Follow-Up of Delayed Health Consequences of Acute Accidental Radiation Exposure Lessons to Be Learned from Their Medical Management
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IAEA-TECDOC-1300 Follow-up of delayed health consequences of acute accidental radiation exposure Lessons to be learned from their medical management Co-sponsored by the International Atomic Energy Agency and the World Health Organization July 2002 The originating Section of this publication in the IAEA was: Radiation Safety Section International Atomic Energy Agency Wagramer Strasse 5 P.O. Box 100 A-1400 Vienna, Austria FOLLOW-UP OF DELAYED HEALTH CONSEQUENCES OF ACUTE ACCIDENTAL RADIATION EXPOSURE IAEA, VIENNA, 2002 IAEA-TECDOC-1300 ISBN 92–0–133202–5 ISSN 1011–4289 © IAEA, 2002 Printed by the IAEA in Austria July 2002 FOREWORD While the use of radioactive materials around the world offers a wide range of benefits in medicine, industry and research, safety precautions are essential to limit the exposure of persons to harmful radiation. When the quantity of radioactive material employed is substantial, as when radioactive sources are used for radiotherapy in medicine or for industrial radiography, extreme care is necessary to prevent accidents that may lead to severe health consequences for the individuals involved. Despite the fact that the precautions to be taken are clearly established, accidents with radiation sources continue to occur, albeit infrequently. The IAEA, as part of its ‘Safety of Radiation Sources’ and ‘Emergency Response’ subprogrammes, follows up severe accidents of this kind. In so doing, the IAEA attempts to document both the circumstances leading to the accident and the subsequent medical treatment in order to define the lessons to be learned from these events. The overall objective is to provide information that will be of benefit to organizations with responsibilities for radiation protection, the safety of radiation sources and the medical management of radiation accidents. The International Atomic Energy Agency has issued a number of publications on radiation accidents which have occurred in the past 15 years, reporting on the causes, radiation safety aspects and medical management of those affected particularly in the acute phase following an accident. These reports cover the accidents in Chernobyl, Ukraine (the Republic of the former Soviet Union) and Goiânia (Brazil), and those in El Salvador, Vietnam, Belarus, Israel, Estonia, Costa Rica, Georgia, Russian Federation, Turkey, Peru and Panama. In 1998 the IAEA published three Safety Reports, co-sponsored by the World Health Organization, aimed at disseminating medical information on the recognition and treatment of radiation injuries, planning the medical response to radiation accidents and occupational health surveillance in the event of accidental overexposure. As part of the co-operative arrangements between the IAEA and WHO, a joint IAEA–WHO technical meeting (TM) was held on 1–3 October 2001 at WHO Headquarters. Ten radiation medicine experts, who had been responsible for providing medical assistance to victims of radiation accidents, and four members of the Joint IAEA–WHO Secretariat, attended the meeting. The objectives of the TM were to review the delayed health consequences of acute exposure to radiation consecutive to a number of recent radiation accidents and to analyse lessons to be learned in their diagnosis and treatment. Eight papers were presented and discussed. These form the basis of this joint IAEA–WHO publication. Accounting for the conclusions and lessons learned from the medical management and follow up of recent severe radiation accidents, a Joint IAEA–WHO Consultancy Services Meeting (CSM) was held on 8–9 November 2001 at the WHO Collaborating Centre for Radiation Accident Management, at the University of Ulm, Germany, where recommendations were developed by the team of medical experts for the Joint Secretariat on updating the strategy for the treatment of local radiation injuries and of acute radiation sickness. These are to be discussed in an upcoming joint publication together with recent follow-up findings. The contribution of all participants to the drafting and review of this publication is acknowledged. The Chernobyl chapters have benefited greatly from the technical review of G. Souchkevitch, the Scientific Co-Secretary from the WHO. The IAEA officer responsible for the preparation of this report was I. Turai of the Division of Radiation and Waste Safety. EDITORIAL NOTE The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries. The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA. CONTENTS Summary ..................................................................................................................................................1 CHAPTER 1. HEALTH CONSEQUENCES IN THE CHERNOBYL EMERGENCY WORKERS SURVIVING AFTER CONFIRMED ACUTE RADIATION SICKNESS..................................................................................5 1.1. Short description of the Chernobyl accident .....................................................................................5 1.1.1. Place, date, circumstances .......................................................................................................5 1.1.2. Radioactive source...................................................................................................................5 1.1.3. Number of affected persons, estimated individual doses.........................................................5 1.1.4. Degree and type of initial injuries............................................................................................6 1.2. Medical actions in the early period after the accident.......................................................................6 1.3. Follow-up of ARS survivors in the Scientific Center for Radiation Medicine, Kiev, Ukraine.........7 1.3.1. Patients and methods of study..................................................................................................8 1.4. Follow-up in the delayed period: Non-stochastic and stochastic consequences in acute radiation syndrome survivors...............................................................................................9 1.4.1. Oncological and oncohaematological pathology.....................................................................9 1.4.2. Haematopoiesis......................................................................................................................11 1.4.3. Immune system......................................................................................................................13 1.4.4. Cytogenetic analysis ..............................................................................................................15 1.4.5. Follow-up of the nervous system...........................................................................................16 1.4.6. Endocrine system...................................................................................................................17 1.4.7. Other organs and systems ......................................................................................................18 1.4.8. Metabolic processes...............................................................................................................20 1.4.9. Follow-up of skin injuries......................................................................................................21 1.4.10. Eyes......................................................................................................................................22 1.4.11. Capacity for work and disability..........................................................................................23 1.5. Conclusions.................................................................................................................................23 1.6. Lessons learned...........................................................................................................................24 References to Chapter 1 .........................................................................................................................25 CHAPTER 2. PSYCHOLOGICAL CONSEQUENCES OF NUCLEAR AND RADIOLOGICAL ACCIDENTS: DELAYED NEUROPSYCHIATRIC EFFECTS OF THE ACUTE RADIATION SICKNESS FOLLOWING CHERNOBYL...............27 2.1. The accident ....................................................................................................................................27 2.2. Follow-up in the delayed period......................................................................................................27 2.2.1. Frequency of medical examinations per year ........................................................................27 2.2.2. Type of examinations (laboratory methods and clinical investigations) ...............................27 2.2.3. Results of clinical and laboratory examinations (cross-sectional neuropsychiatric study of ARS patients with parallel groups, 1996–1998) .....................................................34 2.2.4. Psycho- and neurophysiological studies ................................................................................37 2.2.5. Principles and methods of treatment......................................................................................44