR th s f t n so ya ei e bone-marrow syndrome (BMS) is combined with skin and mucosa injuries. In 4/5 of the patients with BMS of 4 degree the intestinal syndrome has developed, and in part of them (7 patients) pneumo- nitis with pronounced breathing insufficiency was observed.

236 101

l, E? lung injury

3 • o muoosit

101 o1 skin "burns

1 1 I 0 MOO- >200- 200 400 600 1500

severe injuries minor injuries

Fig.I. Rati f differeno t syndromes frequenc n varioui y s dose rang t bone-marro(a e w syndrom f variouo e s degree).

e aggravatinTh g contributio pronouncef no d and/or extensive skin injurie patientse peoplth e s evidenl th swa al r e .n Fo '«1ti t h the area of radiation burns greater than 4055 of body surface (2/3 of the persons with lethal outcomes) burns should be considered, basing on the clinical data, as the leading cause of the outcome of sickness. Skin lesions were the sole cause of the deatpatienta5 n hi role skif .Th o e n injurie s significanswa t for earl wels ya s delayela d time deathf o s . The way of grouping the patients according to the prognosis development of bone marrow syndrome at different stages of observations made for choosing appropriate volume therapeutic treatmen gives publicationw 12) , twa fe detain n11 i a . , n 6 li , s(5

237 We will indicate agai nhige onlth h o ypracticat l significance of such characteristic numbee th lymphocytef s ro sa firse th tt sa day7 3- s after exposure numbee ,th neutrophilef ro 8 days7- t ,sa the time perio reaco t d h coun neutrophilef to 5 s1001- ^ t 0(a weeks of observation) and the period of the development of clearly pronounced thrombocytopenia (from 2 weeks till the end of pro- droma degreI lS phase AR til- e week6 r l4- fo ; s fromomene mth t of exposure, Fig.2).

ta O) o •H

•H

O -H ta o r-i o tf E

.1 i i i i i i i i 0 8 0 5 40 Days real neutrophile curve _____ real thrombocyte curve ...... real lymphocyte curve —•_•_•_•_ expected neutrophile curve

Fig.2. Rati f expecteo o read an dl dyna-r.ic f periphero s y blood picture in victims of the Chernobyl NPP accident.

The highly significan te cariologica th dat f o a l analysif o s bone-niarrow lymphocytes and peripheral blood lymphocytes as well e resultath s f direco s t coun f dividino t g cell n biopsi s y preparations of hemapoietic organs also have been discussed earlier (1,5) and later completed by quantitative information. As it was earlier mentioned (see Pig.2) the infonnativeness of e dynamicth f quantitativo s e indicator f blooo s d e picturth s wa e highest tfith respece subsequenth o t t t cours f ARSo e .

238 The other clinical ( neurological, ophtalmological) and laboratory tests (immunological, coagulation, metabolic indicators) have shown mainl e correlatioyth n with so^ne separate clinical s aggravationit d syndromean S AR s f so (nerv e system injuries- ,to xemia, bleeding). Por biochemical tests (I.P.Turina, M.P.Tarakanova, T.A.Ivano- correlatioe th ) va n wit severite hth sicknesf besye o r th fo t s swa some indicator proteif o s n metabolis d enzymatiman c activit, (I y pronouncee th 12)o S . d hypoalbuniinefni 0 day3 a so fromt afte 0 .1 r exposur observes ewa patientn di s with severe (esdegreS AR - f eo pecially with intestine injuriessurfacg bi a beta-der f eo d )an - matiti criticae th n sI l(Pig. phas3) . sicknesf o e maximae sth l manifestations of infectional, inflammatory and necrolic chances coincided witperioe hth hyperf o d - alphalphd an globulia2 1 - nemia«

.p •ri U •H H f.fl i 0.8 0.« ö 0.4

0.2

10 15 25 30 35 Days Note: Size of injured skin, surface and degree of radiât ion injury in patiônts. NI4 (60?i - II-III) N62 (90# - II-III) No C50 - #II-III ) N9 (46% - I-III )

Pig. 5- Albumin coûtent in blood serum of patients with the acute radiation syndrome of III-IV degrees.

239 The increase of activity of alpha-amylase at 1-5 days in its expression correlated witseverite th h generaf yo l manifestations andS ofAR , especially, with subsequent oropharingeal syndrome (Fig. 4).

•rl O •H rH Pi •H

cd oA

10 15 Days

subjecK t degree of BUS (bone- degree of oro- marrow syndrome) pharinçeal syn- drooie (OFS)

4 IV IV IV IV n II I 8 IV IV III II

Fig.4. Activit f blooyo d serum alpha amylas n patienti e s with e acutth e radiation syndrom f variouo e s degree. Degree of bone-marrow injury.

The increas f activito e f cretinkynasyo t 3-1a e 0 days have been connected evidently with the size of injured skin surface and severity of beta-dermatits (Fig. 5).

240 •p •H O •H iH P<

subject If degree of skin siz f injureo e d degree radiation injury skin surface of EMS

26 ii-iii 60% IV 2 iii-ii 96# IV 6 I-ITI 46% IV I 1I-ILI 50/& I'/ 29 I-III Ù-Q^â IV 8 I-II 25% IV 5 II &% III ei I-II 18% IL

Fig.5- Activity of cretinkynase in pabients with various degree of bone-marrow syndrome (BMS), siz f injureo e d skin surface and degree of radiation injury.

n criticaI l phas n casi f ARf aggravationd o eo e San s hyper- fermentmi observes e smalwa a th s la d secon de increas th wav f o e e n activiti f creatine-phosphokynasyo e evidenth s a td increasan e e of the blood content of alaninaminotranferase, asparaginotransfe- rase, garana-glutamine-transpeptidase (Pig. 6)» n terminaI l phas r extremlfo e y sick patient e increasth s n i e blood (and e urinecreatininth f o ) ured an ea conten notes wa t d (Pig.7)« However n generali ,o correctiv t e du , e therap e chanth y - ges of all these indicators rarely reached extreme values. In all patients survived these indicators have shown clearly positive dynamics and in those patients who died the fatal character of indicator change appeared ha s d onl n lasyi t day f theio s r life.

241 5 9 0 9 5 3 0 4 5 7 0 7 5 6 0 5 5 5 0 5 « 0 4 5 3 0 3 5 2 0 2 5 1 0 1 5 Days subjectN degreS BM subjecf o e N t S degreBU f o e 6 IV 28 IV 1} III 29 IV 26 IV 49 II

Fig.6. Activity of alaminotranferase (ALT) in various periods of the examination.

•p •H •HrH H O •H -P G .-I o o

M-a P aj O

subject N degree of BMS subjecN t degree of 3MS I IV IV 9 IV 2? III

Fig.7. Typical dynamic uref so a conten bloon i t d serum.

242 Bone marrow transplantation aggravate secondary b d y illness (3, 8) found its reflection in the dynamics of biochemical indicators which have been used in particular for indentification of this secondary illness. e analysiTh neuroimmunologicaf so l changes (studiee th f o s titres of circulating antibodies to the brain antigen and myelin protein reactioe ,th inhibitiof no migratiof no d specifinan c agglomeratio leucocytesf no , quantitative relationshiB d an T f o p forms in accelarated reaction of rosette farmation) in comparison wit clinicae hth l neurological picture (l»N, ShafcLrova, L.I» Mura—• vieva alss )wa oshows madewa nt I »tha t after general irradiation the threshold dos e valuth e f afteeo r whic minimae hth l signf so microdestructio braif no n tissue coul foune b d immunologicay db l tests in the prodromal phase of ARS are about 2 Gy. The intensity of neuroimmunological shifts was forced by toxic influences of local radiation injuries coursobservatioe e th th f n e.o I e th n Computer program for the use of the data of coded sickness history of neuioLogical syndrome was created and tested (I.JT.Shakirova and S.M.Shendyapin). The state of hemostasis in accident victims was determined by direct actio ionizinf no g radiation (the injur thrombocyf yo - topoiesis, structural change bloof so d vessel walls wels )a s a l indirect one (L.S. Pochukaeva). The activation in coagulation step at all times of prodramal phase of sickness (the increase in maximal activity of thrombin thromboplasti n autocoagulationi n test permanente ,th , presence in the patients blood of soluble fibrin monomeric complexes) was found. These changes could help intravascular coagulatiof no blood. The increase of fibrinolysis in latent phase of ARS of intermediate degree made possible the dissolution of fibrin formed liquie anth d vesselse d bloo e th stat th n i df n especiall eo .I y heavy case injurf so y this mechanis feedbacf mo s brokekwa d nan

243 the blockade of fibrinolysis lead to precipitation of fibrin and formation of blood stasis in microcirculatory vessels. It could lead to the disruption of organ functioning and to the secondary changes of the vessels walls. On the background of the activation of the system of herao- presence th f stasi o microclotf o ed san microthrombd san s there s enhancewa d inclinatio hemorrhager nfo scase minof th eveeo n ni r vessels injuries. Thu reactioe sth paradoxicals nwa , while hemostasis activation was not leading to heraostatic effect (Pig,8). As the result of permanent observation of patients for one year and a half no necessity to reconsider the degree of severity arisens ha e cours4 Th «2- sicknesf S o eo AR f prodroman si l phase as recovern weli s la y phase corresponde previour ou o t d s ideas (5,6) about peculiaritie acutf so e radiation sickness resulting from total relatively uniform exposure in the indicated dose ranges. It seems appropriate to come back and give special attention to the criteria of diagnostics of slight degree of ARS and to the few observations in the subclinical range of doses to find out more distinctly at what dose levels and in what time the individually significant clinical reactioe signth f so organismf no o ,t exposure could reveal itself (5,6,10). After careful analysi mosf o s t full blood changes, observations made in specialised in-patient facility it became clear, that regular changes of leucocyte and thrombocyte counts in patients appear only at 5-6 week after exposure. There may be a shift of these symptom severar fo s l days (abou weekI t ) with earlie- rap pearanc change th n thrombocytf ei eo e count primare .Th y reaction could be expressed in those cases in different degree, but appears regularly in the later terms (up to several hours after irradiati- d onl sucan n yi ) h on sign nauses sa vomitingd aan .

244 i i l bleeding sickness l

__._.. throinbocyte 2.6 -x—K- protamine test

•H U -M - ethaaol test rH .S1 16 -/—/• MA in autocoagulogram i s. w 3 1,0 Norm "o '•* 0,6 a.1»

10 15 20 Days O.

| j bleeding si< i.' 2.« _._._ th_ 2.6 \ v ' ""pi * —~ x 3.* V \^ £t e 2.2 x v ethanol test 0 5.« X •H f.t »ôH. ^ y •H 1.« ^ x rH 13 * g 1* —/—/—/—/_. /_/_,_»/_ / — 0)1 H i.O N ' id W * N Norm o 'N Off' "N. QA X Oî x 10 15 20 Bays

(a - subject N26, b - subject N25) Note: All the indices are given on multiplicity of deviation from the norm, the arrows mark the manifestations of bleeding sickness. The therapy by plasma and heparin was carried out.

Fig«8. Typical ratios of hemostaais indices in patients with acute radiation sicknes DVd san S syndrome. The external exposure doses in this group of patients accord- e dat th f cariologicao a o t g in l analysis (the frequenc f diceno y - trics )e rang th wer f 0.8-o en i e (80-20v 2S 0 rem). At the retrospective consideration of the cariological data for the group of persons, who have been considered in the early terms of observation as possible patients with ARS of I degree du o differen t et onl no o abovyt d an te mentioned symptoms, there

245 were foun followine dth g regularities (A,V, Barabanovar A.V. Sevan— kaev, M.V. Konchalovskij)« Prom 21 persons, whose irradiation doses have been estimated between 0 and 0.6 Gy according to cariological data, nobody showed the characteristic symptom ARSf so . person0 2 n I s with doses estimated accordin cariologicao gt l data between 0.7-2.1 Gy it was possible to speak about the accep- tabilit diagnosif dynamicdegreee I o y th S AR d neuf ,f an o so s - trophiles count indicated the mean doses in bone marrow about 1-2 Gy. Thus dose whole-bod,f th o e y irradiatio couly G tene 7 b d -n0. tatively considere minimas a d l dose leadin weao regulat t g kbu r individually significant changes in blood picture, which are characteristic for ARS I degree. Good coincidenc e cariologicath f o e whollf o datd e an adyna - mic neutrophif o s l count permitcomo t ee agaison n retrospectively to the validity of diagnostics of slight form of ARS. The diagnostic s possiblsi irradiater fo e d person casse f th eveo e n ni absenc informationf o e n dos,o e levelscase f th i e n wels i ,a s la some information about dose borden si r region (0.6-1.s i ) 2Gy present. We are using those rules systematically adding to them the available methods of dose reconstruction. The following graphs illustrat) (Fig9 . characteristie eth c dynamic neutrophif so degreeI S l AR case count .f th o e n si The first varian diagnostif to c computer program unifying the approaches to the diagnostics of ARS I degree have been developed« assessmene Th effectivenesf to e th f o treatmenf so e on s twa aspects which have been additionally analysed» The main principles and direct results of treatment of ARS of different degree of severity were discusse severan i d l reports (II, 12).

246 ,—— , —— l —— , —— ' i —— i 1 —— ; 1 —— i —— i | —— r i —— « — — i 1 1 —— 1 —— l —— i 1 —— ; 1 —— l | 1 —— i 1 S h ,. A ^ ! : .,.;«-,. 3 ; - -\/:\ ;x,., /x ;,."--- ; ~-~ . 7 '' • V *••> : .../-" M' 1 , ^ _ . . . .^... .. _. .. ^ ...... J .1 " ' «48 : - »*-•>•• : . *-' *» -t •• .•• ra 5

0 \ • ^f^f^^\. •H «3 ...... r ... . V*V ...... / ...... :...... O *3 f • \ /^A,/ •H tu $ ; : v " ; : O ,H 3 _ O -P Î Register UKN=98 sCO dose 15 Gy ; CD aj *'• T ' ' ' ' —— neutrophiles ~ • ---thrombocytes 5 3 . 2,

..{ _.. - . J-...... ,...... ; i .... - : - » 5 » 4 t i 8 c2 «

Time , days

? 3 2 »-.--'""v.\ .'.. .•" . . . ' - f . .. r • * ' v " — - —-• v 1S44 ; ' A * 5• -'--/"/ •A ? ^M'^vJ: v ' 2

Indice s ^ /- \ "v " Jj3 0S 5 \ IWv" / : ! ; ; V>y ; 3 fl ! Keg ister UKN=I03 ; y G dos 5 1 e

matologi c il? neutrophile— — : = s w03 '' 1 s 5 | ; --- thrombocytes '• - : : : • 1 Î : : : ff ! 1 1 . : i • 1 1 c > _ J 1 1 I - i 1 , - . !l1 » . • . s a n a < » T it Time, days

F1ig»9. Typical curves of dynamics of leukocyte (neutrophiles) and thrombocyte numbe patient2 n ri s witacute hth e radiation syndrome of minor degree.

247 The analysis of the causes of lethal outcomes as well as the data on the dynamics of clinical and laboratory indicators of living patients studie thio t d s moment serv addititonas ea l criteria of the effectiveness of treatment. Let us consider in regular order the short preliminary results of those two aspects of observations. As it was said "before due to ARS 3-4 degree, 2? patients have died and one woman due to AR degreeS2 timee .Th deatf so h differe day6 9 - dsin o t fro I mI cludin patiento tw g s with combined the.rmoradiation injuries. Further date ,maith n ao n element pathologo-anatomicaf o s l pictures of the patients, who had died due to ARS and its combinations with radiatio d thermaan n l injurie skif so n timni e from II to 96 days after accident, are given. Specially stressed are the cases with unusual causes of death for a given time of observation. For all the patients the pronounced severity of the course of sickness was noted due to combination of 2-3 clinical syndromes and complex spectrum of toxic and infectional aggravations and circulatory deficiencies. The skin lesions covering the significant part of body surface came forward as one of the leading causes of death in the structure of tanatogenesis for all terms from the moment of irradiation. For death occured earlier than 24th day, the skin lesions were accompanied not only with heavy disruption of hetnopoiesis but also with early pronounced intestinal syndrome« As life times were increasing, the skin injuries have been more frequently connected wit froe syndromeo hon tw m S AR f so (bone marrow acquirer )o independene dth t significance th n ei outcome of the sickness.

The combination syndromef so , their aggravation- di e th d san rect cause deatf so muce har h more varie timen di 8 4 so t fro 4 m2 days after exposure. It gives the impression, that by excluding

248 some of these aggravating circumstances for these terms it could tie possible eve chango nt e outcom sicknesse eth th f o e n seve.I - ral persons for these times on the background of heavy injury of heraopoiesis there were sligh distinct tbu t sign centerf ao f o s regeneration of bone marrow and of regenerating parts of intesti- mucosal na . ?or the outcomes in the end of the second month the extremely high severity of infectional (including viral) aggravations was typical as well as dystrophic changes in parenchymatous organs. For many patients and for different, terma the various circulatory disfunctions in capillaries with the most frequent locali- zation in lungs, under mucosa and in the brain were characteristic. Heavy, fatal haemorrhages were rare. In general the assessment of the effectiveness of the whole complex of measures for treatment of ARS taking into account the severity and combinations of clinical syndromes could be, given as quite satisfactory (I, 2),The analysis of the effect of bone marrow transplantation for the limited group of patients is given in special repor A.A.Baranoy b t t thiva s conference. It is dificult to give the assessement of the other separate components of the treatment. However, taking into acount the data of postmortem morphological studies, it is possible to speak about definite effectiveness of the system of prophylaxis and therapy of infectiona especialld lan y bacterial aggravations s achievewa t .I d by isolation of the patients and by organization of special asep- tic regimen for the patients in the period of agranulocytosis, by therapeutic and prophylactic use of antimicrobial and antifungal drugs and in some cases by local application or injection of anti- viral drug (aciclovir). fro7 Onl person1 n m2 yi S AR dieo o swh t d of 3-4 degrees the diagnosis of sepsis (in 4 cases mixed fungal and bacterial casa3 n ,i s bacterial s confirme)wa d after pathologo-anatomical and postmortem microbiological studies. In others,

249 microbial contamination of tissues was not pronounced, and only insignificant numbe colonief ro notes necrotisr wa fo d c surfaces of ski mucosad nan . e otheTh r important componen f treatmeno t te schemth s ewa replacement therap blooy b y d components e eviden.Th t direct effectivenes allogenif o s d autologicaan c l cryoconservated thrombocytes shoul specialle b d y stressed e patienon r t.Fo witdegre3 2- h f o e ARS 3-Q transfusions of platelets (300,000,000,000 in one portion) have been used in average. Such regimen ensured the absence of life-threatening bleeding for the overwhelming majority of patients with bone-marrow from of ARS not aggravated by other syndromes. This effect was observed even in the case of long-term (14-20 days) and profoun « d500 0 cells/microliter) thrombocytopenia. direce th s tA caus deatf o ehaemorrhagie th h c syndroms ewa observed for one patient. Haemorrhage was provocated by traumatic manipulation when catheter was introduced into the subclavicular vein. For the correction of metabolic disturbances and also in the case of impossibility of direct tract mucosa the undoubted direct effect gave total parenteral nutrition. All necessary means for symptomatic therapy v/ere also used (in cases of the signs of brain oedema, toxic nephro- and hepatopathia, discirculatory and hypoxic encephalopathia)« However, the combination of two or three syndromes rule s fatalth e wa s a « o thest e e Du s hardlfacti t i sy possibl estimato et e LD-5s 0a e alreadw y mentione experte th t da s meetin Augusn gi t 1986. Some kind of general quatitative characteristic of the therapy effectiveness could be the information about frequency of lethal outcomes r groupfo patientf so s with different degree severitf so ARSf o y. s mentionewa t Ai s dpatient3 5 abov f o e losw e s on twit h2 degre ARSf o e, whos ebackgroune irradiatioth n o , Gy d 1 n 4. dos s ewa of practical recovery from ARS.

250 From 21 patients with 3 degree of ARS (dose range between 4.0 survive) Gy 0 an. d6. 14 All patients beside wite son havS degre4 h AR e f o diede , but, as the analysis of pathologoanatomical data shown, the death came resule ath s combinatiof to f severano l clinical syndromes and,n i first place, of the combination of intestinal and bone-marrow syndromes with tota subtotar o l l injurie skinf so . e time deatTh f o s h after combined thermoradiation injuries presence th slighday3 e 2 th n si d f twero ean - degre6 e1 in f o e testine patien e bonf injuro on ed r othere marroan tyfo th r ,wfo what shows the leading role in tanatogenesis of skin injury (pa- 24). No .d an tient5 2 . sNo e breathinTh g problems wer complef o e nonuniford xan m nature for persons, who died at different times. According to the results of pathologo-anatoxaical studies they were significantly pronounced for 13 persons and were especially significant for 7 of them. There were sign expressef so d circulatory disturbances, the injurie alveolar-capillarf so y leve interstitiad lan l oedema for all times of observation and typical fibrillar-haemorrhagic manifestations in persons, who died at later terms« course hal a dynamiyeae a th d f th n re o an I c observationf so l thosal e personacutd ha eo swh radiatio n sickness (ARS) were continue asseso t d completenese sth recoverf so y processes e pro.Th - ces haemopoiesif o s s recovery came very actively- pa 84?n :i f 5o tients after I-I.5 yeanormae rth l blood picture have been restored. The distinct dependence of the completeness of recovery from severity of sickness manifestations in prodromal phase (from dose of general irradiation) was found (V.fT.Pokrovskaya, If.M.Nadezhi- na). Moderate vert jno y stable leucopeni mord aan e rarely thrombocytopenia momene stayeth latesf o o t d t d observatioan 5 1 » 9 n ni 30% of persons who had ARS respectively I, 2 and 3 degrees. At

251 the personf samo e2 1/ tima n witei h incomplete recovery evet a n the first entrance observation the moderate decrease in the number of leucocytes (granulocytes) and/or throrabocyte s notewa s d what indicates insufficient he.-nopoieais. At later term moderate th s e unstable cytopenia evidentl- in y creased and was due to the illness of digestive tact previous to ARS (hapatitis, gastritis, ulcer). patientl Al sdegre3 witS hAR e suffered from local radiation thef o injuries ml havinal r .Fo g cytopeni prolongee th a d treatment including plastic surger necessarys ywa - The studies of capacity for physical work and of energy expenses (V.V.Charitonov, O.P.Efremovtseva) have shown favourable dynamics of these indicators gradually increasing in course of recovery from ARStim e d completenesTh »ean recoverf so y dependea n di certain severitdegree sicknese th th n eo f r irradiatioyo s(o n dose)• The studies of capacity for work and necessary energy expenses for it allowed to note follovfing regularities. The group of persons without clinical signa of ARS in all time observatiof yeare so on )o t preserv p (u n abilite eth o yt fullfill work at significant levels of energy expenses -4.9 kcal/mi characteristie nar patientr fo c s degree I witS hAR . The patients with ARS of 2 and 3 degrees of severity differ from the considered above groups of patients even at the latent phas sicknessf o e d thei,an r abilit r wor yfo limites k i y enerdb - gy expense highet no s r than 3.0-3.8 kcal/min. For the patients with ARS I and 2 degree the levels of physical abilit restoree ar y d wee9 alreadstad , higt an k8 ya t hya value yeaf o rd s afteen tile rlth irradiation. patiente th r Fo s degre 3 wit S indicatore hAR th e capacif so - phase th worr f earl teo fo yt k a y recover worse ar y e than initial (3.5-3.8 kcal/min respectively) and even to the end of the year does not reach the normal levels.

252 The reactions to the physical stress significantly differed individually becaus differenf o e t age, physical conditiond san previous illness of the patients. Very interestin resulte th e f compleso gar x clinico-psychological studies of neural and psychic activities (P.S.Torubarov, P.V.Chesalin, O.V.Chinkina). Complex stress and radiation situation brought about to the development of objective signs of moderate asthenization in early recovery period (4-6 month after accident) only in part of the patients. Asthénie manifestations cor- relates frequencit n i d d expressivenesyan s wit e severithth f o y sickness (3/4, 1/2 and 1/3 in persons with ARS 3» 2 and I degree respectively). However, even this time together with still unfi- nished recovery processes in somatic sphere certain significance developmene th r fo asthenif o t d premorbiaha d peculiaritie perf o s - sonality, aftitude of patient to the risk of irradiation and sickness, the degree of information, profession and the construction of oriented basi r futurfo s e workin d commogan n life laten .I r terms (9-18 month) the leading role of somatic basis of asthenia (ARS severit phase th formationf o en yi d passed)ha , especially because the definite recovery in the function of main organs and systems was observed. Asthenia depended on the socioprofessional factors indicated above workinw , ne adequac e th g f placyo d ean previou e sicknesth o st s personality peculiaritie victime th f o s. Our experience shows, that in choozing the indications or contra-indications for some kind of work the objective many- sided stud physicaf yo d psychilan c efficiency, structur selff eo - estimation, psychic condition of personality, reactions and peculiaritie personalitf so y adequat consideree th o t e d work have great practical sifnificance. Rational choice of working place d favourablan e socially-personal rehabilitation hel reaco pt e th h high degre recoverf o e workinf o y g activit f fulo y l value even in patients who had suffered ARS 2 and 3 degree.

253 The whole complex of all clinical and paraclinical methods of study givpossibilite th e overwhelmine th r fo y g majoritf yo ARS patients (5/6 limio )t n futuri t e onle contacth y t wit- hra diation sources. Onl smale yth l numbe rul e themf o rth e s suf,a - fering from intercurrent illnesses, were limite relation i d f no working regimen (exclusio nighf no t shifts, usag protectivf eo e cloth, gloves, etc.) (N.M.Nadezhina, A.V.Barabanova). Acknowledgement temporaf ,o l invalidit nexr 2 yearyfo 1- t s patienn i mainls twa y motivate reiduay db l manifestation- lo f so cal radiation injuries, higseveritS AR h y f b degre o r yo ) (3 e combination of ARS with other illness. Dynamic observatio patientf no e secon th n dsi year aftee th r accident shows in 3/4 of them undoubted improvement of capacity worr fo k excluding three patient witI ( s h local radiation injury, 2 - non-rational choice of working place). It gives the possibility of gradual broadening of regimen of their working and social activity. t shoulI e noteddb , that correct choic worf o e k adequato t e general condition persoe th f no s after ARS, personal interesn i t this work give e evidenth s t favourable emotionally-psychological influence and stimulates functional recovery. completenese Th f sociao s l -personal rehabilitation afteS rAE s clearlwa y demonstrate whole th eo t dworl screenV T de wheth sn no of Italy, Great BritaiappeareA US d patienr nan ou d t L.P.Tel&tni- kov, who now actively works at the Center of fireman training. Such examples coul mane b d y times multiplied includine th g cases when high professional capacity for work was retained (without or with limited contact with radiation). These patients are engineers and operators of NPP who suffered ARS of 1-2 degrees. Several persons are working now at Chernobyl NPP and their radiation doses in 1987 were not higher than 0.6 rem«,

254 REFERENCES

. Report1 : Acciden consequencess Chernobyt it a t d an P lNP . Infor- mation prepared for the IAEA experts meeting 25-29 August 1986. 2. Summary report on the post-accident review meeting. Safety se- INSA- 75 rie G. sIAENo A Vienna 1986. . Guskov3 a A.K., Baranov A.E. Hématologie effect victimn i s f o s Chernoby P accidenlNP t (ReporRoyae th lt ta Colleg Patf o e r 'lo- meetings t s gi , "Low level radiatiof so n etc. Environmental factors and oncogenesis". Gz>ect Britain, April 1987). . Ilji4 n L.A.„ Pavlovsky O.A. Radiological consequence Chernof o s - byl accident in the USSR and so-i* remedial measures, Report at International Conference on safety criteria of nuclear energe- tics comma 28.09-02.10.87 IAEA Vienna 1987. 5. Pyatkin E.K., Baranov A.E. Biological dose indication with the uschromosomf o e e aberration analysi celd san l coun peripn i t - heral blood and bone marrow. Itogy nauki i techniki, VINITI AN 103. p SSSR, ,3 1980 . ,v . 6. Acute effects of irradiation in humans GKAE SSSR, NKRZ pri Min- zdrave SSSR, CNIatominform, 1986. 7» Konchalovsky M.V., Baranov A.S., Guskova A.K., Selidovkin G.D. Total gamma-therapeutic irradiation in dose 3 Gy in case of acute leukemia. Hemetologi clinicad can l aspect bone-marrof so w syndrome. Med 5-15. pp radiol , , II 1987o .N . 8. Baranov A.E. et al. Bone marrow transplantation after- whole- body irradiation in victims of Chernobyl accident. Ter. archiv. 1987. 9. Guskova A.K., Shakirova I.N. The main regularities of injuries actio radiatiof no human no n nervous system. Literature review. Zh. nevropatol. i psikhiatr. 1988 (in press) lO.Sevankaev A.P. Radiosensitivit chromosomef yo humaf o s n lymphocyte mitotin si c cycle Energoizdat. .M , 1987-

255 11.Guskova A.K. Acute effects in victims of Chernobyl NPP accident, Med. 198?radiol, 12 . ..Ho 12.Guskova A.K. et al. Diagnosis, clinical picture and treatment of acute radiation sickness in victims of Chernobyl NPP accident (I-st communication). Ter. p.rchiv I988. 13.Health and Environmental consequences of the Chernobyl Nuclear Power Plant Accident. Report to US Department of Energy. June 198? Washington D.C. 20545«

256 TRANSPLANTATIO BONF NO E MARRO VICTIMWN I S CHERNOBYE TH F O L ACCIDENT

A.E. BARANOV

Abstract

Bone marrow transplants were carried out in 13 patients suffering from acute irradiation sickness afte Chernobye th r l accident. Only blood relations of the patients were used as donors. The number of bone marrow cells transplante dt leas a musx 10* r kilograe 2 tt*b pe f recipienmo t weight.

experience Th presene th f eo t bone marrow transplant s showha s n defects in clinical methods of early diagnosis (during the first 7-10 days after exposure) of acute radiation injuries to the skin, intestine and lungs which are incompatible with survival.

Another problem with bone marrow transplants for patients suffering from acute radiation sickness is to determine to what extent the depression of marrow activit s irreversiblei y . Spontaneous regeneratio myelopoiesif no s wa s observed 22-30 days after exposur patientn d i receivee ha o wh sd dosef o s 7-9 Gy. A lapse of this order before the onset regeneration is therefore, in principle, compatible with survival under the conditions of modern support therapy. Thus beliee ,th f that prolonged acute radiation pancytopenia which is incompatible with survival start evidentls si already G 6 t dosey5- a y f o s incorrect, at least for the relatively low exposure dose rates experienced by this group of victims.

The result bonf o s e marrow transplant victimn e Chernobyi s th f o s l accident suggest that, in future, the following rules should be observed in transplanting human bone marrow to victims of acute radiation sickness: ) Onl(1 y HLA-identical transplants shoul carriee b d d outd ;an (2) HLA-identical bone marow transplants should be carried out only in patients who have received whole body doses of gamma radiation of 9.0 Gy or more.

The experience gaine myelotransplantation di n following accidental exposur healthf eo y humans (acute radiation disease f humans)o availabld ,an r analysiefo a scarcesi comet i o s ,t sa transplantation bonf so e marrow withou- pa tn i matchin A HL y b g tients injured during reactor break-dow Zincn ni e (Yugoslavia^ and a single case of syngeneic transplantation in Pittsburgh (USA) in 1967. For this reason, bone marrow transplantation (BMT) performed in patients injured during the accident at the CNPP, were guided by the following principles, formulated on the basis of experience of treating acute, radiation disease (ARD) in humans and applying BMT after exposure to superlethal doses in hemoblastoses.

257 Transplantatio. 1 allogenif no c bone marropatiD AR -n wi ent indicates si casen di severf so extremelr eo y severe (irreversible) damag myelopoiesisf o e , occurring when dosef o s total short-term uniform external gamma-irradiation reach 5.0-6.0 Gy and more. 2. Transplantatio HLA-identicalf o n , HLA+haplo+I-identical d HLA-haploidenticaan l bone marro allowables wi , thouge th n hi last case it may be performed only after removal of T-lympho— cytes frografte th m » 3. At any degree of histocompatibility between donor and recipient the prophylaxis of acute secondary disease ("graft- versua-host" disease) is mandatory^as well as, probably, prophylaxi transplanf so t rejection (particularl casen yi HLAf o s - nonidentical grafts). This prophylaxi carries usiny si b t gou d immunodepressants (methotrexate, cyclosporine A, antilymphocyte globulin) after transplantation. numbee Th transplantef . ro 4 d bone marrow cells shoult no d b.wg k recipientf I .o br e pe les s0 . 1 thax n2 Q 5. Absence of negative effect in similar allomyelotransplan- tatiorxfin ARÛ patients with reversible degree of myelosuppression, r eveo n their beneficial effect reduceo t e ,du d term f pancytoo s - penia associated with temporal engraftmen transplane th f o t r o t its low-stimulating effect. Proceeding from the above principles we have carried out D patientAR 3 1 sn i injure T BM radiatioy db n durin accidene gth t at CNPPo During the accident the patients had no emergency dosimeters, The rate of external total gamma-irradiation of bone marrow was estimated exclusively on the basis of previously developed methods, that is by the number of lymphocytes and neutrophilic granulocyte peripheran i s ly amoun b bloo d aberrationf o tan d n si the culture of peripheral blood leucocytes.

258 Some patients, despit e anticipateth e d sever d extremelan e y severe myelosuppression suggeste dosimetriy b d ct datano d ,di undergo BMT because of the following circumstances: I) clinical conclusion on incompatible with life lesions of skin and (or) intestine lacsuitabl) a 2 ;f ko e donor conclusio) ;3 ne madth n eo follow-ue th 10tf o 13to ht y p h da tha t recover patient'e th f yo s hemopoiesin ow feasibles si » Hématologie indices of these patients served as control value relation si patiento nt s undergoing BMT. e donorTh s were selected only fro patient'e mth s clos- ere latives (brothers and sisters, parents)„ Typing of donors and patients for HLA was performed only with respect to antigens of A, B, C loci employing here standard antisera. e bonTh e marro takes wwa n from donors accordine th o t g technique described by E. Thomas and R» Storb. If incompatibility between the blood group of donor and recipient was significant, the erythrocytes were remove myelokariocytophoresiy b d s with bags for blood transfusion after pretreatment with polyglucan. T-lymphocytes were removed from haploidentical transplants by Dr, -f.Reisner , one of the authors of the given method, in conformity with the technique described earlier. preveno T t acute secondary diseas l patienteal s received cyclosporine A (CSA), and some of them were given additionally methotrexate (HT antilymphocytr o ) e globulin (ALG). Usually CSA [ Sandimmun , Switzerland) was injected intravenously hour4 2 s befor3 day0- sr eo afte r transplantation firse th : t dos 12.f o e 5 mg/k administeres gwa infur h 8 fore -f th mo n i d sion, later followe mg/k6 (equay 3- da y ga ldb doses r everh 2 y1 infusions)r h 3 fore f th o m n i . Cyclosporine dosvariabls wa e e depending on its level in the whole blood, which was maintained within the range 400 and 600.

259 Methotrexate was used according to tha scheme described in the protocol from Seattle, that is 15 mg/m2 34 hours after BMT o followed by 10 mg/m 3, 6, and II days later. AL Lymphoser( G , "Serum-So- Impf institut Bern" Switzerland) was administered on alternate days only to patients who underwent haploidentica dosen i mg/k0 T s2 lBM g b.wr singla h s 8 .a e6- infusion. blooe th dl preparationAl s were irradiate gamma-theraa n o d - peutic apparatus (Co ) (dose 15.0 Gy). prophylaxir Fo d therapsan f thrombocytopenio y a hemorrhage, there were made infusion platelef so t mass, derived mostla y yb metho repeatef o d d 4-fold thrombocytophoresi healthn si y donors. Leucocytic mass was not transfused for prevention and treatment of infections. The principal clinical findings, data on doses of total gamma-irradiation, assesse variouy db s techniques, resultf so BMT, length of survival and causes of fatal outcome in ARD patients who underwent bone marrow transplantation, are presented in the table. y leveB f totalo l gamma-irradiatio patiente nth dosl al es assignee b y ma threo wit t dT hBM e groups :grouI p with radiation dose 9.0 Gy, in group II it ranges 6.6-8.7 Gy, and in group III 4.4-6.. 4Gy Ijmamic change numben i s neutrophilif ro c granulocytes, platelets and lymphocytes in 6 patients with BMT patient5 n i d san without BMT, whose total radiation doses ranged 13.o t fro2 4 9. mGfy frod ,an m 11. 13.o 2 t respectivel, 8Gy s ywa withi day0 n1 s afte exposure rth e approximatel samee yth .

e neutrophiTh l coun restoree s noteb t wa o t d n patienti d s from the group with 13 MT. It seems reasonable to assume, that in one case (UCN 9, dose 9,6 Gy) the restored count was due to surviva HLA-identicaf lo l graft patiene .Th d 23 te th die n o d

260 day, and the main causej of his death were II-III degree burns of skin, injurin"bodf o y% surface0 g5 . secone th n dI case (UC dos, N16 e 10. HLâ-haploidentica, 2Gy l B&IT), the patient's own myelopoiesis failed to recover completely, that is confirmed by karyologic studies (see the Table). The patient died on the 91 (+79) day from cytomegalovirus interstitial pneumonia (proved by histologie examination after his death). Histologie studies of autopsy material also revealed alterations in the skin, liver and intestine, thereby lending support to the diagnosis of acute secondary disease. All the patients both with BMT and without it, who were assigned to the group with a dose of 9.0 Gy (with exception of one pa- ) dietient16 dN fro,UC m severe diffuse radiation burns combined with other acute radiation syndromes (intestinal, otopharyngeal, acute radiation pulmonitis) in the period from I4th to 23d day. Change peripheran si l bloopatient3 n i d s with BMT and in 4 patients without BMT, who received, respectively, total radiation doses ranging 6.6 to 8.7 Gy, and 6.8 to 8.5 Gy were the following; 3 patienta wit hematopoiesiT hBU s starte recovero t d . Regrettably, twthef o 25tme th dieh n d 24t(+19do an h y )(+11da froy )da m severe radiation burn acutd san e) (UC radiatioGy Ndos, 6 I 6. e n pulmonitis, and, probably, ARD (disclosed at autopsy) (UCN 27, dose 8.3) patiene .On survives s ha hi t ) d (UCGy dan dos, 7 N29 e8. hematopoiesis has been seen to recover completely. In this case^ acute secondary diseas bees eha n suspected becaus fevef eo r with unclear genesis observable within I3th-57th day, which coule b d relieved solel higy yb h doae methylprednisolonf so e (see Tabl. I) e In two patients of 4 without BMT (UCN 22 and 31, doses 7.1 numbee th bloof ) ro Gy d8 anneutrophili6. d c granulocytes star- daysd restore e 22 patiene b 24te te.d On o th t dhan n tdo from this grou ps survived ha (UG ) Hhematopoiesi22 s ,hi completels sha - yre

261 O T*

in cn" y* O •*- t- Üj t-l »—« M cn c o ai et lü Œ •H c a- i Û- " a. . -a u. :> Q D 5 n u üj n K CQo"c ffl ix a: Q ce i ITS b o 0) os in TH m CD U c L > -w a. L x in in N CD (0 M 0- in N -H M 4J j-uoi«>ifl(iiBi -a 0- -0 0- 0- i »H N tv N i 0 4J - l_ 1 1 1 1 so is 4J in ai 0- -< 0- ai c x+J t- 1 i 1 1 1 1 ri to •H 01 tt. v. u -4 IV OJ * 1 O Oi C 11 0 X > 1 i -N J} K) CN IX L ? i x j < e 1 i -4 1 C l 0-*K) * Nn •H 1 M - i v ne is us -0 * o n o O O O L. -H E 4- E O o CM N in ^i in in -o CT> M Kl DQ fl CQ C H S 8 0 1 0 I 'I l i o in œ -0 l'i m HH - 1 CM •H i moniLr»<,.3>-virE i -H i 1 1 K) M

m CD 1 i 1 1 1 i 1 1 1 _J 1 1 1 1 m in c K T3 U L Cf o* in O CN i— t a 3 m i- 4i 1 i 1 1 1 l 1 i i l 1 a ) U E > T J T r3 c * ffl o (O O 1 »H M in O c K)' •0 m r*- t N -0 CM n CN E in i in o K) N •0 0~ 0- M 0- 3 in u a> ~ • n —o es" N N (S o" O O~ n O 4J o t- a -i O -i M i- C x u 0 a L OJ V. 1 «J a. a. a. 0. D. o. a 4) flj -H 1 0 H C E £ E 0 6 cj E U E e p H C i i 1 0 u c n i g i a o Q 0 0 O 0 v x O 0 00 ) 3 -H r » t! U U u » O O a-*-u l Jc3 -H -u H - . * f -4 .-4 o a« CO O n CD 0- •0 a L -P in «5 (N m 3- m in r. c c -< in m U. CG cn £ m CQ Cd r cn cn es 01 tt I D H l t 0 >5 ut ^ L. Q L > rj 0 >• L 1 1 L. O «T -a s n -0 fO CM f 0- E "t 1- 0l X 0 3 »H -H Tl )U d C I Û J -4 5 « D 03 -

1 +J « S*? 0 58; v •-< £ n> l Cd •o 0- CD •0 I 1 1 i j •H , ^3 L l T M0 l H 1 . > V S I 1 O 0 o o m O o 1 01 0 TJ L U o -0 o o m in n CN i?'! ^ tu L 03l«S 0- -0 •H 4- q }-! J3 l» t- TJ •M Qj 1—4 >~4 v-4 OJ i in ai 1 W L »•H 1 1 55., fe 5 T 1 1 >-4 ^4 t-4 S =

r. a -n ui i -a

oi 1 1 Ut -P X L L 0 0 01 ^>~ Ü^ r~* 5, .rt jl rt — S. CZ IT. t> H (t- " 03•- o , a 1 0 û > TJ *H -t M f'1 N CM * T3 C 4- 01 '^ >• J -^ "-t ? + 1 1 1

r-l -« i wi m -1 N N in m IN n 0- in (N rfi Z « » •i u -0 m 0- CO 0- ch r^ B- in in U W < •• 0 t -0 M C t- L « 1 •M lj- CD O -c N Q • > . > 1 0 •o" 0- '£ «n, l0"0 ...... O 1« S C T3 •0 K> ^ -H CO * O in N 0- fM Q Dl-I HU o C^ rJ r- m i"i in 0 «J- * m

01 Ol CD CN in o N W Kl in -o -n

262 1 Z û o 4- 1. i-i O Tl D er 4J no O Ul CCI 0 1C Ul Ë 01 Ê O 1 en 01 C *• 01 rf C 3 H 01 0 rf 4J Q 0 CCI .Q *• H X: 10 H Ul 0 0l _l C "O _ m e in in ~ Q it 4J oi a in Q l->0 U CX) -H E L in in z 0> 1 Ul oi rf >- r rf>-< 01 ~ - S- CE > xiQJ a o « L U) D 01 -~ I UQ.4JX)p-i4 _J 0 10 rf rf rf >. - tf 01 g 0 O (11 > H! 01 Ul Tl u ' III(J n inSD t ai 4J OLittJ^UUTI it dl^ L 1! *J XItL E 4J E -o m tn . 1 ai 1 1- E 1 i.03t 1 Ol 0 tl l- U t H- >- 1 01 rf "OHl Ol 01 U C rf »rf 4J 0 X> L. >va- 1 rf 1 0 O> C ro l 15 oi o oi in Ol dl 1C ;•£ J3 Ul S- 4J »1. C t 4J in oi 01 C>-4J (- 1 CD E a 0 U Ol u O ^, >. 3 C H c a -H 01 Ul t. 1 rf a DI l. H 0 0 • • . C H- T) 1 4-1 Z XI ^_ >. C .c E Ol l. _^ 0 rf u C u I-t 4J •^ Tl 4J n^ z: OJ L rf Ul 4-J >- U 01 Ul 0 L •o 3 L C 0) 3 U 1 0 a rf rf u D ^ 4-1 r r L C o oj •D ,*^ 3 aj in M C m 1C rf m Ol it Oi TÏ L, H 1C 0 K E 01 Ul . rf .Q ** «r ,-* n U. x: E r oi : t- 4J ns 01 4-1 a ,0 4J t». Q r in 4J m ,— c 0 ^ i . • 01 C u m n v. 1 1 *• • • u 0 in ä H 1 c m l P * 4J XI PH 7Q H >T3 4- •o ; ^ 4J a 0 [J >- o ; ^*. c •o ^-* UJ Q 3 0 in 01 Tl 4J ce 4J in 0 1. 3 en Ul (fi Ul 01 ai V. ^ ai in o i 1*0 (t C Ul E 01 tf. U 3 1C Ol V, 1 • ^ if_ 4J 4J ro a «r •o ^ E û. rf Ul Ul 01 •W XI It en ï r L Ul Ifl i— < •H kO o s. 1 01 Ul 3 0 rf .u XI Ul Ol Ul Ol c X n 1 1 «s i*. E 01 rf o > >, Ul 0 0 C 1 a L 01 g a S T! > . 1 « t . 1 1 4J l C - C • ni . C ,XI O vH i H ' . 0 3 t U 3 L 01 L <0 H It rf 0 rf C • Ol Ul rf Ul > C L 0 e Oi n - 3 ' rf t- •o U ce œ 4J 3 Ol C 4-1 rf Q s c Ul 4J U I 0 1 r 4J U t- >. * 0 — S 3 r. ; J PM Q L en oi U i 0 } •o 4J V- L a. C 01 3 E V- rf 3 Ul 0 C H lu 0 en L Ul ,-4 1 (Ç a K «s OJ 4J V 01 Ul Ol in L 01 O » Ol 1 L Ul 3 Kl f u rf 0 C 0 c \ t L ni in L 01 *k a 10 C n 01 u rf 0 C 1 If. ÔJ ^ 4J h- T3 p~( «H I 0 — ^£ £. Tl u 4J Ul «u 1— ( LU E Ol 1. 01 a rf a UJ 1C a 0 Ol c i H u 1 Oî | • •a pH H- V 4J 0 Ul PM «f. i- 0 •o Ol u 4J 4J 18 Ol 1 ^ 3 L Ul en ni ta E m rf C n) 0 , ti ti a i tl rf D c i 263 covered, whereas the rest of patients died within 16-32 days following exposure because of incompatible with life skin lesions, and, to a leaser degree, intestinal damages, Prom the 20th and 2Ist day the curves of neutrophilic granulocytes in 2 patients with BMT (UGN 6 and 28) testified to intensive phase of recovery, which, in principle, differed from the recovery phase in patients without BMT and 2 BMT-treated patients. This difference may be attributed to the transplant function: it is in these two patients the stable engraftment of HLA-identical donor bone marrow has been proved by high percentage of female (donor) metaphases in bone marrow at the stage of recovery (UCN 28; see the table), and by augmented amount of donor erythrocytes (up to 65 %) of group B by the 65th day after transplantation in the second case, (UCN 6), In two other patients (UGN 5 and II) who were transplanted HLA-nonidentical bone marrow the stage of neutrophilic granulocy- recovers te y occurre e samth e t patientdn timea i s ,a s without BMT« In both cases the chromosomal markers demonstrated that mye— lopoiesis recover ensures ywa celly db recipienf so t (see eth Table). In the BMT-treated group 3 patients died (UGN 5, 6 and 28, radiation doses were, respectively, 4.4, 5.2 and 6.4 Gy) from botAR, D28 h (UGd HLA-identicaan N6 l BMT) from"graftd ,an - versus-host disease (UCN 5> HLA-"haplo+I" BMT) aggravated by

fatal viral w infections fatao .H l outcomes were reportee th r fo d contro lsingla groupn i et .casWo radiatioe th e n burn skif so n injurir o f otheo es r organs wermaie th en caus deathf eo . Radi- ation burns in patients from the control group were approximately of the same degree and size. The experience gained in these myelotransplantations showed clearly that clinical methods employe r earldfo y diagnosis (first 7-10 days after exposure incompatiblf )o e with life acute

264 radiation injurie skinf so , intestine fror d lungfa m,an e sar being perfect. Another problem encountered in ART) patients undergoing BMT lies in determining the irreversible; stage of myelosuppression. Spontaneous recover myelopoiesif yo s observablswa patientn ei s exposed to radiation doses 7.0-9-0 Gy and even 10.0 Gy beginning fro 22nd-30te mth aftey hda r exposure. These term initiatef so d recovery, in principle, are compatible with life under the conditions of maintenance therapy. Therefore, the hypothesis that

long-term, incompatible with life acute radiation pancytopenia occurs likel s alreadincorrecti e b , o Gy yt doset y a 6 s5- s a^ leas thosn i t e cases when dos evert rateno y r e highfo s ar , ,as instance givee th nn ,i grou injuref po d persons. The experience accumulate worr ou k n enabledi reviso t s su e seriousl assumptioe yth n regarding harmless characten i T BM f ro reversible damag myelopoiesisf eo , i.e. when dose totaf so l gamma-irradiation equal 5-9 Gy. In 5 of 6 patients without incompatible with life non-bone marrow injuries who lived more than a month after exposure, the BMT was accompanied with developing well-defined or occult symptoms of acute secondary disease or reaction of graft rejection, and in 4 cases these allo- immune conflicts contributed to fatal outcome. Acute secondary disease, also promoting fatal outcom lunn i e g radiation injury, was disclosed in one patient of 7, who died within a month after exposure. Symptoms of acute secondary disease were observable both in cases with HLA-identica HLA-nonidenticad lan l (haploidentical with T-deplection) las e BMTth t n .caseI s ther notes ewa d short- term engraftraent with early rejectio e transplanth f no t myeloid portion. The findings obtained raise a question on feasibility of the so-called effect of mean lethal doses in humans, when trans-

265 plantatio allogenif no c bone marrow result highen si r lethality exposee th tha n ni d control group e abov.Th e effec s discotwa -

vere 50a-60n di n somsi e specie micef so , revealed late somn ri e monkeys detectet ,no thougs dogsn wa i d t hi . G.Santon i 197s 2 in his review describing use of "bone marrow transplantation in humans pointe t thaou dt "discover thif yo s effect necessitates taking every precaution in transplantation of bone marrow in cases of accident-induced total irradiation of humans, where the exact doses of exposure may be unknown". The result applyinf sr o treatin fo T gBM g patients injured durin e accidenth g t CNPta P provid e possibilitth e drao e t y wth following conclusions with respec ruleo t t performinf so n i g future transplantations of allogenic bone marrow in humans with acute radiation disease: 1) only HLA-identical transplantations are allowed to be carried out; HIA-identica) 2 l myelotransplantation performee b y sma d onl n thosi y e cases whe dose f totanth o e l gamma-irradiation equals or exceeds 9.0 Gy.

266 REHABILITATIO VICTIMF NO F SO ACUTE RADIATION SICKNESS

V.G. BEBESHKO, B.P. PREVARSKIJ, LG. KHALYAVKO, I.V. SHIMELIS, D.A. BELYJ

Abstract

Two hundre nind an de victim f acuto s e radiation sickness followine th g Chernobyl accident are under observation (first degree - 134, second degre, thir 54 fourtd d- e an degre 0 h 2 degre . - e 1) - e

7 (42.5%e patient5 th n I f o ) s having suffered first degree acute radiation sickness, work capability was reduced by 25%; 9 persons with first degree acute radiation sickness were classifie s invalida d e seconth d f o an sd third category e grouth n pI wit. h second degree acute radiation sicknessa , reduction of the work capability was observed in all cases. In the group with third degree, 100% had signs of disability.

In carrying out rehabilitation and prophylactic measures aimed at reducing social risk factors, considerable attention has been given to publicizin a health gf lifeo t present y A . ywa , professional reorientatios nha s beini bee r o ng e majoritgiveth o t nf patients o y .

An analysis of the results of rehabilitation measures carried out durin e yeath g r show a graduas l improvemen n generai t l n healta d han improvemen n workini t g capabilities. However e symptomatologth , f injurieo y s to individual organs and systems remains unchanged.

The developmen f nucleao t r engeneerin d increasgan e contacts of people with radiation sources enhance the risk of different diseases connected with the ionizing radiation influence. Nowdays e worlth , d practic f nucleao e r energy application have stored a certain experience of treating the patients with radiation sickness in its acute period* A valuable contributio e solvinth o t nf thesgo e question mads Soviey wa b se t scientist ( L»As . Ilyin, A.K.Guskova, V.I.Vorobiev, A.VaBara- banova, Ye.K.Pyatkin et al.) that allowed to give timely and qualifie suffered l dthoseha al o medicao t wh d , d durinai l e th g Chernobyl NT?J? accident, e reporth n I t, presente y A.K.Guskovb d a some problems, concerning biological effects of acute ionizing radiation on humans in doses 1 Gy and higher were touched. This pape s devotei re questions th o t d , connected wit e elaborath h -

267 tion of rehabilitation treatment of patients with acute radiation sickness. With this purpose 5 yea month6 1, rn d i , an s after ARS, almost 183 patients got complex clinical, functional and laboratory examination, including radiation anamnesis collection, morphological blood composition tes s wel a ts exami a l - natio f cardio-vascularno , respirator nervoud yan s systems- di , gestive tract: determination of physical efficiency, sex function and the study of biochemical indices and some parameters of immune system. According to the data of dispensary observations, 88 % of patients after recovery from ARS recommenced their labour activity. However, d differen30,ha 7% t degre f disablemento e r Fo . 38,2?5 the reduction of ability to work wasn" t significant: on- y 255Sdegree l Th .f capacito e o wort y k depended upo e severith n - ty of ARS« However, health condition examination of some pati- t shoe absolutno wth ent d di s e characte f thio r s relationship. Table 1 shows, that the majority of patients had changes in different organs and systems.

Table 1. Pathologic conditions in patients after ARS, in different period after the Chernobyl accident

Period Neurocirculatory dystonia Ischémie!Poly- afte ______e th r _ hear neuro! t - accident Cardialgic Hyperki-Astheno- Vegeto disease îpathy syndrome aetic neurotic vascular ______syndrome syndrome dystonia______6- Sino n 7575 4570877t8775 2570 77,1 18 months 61,2 38,3 72,1 80,9 10,2 32,0

PeriodChronicChronicChronicChronicsubatrophic after duodenitis persis- cholecysto rhinopharingitis - thac e ten- he angiocholit t cident______patitis______3 mon ,7277^- 1 .4 Ï 5B738T7§ 8 month1 s 39,9 27,9 57,9 87,1 functiox Se n disorderPeriod s after the accident Copulative Spermatogenic

6-8 mcnt. 18 months 50,8 55,7

268 The moat frequent were functional disorders of nervous system, manifested as neurocircular dystonia and diencephal crisis. The presenc differenf o e t polyneuropathic manifestations swa characteristic. In 39 % of patients miocardiodystony was diagnosed by clinical and electrocardiographic tests. In 2595 ishemic heart disease was revealed, which in most cases had latent course. In the majority of patients digestive organ diseases were revealed: cholecystoangiocholit 5005( e persistin), g hepatiti 27?a( s ), gastroduodeniti 41JS( s )erosiv, e gastritis (6$»), Chronic subatrophic upper respiratory tract changes were discovere morn i dpatientsf eo patientf tha% o 0 n% 9 ,9 f o s this group had mucosal membrane erosion sites, sometimes with ulcérations and haemorrhages. Th functioex se dat f ao n investigation I.F.Yund( s al.t ae ) testif disorderss it o t y » They expresse n shari d p libido reduction e decreas,th spontaneouf o e d adequa,tan s e erections. Sexo— pathological disfunctions were backgroune formeth n o d asthef o d - no-depressive syndrome disturbance Th . hemodynamicf eo s plaa y significan tx functio se par n i t n disorders, alongside with dien- chephalic-copulative disfunction, spermatogenesia changes mani- feste n spermatozoii d d quantit d activitan y y reduction, appea- ranc pathologif eo c forms. majorite th n I casef o y s haemopoiesi d beesha n restored, and only in 7 cases the hypoplastic condition of blood formati- d beeha nn o discovered» Disorder bloon si d lypid spectrum were also observedn i : 47$casef o £ s- hypercholesterinemia n 54-7°f ,i caseo s hyperlypi- demia, that is more than 2 times enhancement of average population indice certaia P.P.Chayalo( r e fo s nag al.t ,e )

269 The stud neutrophyf o y l granulocyt d monocytean e phagocy- tai activity showe reductioe th d f absorptiono n capacitf o y these call d decreassan f reservo e e abilitie phagocytf so e cells, ImmunoLogical studies testife decreasth o t yT-celf o e l immune indices ( to 3% ) > especially T- lymphocyte s with sup- ressor function. Thus, in ARS patients different degrees of internal organs functional changes as weil as disorders of nervous system, sexu- al sphere, immunological and biochemical status are detected. These changes considerably lowered physica d profeccionaan l - ac l tivity. l theseal o t , therape Du f existino y g pathologic syndromes, physical condition rehabilitation should be an integral part of these patients treatment e basi th wilt r sufficienI . fo e slb t wording capacity level preservation and ensuring of high qua- litd vitaan y l activity. With the purpose of health restoration, prevention of delayed radiation effects in ARS patients we have worked out the risk factor system t include.I s social, radiologica d medicaan l l ( clinica functionad lan aspects) l . Risk factor conception completely justified itsel preventivn i f e medicin d havan ee broad application in our country and abroad. Social factors of risk include hypokinesia, irrational diet, obesity, smoking, alkohol, inadequate professional activity. Radiological factors of risk ares interna externad lan l radiation doses, tota d localan - lir radiation. Clinical factors of risk are J different revealed organ and system changes. Functional factors of risk include toleranc physicao t e l load d workinsan g capacity indices. Popularization of healthy mode of life playes the main role in realizatio f rehabilitationo prophylaxid nan s measures, aimed at increas f sociao e l risk factors. Great attentio pais ni o t d the balanced diet, taking into account the facts of obesity,

270 hyperlipidemia, hypertentio digeativd nan e organ diseases,n ,I smokin alkohod an g i prevention explanatory work, reflexod an - psychotherap e veryar y important« Physical activit prescris i y - bed according to the individual programme. It is aimed on reducing hypokinesia factor, raisin totaf go l work capacity, body weight normalization. Load intensiveness dependphysicae th n so l conditions ,i determine basie th f clinicasn o o d l data, toleranc phye th -o t e sical loads and total working capacity. Presently, professional reorientation of the majority of patients has been conducted. However, job placement process e changeb shoulo t ds dynamie b daccordinha d healte an cth o ht g condition improvement, with the account of adequacy of occupational loads to organizm functional abilities and absence of professional contacts with ionizing radiation* After 1,5 years complex treatment of ARS patients there is a tendency of reduction of frequency and manifestation of different organs and systems disorders ( see table 1), At the same time is noted the increase of total working capacity, tolerance to physical loads, hemodynami d oxygecan n loadse supplth f .yo Conciderably reduced numbe individualf ro s with unadequate types of reaction on loads: work pulse values lowered, hemodynamic reaction on load became more adequate, changes on EGG are revealed less frequently« However, the quantity of subjective causes, limiting work capacity increased. 1 ,5 years after exposure cell immunity indices had improved, but they were reliably lower normative values. On this background in 20^ of patients were determined antibodies to thyroglobulin, that may be assesses as a sigh of autoimmune thyroid pathology formation.

271 Thus n patienti , s after ARS gradual improvemen f healto t h condition s i observeds . However e presencth , f numbe- o e di f o r seases and enhanced risk of delayed radiation effects require systematical long-term dyapensary examinations, and complex measure f rehabilitatioo s prophylaxisd nan .

272 PROBLEM EVALUATINF SO G PUBLIC HEALTH AFTER AN ACCIDENT AT A NUCLEAR POWER PLANT

O.A. PYATAK, E.M. LUK'YANOVA, V.N. BUGAEV, V.P. NEDEL'KO, A.E. PRISYAZHNYUK, P.I. BURENIN, V.E. DASHKEVICH, G.A. ZUBOVSKIJ, L.I. IVANYUTA, A.G. KOLOMIJTSEVA, S.M. MAKEEV, A.A. YAKOVLEV

Abstract

e ChernobyTh l accident caused addition i , o externat n l exposuro t e radiation, inhalation and oral intake of the main dose-forming radionuclides: caesium-134 and 137 and iodine-131. Taken together, the adverse factors emerging from the accident at Chernobyl manifested themselves first and foremos vegetativn i t e dysfunction, disturbance neurovasculaf so r regulation d changee reactivitan th e n immuni sth f o ey system. The significantly increasing migration of the population and its inhomogeneous nature, especially in the groups of reproductive age, are bringing about changes in the structure of the population and in family planning strategies.

In the regions studied, dynamic statistical indicators of the spread of infectious diseases have reflected the general trend in our country, namely towards a reduction of such diseases. In 1986, the frequency of acute intestinal infection dropped in a number of regions by factors of 1.5-8.

Ukraine Ith n speciaa e l clinical registe pregnanf ro t wome d babiean n s from the regions under study is being kept. The initial document includes 1630 pregnant women. No significant departures from the norm have been found e coursth n f thesi o e e pregnancie e conditio d birthsth e an sn th i f r ,o o n new-born babies.

Detailed clinical examinatio 6 babie41 f o ns showed thae conditioth t n of the vast majority of them at birth corresponded to a score of 7-8 on the Apgar scale.

Examinatio e reproductivth f no e 7 womesyste41 f child-bearinn o i m g t reveano y abnormalitiesd an ldi e ag . beginnine th t secona a f w o g no d e observatioar e W n period, associated wit e developmenth h f somatio t c stochastic effects wilt I necessare .b l o t y carr t furtheou y r retrospectiv d prospectivan e e analyse e incidencth f o s f o e diseas varioun i e s population groups, taking into accound t an age x se , profession wels ,a medicals a l , social, geographical, ecologica d othean l r factors affecting the organism.

The assessmen populatiof o t n health chan s statuit -d san ges, in connection with the intensive development of nuclear engineerin importane th s i g- t componen e systemth f o t, where general categories, like healt d civilizatiohan n development

273 e closelar y interconnected f groundo t lo stato . t s a Ther ee ar e these categorie t onlno y e closelsar y connected t activel,bu y influence each other e increas.Th populatiof o e n health Level is one of the preconditions of economical, scientific and cul- tural progrens. It exerts arising influence over the tempo of the scientific, technical and socio-economic progress. At the same time, different economic, social and technical factors not only promote the strengthening og population health, but may cause negative health effects. Thus, both immediate (direct) effect and the mediated (indirect) influence through the majorit pathogenif o y c etiological factor othef so r nature have to be taken into consideration. The relative value of direct and indirect effects in their summary influences on the human health may be different and must be taken into account» The last circumstance is very important when assessing the possible acut delayed an e d antropogenic radiation effect differenf so t factors especially in accidental situations. e increasinTh g risk leve present growine a l th n o tg abun- dance of complicated and powerful technical means. The consequences of accidents, which had taken place on different chemical enterprise nuclead san r power plants showe increase th d f o e "pricey accidentan f o " economicn ,i , socia d medicalan l aspects. e measureTh assesmenn so d controtan healtf o l h conditionse th , reduction of negative consequences of the accident must have complex character witfollowine hth g preconditions:

- registratio d assessmennan possiblf o t e risk factors? - determinatio contingente th f o n e examinedb o t s , followed d treatedan ; - selectio adequate th f no e researc controd an h l methods; - establishing of some criteria for decision making and intervention level establishment;

274 - elaboration of strategy and tactics for bodies and institutions of health service. Different aspects of the problem were elucidated in other reports during the Conference. In this paper we discuss only the problems connected wit a hlarg e scale accident. In approaches to the problem of population healthassessment we underlin e importancth e f classificationo e , correct grouping and interpretatio f risno k factor. Firs f allo t t ,i concern s ionizing radiation effects. During the accident on the Cherno- byl NPP besides external radiation, inhalation and peroral uptake of main dose-forming nuclides ( Cs-134,Cs-137) took place. Organotropic properties aad significance of the latter stipulated the necessity of thyroid function detailed estimation. Through examination du-ring two years didn* t reveal any diseases directly connented with ionizing radiation. At the same time the social, demographic and emotion-psychological factors aqui- re a dsubstentia l significance accidene Th . t tooke placth n i e densely populated region, that require immediatn da e evacuation of nearly 150000 inhabitants accompanies wa t I . higy db h tension, enhanced excitement, stress and radiophobia among some groups of population. These condition n causca s e greater e threath r fo t population health than the immediate danger of radiation effects. The complex of negative factors, caused by the NPP accident, realized amon e populationth g , firs f allo t s vegetativa , e disfunctions, neuro-vascular regulation disorders, change f iTrnuno s e reactivity. All this-may cause cardio-vascular and endocrine pathologies, digestive organ diseases, phychic disorders, increase in the frequency of intectinal diseases and aggravation of their course. It is notorious that the population health assessment has a complex character. It is based not only on the morbidity rate, but on the indices of physical development and demographic data.

275 Larg e e acciden scale th densel th f o en i t y populated regio- in n crease e importancth d f social-demographio e c processes- po e Th . pulation migration arises immediately s irregulaIt . r character, the most intensiv n reproductivi e e changeth e groupo t ag es d le s in population structure. The strategy of family planning changes s well a thiH A .s influence considerabl e indiceth y f generao s l death-rate, birth-rat naturad an e l population increase. At the NFF accident not only whole population should be the object of study, but an individual, a family, a cohort, a regional group, etc. The usage of medico-geographic approaches n epidemiologicai l researc f non-infectionao h l diseases showed that population formation e possibl ar e basis th f administn o so e - rative distinction f territorieo s regionsd an s . However- po e th , pulation inhabiting the territories of local radioactive fallouts resulting from Chernohyl ITPP accident is highly getero- genic. There are distrinctions on sex and age, on ethnic ancj ge_ ne tic belonging, on zones of inhabitance and on other risk factors like territorial pathology. Some most conteminated districte ar s endemic on goiter, which is important for the estimation of 1-131 induced alterations. The standardization of cohort observation doesn't allow to eliminate the influence of mentioned distinctions, population heterogeneity, which, according to the UNSCEAJl

Report serve a sourcs f erroro e n assessmeni s interpretstid an t - on of " dose-effect relationship". For prospective stud f healto y h condition f exposeo s - po d pulation several years" data are needed. The systems containing collectio d keepinan n f informatioo g n about different diseases spreading beed ha ,n being improve r countr lonou a - r n gpe i d fo y riod of time. When using these medico-statistical data it is necessar o takyt e into account their dependenc- e pa upo e th n tients attendance to medical and prophylaxis establishments.

276 However, according to the "information received, the real spreading of some diseases ( e.g« hypertension and myocardial ischemia) is much more than registered officially. The dispenfa^ization hold earlier embaraces only separate age population groups, professional group patientd an s s with different diseases, therefore it could not significantly cont- e generaributth o t e l picture universae Th . l population dispensary syste totalls mwa y realize n contaminatei d d regionse Th . brigades of mass medical examination, staffs and regional consultative-diagnostic centres were forme r immediatfo d e mass dispensary system on places. The brigades included general practitioners, paediatrists, obstetricians, gynaecologists, endocrino- logists, and laboratory assistants. They worked together with territorial public health establishments. Haematologists, onco- logists, oculists, neuropathologists, urologists and dermatolo- gists were additionally included into the regional consultative diagnostic centres. Compariso e resultth f o f ntota o s l medical screening carried out by qualified specialists among the population with retrospective information , e personabaseth n o d l comp- laint, may lead to the increase of registered data and to erroneous conclusio pathologn no y frequency increase. These mistakes wer e einitia th mad n o e l stag f worko e s with respec o hypothyt t - roid goiter. However special investigations didn "t discovea r considerable difference between the studied and controlled districts. Thorough examinatio e adulth f tno populatio f conno - taminated regions allowe o discovet d e significanth r t frequency of latent diseases, e.g« carrtio-vascular, disease f centrao s l nervous, respiratory and digestive systems. Their spreading 3-5 times exceeds the officially registered data,based on population attendance. However, these deviations are not observed for strictly controlled type f diseaseso s , firs f allo t , infectionad an l oncological n controlleI . d region e dynamicth s f statistio s c data

277 of infectious spreading indicated the tendency to reduction, common for our country. In 1986 the frequency of acute intestinal infectious diseases reduced 1 ,5 - 8 times in a number or regions rate f viruo eTh . s hepatitis reduced nearl l oveyal e th r country. In 1986 the frequency of respiratory-virus diseases in some district a risin d ha sg tendency monthld ha t ybu , seasonal peculiarities. In droplet infection group epidemic process dynamic peculiarities wit e increasth h f morbidito e y 4 leve2- n i l years remains example Th . f effectivo e e immunizatio s i childn - hood epidemic parotiditis morbidity. In a number of regions its rate reduced 5-3 times during 4 years. Malignant tumor morbidity level in the investigated regions approache e normath s l distribution with respec averagn a o - t t in e dices. In some regions transference of blood-forming and lympha- c tissuti e cancer frequency froe 3-rh plac markedmth s 5t do wa et . Indices range between maximum and munimum levels was not large. Territorial différencies in malignant diseases quality remain stabl n timei e . Morbidit certain o y n nozologic forms coinside with general tendencies inherene wholth r e fo tcountr s wela y l r republicfo s a s containin e mosth g t contaminated regions. Among the children population of controlled regions in 1986- 1987 there were not registreted any extra leukosis cases, i.e. the spon- taneou t overcomes no leveearlo s to t presenwa o l t y A s .i t i t mak a conclusioe n abou y oncologian t c effects connected wite th h Chernobyl accident. The epidemiologic investigation experience testified the possibility of their manifestation in 5 years.

Very importan r populatiofo t n health estimatio s i ndistin - guishing of the most vulnerable groups, critical subpopulations, requiring special attention, immediate and complete prophylaxis measures, treatmen dispensard an t y observation. These subpopulations include pregnant women, newborns, children and teenagers.

278 In Ukrainian SSR special clinical scientific register of pregnant wome newborned nan s frocontrollee th m d region s formedsi . Its entry document contain 4 clinico-laborators16 y indices- .To tally 1630 pregnant women from the controlled districts were observed. Those o wer,wh e irradiate n tim i dpregnancf o e y hadn"t y significanan t disorder pregnancn si y cours d deliveryan e- fe n i t d neonatan s tu e state. Perinatal death inde d congenitaxan l ano- maly frequenc thin i y diffet s no grou d r di pfro m preaccident values. The indices characterizing immune and reproductive system blood conditions haven*t changed too. Among women exposed before conceptio complee nth x dynamic examination discovered som- in e creas obstetrican i e l pathology: pregnancy frustration frequen- 2 times - s increasec5 ha y, , 1 lat n i ed toxicosis, premature birt d bleedinan h g during delivery. Accordin prenatae th o t g l diagnostics data there were 5?5 of placenta pathology ( hypotro- phy, destructive changes). Estrogene secretion in fotoplacent complex changes were observed. However " critical " levels, te- stifying to fetus intrauterine hypoxia or sincitiotrobas irreversible alterations v/ere indicated i£ Lther in blood nor in urine of pregnant women. Indices of cell and humoral immunity, studied in pregnancy dynamics were in physiological standard. The revealed distinctions between two groups of pregnants to some extent confir maximue th m m radiation e effectth r fo s primary stage pregnancyf so pre-implantation :i n n perioi d an d period of organogenesis. At the same time the frequency of congenital malformations in contro led contingents did not increase and remain on the level, corresponding to spontaneous at preaccident perio. ) abou% ( d3 t0, The thorough clinical examination of 416 newborns showed that the condition of majority of them at delivery time was correspondin mar8 Apgaf - ko 7 ro t gscale .smalA l number were borI stagresula I asphyxin s ni - a e theif to 1 f rao mother*s

279 extragenital or obstetric pathology. Two children were born with malformation prematurele on d an s y born. Som newbornf o e d sha immune system disbalance, expresse n insignificani d t reduction of T-lymphocyte leve B-lymphocytd an l e level increase; enhance- men immunoglobulif o t nM con-cent , whic s i hprobably , connected with adaptation accomodative mechanisms tension. Incorporations of any significant radionuclide quantities was not discovered in newborns. The investigation reproductivf so e functio wome7 41 nf no in fertildifferenf o e ag e t professional group frocon( se th m- trolled regions ) showed no pathologic changes. Hormon indices of ovary activity, adrenal gland hypophysis, thyroid gland, huœora d celan l l immunity were identica o controt l l group. 1200 children from the controlled regions were examined according to the specially designed unified scheme. The instrumental, immune, hormon d othean e r laboratory methods were t*ssd durin examinatione th g n comparisoI . n wite controth h l group, examined in 1980-1986, the healthy children of this population hao significann d t deviation investigaten si d organ d systemssan . Clinical pictur recurrenf o e chronicad an t l unspecific lun- gdi seases (106 children ) and chronical digestive diseases (186 children t diffeno d r)di from thos preaccidenf o e t periodt .A the same time in children with bigger radiation loads a tenden- hypoimmuno ct y e condition formatio s observednwa . Thahavy tma e caused more frequent respiratory virus infection thin i s s group. Besides, in this category of children, the increase of asthenoneu- rotic syndrome was noticed. During 1986- 198 regionn 7i s with higher level radiof o s - active contamination the-thorough contro populatiof o l n health condition continued. Ho changes in distribution of investigated peopl healtn o e h group comparison i s n with control were observed.

280 Preguency of hâematoiogic deviations fits the normal distribution function, whic peculias hi healthr fo r y contingents, Sick- and death rate study according to the materials of complex examinations didn*t discover significant change n comparisoi s n with the preaccident period t shoul.I e mentioneb d d that systematic examinatio populatiof o n n health conditio d radiationan n situation in the controlled regions, confirmed high effectiveness undertakee oth f n protectiv d prophylaxian e s measures. Summinr observationsou p gu n statca e ,w tha presentt a t , amon exposee th g d durin Chernobye th g l accident population there are no diseases directly connected with the ionizing radiation.. But it doean* t mean that the accident had no influence on population health. We suppose,, that very important is investigation of vegetative disfunctions, so-called vegeto-vascular dystonia. Somatic effects of combined effect of low radiation doses and other factors, observed during the Cherobyl accident are of great importance as well. Nowdays we enter the 2-nd period, connected with the development of somatic and stochastic effects« Based on the experience of the health condition studies of Japaneese A-bomb victims, we can expect appearance of leukosis in 2 years after exposure, mammary cancer in 5 years and other tumours ( e.g. thyroid gland, lungs, digestive organs) in later period. Therefore toda e musw y t focu r attentiosou n revealinno g risk factor d precance;an r fprms. Result f totaso l medical screenin exposef go d populatio e vernar y importan future th - r co e fo t ntro prognosid an l healtf so h conditions, forecast radioinf so - duced somatic effect d theian s r distinguishing from spontaneous ones r thes.Fo e necessars aim* it s conduco t y t profound retrospective and prospective sick-rate analysis among different population groups, taking into accoun td professiona agean x ,se l peculiarities as well as medico-social, geographic, écologie and other factors, affecting human health.

281 PSEUCHONEUROTIC DISORDERS ASSOCIATED WITH THE CHERNOBYL ACCIDENT

Yu.A. ALEKSANDROVSKIJ

Abstract This survey relied largely on random selection. As a rule, the attention of the specialists was directed to people with certain specific complaints. Psychogenic disorders observed in the area of the accident at the Chernobyl plant were followed and studied by a team of specialists from the USSR Ministry of Health, beginning on 29 April 1986. According to the nature of the observed stress effects and of the resultant psychic disorders, it was possibl delineato et e three periods: firs e acuttth e disastee perioth f o d r from the time of the accident, lasting about 10 days until compilation of the evacuatio populatioe th f o n n froe dangeth m r zon May)5 ( e ; secone th d intermediate delayed period e perioth , f comparativelo d y early consequences Octobeo t y (froMa r m6 1986) d thirdan ;perioe ,th remotf o d e consequences. yeare e coursth th ,f n o eI 157 2 people were examined. The data available indicate that the psychogenic disorders observed after the Chernobyl accident can be regarded as the consequence of a single process e dynamic,th e whicf so th hane determinee y on har b d e th n o d characteristic e emergencth f so y e traite otheth situatioth d y an srn b o d an n e degreth preparednesf eo e peoplth f so e involved e speciaTh . l e naturth f o e stress situation in all three periods - the threat to health - gave rise to certain characteristic clinical observations, primaril higya h degref o e somatizatio d hypochondrianan n understandinA . psychologicae th f o g l disorders affecting thos o liveewh d throug e Chernobyth h l accidentf o d an , their effects on the work capability and pattern of life of people at various stages afte e accidentth r s mad ,possiblha t i e develoo t e d implemenan p a t comple d refinexan d syste prophylactif o m medicad an c l measures.

Psychological overstrain, arisinlife-threatenine th n gi g situations may cause psychic diaadaptation with its different manifestations in psychotic disorders and the breaches of non- psychotic character. The knowledge of frequency, clinical structure and dynamics of physical disorders arising in extreme conditions, allow organizo t s e adequate treatmen d prophylaxian t s either in the place of life-threatening situation development or durin e subsequenth g t stage victimf so s evacuation« The events on the Chernobyl NPP were an example of extreme situatio n whicni e observehw d staged developmen psychogenif o t c effect numeroun si s contingent populatiof so n involve lifen i d - threatening situation»

283 The acute threat to their life and health at the 1-st stage of the accident was followed by the chronificatlon of life- thre- atening situation, including additional stress factors ( the loss of home, property, changes in their mode of living etc.) The stud psychogenif o y c disorder accidene th n si t zond ha e bee na tea carrief specialisty o mb t ou d s froMinistre th m f o y Public Health ( USSR) since 29 April 1986. The psychiatrists and psychologists included essentiao intgroupe tw th o d ,ha l tasks: (1) to study the character, structure and dynamics of the physic disorders observed; (2) to organize, and if necessary, to conduct treatment-prophylaxis measures directed to the revealing and timely treatment of patients with psychic disorders. The peculiaritie stresf so s influence distinctive th d san e feature psychif so c disorders inducee latteth y rb d alloweo t d periods3 poin t ou t : 1) The acute period of disaster: started since the moment of the accident and continued approximately for 10 days, up to the end of evacuation from the dangerous zone, ( May 5)» The main stressogenic influenc e threath o lifs d healtht twa e an e , connected with the possibility of radiation injury. 2) The postponed period ( "the period of early effects") starte Octobee d continueth an d o 6 sinct r y p 1986u dMa e . At this time the inhabitants of the accident area, HPP person- d neliquidatoran l s were deploye n villagei d s remote froe th m accident point 60-80 km. The conditions of everyday life, life-threatening situatio e workinth t na g places uncertainte th , n futui y - re life and labor guarantees, the loss of a house, property, chan- e livinth gin f o g mode" sub-acute e b - o turnet t " ou d stressoge- c factorsni , which determine extremete th dsituatione th f o y . ) Sinc 3 e momenth e w puttinf shiftino tne e th g g settlement into operation and provision of the evacuated people with resi-

284 dence occupationd an s 3-re th sd period began s callei t I . d "the period of late effects" and can be characterised by the apprehen- sion of possible radiation injury development ( especially for parents worrying about their children's health t I expresse» s itself also in hard adaptation to the new mode of life and work, subjective attitude f certaio s n group f victimo s s about insufficiencd an y unec[uality of social assistance,

During one year 1572 persons were examined: 554 of them were reckoned in 1-st period, 416 in 2-nd and 602 in 3-rd. The selection for examination was random. As a rule, the specialists choose patients with different specific complaints. Taking into account, that psychoneurological examinations hadn* t been conducte e wholth r e fo dacciden t zone population e presenteth , d data don% t allow to discover common epidemiological regularities e observeoth f d psychogenic disorders presene Th . t report does t containo n analysi f developmeno s t tendencie e coursth f d o e an s neuro-psychic disorde n acuti r e radiation syndrome patients. We suppose, that on all the stages of the accident situation developmene specialistth t examined ha s de individual nearlth l al y n i s e criticath progressivd l ha zono wh e e psychotic disorderse Th .

pre-clinical manifestations including acute Stressor and adapta- cion reactions wer f non-psychotio e a rul s ea d transitoran c y character,That's why in many cases patients didn*t consult specialists. The clinical psychopathological method was the essential one; psychodiagnostical and psychophysiological methods were also used, as well as medical documentation studies. The analysis showed that during the formation of psychic

disorder conditiond an s f psychio s c disaaaptatio e perioth n ni d of developmen d liquidatioan t e consequenceth f no e Ghernoth f o s - l accidenby t certain tendencies were revealed. At the 1-st stage the extreme stress effects have besp developing during several daywerd an se connected wit e vitath - h ba l

285 sis of existence, and as a result there have formed relatively uniform reactions, generally determined by fear and anxiety expresse different da t levels. The outward expressio stresf no s reaction majorite th n i s y of cases were in this period analogous to the first stage stress reactio werd nan e expresse stand-still" y db " responce- re e th - ductio movinf o n g activity hyperdynamiy b r ,o analogue th a- e of " escape". Developing according to the typical stages, descri- ben literaturei d , fea anxietf ro y didn *react h psychotic level, except for rare cases. They formed under the influence of available information and in the conditions of total absence of any concrete sensor effects. It gave the possibility to prevent pa- nic by the interference of correcting influences. These psychotic disorders marked in the acute period, were determined by reactive psychosis ( peculiar for highly hysterical persons having some knowledge abou e consequenceth t f radiatioo s n effectd an s exaggerating them in the actual situation. In some cases were reac- tively provoked aggravatio existinf o n g psychotic disorderse .Th frequency of psychosis was insignificant for the numerous contingents of evacuated people and those, who took part in reconstructive works. It yields to the frequency of acute psychotic disorders,marked in natural calamities and accidents where staggering factor is " visible" (hurricanes, fires, earthquakes etc.). Durin postponee th g d perio reactive th d e psychosis wer- ob e serve n rari d e cases. Durinperioe th latf g" o d e effects" they were not registered at all. Alternative dynamics was established in the frequency of non-psychotic psychogenic disorders. During thy 1-st and the 2-n.cL periods the number of patients in neurotic condition remained unchanged3-re th dn perioi t ,bu d arose significantly o som.T e extent t occuri , s becaus2-ne d th 3-r dan n i ed period of the psychic disadaptation functioning the peculiarities opersonalitfa greaa f cone o whola b t e s n -valuea yar eca t I .

286 nected wite chronificatioth h f stressogenio n c effects. During this period neuro-psychic activit y" sensitize previe th y -b d" ous extreme effect undes e powerfuwa sth r l influenc f so-calleo e d "second calamity "- the loss of a house, property, separation with relatives, difficult everyday life. indicatee Th ) d psycho- genie effects were lengthened in time and have 2 qualitative cha- racteristivs, peculia r psychologicafo r l mechanism f psychio s c adaptation and disadaptation. On the one hand- this was the vague resolution of the situation in time, on the other - understanding and insurance in happy end, as guaranteed by the state. This 2-nd peculiarit s stipulateyha e mobilizatiodth f adaptano - tion mechanisms. It also significantly postoned the development of psychogenic disorder e leveth f shaln o lo s ] ow, clinically non-

structure a extrapersona ruld s a dan e l astheno-affective conditions. These conditions, which cause e disorderth d n physii s - ac c tivity were determined by a sub-acute health threat subjectively endured» Its stressog-enic manifestations were decreased by the syste f protectivmo e measure d limitatioan s f workinno e g th tim n i e d ange rous z one. e 3-rth dn perioI d thera subjectivel s i e y significan- he t alth-threatening factor on account of being on the contaminated territory during the accident which is decontaminated nowadays. This factor stabilized in a way, chronified, earns into the structure of ordinary life and this made possible to revise the situation intellectually, as well as personal feelings and emotions. Stress chronification e lac f th informatio,ko n abou s leng-thit t , prognisis, real health possible effectth d an se measure f elio s - minatio l thesal n- e factors determined "overstrai demobilid nan - zation of psychological adaptation mechanisms". Together with enduring non-specific psychogenic disorders in this period, personal, specific forms of diaadaptation began to prevail, which in the 1-st and the 29nd periods were observed only in rare ca-

287 ses. However, like durin whole gth e situation certait ,a n stages e disasteth f anxiouo . ran s tension remains e samth e t .A tim e depending on personal features, somatic burdens, presence of exogen hazards somatic-effected depressions develo wels a ppersiss a l - tent radiophobias and psychosomatic diseases; latent organic disorders may be decompensated, psychopathic manifestations begin, to form. Alongside with the described psychogenically provoked manifestations e e stagesituatioth th f l o sal nt ,a developmens wa t marke numbea d personf o r s with transitory adaptation reactions of non-psychotic character, which, as a rule, recovered complete- . Theily r development depended upon insufficient preparednesr fo s the works in concrete, extreme conditions, unusual physical, and psychological overloadings, to say nothing about psychogsnic factors, peculiar for each stage. Represented data show that psychogenic disorders, observed durin Ghernobye th g P acciden lHP t classifie b n ca tresula s a d t of uniform process« Its dynamics is determined, on the one hand - e peculiaritiebth y extremf so e situation e othey perth b r- n -,o sonal characteristics and the degree of preparedness. It reflects the coomen conformin e stat th f psychi o ef o g c disadaptation development in extreme cases. It is necessary to point out that represented data reflect certain tendencies in accordance with the psyche^enic peculiaritie d forf psychio an sm c disadaptation.

Durin perioe gth d whe magnitude th ne effecte th th f d o esan temp f theio r developmen e objectivelar t y surplus, simple reactions (like anxiety and asthenia ) prevail, but the individual reaction forms play the minor role. When stress becomes chronic and may be classified as " life obstacle " - the individual reconstruction acquires special significance. The originality of stress situation during all the periods (health threat) stipulated a number of clinical peculiarities of observed disorders,

288 first of all enhancement of somatic and hypochondriac manifestations. The e accompaniear y y vegetativb d e polymorphic disfunctions, and asthénie symptomatics had an evident "organic shade" (amnestic disorders, absentmindedness,understimation of the situation). It should be marked, that professionally trained specialists, havin a ggrea t experienc f woro e n extremi k e conditions, did not as a rule suffer from neurotic reactions and disorders n spiti f theio e r responsible work« These disorders'are peculi- o incompetent r a t people, havin experienco gn f woro e n extrei k - me conditions. It shows once again the importance of preliminary trainin e workth n complicater i s gfo d conditions. The revealed peculiarities of psychic disorders in the contingents involved into the Chernobyl accident ( population and liquidators e influencth d an f )thes o e ee vitafactth - n ac lo s tivit occupationad yan l attitudet s pu allowe d an o wort t d ou k into practice the differentiated system of necessary treatment- and-prophylaxis measures. Durin e firsth g t period e specializeth , d medical assistance was rendere ddirectes onlr thosewa requireo fo y t t I a dwh , . it d e discoveryth , d extractiocuppinan f of g n froe criticamth l zone of individuals with acute psychotic conditions» During the same period for many inhabitants of accidental areas Tranquilizers were prescribed especiall r those fo yfelo twh , developmenf o t the neurological reactions, the appearance of psychogenic disorders, insomnia. Nootropi d bemitian l l were recommende r those fo dtooo wh k, activ e liquidatio th par n i e accident th f no t consequences. The somnolent tranquilizers were recommended for periods of rest. Since the second period consulting, diagnostic and psychoterapeutic measures played the leading part in the treatment, prophylaxis and psychoterapeutic assistance. In the districts where the rescue workers lived the complexes of psychoemotional

289 relief were opened n somi s wel a ,es a l medical enterprisef so the region. In one of the stationaries the department of neuro- sis was opened. A powerful rehabilitation center for the participants of reconstructive works began functioning in Kiev. The majority of residents from the accidental regions and the personnel of the N?P received there a number of health maintaining procedures, including psychotherapy. Simultaneously medicae ,th l personnel from the territorial psychoneurological hoapitala were enliste wore th k o t witdevacuatee th h d population e know.Th - nme thod grouf so d individua pan l psychotherapy were use wids a ds a e possible together with reflexotherapy, physical therapy, generally maintaining praparations, psychopharrcaceuticals etc. The mentioned medical measures had been conducted differentially, according to the conditions and peculiarities of life and occupation. e stageDurinth accidenf l so gal t consequences liquidation psychologists and psychiatrists paid much attention to singling out the causes, inducing neurotic reaction. Among these causes the major ones are: insufficien d wrontan g information about the nature of the radiological situation, especially in the first period of the accident ( which raise a wave of panics); the late information about financial compensations, bad organizatio liff no e condition d othesan r psychologically hurting circumstances. 'Timely analysis of social, psychological and socio-hygienic caused gave us the reason to address different in- stances with request immediatelo st y eliminate them. As a result of undertaken measures psychoemotional tension and neurotic disorders were eliminated considerably and microso- cial contacts and ability to work improved. Thus, treatment-and-prophylaxis of neuro-psychic disorders during the Ghernobyl NPF accident demanded wide and multiple psy- choneurologist*a activity directe e solutioth o t d medicaf no l and medico-social problems. Evidently, in all life-threatening

290 situations e activitth , psychologisa f yo psychiatrisd an t t will be much wider than their usual diagnostic and treatment activity. e Chernobyth f o e l on Thilessons s i s , urging corresponding trainin f specialistsgo .

291 STATE OF THE PITUITARY AND THYROID SYSTEM IN CHILDRE VARIOUT NA S TIMES AFTER EXPOSURO ET RADIATION AS A RESULT OF THE CHERNOBYL ACCIDENT

E.Â. BENIKOVA, E.V. BOL'SHOVA, I.A. ZVONOVA, G.A. ZUBOVSKIJ, V.V. MARKOV, E.G. MATVIENKO, N.G. MAKHON'KOVA, V.A. OLEJNIK, N.T. STARKOVA, N.F. TARASOV, N.D. TRON'KO, A.K. CHEBAN, E.V.EPSHTEJN

Abstract

A clinical/1 laboratory examinatio s mad f wa nchildreo e f o e nag fro e mth 1-14 years from the area of high radiation. The examination was carried out on a continuous basis, beginning in the first half of May 1986 and is still in progress.

o stagA n s thert clinicay wa e an e l evidenc f thyroio e d dysfunction, but, in a significant proportion of the children an increase in the size of the thyroid gland was noted. In May and June 1986, 77.5% of the children had a first or second degree enlargement of the thyroid gland. At the same time, there was an increase in the level of T 4 in the blood: 85.20 + 7.36 nmole/L to 348.33 + 38.26 nmole/L.

e subsequenth n I t stages a gradua, l normalizatio f theso n e parameters was noted. No other significant functional or organic disorders of the pituitary-thyroid system were detected.

s knowi t I n that durin e firsth g t year afte Chernobye th r l NPP accident iodine radionuclides were a principal factor of population internal irradiation. These radioactive nuclides were uptake a through the respiratory organs as well as through biologic chains with the food stuffs. The radioiodine accumulatio n thyroxi n d gland causee th d exposur f thio e s organ. Absorbed dos f childreo e s somewhanwa b higher tha e relativeln th tha f o adultt o t e du ys higher iodine accumulating capacity of their thyroid glands. According to the modern conception, the injury of thyroid gland unde e conditionth r f irradiatioo s s nobservei n childi d - ren more often tha adultsn i n . Besides s i als t i o, necessary o taket into account thae possiblth t e outcome f thyroio s d gland diseases are considerably more serious for children. This cir-

293 cumstance necessitates particularly intent attention and the stud f dynamicyo f thyroio s d gland functional stat n childreni e , involved in contacts with ionizing radiation, We have carried out clinical laboratory examinations of children from 1 to 14 years old from the zones of enhanced radiation. The examinations began in îfey 1986 and are beingcontimied« We estimate e functionath d l stat f thyroio e d glan totan o d l and free thyroxin, thyrotrophin, thiiodothyronine, thyrocalcito- ninantibodied an e o thyroglobulit s e radioimmun blooni th y b d - nological method with the help of standard kits. The examinatio carries n dynamicsi nwa t ou d n fivi , e stages; 1 stage May 1986 - July 1986 2 stage October 1986 - December 1986 3 stage Marc y 198h 198Ma ? - 7 4 stage October 198 - 7Decembe r 1987 5 stage w Marcno o t h p 198u - 8

During the examination of children on every stage there wert revealeno e y symptoman d f thyroio s d gland disfunctions. But it is necessary to note that on the first stage of examinatio observee w n e increasth d f thyroio e d gland dimensiona n i s certain par f childreno t 8 mont6- . s late observee w r a 1,5d2 - times reductio f thyroio n d gland increase frequenc n thesi y e children n interpreca e W .e increas th t f thyroio e d gland, which took place during the first months after the accident as transitory vascular and secretory reaction in responce to the radiation influence. On the first stage of the examination in children, who had been in contacts with the sources of ionizing radiation observee w , e increasth d f averago e e value f totao s l thyroxin content in blood. In order to clear up the reasons of absence of thyrotoxico- sis clinical syndroms at the high level of total thyroxin we determined free thyroxin concentration. It is known that the re-

294 alizatio hormonaf no l effec defines ti considerabla o t d e extent by the level of free hormone. It was found that the content of biologically free thyroxi withis n wa limit e nth normaf so - lva riations or exceeded them insignificantly. Here we have to un- derline tha e determinew t d free thyroxin level onl children yi n withige th hh concentratio f totano l thyroxi bloodn ni . secone th n d O examinatio e stagth f o e e tendencth n noro t y - malization of thyroxin level in blood was revealed, and by the third, fourth and fifth stages the hormone content reached the normal values. The analogous picture was observed for another thyroid hoîv- mon etriiodothyronin- increas s firse it th ( e t n o estag f o e examination and normalization of its level in the subsequent periods) .

mose th tOnf o importane d direcan t t indices reflectine th g functional stat f thyroio e de conten glanth s f i thyrotropido t c hormone of hypiphysis in blood. In general the average level of thyroprophi blooe th observef o dn ni d childre t diffeno d rndi from the normal values. At the same time on the first s^age the thyrotrophin concentratio bloon ni f somo d e examine s slightlwa d y reduced. This reduction is obviously connected with the increase of free thyroxin level in blood of these children according to the principle of negative inverse relation. And on the contrary, we observed in a part of children in that perio transitore th d y increas thyrotrophif eo n leve bloodn i l . The latte e explai rw manifestatioe th y nb f stresno s reaction. e confirmatioTh thif no s suppositio activatioe th hypoe s ni th -f no physical adrenal system, reveale firse th tt da stag examinaf eo - tion. It should be supposed that simultaneous multi-directed influence of two factors on the secretion of thyrotrophin: stress

295 and hyperthyroxinemin levels of the content of this hormone in blood. nexe th t l stageal n O examinatiof so everage nth e content of thyrotriphi e individua th bloon ni d an d l indicedift -no d sdi fer significantly fronorme th m . Sid y sidb e e with this, anaiizin individuae th g l indices ( in the whole mass of children ) of thyrotrophin and thyro- n levelxi n i bloods2 childre9 n i , e revealenw d simultaneous increas f thyrotrophio e n concentatio d decreasnan f thyroxio e - co n ncentration, i.e. so-called laboratory hypothyrosis. All these children,without exception,were subjecte extendeo t d d clinical and laboratory examination resula s a ,f whic o te diagnosi th h s of hypothyrosis was confirmed in 12 cases. That does not exceed spontaneous frequency of this pathology. t shoulI e supposedb d thaeffece th t f radioiodino t e absorbed by thyroid gland depends not only on its quantity but also on the age of a child. In this connection we had analized the state of hypophysial thyroid system depending on the age of child. On the first stage of examination we revealed the inverse dependence e tota th chila ld f o thyroxian d betweee ag e nth n contenn i t blood. This dependence remaine o somt d e e extenseconth n do t stag f examinationo e . We also should take into account the fact that physiologic augmentatio f thyroino d glan mees i d t with more ofte pren i n- and pubertal periods. That is why these contingents of children need long-term clinical laboratory examination in dynamics. Therefore estimato ,t e rol f separatth eo e e components capable of causing subsequent thyroid gland pathology it is necessar multi-factoe us o t y r analysis. d reveale Wpare ha e childreth f o t n i d e increasth n f o e thyrocalcitonine content in blood, which normalized in 6 months.

296 We can suppose that the transitory increase of this hormone level is connected with the activation of thyroid gland S- cells by incorporated radioiodine. Side by side with the hormonal investigation of functionai atat thyroif o e d glan e determinedw contene th d antibodief o t s to thyroglobulin. On the first stages the increase of level of antibodies to thyroglobulin in blood was determined in 59» of the examine d thedan n7»6S&- . Thoug observee th h d - growtne s i h gligible same th e t ,a time taking into consideratio e importh n - tance of this index for the prognosis of autoimmune pathology of thyroid gland, thorough control of this index in dynamics necessarys i . Taking into accoun e anatomith t c proximit f thyroio y d an d parathyroid glands we consider it necessary to investigate the functional activity of parathyroid gland, too. The parathormone concentratio e firs bloon th i n tn o dstag examinatiof o e s connwa - siderably enhanced in the majority of children, 12 monts after the acciden parathormone th t e leve n blooi l f chil.dreo d n became completely normal. It is possible that the revealed augmentation of parathormone content in blood is connected also with the parathyroid gland activisâtion as a responce to incorporation of iodin thyroin i e d gland. In order to clear up the structure of thyroid gland the ultrasonic investigatio pare childref th to f no carries nwa d out. y considerablAn e change thyroin ai d gland werobservedt no e . Thus, summing up the afore said, we have to note that any expressed pathology of thyroid gland in children after the contacts with ionizing radiation wert revealed no epare f th o t n .I children the augmentation of thyroid gland, the increase of thyroid hormone, thyrocaLcitonin parathormond an e e level bloon i s d took place. 6-12 months afte e accidenth r normalizatioe th t n of indices characterizing the function of hypophysial thyroid

297 syste d parathyroian m d gland were notede samth e t A .tim e onuy two years passed after the accident. Taking into account the da- f worlto a d literatur e considew e r thae childreth t n subjected to radiation influence neee furtheth d r thorough clinical-laboratory e timelcontroth r y fo ldetectio f thyroio n d pathology possible in this situation and prescription of adequate therapy.

298 MEDICAL CARE DURIN RADIATIOE GTH N ACCIDENT ( Cs BRAZILN )I , 1987 137

G.D. SELIDOVKIN

Abstract

The report describes the activities of diagnosis, prognosis and treatment of overexposed individuals during the radiological accident of Goiani n Brazili a particulan I . t i describer e handlin th sindividual7 1 f o g s who suffered acute radiation syndroms.

After summarizing the development of the accident the report describes the radiation injuries of people, the biological dosiraetry methods used for the diagnosis of doses and the methods for decontamination. The treatment and the respons patiente th f o e s alsi s o describe detailn i d .

The group, consistin individualT I f go s with, different symptom f acuto s e radiation syndrom beed ha en forme a resul- s a df o t stealin destroyind gan highla f go y radioactive cesium containing source in the city of Goiania (Brazil)« During the 1,5 months nearly 250 individuals were examined. f e methodo themth 5 y 2 b f ,physica o n sI l dosimetr e signth y s of contact with radionuclide were discovered, especiall e skiyth n contamination. At the first stage 26 individuals of this group were hospitalized on the suspition of radiation sickness, but in a short period of time, 6 of them avoided this diagnosis. Further examinations alloxved to cancel the diagnosis, regardin morg3 e patients. The most injuried individuals (at first 10, then another 4) were moved to the Navy Hospital Marsilio Dias, Rio-de-Janeiro. The scheme of accidental situation, included into the sickness histories, didn'n satisfy the comparison with clinic and anamnes- tic data. Therefore, retrospectively, but quickly enough, we had suggested another version adoptee Brasiliath y b d n specialists. 3 September1 unemployen A . d Roberto foun a metad l installation in the oncological hospital that was closed at that time.

299 Together with his friend Wagner, he removed the parts of this installatio homes hi o ,nt wher September8 e1 kepe th t o thet .p mu With the help of Wagner, Roberto dismantled the defence of the installation and extracted a cylinder with the length about 30 cm and the diameter about 10 cm. (weighting 25-30 kg) containing 137-Cs. After that, Roberto broke the hermetically sealed installation by the screw-driver. At the same day, the metal parts of the installatio cylindee th d nan r were removeDevair'e th o t d s scrap metal depositor remained an y d there until September1 l2 . Devair's emploee Ademilson had been processing: the metal and probably 20 September was subjected to the first irradiation dose.

After sellinmetae th lf go partse evenin Sep1 th 2 n -,f i go tember Devair discovere cylindeda centre wares th hi n f -ri eo house, enaming strong blue glow broughe .H intt house ti th o e and used as a night-light, Por more than six days, the cylinder, containing the radionuclid s standin 1,2-1,ewa e th n o g5 metre heigh ches f drawerso t , 1,8 metre away from Devair wife's bed. Maria-Gabriella Fereira, his wife r ,spar he spen el al ttim thin i e s room. Septembe3 2 r Devair ordered another man, Israel disaso ,t - sembl e cylindert wit th i hele e attemp f th o hth o d p t o t t,bu hammer failed. 24 September Devair's brother Ivo came to visit him and with the screw-driver separated the pieces of the source, put them, into the pocket d broughsan homet ti year6 gave daughted .s H sol ehi r Leide one of the pieces at meals. Probably, she ate the particles source oth f e together with e samfoodth e t year4 .A time1 s s,hi n Lucimaolso d r received another piec f sourceo e . e Whes i nLo Odette came to see him, Ivo smeared her neck with the powder, moreover, som er breast crumblehe n o ,t hip sgo d stomach san . Then Tvo went to Loise's husband Cardeck and thus, some particles of cesium got into Cardeck's bed, where he slept.

300 e remainderTh source th o scatteref eIv so e yarf th o d n i d his house, part of them got into the rooms. 25 September Devair continue disassembline th d soure th -f go ce. Ademilson, obviously, helped him, takin cylindee gth s hi n ri hands. Devair scattered the particles of cesium in the yard, some of the intt housee mgo th o . Those people visitin m tooe ghi th k source partth s souvenirsf ea so same th e t .timeA , anothe- rDe vair 's son Adson Batista was irradiated, Devair's friend Adson Fabiano also received the practicles sourcee oth f , brought them hom d shareean d with Odesaone th d ,an next day with his brother Ernesto. 27 September e medica.Th l personnel, wher victime eth s applied for help, suspected the possibility of irradiation and De- vair ordered Gerald brino t ocylindee gth dosimetryr fo r n ma e .Th s carryinwa about gi t half-an-hou righe th tn ri shoulder . September0 3 . Maria-Gabriell e ad slep th Abruha n o ti ,wh same momene rooth mhospitalisatiof o o t cam p eu r daughhe f -no ter and her husband. Thus, the indicated people and some other were subjected to external irregular irradiation, their skin was contaminated by nuclide with the possibility of its incorporation. In the centre of the city had formed 7 comparatively large zones contaminated by radionuclides and about 50 minor ones. Thus, in Roberto's house were radiocesiumf discovereo i mC 0 e sign50 d . Th f cesiuso m wer etree founth e n topso d , 10-15 metres height, standin0 g25 awam 0 any d80 fro m Devair's house. e commoTh n activity discoveree th y ,b d quotas (the passport data missing) are estimated as approximately 1370 Ci of 137 CsCIO-j. injuree th Medicas organizeo t dwa d ai l d accordin existine th o t g g worle ith n d common rules, Pre-hospita s providee wa th d lai y b d Brasilian physicians and, taking into account thei abilitiesn row , all the persons, suspended of the radiation damage, were hospi-

301 observatione talizeth r fo d , totall patients6 2 y- . Anothe9 r2 were followed out-patientl finae th lo t rejectio p yu suspif no - tion of radiation syndrome. Both hospitals (in Goiania and Rio) are hospitals of common type. They were accomodate r deploymenfo d patiente th f o t s with combined radiation injuries. The walls and the floor were covered with plastic pellicle. Skin integuments were treatewardse th n .di Radiation protection of the personnel was carried out since the first day of receiving the patients by permanent clothes changing d usinan g special plasti d papecan r wear. ?or diminishing the second absorption of Cs from intestine all the patients since the first day of the hospitalization re- c eived "Radiogardas" (Kail Ltd., West Berlin) preparatiof no "Prussian blue" type, binding and at the same time transfering cesium intinsoluble oth e compound Goianin :i a 10-1dayr pe n ,i m 2g Rio 4-6 gm per day. The enployruent of the preparation allowed to increase cesium excretion in 2-4 times without decrease of its concentratio urinen ni , i.e y influenc.an naturallyt no ed ha t ,i on the nuclide metabolism in the basic deposition places and, correspondingly, in blood. With the purpose of strengthening of radiocesium excretion with urine patiente ,th s receive diuretice th d s (furocemid), which increase urine dth e volum witd unchangee ean h th d same concentratio nuclidf no e increase s totait d l withdrawal. The internal Cs 137 irradiation occured obviously as a result of the radioactive compound swallowing. The final accouninternae th f to l irradiation doses, according to the data of biophysical study of the patients in Brasil, s conductewa Gusey db v I.A. s shownItwa , thadosee th tinternaf so l irradiation, exceedin gday0 0,0(3 s y 5afteG r radiocesium consumption onld )ha y 9 individuals. The comparison of these doses and those, calculated

302 by the cytogenetic methods, showed that the internal irradiation compose moro sn e than I5-3C$ frokariologicalle mth y assessed value (excep aboud Leider ha fo t t o ,wh 50?S) . •Thus, we come to the conclusion, that the levels of internal irradiation couldn't caus developmene th e direcf to t biological effect d actuallearle an sth yl manifestationyal d beesha n deter- irregulare mineth y b d , total, external irradiation together with local radiation injuries. The analysis of information about the quantity of nuclide excreted with urine showed significant fluctuations (abou- ti t8 mes). If we except Leide*s case, avarage biological half-life for the groupatient9 f po s havin majoe th g r nuclide contamination (accordin Guseo gt Dementievd van 20-3s )wa 0 days, i.e usage .th e of diuretics together with "Radiogardas" hastened the nuclide ex- certion in 2-3 times. The principles worked out in the clinics underlined the prognosis of expected acute radiation sickness. For the assessment symptoms of primary reaction as well as the rare dat hématologin ao e studiefirse th tn i sillnes s decade, and the cytogenic analysis of periphery blood lymphocyte culture were used 0 fro .1 patient4 1 m s (Rio) were notice havo t d e primary reaction symptoms, such as nausea and vomiting. The possibility of postponed symptôme development and the disperanc intencits it e tim momentaniouf th f yo eo n i y s irradiation, were suggested talcing into account the prolonged influence character and the experience of total therapeutic irradiation, conducted amon clinic'e th g s patients e retrospectiv.Th e analy- showeds si , thaperiode th t vomitinf o s g appearance wer6 e3- hours afte beginnine rth irradiatiof go severt na e ARS, those with aboun i t ti 8—1d mediaha 2S nAR hours . Anorexia could be marked as well but much more rarely: in two patients with severe ARS and in one - with median one.

303 case3 n firsi e s y th frequen tda f o d en t e wateth o Urt p stools occured« Only in Leide's case it could "be assessed as an irradiation reaction (symptôme) as she had the diarrhea relapse, she had melena, as well. Pour patient wit2 ( s h severwit2 d h an emedia n ARS) felt sictired kan d durin 2 daysg1- . Nobody had any significant temperature rise. The analysis of hématologie data allowed to predict that in all cases, a dose of gamma irradiation doesn't exceed 6 Gy, excludin threae th g f dangerouo t s bone marrow syndrom - ARS.f o ere t I jecte idee f bonth do a e marrow transplantation. The dynamics of laboratory investigations corroborated this opinion and allowed to group the victims according to the neutrophyl account changing. Thi mosse th tes ts i texac t characteristic bone oth fe marrow syndrome conductee .Th d groupin appron i s -gwa priate correlation with cariological investigations. Therefore, we can conclude that as a result of Goiania accident (Brasil) there wer case5 e acutf o s e radiation sickness ,patient3 s received media rese sligh- n th 9 t dos d tean damag bloof eo d formation. Haemopoiesis had restored in all the cases, except for Lei- de's dieo ,wh d during medullar radiation aplasia othe3 . r victims died afte beginnine rth haemopoiesif go d an 4 3 s, repai32 n i r- days8 3 .

Except for the period of abortive rise, the neutrophyl dynamic s quitswa e ordinary that .A t tim bloon ei d platelets were mainly defined, which is probably connected with the lower affe- ctation of commited and morphologically recognizible cells. At the same time, stem cell death was similar at one-event irradiation. In 8 cases stimulating macrophagal and granulocytic cell facto s used rwa e facto .Th glicoproteis ri n (molecular weight 14000), regulates granulocyti macrophagad can l proliferatione .Th

304 facto consideres ri strictle b o dt y specific, acting througe hth sell surface receptors, independent from other mediators. There date ar a about other stimulating factor effects experimentas .A l studies showed, the factor stimulates of granulocytes yield as wel s thal a monocytesf o t , eosinophyles somo ,t e extent megaca- riogenesis, but it has no influence on erythroid and lymphoid cells. Moreover factoe th , r potentiates phagocytosis function, stimulates prostaglandin yield, activates plasmonogene. Taking these properties into account, as prof. Gale has recommended accelee e facto, th th decisio a ther r e s -rfo us ewa o nt ration of peryphery blood cell repair. In all the cases (except Leide's), where the factor was used, transient growth of granulocyte number was observed. Estimating e actioe factoth th casen f rni o ARSf so e coul ,on d observe actu- l absenca duratiof effece o eth n to f totano l agranulocytosist .I can be explained by the peculiarities of bone marrow radiation injury. Cell proliferation kinetics is synchronized by irradiation, d talcinan g into account that factor influences commited cells, some period of time is required for their accumulation. This is the result of repair after dose-dependent radiation myelodepres- sion. The patients with severe and middle degrees of bone marrov/ syndrome during the period of granulocytosis received antibiotics accordin adoptee th o gt d scheme ,r bon workefo et marrodou w transplantation e treatmen.Th t begun after receivin bacteriologif go - cal inoculation or after appearance of the obvious symptoms of infection development. As a rule, at first, were uaed antibiotics of aminoglicosi- de and cephalosporin groups T later amphotericin B was added; the patients received selective intestine decontamination. All the patients with different degree of EMS (numbered 8) climas it infectioud n xha i s complications thef o m.5 with severe form of BMS had stomatitis; in 2 other cases - esophagitis and pharyngitis.

305 The frequency of especially serious infectious complications development in two subgroups was similar: pneumonia - 2 oases in each subgroup d sepsisan ; , documente blooe th dy db microflora inoculation - 3 cases in each subgroup. Microorganisms - stimula- tors: clebsiell cases3 a- ; mixed flora: clebsiella -t- collibacil- lus - I case, un-indentified (for the mission period), G - flora - I case, staphylococcus and pseudomonas - I case. Two woman-pa- tientpositiva d sha e reactio cytooiegaloviruseo nt s presence test. Serious infections wer mose th et obvious cause patienf o s t deaths individual2 : n eacsi h subgroup. When the trorabocyte level reduced, the patients were prescribed donors trombocyte transfusion. They were received wite hth help of blood cell separator CS-3000, from one donor for each transfusion. Hecuorrhagic syndrome proper waa observed only in 4- cases, moreover patient,2 moderatd sha e skin hemorrhages patient4 ; - s eye sciera hemorrhages d bloo ha excrementsn i ;dI , odontorrhagia and mu.socal oral cavity hemorage autopse ,th y revealed subarch- noid hemorrhages that have evidently formed during the terminal period. Onlpatiene yon Leidserioud - t ha e- s hemorrhage: abundant nasal bleeding day,3 s melena, bloo fecesn i d autopse ,th y showed minor subarchanoid hemorrhages hemorrhagid ,an c change colonn si . Practically all the patients in Brasil had local radiation injuries, expresse bulloue th n d desquamativi ds an e radiodermati- tiscase2 onlt n Bu .yi s radiodermatitis covered 20-25 bodf ^o y surface, in I case - 10% and 3 - 55& in all the other cases» Ra- iioderrastitis located on the open body parts, especially on hands. Radiodermatitis course at small damaged parts was favourable and finished with complete rehabilitatio months5 1, e - .On I n ni can expect benefitial effect of the "Oxopherine" (BRD) on the re-

306 ducin e periodth g healingf ,o e preparation.Th authore th - s ,a saf firm, favours the development of macrophagal activity on surface of the wound and thus forming better conditions for epitheliza- tion d alo.an e solutio stimulatora s na . In 3 cases there was a necessity to make necrectomy of small akin piece subcutaneoud an s s fat. Wouncase2 healed n i dsha d completely patiene recurrenca on d t ha t,bu ulcerrouf eo s process e thinth gn o afte month5 r1, . Whe lesione nth s were ample healino ,n occured gha d during2 morr o patiente e th months f o s subjecte e swa .On hano t d d skin necrotomy and on the 63-th day the terminal phalanx on the left hand finger was amputated. In the patient with radiodermatitis of both forearms and hand necrotie th s c procese th s f intensificatioo d en e th o t p nu 3-rd week caused considerable intoxication on 25-26-th days. In- vestigation with Tc-pyrophosphate incubated with autoerythrocytes took place on the 25-th day, confirmed the cessation of blood circulatio lefn ni lefe tth 26-t e t hand y th forear hda n . O s mwa amputated on the boundary of middle and upper third part. It liqudated intoxication and lowered considerably body temperature. The wound healed by the first intention. All the patients were discharged from the hospital up to the end of the 3-rd month. Only two of them had the leukopenia clinical symptoms and one individual had a residual wound postuleerous process on the thigh.

307 DISCUSSION

P.V. RAMZAEV (USSR) Firs allf to would,I , lik noto succese et th e clinicianf so s who had struggled, with radiation, sickness in treated individuals mored received an ha e fac d .o Th tra wh d tha 0 dose60 t manf o sf yo them survived testifies that radiation medicin appropw no s -eha riate means that givpossibilite th e increaso yt formee th e- rva luetimes 2 letha f n o si .) l dosD (L e Second, another groun optimizr facdfo e th t s thami t there were no victims among lay population, moreover, there are no grounds for anxiety about future. The latter statement is based on the following: according to the latest concepts adopted by In- ternational Commissio Radiation no n Protection (ICRP d UNSCÏÏAJ)an R o radiatiothern s i e n damage expecte e doseth st a dlowe r tha0 5 n rern. Howevar, eve t rathena w doserlo f exposuro s e - causeac y b d cidental irradiation there are huge resources in the USSR for reduction of total irradiation dose. Thus, only for 3-5 niin natural irradiation fro ms daughter it rado d nan s exceeds 2rem/yea- to f ro tal irradiation and can reach 16 rem/year for lungs. For this contingent radiation effects connected with the collective radon 0 time7 dos 3 ± es higher thatotae th n l collective dose froe th m Chernobyl accident. My point of view is that as far as the Chernobyl accident is concerned practical health service has no particular interest but r enlightmenfo t work systee .Th thif mo s wor developeds ki r ,fo instance Ministre th n , i Publi f yo c RussiaHealte th f ho n Federation. othee Onth r hand, Chernoby befort numbea pu s s eu complif lha ro - cated tasks; they concern dosimetry, medical radiobiology- ,ra diation protection, etc. These problems haveopiniony m n ,i - ,in ternational character consideI .y Thawh expediens t rti i o tt make a proposal about organization in Kiev on the Base of All Union Scientific Centr Radiatiof eo n Medicin Internationae eth l

309 Centre on Medical Aspects of Nuclear Engineering. In the new conditions of Perestroyka in our country this proposition will be accepted by authorities.

C.E. BRANDAO-MELLO (Brazil)

MEDICAL ASPECT GOIANIE TH F SO A ACCIDENT

In September, 198?» two unemployed men removed a sealed Ce- sium-137 ( Cs) source from a radiotherapy center in Goiania, Brasyl. Over the next several weeks a large number of persons came into concact with the source. Exposed persons were evaluated clinically and haematologically on September, 30, 1987 at the triage cente Goianian i r . severite Baseth n o dacutf o y e radiation syndrome (AUSd )an skin lesions, patients were treate differentt a d , medical sites: primary leve locat la l dispanceries, second leve General- l Hos- pital of Goiania and tertially level - Radiation Medical Unit at the Navy Hospital in Rio de Janeiro. Aproximatel 9 person24 y s were exposedmoderatd ha 9 o .12 t e severe internal and external contamination. 79 persons were mana- ged as out-patients. Fifty persons required dose medical surveillance. 20 of these 50 were hospitalized of whom thirteen developed severe bone marrow depression. Eight received GM-CSP (Gra- nulocyte Macrophage Colony Factor). Five received supportive care including prophylactic antibiotics, anti-viral and anfci-fungal drugs and transfusion of red cells and platelets. Four patients died during the first month after the accident from complication includinS AR f so g bleedininfectiod an ) (2 g n (2). Internal contaminatio inhalationo t e ndu , ingestio- ab r no #7 s assesewa vivosorptios n C d"i totay "b f nlo body counting and "in vitro" by radiochemical analysis of biological specimens. Persons with substential contamination received "Prussian Blue" at doses of 1,5 to 10 g per day:

310 Presently most victims are well; one remains hospitalized with a severe radiodermatitis of the right thigh. A perspective programme of following-up is in progress.

T. SHARMA (India)

SHOR LOND TAN G TERM CYTOGENETI GENETID CAN C STUDIES OF THE POPULATION AFTER THE CHERNOBYL ACCIDENT

surem a I , cytogeneti genetid can c analysi - e goinaf sar n go ter the Chernobyl Accident but in the present conference no data have been presented. I sencerely hope the data will be published in near future as well as in later dates and when the data are generated. It is very important what has been emphasised in this meeting o lesn f sbuwilo t ti importancinvestigato e t lb y - tr cy o et e eth togenetica geneticad lan l aspect wells sa wilt .I desirabl e lb e to do proper cytogenetical and genetical analysis and, if necessary, in collaboration with talants and expertise available from different countries Chernobye .Th le accidenonlth t f no yo s twa USSR, it was of whole mankind.

311 POPULATION STUDIES, PUBLIC HEALTH AND ALL-UNION REGISTER MEDICAL DEMOGRAPHIC CONSEQUENCES CHERNOBYE TH F O L ACCIDENT

N.I. OMEL'YANETS, G.I. MIRETSKIJ, M.M. SAUROV, V.F. TORBIN

Abstract A demographic study was made of the population evacuated from the 30-km zone aroun e nucleath d r powee populatioth rf o plan d an nt livin n areai g s over whic e radioactivth h e cloud passe d ovean dr whic e plum th hs formed wa e .

Foe farmerth r s evacuate e Chernobyhome5 th d 65 fron i s1 m1 l region, houses700w ne 0 , e Kiebuilth vn i tregion alreadd ha , y been provided within 5 e monthsummee accidentth th y f f b 198o o s r d 7an , another 5000 houses were available.

A study of the resettlement of the population carried out a year after the accident showed that more than 60% of those evacuated continued to live in e regionth s from whic e evacuatioth h d takeha n n place; abou wer% 5 te resettled in other republics, and 20% within their own republic.

Chernoby accidenP NP l t unlik e accidentth e s whic d takehha n plac n othei e r countries characterizes wa , certaiy db n peculiarities. Among them are: releas f fussioo e n products beyone th d bounds of the NPP-site, contamination of the enviroment by the radionuclides by stages, the involvment of large groups of the population inte consequenceoth e accidentth f o s . Abou I thousant d e territorth squarf o s contaminatedm k eywa e populatioth , n from this area was evacuated, some people continue to live in the regions with technogene enhanced radiation background.

Low exposure dose f populatioo s a e resulaccident th s na f o t r and well-known data concerning the influence of ionizing radiation on the human body don't allow to single out immediately after the acciden e primarth t y damage f organo s d system an o sestimatt r o s e the appearance of diseasses in exposed population. At the same time studth e f demographio y c situation resulting froe accidenmth t on the territories adjacent to the zone influenced by Chernobyl NPP realeases is of a certain theoretical and practical interest. The present repor s devotei t e result e investigationth th o f t do s s on this problem.

315 populatioe th stude e objec s th Th ywa f o t n evacuated froe mth radium 3k 0 s people zon th NPPf eo a e, an areae livinth n o sn gi the rout radioactivf o e s etrac it clou ed an dformation . Wit- hre e characteth garr fo df acciden o r t developmen e investigateth t d territories were selected: Gomel and Mogylev regions of Byelorussia (north western trace), Chernigov region of Ukraine, Bryansk region of Russia (north-eastern trace), the city of Kiev, Kiev and Zhito- mir regions of Ukraine (southern trace). As indices characterizing demographic processes there were studied the character and the degree of mechanic movement of the evacuated population (migration streams, direction e structurmigrationf so ag d an migf o ex -,se rants naturad )an l movemen populatione th f to , namelivine th dn go territories (birth-rate, death-rate, natural increase of the population). The indices established during the post-accident period were compared with these of the previous five pre-accident years d alsan o wit All-Unioe th h republid nan c indices. e thase t n abou figurca e Prodatth e e t w f th meI 116,ao 5 thousand people were evacuate dm radiu k fro 0 3 ms zon Chernobyf o e l WPP, and the majority (71 »6 thousand) from the Ukrainian SoR (Kiev

91,6

0,181

Byelo- Russian Ukr.SSR russian Sov.Fed. SSR Soc.Rep.

Fig.I. Quantit personf o y s evacuated froChernobye th m P lNP zone of exclusion.

316 and Zhitomir regions). The places of evacuation of people on the territor e Ukrainia th e showe f ar yo R figurn o dSS n , fro2 e m which we can see that the population from 72 settlements, including the towns of Prypiat' and Chernobyl, was evacuated in 5 neighbouring regions situated beyond the limits of 30 km radius zone.

Kiev region Kiev region Pplessky district BorodianBlcy district tow f Prypiao n t Tow f Chernobyo n l I villageI s town of Erypiat 2? villages

town of Chernobyl

70 villages

Kiev region Kiev region Ivankovsky district Makarovslçy district _Chernobylsky district 24- villages 5 villages

Zhitomir region Narodichsky district Qyruchaky district 5 villages

Fig.2. Places of withdrawal of evacuated population from the JO km radius zone of Chernobyl NPP .

Proceeding from the analysis of current radiological situation the evacuation as a temporary measure of preventation of population overexposure became constant, and was guaranted with the govermental measure ensurinn o se evacuateth f go d population with e permanenth t residenc workd d creatioan e an , a follo f o nsysp wu - tem of their health status. In Kiev and Chernigov there were al- lotted in a short period of time more than 8 thousand flats with modern conveniences for evacuated power engineering specialists. Later they were given 6 thousand residences more.

317 With the purpose of settling the inhabitants of rural areas 5 house66 I o livesI wh beforn i d accidente th e s decidewa t ,i o t d buil residencee th d s mainl farmsteaf yo d type thousan.7 w ne f o d houses were constructed alread monthy5 s afte accidente rth d ,an summee bth y 198f ro 7 abou- thousan5 t farmsteadf do flatsd san . e datTh a about distributio builw ne tf no house representee sar d in Tabl. I e

Table I. Distribution of apartment houses built for the evacuated population in Kiev region

District, : Number of : Number of : Number of : Number of settlement : village house: block : sflat : £ so f so : farmstead : flats : : : typ: e I : 2:3:4:5 Barishevsky 7 1630 district Boguslavsky I 146 district Borodiansky 7 1190 district Vasilkovsk- 0 y40 4 district Vaailkov I 108 Volodarsky 4 470 district Volodarka 2 80 Vyshgorodsky 4 26o _ district Novosyolky I 60 village Zgurovsky I 120 - district Zgurovka 0 20 4 120 Ivankovak- y 0 52 5 district Kiev-Sviato- - - - shinsky district Vishneovoye I 200

318 Table I (cent.) : 3 : 2 : I 5 : 4

Kagarlykaki 3 ISO - district Kagarlyk I 30 Makarovsky 17 2105 - district 0 54 5 Mironovsky - district - Mironovka I 100 Per eyas lav-Khmel- 5 310 - nitsky district Pereyaslav- - - 3 134 Khmelnitsky Polessky — — district - - Polesskoye 3 134 8 28 4 Skvirsky - - district Skvira - - I 80 0 39 Stavishchansk 4 y - district Stavishche - - I 40 5 18 I Tetiyevsky - district Tetiyev - - I 40

7 22 4 Fasfcovsky - district Chernobylsky - - - district 8 4 2 - Gornostaypo - l 0 1 Yagotinsk121y 3 district Yagotin - I 108

87 IOI84 25 1362

319 s constructeItwa villagew totan ne block5 i d 2 7 l8 d f o ssan flat n townsi d villagessan . Sid aidy b e e with dwelling-housee sth social objects were built and among them, as we can see from Table 2 - schools, kindergartens and day-nurseries, shops, bath-houses, etc.

Table 2. Social objects built for evacuated population in Kiev region

Objects Quantity

Schools 33 6 4 Kindergartens 1 3 Shops 2 2 Medical establishments 9 1 Bath-houses Dining-rooms 14 Complex reception services 22 Local official quarters 29

Equally with the social problems the legal questions were de- e evacuatecideth - d d advantage peoplth d eha e before other citi- insurance th zen n i s f jobo e , healt d consumean h r servicese Th . medical follow up of their health was instituted. In order to in- form health protection bodies and establishments about evacuated person propen si r timnationae th e l information syste s createdmwa . On its basis is formed the All Union registry of evacuated population, closely connected with the All Union distributed Registry. It will giv opportunitn ea embraco t y e evacuateth e d populatioy nb the scientific investigation mann o s y aspects: demographic, dose, epideraiologic, clinical, as well as estimate immediate and delayed radiation effects. The data frofigure th m sho3 e w that durin firse gth t year afte e accidenrth followine th t g syste f settlino m s formedgwa : about 85^ of evacuated remained to live in their own republic, mo-

320 80 76,9 GO

O1 0 Russian Byelo- Mold. Lithua- Other Place of Ukr.SSR Sov.Eed. russia R nia SS B nrepub nSS - residence Soc.Eep. 5SR lies is unknown

Eig.3- Place residencf so populatiof o e n evacuated froe mth territore Ukrainia th USSe n th o R f R o y(accordin nSS o t g the dat namelists)f ao . e samth r e en thef regionsi o than - m% .60 . Abouf evacueeo % 5 t s were settled on the territory of the country. Up to IQ?£ of evacuate d changedha place th dresidencf eo - de e e oncar e w mor d ean finin mort gi e precisel yprocese nowth n .migratiof I o s dépe th n - lacements within the settlements, connected with the change of temporary residence constanr fo s t ones, prevail. Ther alse ar eo attempts of some evacuated to return home within the limits of 30 km radius zone. These are eldery persons and the persons of old age, who can not leave native locality by force of habit. Accordin date retrospectivf th ao o t g e observations (fig. 4-7) the territories of the Ukrainian SSR adjacent to the accident zone are characterized by a high birth-rate in the towns and a low birth-rat rurae th ln ei areas d significan,an t scatte deathf ro - rate data. The most inauspicious indices of natural movement of the population were recorde Chernigon di v region, wher natue th e - ral increase was practically absent. At the same time in Kiev the birth-rate was considerably exceeding the average, the death-rate lowe% v/a3O s r than tha Ukrainen i t balance ,th naturaf eo l increa-

321 s positivesewa Byelorussia e th n I . accidente n th zpn f o e , thas i t mainly agricultural indicee ,th naturaf so l movemen popue th -f o t lation were considerably higher tha nUkrainiae thesth f o eR nSS d approximatean average th d e indicecountrye th f so mainld ,an y hige th h o t birth-rate e du aree Russi.f Th ao a take intermee sth - diate place among the above named territories according to the investigated indices. For all aones the fluctuations in the indices of death-rat causen o e characteristice sar . Ther certaia s ei n dependence of these indices on diseases, when the level of urbani- zatio medicad nan l assistanc importants ei . However, durine gth recent years (1983-1986) in all the followed regions the growing posative tendencies in demographic indices began to apper; these tendences were linked with the growing popularity of "healthy mode of life".

m 18 -P loi

V •P M ^ 12 .O •P h •r-f Z years 0 1981 1982 1983 1984 1985 1986 1987

— Ukrainia — —- R SS n — •—•— Kiev —•—•— Kiev region- —o—o— Zhitomir region —«-o — ,0 Chernigov region

Fig.4-. Birth-rat e territorieth n o ee Ukrainia th f o sR SS n adjacent to the zone of Chernobyl NPP accident(per 1000 inha bant i . ts)

322 •x

Fig.5- Natural increase coefficients on the territories of the Ukrainian SSR adjacent to the zone of Chernobyl NPP accident (per 1000 inhabitants).

16,

14-

O 12

10' •H rH Öl

- -- - Ukrainian SSR — «—1-_ Kiev years —•—»— Kiev region r jui —o—o— Zhitomir region 1981 1982 1983 1984 1985 1987 _—Chernigov reeio

Fig.6. Levels of mortality on. the territories of the Ukrainian SSR adjacent to the zone of Chernobyl NPP accident during the period of I98I-I98?.

323 18 ir 16

^ID JT4- * - o CJ Gomel region 3 >1 > 3 I2 Kiev region J3J ii B ü TU * - -- - Ukrainian SSR — « — «— Kiev Kiev region years —— ° — ° Zhitomir region ;l ___ ^ —f^, — ,0 Chernigov region 1982 1983 1984 1965 1986 1987

Fig. 7- Levels of child mortality on the territories of Gotr.el and Kiev regions durin e perioth g f 1982-1987o d .

As we can see from figure 4, the natural increase of population during the first post-accident year didn't differ from the usual. The considerable changes in the birth-rate and death-rate wer t registeredeno , dat e eithef figth o a e .rse 5i6 e exeptioTh . n were some region Ukrainiae th f o s n S3R, adjacent immediatelo t y th eaccidente th zon f o e . Ther insignificane eth 239J- 8 )( t transitory lowerin birth-ratf go observeds ewa . Having thoroughly e structurag d an populatiof o ex studie se e th d n livin thesn go e territories, migration activity of the population, the frequency of abortions, we came to the conclusion that the lowering of birth- rat s connecteei d wit removae hth pregnanf o l t wome r sanitafo n - tion, wite departurth h womef o e fertilf o n e froag e m theoe territories andcertaia o t , n extent, witchangee hth familn i a y planning strategy under the conditions of post accident radiophobia. As for the child mortality, we can see from figure 7, that since 1985 it continue to lower in Ukraine as well as in Byelorus- sia, thougs lowerin ratit e f th ho e g slightly reduced.

324 causee th chilf n so I d mortalit didn'e yw t revea y changelan s in their structure in compairison with the pre-accident period. The outcomes of pregnancy, health status of children born by women who were pregnant at the moment of the accident, we have' no ground speao st k abou y changepopulatioe an t th n si n reproduction. The foregoing data permit us to make the following principal conclusions: 1. Under the conditions of a large scale accident of NPP reactor the evacuation of the population from the zone of ionizing radiation influence becomes necessary. Unlike the large scale acciden n otheo t r industrial objects nucleae th , r accident make th e evacuation permanent, because due to the actual radiological situation re-evacuatio settlemente th o nt s situated nea woulP rNP d be hardly possible within the next few years. Evacuation in its turn result intensificatioe th n si mechanif no c movemen thif o t s categor populatione th f yo ,demographif o i.e e change on th . f o e c indices. 2. The hightened migration activity of the population doesn't always promote its social well being. But taking into consideration that in connection with the measures undertaken by the state in the new places of residence of evacuated people the conditions f lif o d workean , socia medicad lan l services were improved, there is every reason to expect their favourable influence on the health e peoplth thif f o eo s category. P reactoNP e Th r . acciden3 f lergo t ionizine th scal d ean g radiation influence connected wit don't hi t exert influence upon the principal indices of natural movement of population (birth- rate, death-rate, natural increase, child mortality) during the first post accident year.

325 ORGANIZATIONAL, METHODOLOGICAL AND INFORMATION ASPECT MASE TH SF INDIVIDUASO L DOSIMETRIC SURVEYS CARRIE CONTAMINATEN I T DOU D AREAS FOLLOWING THE CHERNOBYL ACCIDENT

A.F. TSYB, V.F. STEPANENKO, V,A. PITKEVICH, E.A. ISPENKOV, V.K. IVANOV, E.G. MATVEENKO, M.A. MAKSYUTOV, O.G. POL'SKIJ, R.N. TURAEV, A.E. ROMANENKO, N.I. OMEL'YANETS, B.A. LEDOSHCHUK

Abstract

The dositnetric surveys carried out after the Chernobyl accident relied on a preliminary evaluation of radiation conditions shortly after the explosio werd an ne backey speciab p u d l arrangement e personneth n o s d an l organizational side, as well as by appropriate information techniques and methodology.

The calculationa e worl th par f mathematicakf o o tinvolve e us e th d l modela specia d an s l computer prograe dosimetrith r mfo c calculationse Th . models include parameters agreed upon by leading experts of NCRP (USSR Ministr f Healtho y makd t an i possibl)e o adapt e e dosimetrith t c calculations to various situations corresponding to the sex, age, height and body mass of those examined, their whereabout typd f nutritioan so e e controlleth n i n d e frequencth zone d an ,f contaco y t with radioactivity computee Th . r programs are designed for speedy calculations and allow an assessment of absorbed doses n fieli d conditions (using small computer technology n hospitai d an ) l condition t differen(a s t e ail-Uniolevelth f o s n distribution register).

The main part of medical measures on population health protection after Chernobyl accident is the timely and adequate dosimetry of all the individuals subjected to radiation exposure. The main objectives of this examination are: - Immediate classificatio e examineth f o n d population accordin o gt dos e risk groups; - For the groups of enhanced risk, provision of urgent prophylaxis and treatment measures according to dosimetry data; - Decision making for minor risk groups about the character arid exten f protectiono d , prophylaxis, treatmen consequend an t t follow-up; - Obtaining necessary data for the Registry with the conse- quent long-term medical follow-up.

327 n cas I inadmif o e higy l b hssi leve radioactivf lo e contamination, neccesitating urgent population evacuation, dosimetrs i y conducted with the aim of immediate estimation of contamination level skinf so , clothes, private things. Through dosimetry examination, including estimatio bodf no y radionuclide contend tan internal doses has to be conducted soon after evacuation of population from dangerous territories. Irradiation doses froenhancee mth d gamma-backgroune b n dca estimate basie th dosimetrf sn o o d y dat f environmentaao l contaminatio d individuanan l inquest abou behavioue th tcone th -n ri trolled area. For the population of permanently controlled zone dosimetry may be restricted by the assessment of the average absorbed dose of external irradiation for a concrete settlement (excludin territorie« th g s with high exposure rate gradients). Besides, absorbed dose internaf so l irradiatio- in o t e ndu halation of radioactive substances have to be estimated separate- eacr fo h y casl e basin individuan o g l spectro d radiometr-an d yan the inquest of examined individuals about their behaviour regime in dangerous zone and the peculiarities of diet. The individual approach is necessary due to the revealed individual differences in internal doses that have the character of lognormal distribution. That is stipulated by both individual peculiarities of radioactive substances metabolism in body, and by the specific features of food-stuff consumption and behaviour in controlled areas wels ,a s cattlla e farming, adopted protective measures, local irregularit radioactivf o y e contaminatio territorye th f no . 198y autumd ma 6an n I n 198 sprinn weli s 6 a autumd s la gan n 1987 mass individual dosimetry examinations were conducted, that embrace e populatioth d f territorieo n s subjecte radioactivo t d e fall-outs with relativel w contaminatioylo requirt nno thad edi t evacuation e tim .Th f ex?jnins.tion o e s chosewa s n accordin o seat g - sonal peculiarities of cattle farming (pasture and stalled cattle

328 keeping) that is the main link in transport chain of radioactive substoJQces from environment to human body. In autumn 1986 and 1987 dosimetr s conducteywa d within total medical screeninf go the controlled contingents. Dosimetry investigation was based on the results of preliminary assessment immediately after the accident and had methodical, personnel, organizationa informationad lan l support. e estimatioTh situatioe th f no correce s aimeth nwa - t da de t termination of contaminated areas, decision making about population protection, expediency of individual dosimetry examinations choise th a sadequatf t eo wela s la e methodical support wite hth regard of future works. Situation estimation included determinatio externaf no l gamma-background, selective measurement radiof so - nuclide composition and environmental contamination level, as wel contaminatios la foof no d stuff d correspondinsan g territory quartering. For these and other works connected with the mentioned problems complex working pla s developenwa d adoptedan d t I . included medical establishments, sanitary-epidemiologic service, civil defence boards, research institute USSe d Repubth an R f so - lican Ministries of Public Health and Academy of Medical Sciences, establishment d institutionsan Goscomhydromef o s d Gosagroproman t . Organizational support was provided by the Party and Soviet bodies. acute th et a accidene perio s th a f r maio de A fa sth t n danger was that from radioiodine affecting thyroid gland, and the critical group from this point of view are children and pregnants (foetus) y 198Ma 6n ,i this grou s subjectepwa individuao t d l thyroid examination. Data obtained were immediately addressed to medical establishment decisior sfo protectivn o n d prophylaxian e s measures. Individual dosimetry survey of radiocesium content was started later (autumn 1986, sprin autumg- n 1987). This examination involved both children (including unborn) and adults. Toge-

329 ther with dosirnetry total medical screening of the population was launched» Primary medical documents were compiled. Data obtained were entered int a computeo r databas d servee- an basida s da r sfo ta arra dosimetrf yo y informatio All-Unioe th r fo nn Distributed Registry of individuals subjected to irradiation as a result of the Chernobyl accident. Methodical support included hardwar calculatiod ean n parts. Various instruments from laboratory equipment were widely used: multichannel and singlechannel spetrometers, whole body monitors, thyroradiometer d portablsan e field dosimeters. Method fielf so d radiometr d spectrometryan y were urgently assimilate- ac e th o dt tual situations, corresponding instructions were d workean t ou d distributed. Significant contribution in medical support of these work s don sspecialisty wa b e s from Moscow Institut Biophysicf eo s (USSR Ministry of Public Health) and Leningrad Institute of Radi- ation Hygiene (Ministr Publif yo c Healt Russiaf o h n Federation). On contaminated territories measurements were conducted, as a rule, in stone or concrete appartients. That decreased gamma- background significantly. Measures were taken against radioactive contamination of appartments. Most important methodical points are: thorough preliminary and then periodical calibratio d intercollatio- nan in e th l al f no volved instrument radioiodinn so d radiocesiuean phantomn o m f so thyroid gland and whole body, containing standard ammount of activity. Positivexperience th s ewa calibratiof o e n with voluntary phanton-carrier uptaked ha o nswh standard ammoun radiocesiuf to m and who were regularly checked. This calibration was conducted in field conditions for various body positions. The involved equipment, mean dosimetryf so , phantoms, were checke d calibratean d d by special expert commission, formed on the dercee of the USSR Ministry of Public Health. Age dépendance of calibration factors and shielding coefficients as well as their dependence on body

330 weigh positiod an t n were determined with body physical phantoms and calculation wits- h specially developed adoptable mathematical age-dependent phantom wholf so e bod d thyroiyan d gland. The methodical support includes mathematical models and dosimetry calculation software modele .Th s include parameters coordinated by the leading experts of NCRP (USSR Ministry of Public Health d allo)an adopo wt t dosimetry calculation variouo st - ssi tuations correspondin agee th , o sexgt , height, e weighth f o t examined individual, the character of this diet in the controlled area, the duration of his presence in the zone of radiation effects. This software provide rapid estimatio absorbef no d doses bot fieln hi d (small computers d stationar)an y conditionn (o s different levels of the All-Union Distributed Registry). Personnel of dosimetry examinations includes specialists and specially traine n spectroi d radiometrd -an y individuals. More- over, every medical team must includ t leas ea o dosimetr tw t y specialists and one specialist in dosimetry registry. One specialist on computer methods is capable to process the data provided by 7-10 medical teams. Organizational suppor mainls i t y connected with transport means, immediate connection betwee centre th e team nth d e an sbus y with active data processing, decision making, detrmination of schedul worksf o e , intersubstitutabilit f specialistso y , instrument service. e experiencTh e gained makes possibl concludo et e thae th t principle poin mast a t s dosimetry examination informationas si l support of the work. Taking into account the low level of radiological knowledge in lay population, with the aim of prevention and prophylaxis of unreasonable radiophobia, elusidative works have to be launched together with dosimetry. Information of mass media. s als i greaf o t importance.

331 The following criteria of this informational support can be singled out: - reliability and uncontradictory character of information, which implies preliminary expert assessment of all the published data without any exclusion as well as formation of centralized information centre; - competence and independence of Informators, necessary participation of specialists, preferably physicians, confident for the population; - regularity and immédiateness of information, regular pub- lishin bulletinsf go , constant informatio masn i n s media, fixed information time on TV and radio; fast reaction on any changes situatione th n i , preventio rumoursf no ; Opennes- informationf o s , tha possibls i t heldiny b e g regu- r brieffingsla , meeting specialistf o s s wit y populationhla , consultation "question-answerf o s " type, including anonimous. The above information is of great importance because the negative consequence f radiophobio s y tur highlt ama nou y essential from both medical and social points of view.

332 DATABASE FOR A SYSTEMS ANALYTICAL APPROACH TO STUDYING THE MEDICAL ASPECTS OF THE CHERNOBYL ACCIDENT

I.I. LINGE, K.K. DUSHUTIN, LG. ZAJTSEVA, L.N. KOVGAN, S.G. LABUZOV, A.A. NIGIYAN, V.F. KHOKHLOV

Abstract The main elements of the program data base were the all-Union distribution registee SDACHth d A ran compute r system (Chernobyl accident data system) which ensured reliable functionin PRIORRe th f o gA expert system [acronym stand r "takinfo s f optimuo g m decision e evenradiatioa th f o tn i s n accident"].

e developmenTh f criterie o optimut th r fo ma selectiof o n counter-measures follows three path medicals- , economis i d sociad an can - l based on a regulatory document entitled "Criteria for taking decisions or measure proteco t s e populatioth t e evenreactoa th f o n ti n r accident".

The long-term program for studies of medical aspects in the Chernobyl accident has a general task to develop and realize on the base of Chernobyl experience effective therapeutical and pro- philactic measures aimed at protection and support of human health in large radiation accidents. An active component inherent to the task determines a due considéracio multifactoe th f no r characte e effectth f ro s resulting from accidental consequences. In these circumstances the use of a systemic analysis has been essentially justified, Asystesa shale mw l consider detriment characterizey b d harmful effects on the population caused by the accident in Chernobyl (investigations of its scope and specific features, possibilities and methods of its decrease, assessment of the efficiency of measures directed at its decrease or prevention which were already realized or are in the stage of realization and development of a complex of highly effective measures for protection populatioe oth f largn ni e radiation accidents). e difficultTh describinf o y systee th g m under stud s deteri y - mined by the large number of acting factors, objects against

333 which, the effects are directed and types of reactions of these objects to the effects. As the main factors of action it is necessary to consider the following: proper radiation effects resulting from the Chernobyl acciden tinformatio; falloue th harmfud n no tan l radiation effects on to the human health causing the so-called radiophobia; social, economic and hygienic measures for the liquidatio consequencee th f no accidente th f o s , practical actions of public health authorities and special organizations e coursth n f investigatioei o d liquidationan conseque th f no - ences of the accident. The objects against which these factors act are various populational cohorts: those evacuated from the zone of CNPP ; those living at the territory contaminated by radioactive fallouts; member workine th f so g team r elimifo s - natin e consequencegth accidene th f d individualo s an t o werswh e not exposed to radiation but who are sure that they were; authoritie publif so c healt researcd han h medical establishments. Reaction of the system to the action of the above given factors realizes followine itselth n i f g negative phenomena: social

and demographic eventsf mass radiophobia, increased morbidity t causeno radiatioy b d n effects; diversio resourcef no d meansan s of public health to the search of diseases induced by radiation. e positivTh e reaction systee th f mo s include early diagnosif o s diseases by mass screening; accumulation.of experiences useful in case of radiation accidents. e stud Th f thio y s syste s impossibli m e withou reliabla t e information base e maiTh - n direction developmens it n si t are: 1. Creatio date th a f banno r investigatin kfo g regularities in the formation and determination of individual and collective radiatio npopulatioe doseth o st d membernan f so the working teams eliminatin consequencee gth accidente th f o s .

334 Creatio. 2 date th a f recorno r individualfo d s exposeo t d radiatio Chernobye resula th a na f to l acciden provido t ea long-term automatic registratio thesf no e individuals, their children and future generations, radiation doaes and estimates of their changes s healtit d han .

3. Collection, analysis and systématisation of investigation resultconsequencee th f so accidene th f so d experi tan - enc f theio e r elimination, i.e. l informatioeffectival f o e us e - nal resources.

4-. Provisio f efficienno t managemen researce th f o td han practical work for the liquidation of the consequences of the accident. Ail-Unioe Th n Distributing Registe ) realizin(I f ro 2 . gp the direction computee th d san r system CJA^ n Russian(i A ) (Data System of the Chernobyl Accident) which must provide pp. 1, 3, 4 of the directions have become central components of the information base in the studies. e datTh a bas esystee (DBth f )mo CflAHA includes organizational (scope and types of measures and examinations performed) instructional and methodical (methods and approaches used in carrying out examinations and measurements) and factographical information on all recorded data from the inputs and outputs of the system.

These information objecta are divided in two specific type factographicas: documentad lan l sections. documentae Th l sectio DB-(Pigf no include) .1 folloe th s - wing subsections: registrational data of the documents; working plans; contents of the documents; responsible workers« The above mentioned sections include (respectively): - title, authors, key words and registrational data of all documents on the subject;

335 DOCUMENTAL SECTION

REGISTRftTIGNftL BftTfl E DOCUMENTOTH F S E OSUBJECTH N T WORKERS : ORGANIZATIONS. PROBLEMIC COMMISSIONS. EXPERTS

TEKSTR O S LIST F PftPERO S S ON THE PROGRAMS FRAGMENTS OF STUDIES flND OF TEXTS UORKING PLflNS FROM THE TIME OLLOWED

DOCUMENTS flN l f DDEGRE E OF FULFILMENT

1. Outcoming data of the documents on the subject 2. Responsible workers: organizations probletnic commissions, experts

3. Texts or fragments of texts from the documents 4-. Lists of papers on the programs of studies and working plans. Time allowe a degre d an df fulfilmen o e t

FIG.i. STRUCTURE OF THE DOCUMENTAL SECTION E SYSTEOTH F M

336 - programs, plana, time allowed, stages of vrork and degree fulfilments oit f ; mos- t important text section documente th f so s including regularities, instruction methodsd san ; - information about organizations and experts - participants worke ith n . During one-two years the whole number of documents included into DB will reach 1-1,5 thousands (without about 500 papers of the foreign author• ) s In creation of the factographical section of DB specifica- accumulatee tionth f so d information fund long-terman d , planning wore th k f wero e taken into account. Data sets on radioactive contamination of soil, vegetation, environmental object d foosan d products were created. They also included dat measurementn o a incorporatee th f so d activity„ individual dosimetry, health state of some population groups and on other indices. The systems of information computer analysis were widely used for therapeutical purposes in such fields as hematology, biochemistry, immunolog d drugsyan . Models developed earlier were useintegrar fo d l estimation radiologicaf so l consequences accidente th f o . Finally the following structure of the factographical sectio acceptes nwa d (Pig . Generalize.2) d data were recordr sfo 5000 populated location USSRe th ,n si (includin g "clean contro"- l ones) rivers and other water reservoirs. The complete list of items in üüs Register was not determined, so it can be enlarged to 1-2 thousands of items in accordance with reguirements of a systemic analysis of the subject- The items concerning populated locations, in particular include: administrativ- d territorean y divisions popul?e , th siz f -o e groupss it tio d ,n an measure e datd yeath an ef ro s performed, dynamics of changes in gamma dose rates ;

337 FACTOGRAPHICAL SECTION

GENERALIZED DftTft

OBJECTS OF POPULATED LOCATIONS E ENVIRONMENTH T

RBDIflTIBN DOSES,

MEASURES UNO

THEIR EFFICIENCY

fiRCHIVES QRIGINflL DfiTfi ccntimi suRYflY

SPECTROHETRY. INDIVIDUALIZED DflTfl

HflDtDMCTRY.

RHMOCHEMST- CBS r BCUJ«o - INDIVIDUAL MEflSUREMEN- IN F O t TC KADXfl! - «r. ECTl « »rsidsno e DQSIMETRY CORPOROTED flCTIVITY

1. Factographic section . Generalize2 d data Populate. 3 d locations 4- Objecta of the environment 5- Radiatio d hygieninan c situation 6. Demographic data Geographica. 7 l data . Radiatio8 n doaes, measure theid an s r efficiency 9« Radiometrie and dosimetric examinations of the population 10. Contamination by radionuclides 11. Archives 12. Original data (gamma survey, apectrometry, radiometry, radioche:uistry, etc) 13. Individualized data 14-. Cases of acute radiation disease 15- Personal doaimetry 16. Measuremen f incorporateo t d activity

. 2 STRUCTUR G FfiCTOGRflPHIE FI TH F O E C SECTION OF THE SYSTEM

338 - dynamics of changes in radionuclide contamination density in soil, vegetation, food produced within the controlled area, mean dose internaf so d externalan l irradiatio populatioe th f no n occupationas ait wholsa d groupse ean ag d ,lan result medicaf o s l examination populatione th f so , etc. n cas I necessitf o e distributioe th y n characteristicf o s these value givene sar e individualize.Th d subsectioB D f o n include liste sth individualf so s fropopulatioe mth d proffenan - cional workers witrésulte hth theif o a r dosimetric examinations. In this case the list of indices will be enlarged only at the

expense of an addition of more detailed data on incorporated activity and radiation doses. Other subsections of the lower row contain archives of the original data including radionuclide conten samplen i t soilf so , vegetatio foodd nan , resultf so detailed radiatio hygienid nan c examinations, etc» systee Datth af m o suppl CflAHB performes D i o Ayt d either n computeo r carriers frodate mth a bank organizationf so d san individual research workers or from scientific reports» articles d othean r materials e structur.Th informatioe th f eo n obtained is changed in accordance with the registration objects in DB. The problem of excess information is solved by an analysis of data supplie r treatmenfo d optimizatio y b d tan e infor th f n-o mation relations. It should be noted that by a number of indices characterizing the first days after the accident excess of the t ruleinformationo ds i outB D make t .I n ni possiblt si o et increase credibility of data and to accelerate their treatment. Software provisio allowB increaso D t f e o nson e without any limit nomenclature of the data stored in the factographic section, to form depending on the character of an inquiry separate document r setso f texso t documents, y tablean f o s form, charts and schemes. Besides the existing programs for s ta- tistical treatment the system C.HAHA will be provided with the

339 fund of programs for calculating dose values, radionuclide transfer, algorythma of essential factor selection, multifactor and cluster analysis. To sum up, the computer system CßAMA provides the effective control of working plans, the search for references and methodic s in certain scientific directions» reliable storage f factographio ce subject th dat n o a t ;i als o provides: - effective access and possibility of computer treatment generalizee oth f d information; - systematizatio generalizatiod nan datf no medican o a l effects of the accident ; - possibilit usinf o y g datr estimatinafo effecte th g f o s not projected accident plantst a ; - centralized provisio All-Unioe th f no n Distributing Regi- ster with all data for calculating individual radiation doses.

The existing experience of handling the problems of diagnosis, predictio plannind nan g prove advantage th se exper th f teo system for making decisions on radiation protection. The computer system CßA^A can provide the use of stored information and research data on the effects of the accident for creating such an expert system. n thiI s castase makinf th eo k g desision characterizes si d followinge bth y : possibilite th - quantitativf yo e determinatioe th f o n magnitud actine th f go e factors; necessite th - y quickl seleco t y mose th tt economical (fos rit mose costth t d effectiv)an e (fo givee rth n situation) decision out of many possible ones; greae th t- numbe variablf ro e quantities characterizine th g situation; - the lack or low credibility of some original data.

340 These characteristic sexpere substantiatth f to e us e eth system primarily for the practical purposes of public health followine ath t g level administrativf so e division: raion (district), oblast* (region) and at higher levels and also in regions nea thin ri Plan st bu cast e with accoun locae th lf o tconditions . The model of the expert system ÜPMOPPA (in Russian) (Making Optimum Decision Radiation si n Accident beins i ) g created followine byth g scheme: accumulatio) 1 factf no s; productiof o t se ) 2 n rules (i.e. expertise rules); mechanis) 3 logicaa f o m l conclusion together wite hth structur knowledgef eo ; mechanis) 4 makinf mo conclusioe th g base uncerf th eo n no - tain and incomplete origional data; 5) mechanism of explanation and inspection of each conclusio systemne th mad y b e.

Analytical abilities of the system are provided by encoding exper f tproductioo knowledgt se a s n a eforin e ruleth n ;si

M EC (premises) (action)O ,T , (IIO), wher - indee00 detef xo r minatio adequate th n calculatee f b whico n ee hca methodon y b d s e.g. credibility coefficients, conditions of probability, etc. expere th e wor Th f tko syste carries i maccordancn i t dou e witfollowine hth g unit—scheme (Pig wher) .3 e oblast uses i *s da a region. The expert system is supposed to perform a constant generation of the plan of actions providing greater accuracy in estimatin gradiatioa hygienid nan c situation.

341 ORIGINAL INFORMATION REFERENCE INFORMATION Feari HERSURE- 1 FROM [RISK CATitt-acuf O c CEOCHflPmCfiU.SaclflL. ECONOKIC. MED I CRU BMD KENT LOCATIONS jttUCLEflM OBJECTS flBOVE OTHER DATA «BOUT REGION | I

GENERATION

F THE PLflN OF MEASUREMENTS flCCDR-

DETAILED RfiDI DING TD THE PUftM Y TUPtTia

ESTIMATION QEL-N RLGORYTH.1S OF RADIATION BCSE CHLCULBTIOM

CflTflLQCU F KEflSURSO E S SEARCH OF PLPtM CF THE EXPERTISE RULES AN ADEQUATE

MEASURE -^.OPTIMIZATIOY NB

. .SÎ3CÎRI. flNP

REOLI20TION OF THE PLflN

1. Original information 2. Reference information 3« Prom measurement locations 4- Riak catalogue of nuclear objects 5« Geographical, social, economic, medical and other data about the region Pro. 6 m above

Pig. 3. Scheme of the work of the expert system IIPiTOPPA

342 Fig. 3 (cont.)

7. Generation of the plan of detailed radiation situation . Measurement8 s accordin plae . th nY. f go 9« Express prediction of the doses for populated locations Estimatio. 10 radiatiof no n doses 11. Algorytho dosf so e calculation 12. Plan of the measures M.. 13- Search of an adequate measure 14- Catalogue of measures 15« Expertise rules Optimizatio. 16 medicaly nb , socia d economilan c criteria

Realizatio. 17 plae I th nM f no Syste. 18 explanationf mo d inspectionsan s

When the amount of accumulated data is sufficient for making decisions generatio plae th actionf no f no performeds si . e nexAth t t iteration correctes i t si d wit accoune hth newlf o t y coming information abou radiatioe th t n situatio plad nan n realization e uni *plaTh f o t n generation includes particulan ,i r input of information on the levels of gamma radiation, concentration and densit contaminatiof yo radionuclidey nb soilf so , water, vegetation and food« The unit of radiation dose estimation provides the calculation of average (for populated locations) and maximum individual doses of external gamma irradiation of the whole body, internal irradiation of the whole body and the thyroid by inhalation and ingestion intake of radionuclides. The unit of the search of adequate actions is supposed to achiev finae eth l aims: preventio radiatiof no n diseas prod -ean tection from exceeding the permissible dose values to the critical organs in the groups of increased risk. Decrea.se of the mean dose down to the limit of accidental irradiation and lower is desirable.

343 Development of criteria of the optimum selection of measures is carriethrey b t e ou ddirections : medical, economi sociad an c l normative bases th i n d o d an e document "Criteri r makinafo g decisions on protective measures against the effects of reactor accident". Generation of the plan of actions requires information, resourcee oth n region e th n si : drugs, transport, "clean" food and water. These data as well as information on the number of population and geography of the region must be supplied when the syste s establishei m regione th n di , e uniTh t "Explanation System s suppose"i provido t d e th e possibilit inspectiof o y decisione th f no ssysteme th mad y b e. e explanationTh e mad sreferencear y b e pointe th normaf o so t s - tivd instructionaean l documents e experienc.Th creatinf eo g B CÄAHD A shows thasummare th t y numbe f theso r e documents doe t exceesno d 150. Realization of the system ÏÏPKOPPA is carried out at Personal computers» In conclusion the authors express their acknowledgement to the academician of the Academy of Medical Sciences of the USSR L.A. Ilyin for putting the problem constant attention and support of the work.

REFERENCE

1. A.F. Tsyb, V.K. Ivanov, E.G. Matveenk V.F, o . Stepanenko, V.V. Pozhidayev, E.A.Ispenkov, V.A. Pitkevitch, O.E. Stadnik. "Experience in the development of the Ail-Union Register of individuals expose o t dradiatio n afte Chernobye rth l accident for providing a long-term estimation of their health and its alterations". Vsesoyuznaya konferentsiya po mediko-biologicheskim posledstviyam avarii ChAES (Kiev, 1988).

344 PREPARATION OF AN ALL-UNION DISTRIBUTION REGISTER OF PERSONS EXPOSED TO THE EFFECTS RADIATIOF O RESULCHERNOBYA E S NTH A F TO L ACCIDENT, WIT HVIEA EVALUATINO WT G EXPOSURE DOSES AND MAKING A LONG TERM PUBLIC HEALTH FORECAST

A.F. TSYB, A.N. DEDENKOV, V.K. IVANOV, V.F. STEPANENKO, V.V. POZHIDAEV, V.A. PITKEVICH, E.G. MATVEENKO, E.A. ISPENKOV, O.E. STADNIK, O.G. POL'SKIJ, R.N. TURAEV, A.E. ROMANENKO, N.I. OMEL'YANETS, B.A. LEDOSHCHUK, A.S. SYTNIK, V.N. BUR'YAK, V.A. STEZHKO, G.A. LOSEV, P.V. RAMZAEV, M.I. BALONOV, Yu.O. KONSTANTINGV

Abstract

The ail-Union distribution register is a multilevel information and control system covering almos e l countrypartth al t f o s .

This kepe register manb fo to yt a large-scal decadess i s ri t i : e project of great significance for the selection of strategies and tactics for the development of nuclear power, for the use of ionizing radiations in the economyr effectivfo d d completan , an e e solution o radiatiot s n safety problems. Smooth and well-co-ordinated work by all specialists and organizations involve s preparatioit n i d s therefori n e essential.

Ministr f Publio y c Healte USS s adopteth ha Rf o h a largescald e progra e developmenth n mo e All-Unio th f o t n Distributed Regist- y immediatelr y afte e reactoth r r acciden t Chernobya t o ensut l - a long-ter e r m automatized personal follow-u f accidentallo p y irradiated individuals, their childre subsequend nan t generations, radiation doses, health s statuchangesit d Aile an s Th -. Union Distributed Registry is an information and operative multilevel system that includes practicall e regione th th l f o yal s countr provided an y s automatized suppor: to t - the measures on prophylactic medical examination of the population

necessare th - y treatment-and-sanitation measure disn o s - pensary system results

345 - the study of the structure, nature, dynamics of disease tendencies and their outcome in the followed contingent - special and scientific programs on medical consequences reactoe th f o r acciden Ghernobylt ta .

Specificity of the All-Union Distributed Registry is determined not only by its large scale from the point of view of territory and quantity ( more than 600.000 subjects, and a half of them,i.e. about 300 000 subjects are on the union level registry)e oth f quantite varioue th th y , b f o ys specialist- sin absence volveth d f prototypo ean d e createth f o ed systet mbu also by the fact that it was necessary to begin the work on dispensary examination and its information supply as early as possib- evaluato lt e e medical consequence e reactoth f so r accidend an t to take necessary measures. That*s why the draft decisions of the Ail-Union Distributed Registry were being corrected according experience tth o e e processgaineth n i - d operatiof ,se o s it f o n parate component d subsystemsan s . e optimaTh l hierarchical structur Registre th f o e y includes region, area, republi d unioan c n e follow-uplevelth f o s . This structure of the All-Union Distributed Registry makes possible maximum dynamic follow-up of the appropriate individuals, the effective use of computer technology ( large, medium and personal computers) and mathematical software of different complexity, communicational binding of the examination data in magnetic tapes. Before getting to the union level, the data on dispensary system of the detected groups of population undergo a comlex processing, i.e. official registration in the central region hospita citr lo y hospital examinatione ,th , magnetic tape information transfer, logical machin repube e th dat e checth n -ai f o k lic computation centres before sendin datf gof a - arraOb o t y ninsk and the ultimate logical program check on the union level.

346 It should be emphasized that this control system provides for quite satisfactory quality of documents received on the union level of the Registry. The system of double control ( visual one examinatioe ath t n comissio machina d nan ecomputine checth n ki g centres) practically exclude possible sth e registratioe th f no false document highest whicno centr e rpe h ar tha .5 n0. The All-Union Diatributed Registry consist f threso e main objective subsystems of support: - organization- and-niedicine - mathematical software - dosimetry

The main function f subsystemso s : 1) wordin f formalizeo t ou g d medical document instrud an s - ction o filt s l thep mu

2) magnetic tape control, database maintenence, information processing with special computer program 3) calculatio reconstructiod nan f individuao n l radiation doses, separation of risk groups.

Now we discuss the structure and function of the registry subsystems mentioned above.

The first subsystems, i.e. organisation-and-medicine support includes Registry Regulations which determin e purposesth e , structure and executive institutions. These Regulations also control the order of information processing on different levels, the study population s wela e volum, th l d frequencan e f prophyo y - lactic and treatment-and-sanitation measures. The most important Ail-Unioe aspecth f o t n Distributed Registry functios i n a preparation of medical documents for computing, i.e.: - a record card filled up once medicaa - l card witdate initian th ho a subsequend an l t examinations - dosimetry data list

347 Organisation-and-medieine supporRegistre th f to y alss i o composed of a number of instructions and recommendations rela- ting- to the correct registration of the documents mentioned above on the region level and information transfer to magnetic tapes present A . a largt e e locavolumth lf o einstructional - methodical work has been done to provide the right official registratio originae th f no l documents. The second subsystem ( mathematical software ) consists of three blocks: control and correction of the initial documents, database management system and an analytical block. Logical machine check include o complexetw s softwaref o s . f theo me providOn e tesd correctioan t l initiaal f no l materi- s personallyal e secon .Th e associate on d s witwhole th h e data bulk. The machine check results in an error protocol in a sui- tabl ecompile a ford man d magnetic tape with false documents for correction. The second block, i.e. the All-Union Distributed Registry data-base provides information storage and multipurpose information access. The choice of DBMS for the All-Union Distributed Registry follow-up of the persons entered into the Registry and

also the realization of complicated queries.

e thirTh d analytical block records outpu tAlle th dat- n o a Union Distributed Registry status and dynamics and also reveals tendencies in health status of the study groups. The dosimetry subsystem of the registry effects the automated calculatio d transfenan o databasrt e individuath e l absorbed, doses of the internal and external exposure which are accumulated in the thyroid gland and the whole body. For this, the information entering into the Registry after filling up the initial document s usedsi dosimetre .Th y subsystem exercises logical controe dosimentrth f o l y registry information — besidea c e th s culation and reconstruction of the absorbed doses.

348 Right before this Conference, in Obninsk was held the meeting of the leading experts of the country. They have developed concrete proposals concernin e developmenth g f regionao t d an l

central informational search systems of radiation hygienic data about environmental contaminatio d contaminatioan n f fooo n d products. These systems, function within the Registry, will form e informationath l basi r individuafo s e reconstructioos d l r fo n future Registry functioning. Creation and introduction of the Registry, provision of long-term automated personified registratio f individualno s subjecte e actioth f ionizino nt o d g radiatio complicatea s ni d organizational,medical, scientific and technical task. Long-term characte e Registrth f o r y functionin ( gsevera l decades it , ) s large scale, demand good organized coordinated work of every involved specialist and organization.

As an example, we can take data retrieval on the children who had thyroid dose exceeding in a number of cases 300 mSv (these children compiled abou e retrievat th 2-3?totae - f o Th 5vo l . ) l e retrievath lum childrenf 0 o eabous 00 0 wa lr 4 thes t Fo . e children we had the information about the levels of thyroid hypophysial hormonen blooi H d TH serum. . Radioimmunoassa e seruth f mo y was conducted afte month6 r s after radiocontamination. The concentration of THH is in the norm ( within 0,5-4,5 med/1), that show e absencth s f alterationo e e functioth n i sf o n thyroid gland. Every registered chil s i dfollowe d accordin0 0 g the programme of dyspancerization. One more example e concerninregionth f o f Ukraine o se on g , f evacuateo 0 Amon00 d linine 5 controllean th 6 dg n go d e accidenth f o territoriey t da ther e th e n 100o s 7 pregnan- wo t men. Pregnancy was preserved in. 97,4?& of the women, 96/5 of them had no pathology in the course of pregnancy. 98?£ had timely de-

349 livery. These data sho e effectiveneswth e undertaketh f o s n complex measure f treatmeno s d sanitationan t . For bhe future development of the Registry we must conduct multilevel analysis of the huge volume of collected data and provid r long-terfo e m dynamic functionin e Registryth f o g .

350 ORGANIZATIO PLANNIND NAN WORF GO K INVOLVED IN THE LONG TERM CLINICAL OBSERVATION OF CHILDREN WIT HHIGA H RADIATION RISK

V.N. BUGAEV, E.I. BOMKO, E.M. BRUSLOVA, A.I. AVRAMENKO, L.A. BULDAKOV, N.F. RUBEL'

Abstract

Operatio e registeth f o n r involves analysin e basith g c parameters characterizin e healtth g f childrenho , carryin t epideroiologicaou g l studien o s various type f diseaseo s , refining dose parameter reconstructind an s g actual doses, establishing spatial and temporal dose distribution patterns, providing systematic information in support of the register, and so on.

By 16 May 1986, thyroid dose monitoring had been carried out and detailed blood analyses performed on 140 000 children, who were also given complete medical examinations by specialists. In 95% of these children, the calculate e yeadth caesiurf o followin d men e e accidenintakth th g t s a e wa t less tha rem1 n .

Further information support for the register of the child population wit e samth h e comprehensive volum f medicao e l information will makt i e possibl o studt e e teratogenith y c effect f ionizino s g radiatio abnormad an n l growth and development of children exposed at an early age, and to determine risk coefficients as a function of time, teratogenesis and cancer of the more sensitive tissues, as well as the effects of small doses of ionizing radiation.

Elaboratio f prophylactio n c measure f sociao s medicad an l l nature takeb o t ne afte e acciden th e Chernobyr th t a t l NPs Pwa based primaril knowledgn yo f quantitativo e qualitativd an e - ein dicators, characterizing the health status of residents, taking into account the dose burden. This is of particular significance for pédiatrie contingent, bein mose gth t vulnerable critical group of population, and forming at the same time the foundation of future health and well-being of the nation. Accordingly, it seems evident, how important it is to develo specializea p d registe r pédiatrifo r e contingent, exposeo t d ionizing radiation following the accident at Chernobyl NPP, to be able to ensure long-term computer-aided personal registration of pédiatrie patients, radiation doses, state of their health and changee latterth n i s .

351 So far uniforo ,n m concep bees tha n accepte countrr ou n i dy regarding development and functioning of registers, and provisio substantiatef no d criteria, categories, level observaf so - tion, organized support of such computerized systems» In the literature available ther presentee ear d dat design ao funcd nan - tionin clinical-dosimetrif go c registers, specifically- re r ,fo sident Hiroshimf so Nagasakd aan surviveo iwh d atomic bombing, and also for minera from uranium mines. A special feature in functioning of these registers is that they were compiled in a retrospectiv d includan y ewa partial clinical data obtained through sociologie poll morbiditn so y mortality rate, general conditio injuref no d persons same th e t .timeA , keepin sucf go h register lona r gs fo tim e showed tha desira t enteo t e r maximal amount of information in a data base is hardly warranted, since it becomes impossible to process the material, to generalize it, and thus the number of errors increases in avalanch-like manner. Therefore, at the stage of designing a specialized clinical- dosimetric register, the top-priority tasks are to develop a uniform concept of its functioning, substantiate criteria, levels, categories of observation, provision of software, and organizational support of a register. Functioning of register envisages analyses of principal parameters, characterizing the health status of pédiatrie patients, epidemiologic studies, clarifying various nosologie forms, assessmen f doso t e parameters, their reconstructio normalid nan - zation, elucidation of temperospatial distribution of doses, sup- plf systematio y c informatio supporr nfo registerf o t , elaboration and correction of prophylactic measures, and, finally, wor- recommendationf o kin t gou sociaf so medicad lan l character aimed at maximally possible lessening of effects of ionizing radiation. Proceeding froabovee th m , composin d functioningan a f go register for pédiatrie contingent included forming and collect!-

352 on of input information, its formalization, development of a. data "base, analysi prognosid san possiblf so e disorder healthn si , status of pédiatrie population due to effects of ionizing radiation, and, finally, makin decisionf go theid san r implementation (Pig. I).

Subject brunch

Data collection

Formin f entranco g e datoa

DATA BANK

Real i 23 t ion Exit data of decisions

Address to data sources

Other sioi c nDe data mak i ng sources ANALYSIS

P'-ognost icafc ton

FIG. 1.

SCHEME ÜF ARRANGfNG AND FUNCTIONING OF REG [STEP FOR PF.DIATRIC

POPULATION.

353 The first stagregistee th worf o en ko r appears essential mann i yd respectan s cruciasuccessfus it r lfo l functioning, adequacs reae it th d l o an yt situation . This stage comprisee sth following items: - perception, abstraction and description of application domain; - clarifying and elucidation of users* information demands} desig- conceptuaf no l infological mode externad an l l infological model applicatiof o s n domain; - datalogical design. abovee vien th I followine f wo ,th g e taskth st a wert se e first stage of work: identifo t ) 1 groupe yth personf o s s eligibl r enterinfo e g registere th n i ; 2) to define the volume and content of information, needed for composing the register; 3) to choose the way of obtaining the required information and to organize its collection; collecto t ) 4 , formaliz ented ean r information into computer. The principal criterion for entering in a specialized subregiste r furtherfo r in-depth scientific studie pédiatrif so e contingent with increased radiation risk were doses of thyroid exposure over 2 Gy. The information was supplied through the following scheme (Fig) .2 To accomplish the above-mentioned tasks the Ministry of Public Health of the UkrSSR has organized 203 republican medical teams consisting of a therapist, pediatrician, obstetrician-gyne- cologist, laboratory assistant, dosimetrist. The work performed allowed determining of groups to be included in prophylactic observation depending on thyroid dose of iodine radionuclides.

354 * USSR MH' JÛL All-Union distributed register

** Clinico—dos imetrie Register AUSCRM RICC AMS USSR USSR

Central Dose Regisfcer

TTG Ex t . -, Resu1tf o s Resultf o s thyroid gldtnd dosimetr ic hormones 131, i nves t iga - in^ estigation t ions [37-^ 'Rr o —————i — s C 4 [3 endocrino Iogy AUSCRM and metabolisms USSK M in.H lth.of l Ikr^ , rtg______

Complex health assessment.

f L Orga d systenan m Presencf o e DF-gree and h civ- wo -i it/ of chrani ça L and functional filiysical arid congeni ta 1 conditions neu r op s /ch ica 1 pa tho logy deve lopnten t

Rep'-i leabI n City CRH hc, = p i ta 1 hu=p its'

USSR Ministr f Healto y h All-Union Scientific Centr f Radiatioo e n Medicine

FIG. 2.

SCHEME OF INFORMATION STRUCTURE IN COMPILING REGISTER FOK PEDIATRIC CONTINGENT WITH INCREASED RADIATION RISK.

355 EVACUAT ION 2QNE

. •"•— 1 « 1 1 1 *

D» r C. £ .p Clothe s dosimeV i m L i n a t io t Clothe s chan g i n ç O •or y medi c e 3 in ••H X L ÜJ o

San iont i,ta examinâ, on tj treatmen1 o t revealed unspecific pa- w placNe e thology of residence

* Control post * * Central Regional Hospital

FIG. 3.

SCHEME OF ORGANIZATION OF MEDICAL DOSIMETRIC SERVICE DURING

EVACUATION OF PEDIATRIC CONTINGENT AND PREGNANT WOMEN AFTER THE

CHERNOBYL ACCIDENT.

356 Till May 16, 1986, 140 thousand infanta and children underwent radiation monitoring of the thyroid gland. Parallel to this, comprehensive analysi bloof so mads pédiatrid dwa e an e contingent was examined by doctors of various specialities. Owing to devised organizational measures it became possible to start on 10th of May evacuation of pédiatrie population in an organized manner to southern region UkrSSe th f Rso where infant childred san n could improve their health e stage.Th evacuatiof so pédiatrif no e contingen d pregnantan t wome e depictenar Pign i d « .3 Efficient syste prophylactif mo c examinatio pédiatrif no e contingent was organized with special reference to the value of radiation e samdoseth et tim.A. e ther s establisheewa Repube th d - lican specialized dispensary on radiation protection of population. This dispensary has a consultation clinic and specialized laboratories with hématologie, endocrinologie, neurologic, and differential diagnostic units. Further, mobile human radiation counters (HRC) were made available. o determinT e cesium intracorporeal content stude th , y enrolled primarily residents of Polessky and Ivankov districts of Kiev region, Narodichi distric Zhitomif o t r region persond ,an s evacuated fro cite Pripyamf th yo d Chernobytan l district. In 95 % of children and infants the calculated dose of cesium intracorporeal conten lese founs b twa so m t dtha re nI from the moment of accident till the end of the year. On the 10th of October there was initiated the second stage of prophylactic examinatio pédiatrif no e contingents from northern district Kievf so , Zhitomir, Chernigov region thosd san e evacuated from the city of Pripyat. This examination was carried out by mobile medical teams consistin pediatriciana f go , endocrinologist, hematologist- ,la boratory assistant, neuropathologist ophthalmologist patie .Th - ents were checked for blood thyroxin content, and also blood

357 comprehensive analysis was made. If any somatic pathology was detected, the pédiatrie patients were hospitalized in corresponding units of regional hospitals. Infants younger than a year were admitted to the Kiev Research Institute of Pediatrics, Ob- stetric d Gynecologysan dependin, ,or dose th e n burdeno g o ,t the Republican specialized dispensary on radiation, protection, d Kiean v Research Institut Endocrinologf o e Metabolisd yan m, o thesT e teams local publie bodieth f co s health system have recruited paramedical personnel including manipulation nurses. The teams were equipped with laboratory instruments and had transport facilities. Blood smears were analyzed on the spot, while to check the bloocontent. T TTHr , fo d ampulee ,T, ,th s ever wery yda e deli- vere Endocrinologf o Kieo t dI vR d Metabolismyan . The medical teams were instructed at the Ministry of Public heaUkrSSe e Healt boarf th th o d r treatment-and-pro y f Rb ho fo d - phylactic maternal and pédiatrie assistance and by the head of department of specialized aid. 86 thousand of pédiatrie patients were examined by 60 medical teams within 2,5 months. The obligatory condition in the work of medical teams was to specialla fil n li y dev informatiod ise n paper medium for,a m of child development history, where diagnoses of all specialists were necessit e recordedth f i d y ,an arose , recommendations were given regarding further follow-u d treatmenpan pédiatrif o t - epa tients. All-Unioe th n I n Scientific Cente Radiatiof ro n Medicine (AUSCRM), AMS, USSR, all the forms were thoroughly analyzed and the expert opinio s expressenwa d whethe thet no y r rwero e filled correctlyn i pathologe th d ,an y disclose s relatedwa dato t d a of radiation monitoring. Proentire mth e arra registeref yo d madical information- ,ob tained for 86 thous« pédiatrie patients in the course of organi-

358 zed by Ministry of Public Health large-scale prophylactic examination of infants and children in the northern regiona of the UkrSSR, researchers from USSCRM have selected file of documents for 5800 pédiatrie patienta whose thyroid radiation dosea excee- (Pigy G 0 . de.2. d4)

Though, of people

150-

May August 1986

Stag- f instrumentaI o e l data collection — Machin I I e processin f datao g , dose estimation IH- Collection of registration - medical documentation - Organizatio V I f speciao n l subregiste f childreo r f o n excessive radiation risk group FIG. 4. DYNAMICS OF FORMING OF SPECIAL SUBREGISTER FOR PEDIATRIC

. / m Re O POPULATIO2O E > UKRAINIA D TH / F O N R SS N

359 Formalized input information on magnebic medium provided the possibility to compose a data base which served as a basis for specialized register for pédiatrie contingent being under observation, and also to derive first results reflecting the state of pédiatrie health. Comprehensive assessmen f pédiatrio t e health includee dth following indices: - functional stat f organo e systemsd an s ; - degree of physical and neuro-physic development and its harmonious character; - presenc f chronio e c pathology (including congenital one). By the state of their health all infants and children were assigned to the following health groups:

I grou p- health y pédiatrie contingent, withou signy an f tso disorders in the health statua and who have not fallen ill during the observation period. I grouI p- infant childred an s n with functional disturbances, t risa f developinwhe ko ar o ga chroni c patholog d shoyan w higher disease incidence; groupV III, - sIV disease, d infant childred an s n with chro- c pathologni e stagth f compensationt o ea y , subcompensatiod an n decompensation. During the analysis the attention was given to distribution of pédiatrie patients by health groups, relationship between numbef pédiatrio r e patients with revealed nosologie form cond an s - ditions ,e associate b whic y ma h d with risk factors (primarily, such factors as thyroid hyperplasia) and the total number of infant childred an s n examined. Further analysis elucidated percentage of individual, most frequently occurring diagnoses, in total structure of morbidity. These data were related to thyroid radiation dose, taking also into account the patient's place of residence.

360 Assessment of health status of pédiatrie patients with increased dose-related risk revealed, that percentag infantf eo s and childre health 4t n n i d hassigne an w group d lo 3 s o dt swa different dose groups and amounted to 4-8 % in Narodiohi, Ovruch, Polessky, Ivankov, Kozelets, Repkin districts end to 13-17, Chernigon i 5% Chernobyd van l districts patiento .N s from the 5th health group were identified in She contingent examined

(Fig. .5)

20-

ro-

t° 30 30-75 75-200 2ÜO -t-cG > 200

- Narodichsk N y district Ovruchsk- 0 y district P - Polessky district Cht - Chernobylsk> y district [v - Ivankovsk/ district Ch CherncgOvsk- r y district - RepkinskR y district - KozeletskK y district - averagM r Ukrainfo e n 198i e O 1965

FIG. 5.

INCIDENCE OF CASES RELATED TO 3 - 5 HEALTH GROUPS AMONG PEDIATRIC

PATIENTS WITH VARYING DOSE F THYROIG S D RADIQIÛUINE IRRADIATION <••'•

Presence of chronic or primary detected diseases and premorbid conditions was not influenced by belonging to a dose group. Only territorial differences were disclosed e perith r - Fo . od of examination the number of pédiatrie patients with determined diagnoses was the lowest in Ovruch district of Zhitomir region (24,5 %) and the highest one was in Chernobyl district of Kiev. regio%) 2 (5 n

361 orden I analyzo rt structure eth morbiditf eo pédil al -r yfo atrie patients included in the specialized register, first, the incidenc eacf eo determinef ho d diagnose s beesha n appraised. These findings revealed 5 most frequently occurring diagnoses of premorbid conditions, the percentage of which was on average 6 fro5% entire mth e numbe ascertainef ro d nosologie formf so pathologica d premorbian l d conditions: thyroid hyperplasia, chronic diseases of tonsils and adenoids, acute and chronic infecti- uppef o s r on respiratory tract, iron deficiency anemia, disea- seteetf o sd theian h r supporting apparatus. Some territorial special features have been disclosen i d the incidenc f thyroieo d hyperplasia with respec totae th lo t number of determined diagnoses in each group. In fact, the proportion of thyroid hyperplasia (TH) in the structure of morbidit pédiatrif yo e patients with increased radiation risn ki Zhitomir region equalled 34,2 $, in Ovruch district, and 36,8 % in Korodichi district. These values differed substantialln i y various districts of Kiev region: in Chernobyl district the TH

proportio Ivankon I6js i nwa , 4 % v distric amountet i t 28,o t d% 0 t anPolesskn i d y distric reachet i t d o clear-cu60,N . 3% t differences in the TH proportion were found in surveyed districts of Chernigov region, wher amountet ei fro% e 4 mth 7 45,o dt - 9 total number of all diagnoses. additionn I analysie ,th age-relatef so d distributiof no thdemonstrateH eT d successive increas incidencH T n ei e with advancing instancer ageFo . incidence ,th detectef eo n i H dT pédiatrie contingent from Uarodichi district in the age groups under 3 years, 3-6 years, and 7-14 years varied from 15.6 to 17.6 and 27.8 %\ in pédiatrie patients from Ovruch district it ranged from 5.7 to II.4 and 14.3 #, while for Chernigov district it was from 12.6 to 27.8 and 38 %.

362 The TH incidence may be regarded as an evidence for iodine deficiency in the given region (Pig. 6). Prom this viewpoint the situatio mose th t s nfavourabli Narodichn ei Ovrucd ian h districts of Zhitomir region. In these districts, in the course of prophylactic examination mean TH incidence in pédiatrie patienta with increased risk was found to be 15.5 %. In Chernigov region this value amounted on average to 28.6 % in pédiatrie contingent with increased radiation risk. In Kiev region the TH incidence varied considerably in different districts: in Checnobyl d Ivankoan v districts this pathologic conditio s identifienwa d in 10.2 of pédiatrie contingent, and in Polessye this value reached 33.. % 4

40 -

30 -

20 -

10 -

o J

30 30-75 75-200 200 ___i

- PolesskP y districb Narodlchsk- N y district 0 - Ovruchsky district

FIG. 6.

INCIDENCE OF THYROID HYPERPLASIA IN PEDIATRIC PATIENTS KITH VARYING DOSES OF THYROID RADIOIÜDINt IRRADIATION (•/.)

Therefore, primary analysis of input information of a specialized subregister for pédiatrie contingent with increased radiation risk revealed peculiaritie healte th n shi statu- in f so

363 fants and children in the surveyed districts of Kiev, Chernigov and Zhitomir regions d als,an o disclose incidence dth e th f o e most frequently occurring diseases. These findings will form the basi further sfo r long-term dynamic follow-u pédiatrif po e patients expose ionizino t d g radiation d wil,an l provid possie th e - bilit elaborato t y e measures aime minimizint a d consequene gth - ces of radiation effects. Further information supporpédiatrie th f o t e register provided under the same conditions of expanded volume of medical information will allo researchere wth clarifo st followine th y g scientific issues: teratogeni- c effect ionizinf so g radiation, particularly cases of mental retardation, delayed development and growth; - developmenta d growtan l h anomalie pédiatri. sin e patients exposed to radiation at early age; - ascertainment of risk coefficients, depending on time, teratogenesis, moscancee th t f rsensitivo e tissues, elucidation of effectw doselo ionizinf f o so s g radiation. And, finally t becam,i e possibl o tacklt e problee th e f mo standardizing the values discussed proceeding from the extent of harm cause humao t d n health.

364 DISCUSSION

S.P. YARMONENKO (USSR)

The sad experience of the Chernobyl accident has revealed shortcoming n knowledgsi physicianf o e s about biological effects of ionizing radiation. That result certain si n difficultien i s involvemen f thesto e physician accidene worke th th n so o s t t consequences liquidatio face th t n i thawels n a s tla this lack of special education of medical personnel is one of the main reasons of radiophobia among general public.

y propositioM introduco t s i n e intResultine th o g Document Conference th f o e followinth e g point:

to improve the education, of the contemporary physicians in the field of radiation medicine. For this purpose to introduce the course of this discipline for medical students.

365 STATEMENT BY PARTICIPANTS

The human mins discoveredha d unprecedented possibilities in the sphere of use of nuclear energy for peaceful purposes. Today, everything depend whan so t nuclear energy wil usee lb d for — either the creation and development of mankind's creative potential s destructionit r ,o . We, participants in the Conference, resolutely come out in support of creation — the peaceful coexistence of 'all sta- e enormouth commoe f o th e s d te natous e energr an sth fo m f o y the developmen f scienceo t , engineerin d gan prosperitf o y l peoplesal e destructivTh . e militare forcth f o e y atom must never be let out of control, for otherwise there will be a global catastroph lifl Earthn al o er fo e. Chernobye Th l acciden s oncha t e again confirme necee th d - ssity of the governments of all countries to take measures which would rule out any mischances in the use of nuclear energy. We welcome any steps which may be taken in this direction. Having thoroughly discussed the medical consequences of the accident at the Chernobyl Nuclear Power Station, we believe that today the duty of each state and each citizen is to become awar theif eo r historical responsibilit reducinr fo y g nuclear armaments. We are convinced that the new thinking and new realistic principle interstatf so e relations, based thereon, will eventually plac atoe e energth th em f yentirelo e servicth t mankindf ya o e . The Soviet-American EliminatioTreate th n yo Mediumf no d -an Shorter-Range ML asiles, signe Mikhaiy db l Gorbache Ronald van d Reagan, provide groundworsa optimismr ou r kfo . All of us, our patients, children and grandchildren need worla d without missile nuclead san r weapons. chorue Joith physiciann f nsi o d medicasan l scientists!

367 CONCLUDING SPEECH

A.E. ROMANENKO

Esteemed participants of the Conference! Dear guests! Ladies and gentlemen! Comrades!

Here,in the capital of the Soviet Ukraine, we have held a major scientific conference concerned with medical aspects of the acciden Chernobye th t ta l Nuclear Power Station, which, judginkeee th n y attentiogb y specialistnb showt i n ni d an s broad sections of the public, has acquired global significance. Despite tbe fact that two years have already passed since the accident intereste ,th s take n everythinni g tha s conneci t - ted with Chernobyl does no L diminish. This is evidenced by the accreditation at the Conference of almost 140 newsmen, including ove 0 foreig3 r n journalists o represen,wh 6 Sovie2 t d an t 3 foreig2 n mass media. The Conference was attended by specialists from 26 ministries and departments of the USSR and Union republics, 45 research establishments, as well as more than 60 foreign scientists, representatives of the IAEA and a number of international organizations. It is no mere chance that such a great interest is displayed in the accident at the Chernobyl NPS: its scale, despite the preceding experience in other countries, proved unexpected, thus posing befor country'e th e s public health services extremely difficult problem protectio e d taskth san f so f no health of people in the areas involved in that situation. These problems and tasks called for scientific comprehension, quick response and timely decisions.

369 The acciden numbea Chernobye d th distincf ha t ro a t S lNP - tive features which prevented makinresulte th gf o s fule lus of numerous theoretica d applielan d studies previously carried out both in this country and in foreign and international organizations, which dealt with problems of radiation safety. On the other hand, as shown by the experience of Chernobyl, the complexity and manysidedness of the problems of population protectio e cas radiatiof th o e n i n n accidents, which knoo wn state boundaries, callarge-scalr fo l e international cooperation. o yeartw se Th that have passed were remarkabl t juseno t e strenuoufoth r s work aime neutralizint a d e accidength d an t eliminating its immediate consequences, but also for the urge to undertake further exploration of the problems of coexistence peacefue mankinf o th d an dl atom. Amids thesl al t e problems, prominenc s beeeha n give researcheo nt e fiel th radiof o dn i s - logical medicine — a rapidly developing branch of medical science, vitacooperatioe th whico t le ar h f variouno s branches and involvement of many countries. Twenty-nine reports have bee e Conferencen th mad t a e . Runnin l througgal reporte e firsth h th s this twa sr timfo : e in world practice, large-scale state-organized measures have been implemented, basically new decisions have been made, and the entire medical experience has been tapped to maintain the healt thosf o h o tooe wh eliminatio e k th par n e i t th f o n accident's aftermath, as well as the residents of the accident—stricken areas. The participants and guests of the Conference had an opportunity to visit the Chernobyl Nuclear Power Station, the town of Slavut ich built for its personnel, to familiarize themselves with the work of the All-Union Center of Radiation Medicine unde USSe rth R Academ Medicaf yo l Sciencea d san

370 number of research and medical-and-prophylactic establishments directly involve tacklinn i d g medical problems stemming from the Chernobyl accident, as well as some other medical-and-prophylactic establishments in Kiev. Allow me to extend ray sincere gratitude to all our quests, representative internationaf o s l organizationse , th suc s ha United nations Scientific Committee for Atomic Radiation Effects, the World Health Organization, and the Inbernational Atomic Energy Agency participateo ,wh Conferencee th n i d . The invitation to the Conference of the world's leading scientists and specialists enabled us to launch a wide discussion of the data obtained, and to map out ways and prospects of further studies. Generalizatio d utilisationan e th f no experience gained durin e eliminatiogth aftermate th f no f o h the acciden Chernobye th b a t l Nuclear power Stab ion s wela , l as other radiation accidents, will facilitate the protection and maintenance of people's health in the context of ongoing developmen nucleaf o t r power engineering. It is v;ith the feeling of great satisfaction that we can state: the Conference has been held in the atmosphere of mutual understandin d cooperationgan . Thi bees s ha meetinna colf o g - leagues vitae uniteth ly b dimportanc e taske ar th e sf w o e faced with, highly human responsibilite e th aim d san y before mankind.

Today, many in the West argue that Russians proved to be unprepare r suc fo daccidentn ha . However s testifie,a e th y db entire work of the Conference, this was not the case. The questions of organization and effectiveness of the measures that were taken were based on medical approaches which had been worked out in advance and their proper organization. In my opinion, this is the most important thing that can be inferred from the Kiev meeting, for it undertook a thorough scientific analysis of the Soviet public health system.

371 Along with s witthiswa hs ,a goo d reason pointe n j'ai et ou d debates e eliminatio,th accident'e th f no s aftermath revealed serious shortcomings n particular.I , ther . comps 3 lac ewa f o k- rehensive system approach to the elimination of a large-scale radiation accident, physicians showed inadequate practical knowledge in the field of radiation pathology, while the radiological service was short of dosimeters and radiometers. A. considerable par f equipmeno t t outdatee prove- "b ob o d t d an d solescent. The sanitary-and-educational and explanatory work amon e populatiogth obviousls nwa y inefficient. At the same time, it should be noted once again that the Conference has convincingly proved: our experience of a truly titani d effectivan c e effor eliminato t t e consequenceth e f o s the acciden Chernobye th t a t l Nuclear Power Statio greaf o s tni importance not only for Soviet but also world science and practice. This experienc invaluabls i e r furthefo e r development of nuclear engineering and prevention of nuclear war. Allow me once again to thank all the participants and Conferencegueste th f so wels , a thos s la delivereo ewh d reports and debates e spokth gool n ei al d wis,I u healthyo everd han y succes youn si r work hereb.I y declar Conference eth e closed. minutesw fe a n ,presa I s conferenc Sovier fo ed an t foreign newsmen will be held in this hall.

372 ORGANIZING COMMITTEE

Chairman First Deputy Ministe Publif ro c SERGEEV Health of the USSR Gennady Vasilievich

Vice-Chairman Deputy Minister of Public Health USSe th R f o KONDRUSEV Alexander Ivanovich

Vice-Chairman Minister of Public Health of the EOMAHENKO Ukrainian SSR; Directo Alle th - f ro Anatoly Efimovich Union Scientific Centr Radiaf eo - tion Medicine, USSR Academ- Me f o y dical Sciences

Vice-Chairman Directo Institutf ro Biophysicsf eo , ILYTN USSR Academy of Medical Sciences, Leonid Andreevich Vice-Chairma f USSno R Academf o y Medical Sciences

MEMBERS OF THE ORGANIZING COMMITTEE

AVETISOV Scientific Secretare th f yo Grigory Michallovich National Commission for Radiation Protection

AKUIOV Deputy Ministe Publif ro c Health Konstantin Ivanovich of the Russian Soviet Federative Republic

BEBESHKO Deputy Director of the All-Union Vladimir Grigorievich Scientific Centr f Radiatioo e n Medicine, USSR Academf o y Medical Sciences

BULDAKOV Deputy Directo e Institutth f o r e Lev f AlexandrovicBiophysicso , hUSS R Ministrf yo Public Health

DNŒTRIEV Vice-Chairman of the Soviet Committee Aleksei Ivanovich "Physiciane e Worlth th r f fo do s Prevention of Nuclear War"

373 DUSHUTIN Scientific Secretary of the Konstantin Institut Biophysicsf eo , USSR Konstantinovich Ministr Healtf yo h

GORDEEV Deputy Director of the Institute Konstantin Ivanovich f Biophysicso , USSR Ministry of Public Health

GUSKOVA Head of the Department of the Angelina Institute of Biophysics, USSR Kons tantinovna Ministr f Publiyo c Health

KARKESCHENKO Deput ye Thir Chieth f do f Main Nikolai Nikolaievich Departmen e USSth Rf o tMinistr y of Public Health

KOMAROV Deputy Directo Centrae th f ro l Eugeniy Ivanovich Roentgenoradiological Research Institute, USSR Ministry of Public Health

LICHTAREV Hea Departmenf do Alle th -f to Ilya Aronovich Uniori Scientific Centre of Radiation Medicine, USSR Academy of Medical Sciences

NIKITIN Councello Internationae th f ro l Ivan Kupriyanovich Relations Board at the Ministry of Public USSHealte th R f ho

PANIN Head of Department of the All- Nikolai Nikolayevich Union Scientific - CentrRa f o e diation Medicine, USSR Academy of Medical Sciences

POLSKY Head of Department of Radiation Olee Glebovich Medicine, USSR Public Health Ministry

PRISYAZHNYUK Hea Departmenf do Alle th -f to Anatoly Yevtichievich Union Scientific Centre of Radiation Medicine

374 PYATAK Deputy-Director of the Ail- Oies A.vdeevich Union Scientific Centrf eo Radiation Medicine, USSR Academy of Medical Sciences

RAMSABV Director of the Leningrad Pavel Vasilievich Research Institut Radif eo - ation Hygiene, Ministrf yo Public RussiaHealte th f ho n Soviet Federative Socialist Republic

SERDÏUK First Deputy Minister of Andrei Michailovich Public Health of the Ukrainian SSR

T SIB Directo Medicae th f ro l Radio- Anatoly Fedorovich logy Research Institute, USSR Academ Medicaf o y l Sciences

TURAEV Chief Radiologis Radiatiof o t n Rudolf Hilovich Medicine Department, USS- RMi nistr Publif yo c Health

ULASCHIK Minister of Public Health of Vladimir Sergeevich the ByelorussiaR nSS

ZHAKOV Directo Institute th f ro f o e Igor Grigorievich Oncology and Medical Radiology, Ministry of Public Health of the Byelorussian SSR ZUBOVSKY Head of Department of the Moscow German Alexandrovioh Roentgenoradiological Research Institute, Ministr Publif o y c RussiaHealte th f o hn Soviet Federative Republic

375 LIS SOVIEF TO T PARTICIPANTS

Abdukhamedov K.A. Chazov Ye.I. Gorbov VoG. Aitmagobetov R.A„ Charyev B.Cb.. Gordesv K.I. Akulov K.I. Chayalo P.P. Gordienko S.M. Aleksakxin R.M. Cheban A.K. Grachev N.F. Alexandrovsky Yu.A. Chebotariov V«P. Grid" ko A..N, Aniskevich V.V. Chicalova I.G. Grischenko V.G, Annenkov B.N. Cherstvoy Ye.D. Grdzinsky D.M. Antonov V.P. Chobotko G.M. Gubriy I.B, Arkhipov N.P. Ghumak A.A. Gudzenko AVV. Àstakhova L.N. Chumafc V0K0 Gur N.Vo fk . Ataeva A.X. Chusov Ye.N. Gurinovich N.A. Atsmaniuk N.P. Dedenko I. A« Gusev I.A. Avraraejiko A.I. Demchenko V.I. Gustova L.I. Avraaienko N.L, Demianovskaya E.E. Gus* kova A.K. Badaudinov A.S. Deniaiuk A.B. Ilyin L.A. Bagnarel I.N. Dekhtiareva 0,3. Ispenfe:ov E.A. Baleva L.S« Didyichenko V.M. lushkavichus K.P. Balonov M.I. Dmitrenko E,A. Ivanov V.K. Baranov A.Ye. Dobrovolsky L.A. Kachanpv M.A. Barkhudarov R.Mo Dotsenko M»0« Kalashnikov îï.V. Bazuika D.A. Drannik G.N. Karakash S,I, Bebeshko V.G. Drozdova V.D. Karatchev I.I. Beibutov Sh.Sh. Dubovaya N.P. Karkischenko N.N. Beloled R.M, Dushutin K.K, Kasianenko A.M. Belyi D.A. Dzubik A.Ya. Khaitov G0Sh. Beregovoi Yu.V. Fedorenko Z.P. Khaliavka I.G. Beskrestnov N.V. Pilonov V.P. Khanson K0P. Bezdrobnui Yu.A. Fritafcaysa I.Yu. Khomazmuk I.N. Bobileva O.A. Frolov A.P. Khomenko N.R. Boguslavsky V.P. Galitch L.N. Khraacb. V.I. Borako E.I. Galkina S.G. Kindzelaky L.P. Bondar A.Yu. Gasanov R.I. Klimenko V.I. Botiakova N.V. Gasilina N.K. Kniahnikov V.A. Botchkov N.P. Gelashvily K.D«, Knyazeva Z.V. Bouer V.A. Geraskova O.N. Kolpakov I.E. Brui G.F. Gladkov G,N. Kolyadenko V.G. Bruslova E.M. Gluchenky Ye.A. Komarenko D.I. Bugaiov V.N. Gnatenko O.Z. Komarov V.I. Buldakov L.A. Golovach R.E. Komarov Ye.I. Buravliev V.N. Goldshtein D.S. Komissarenko S.V. Buriafc V.N. Gonchar N.M. Kondrashova V.G. Buzunov V.A. Goncharenko L.I. Kondinsev A.I.

317 Konstantine»v Yu.I. Mikhailovsky S.V. Poahkua A.S. Korenev N.M. KishanchuK- N.S. Prasolov A.P. Korenkov I.P. Mikulinsky E.P. Prevarsky B.P. Korobeitchenko G.D, Milushkin I.N. Prister B.S. Korotkova G.V. Minchenko Zh.N. Prisyzhniufc A.Ye. Koscheev V.S. Mogiley V.L. Prus E.S. Korzun V.N. Moisa D.I. Pus*kov M.I. Kovalenko A.P. Moroz G,L. Pya-Eak O.A. Kovbasa I.G» Mostopan A.I. Rakochi A.G. KovgaN nL. Naboka M.V. Ramzaiev P.V. Kozliuk V.M. Narin V.N. Razumeeva G.I„ Kukhar* V.P. Natarov V.V. Redkin V.V. Kulagiri S.M. Nikolaev V.G. Romanenko A.Ye. Kundiev Yu.I» Nikonov M.P. Romanov L.R. Kulagin S.M. Nikula T.D. Romanova A.P. Kurilenko N.A. Niagu A.I. Romaniuk G.V. Kurilo L.V. Hovikova N.Ya. Rubel* N.P. Kuzin M.I. Oganesian N.M. Rudhev M.I. Kuzmenko E.L. Oleunic V.A. Salyga L.I. Lageza V.l. Omelchenko V.N. Samoilenko V.M, Lapin* sh Ya.Ya. Omelyanets N.I. Samorodov V.A. Lazar" A.P. Oradovskaya I.V. Samusnevich I.G. Laziulc G.I. Osanov O.P. Savkin M.N. Ledoschuk B.A. Osechinsky I.V. Savran A„V. Liberman A. H. Otroschenko P„G. Schutsky Yu.I. Likhobabenko V.l. Panchenko N.A. Serdiuk A.M. Likhtariov I.A. Papoian S.A. Solidovkin G.D. Linge I.I. Parchomenko V.l. Sergeev G.V. Litvischenko B.I. Pavlovicb. A.P. Serkis Ya.I. Losev G.A. Pavlovsky O.A. Shandala M.G. Los* I.P. Perechrestenko P.M. Shemetun A.M. Lukfanova E.M. Perminova G.S. Shimelis I.V. Lukianchuk V.E. Petrenko S.V. Shmelev V.l. Ly i se nie o E.Yu. Petrenko S.V. Sherbenko 0.1. Lyisenko 0«V. Petruk D.A. Sherbinskay, M » aA Makarova I.V. Petuchov A.S. Shestakov V.l. Malashevsky V.V. Pilinskaya M.A. Silich Yu.M. Malkin G,G. Pilipenko N.I. Sivachenko T.P. Malyzhev V.A. Pinchuk V.l. Sitnik A.S. Margulis U.A. Pirogova E.A. Skriabin A.M. Markov V.V. Pitenov V.A. Skuratova 0«P. Maschenko N.P. Pogorelova E.I. Smoliar V.l. Matveenko E.G. Polsky O.G. Sozinov A.A. Matsuka 6.X. Pomozan V.A. Spizhenko Yu.P. Melhik V.V. Ponomarenko V.M. Stepanenko V.P.

378 Stepanova E.I. Tulinov V.B. Yaremenko I.I. Stezhko V.A. Turaev R.N. Yarmolenko S.P. Strapko N.P. Ulaschik V.S. Zadoroztmaya T.A. Suchovilin V.V. Vartanian M.E. Zaitsev I.G. Tal'ko V.V. Vasilenko S.V. Zakirov M.Z. Tarânenko M.G. Vepkhvadze R.Ya. Zakharash M.P. Terekhova A.N. Yishnevsky I.N. Zamostian V.P. Ternovoy K.S. Vishtal N.M. Zapesotchny A.Z. Titov L.P. Volkovinskaya I.N. Zavalny V.N. Torbin V.P. Voloshin U.V. Zhakov I.G. Trefilov V.I. Voloshenko O.I. Zhalbe I.D. Tronko N=D. Voloschuk S.S. Zhdanova N.ÎT. Tsvetkova N.I. Vozniafc V.Ya. Zhukovsky V.G. Tsvetkova O.A. Vvedensky V.V. Zubovsky G.A. Tsib A.F. Yafcovlev A.A.

379 LIST OF FOREIGN PARTICIPANTS

IAEA DDR Slovakia ( CSSR ) Arndt D. Vladar M. Benn. B t et Musio. lD Calpas St. Blix H. Schmid. tW Jurina V. Garter M, Stopp G. • Gonzalez A. Finland Hosen M. India RutomaalT Sharma T. WHO USA Bair W. Waddington J, Canada Wald tf. Auderso. nT Gal. R e Bulgaria Goldman M. China Catlin R. Bliznakov V* Zhunlia. nG Fabrican. tJ Shopo. vN Lushbaug. hC Cuba Mettler P. Brasil Martinas E. Anspaugh L» Moreno Carbonel C. Patterso. nJ Brandao-Mello C.E. Terr. yH Sinclair W. FRG UK Norway Korbling M. Baarl. iJ Roat. S h Kubane. kB Ofteda. lP Rubber. E y Schwar. zE S tathe. J r Poland Yugoslavia Hopewe11 J. Bonczac J. Pejuskovi. cB Hungary Jedlinskr. W i Radmolovi. cV Majle T. Trajkovic M. Sztanyik L. Päpay D. France Tura. yI Remania Jammet H« Manesc. uS Pellerin P.

381 ORDEO T W R IAEHO A PUBLICATIONS

exclusivn A e sales agen r IAEtfo A publications whoo t , l ordermal s and inquiries should be addressed, has been appointed followine inth g country:

UNITED STATES OF AMERICA UNIPUB, 4611-F Assembly Drive, Lanham, MD 20706-4391

In the following countries IAEA publications may be purchased from the sales agents or booksellers listed or through major local booksellers. Payment can be made in local currenc witr yo h UNESCO coupons.

ARGENTINA Comisiôn Nacional de Energi'a Atômica, Avenida del Libertador 8250, RA-1429 Buenos Aires AUSTRALIA Hunter Publications GippA 8 5 , s Street, Collingwood, Victoria 3066 BELGIUM Service Courrier UNESCO, 202, Avenu Roiu ed , B-1060 Brussels CHILE Comisiôn Chilena de Energie Nuclear, Venta de Publicaciones, Amunategui 95, Casilla 188-D, Santiago CHINA IAEA Publications in Chinese: China Nuclear Energy Industry Corporation, Translation Section, P.O. Box 2103, Beijing IAEA Publications other tha Chinesen i : China National Publications Import & Export Corporation, Deutsche Abteilung , Beijin, 88 P.O x g.Bo CZECHOSLOVAKIA S.N.T.L., Mikulandska4,CS-11686 Prague 1 Alfa, Publishers, Hurbanovo nämestie 3, CS-81589 Bratislava FRANCE Office International de Documentation et Librairie,48, rue Gay-Lussac, F-75240 Paris Cedex 05 HUNGARY Kultura, Hungarian Foreign Trading Company, 149x P.OBo ., H-1389 Budapes2 6 t INDIA Oxford Boo Stationerd kan y Co.,17, Park Street, Calcutta-700016 Oxford Book and Stationery Co.,Scindia House, New Delhi-110001 ISRAEL Heilige . LtdCo . & r Kere3 2 n Hayesod Street, Jerusalem 94188 ITALY Libreria Scientifica, Dott. Luci Biasie od o "aeiou", Via Meravigli 16, 1-20123 Milan JAPAN Maruzen Company, Ltd, P.O. Box 5050,100-31 Tokyo International PAKISTAN Mirza Book Agency, 65, Shahrah Quaid-e-Azam, P.O. Box 729, Lahore 3 POLAND Ars Polona-Ruch, Centrala Handlu Zagranicznego, Krakowskie Przedmiesci , PL-00-06e7 8 Warsaw ROMANIA 136-137x lleximBo . 0 ,,P Bucharest SOUTH AFRICA Van Schaik Bookstore (Pty) Ltd, P.O 724x Bo . , Pretoria 0001 SPAIN Di'az de Santos, Lagasca 95, E-28006 Madrid Diaz de Santos, Balmes417, E-08022 Barcelona SWEDEN FritzeB A s Kungl. Hovbokhandel, Fredsgata , P.O 16356nx 2 Bo . , S-10327 Stockholm UNITED KINGDOM Her Majesty's Stationery Office, Publications Centre, Agency Section, 51 Nine Elms Lane, London SW85DR USSR Mezhdunarodnaya Kniga,Smolenskaya-Sennaya 32-34, Moscow G-200 YUGOSLAVIA Jugoslovenska Knjiga, Terazije 27, P.O. Box 36, YU-11001 Belgrade

Orders from countries where sales agent t bees ye hav nt appointeeno d dan requests for information should be addressed directly to: Division of Publications International Atomic Energy Agency Wagramerstrasse 5, P.O. Box 100, A-1400 Vienna, Austria