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Radiation Poisoning Rick Layman, MS , DABR Instructor Diagnostic Medical Physicist Department of Radiology the Ohio State University Medical Center

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Radiation Poisoning Rick Layman, MS , DABR Instructor Diagnostic Medical Physicist Department of Radiology the Ohio State University Medical Center Radiation Safety Radiation Poisoning Rick Layman, MS , DABR Instructor Diagnostic Medical Physicist Department of Radiology The Ohio State University Medical Center Outline Possible Radiation Emergency Scenarios Radiation Safety – Possible scenarios • Medical – Radiation Basics • Terrorist use of nuclear materials – Decontamination procedures • Catastrophic event Medical Aspects of Radiation – Biologic effects – Radiation sickness 1 Medical Radiation Event Medical Radiation Event • 40 year old male underwent a coronary angiography, coronary angioplasty and secondary angiography due to complications, • Radiation Oncology followed by a coronary artery by-pass graft. • All procedures occurred on March 29, 1990 Appearance of skin injury post- procedure: (a) 6-8 wks (b) 16-21 wks (c) 18-21 wks Shope, T, (a)(b) (c) Radiographics, 1996, 16, 1195-1199, 1996 Medical Radiation Event Terrorist Use of Nuclear • Acquisition protocols were not set Material properly resulting in excessive exposures • Radiological Dispersal Device • Cedar Sinai (L.A.): 200 patients overexposed during 18 month (i.e. “dirty bomb”) period • Providence St. Joe (L.A.): 34 • Combine radioactive material with patients overexposed during 20 explosive device month period • Glendale Adventist Medical Center • Blast effect plus radioactivity (L.A.): 10 patients overexposed during 10 months After Stroke Scans, Patients Face • 8x national average for exposure Serious Health Risks, The New York Times, August 1, 2010. 2 Terrorist Use of Nuclear Catastrophic Event Material • Goiânia, Brazil • 1985: Private Improvised Nuclear Device or Nuclear Weapon radiotherapy clinic closed • An actual nuclear detonation down • 1987: teletherapy • Allegation that 50 to 100 one kiloton head stolen • Unit dismantled, suitcase nuclear weapons unaccounted Cs-137 source for from former Soviet Union capsule ruptured causing major • Various rogue or terrorist supporting contamination • 50.9 TBq (1375 Ci) states caesium-137 teletherapy Used with permission from Brian Dodd, BD machine left in Consulting, HPS Past President abandoned clinic Catastrophic Event Goiânia, Brazil Reactor Accidents • 112 000 people monitored • Three Mile Island - 1979 • 249 people contaminated • Chernobyl – 1986 • 49 people 0.1 - 6.2 Gy • Tokaimura, Japan – 1999 (uranium processing • 4 pppeople died facility) 6 y old girl • Fukushima, Japan – 2011 18 y old man War Veterans 22 y old man • Operation UPSHOT-KNOTHOLE 38 y old mother • Exposures ranged from 0.4 – 31 mSv (equivalent to 5 – 390 chest x-rays) 3 Radiological Accident Catastrophic Event Statistics (1944-2000) • Gilan, Iran ~ 400 reported accidents • 1996: Ir-192 source ~ 3000 exposed persons used for industrial > 100 deaths, more than half involving radiograph y f all s out patien ts of shielded container In addition, orphan sources can be mixed up with scrap causing • Manual worker picks contamination problems up source and puts it in chest pocket Illicit trafficking involves orphan sources Used with permission from Brian Dodd, BD Consulting, HPS Past President but very few orphan source incidents are due to illicit trafficking events Gilan, Iran The Basics of Radiation Ionizing radiation is electromagnetic • Resulting in severe energy or energetic particle emitted from a radiati on b urns t o source. the chest Ionizing radiation is able to strip electrons from atoms causing chemical changes in molecules. 4 Ionizing Radiation Natural Background Primarily radon and gamma rays • Ionizing radiation is emitted by from the atmosphere • Ground -Radioactive material – 222Rn • Building Materials -Machine generated • Air (x-rays, LINACS) • Food – 238U and 232Th from drinking water • Biological effects from • Universe ionizing radiation are – Gamma rays generated in supernova dependant on the energy and • Elements within our own body type of radiation – 14C Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2, 2006 Electromagnetic Radiation Manmade Sources Used in medicine, research, and industry • X-ray equipment • Radioactive materials Assumes everyone receives two diagnostic x-ray exams per year Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2, 2006 5 Key Point: Key Point: Every individual receives low levels of radiation every day of their life Not all radiation is equal Background Radiation Around the World Particulate Ionizing Radiation • Alpha particles: two protons and two neutrons • Beta particles: release gamma • Neutrons: causes other substances to become radioactive 6 Gamma or X-Ray Radiosensitivity Physical Factors (Photons) • Linear Energy Transfer (LET) • High energy rays – Measure of the rate at which energy is transferred from ionizing radiation to soft tissue. • Very penetrating • Relative Biologic Effect (RBE) • Difficult to shield – Ability to produce biologic damage • Can be produced from • Fractionation radioactive decay and a nuclear Biologic Factors weapon explosion or reactor • Oxygen Effect accident – Tissue is more sensitive in the presence of oxygen • PPE will not protect against • Recovery photon radiation • Age Radiation Sensitivity and Age 7 Law of Bergonie and Radiation Doses and Dose Limits Tribondeau • Stem cells are radiosensitive. The more Flight from Los Angeles to London 5 mrem mature a cell, the more resistant to Annual public dose limit 100 mrem radiation it is. • The younger the tissue and organs, the Annual natural background 300 mrem more radiosensitive they are. Fetal dose limit 500 mrem • When the level or metabolic activity is Barium enema 870 mrem high, radiosensitivity is also high. • As the proliferation rate for cells and the Annual radiation worker dose limit 5,000 mrem growth rate for tissue increase, the radiosensitivity also increases. Measures of Radiation Radiation Doses and Dose Limits Exposure Heart catheterization 45,000 mrem • Rad = Radiation Absorbed Dose: measures amount of energy actually absorbed by a Life saving actions guidance 50,000 mrem material (i.e. tissue) (NCRP-116) • Rem = Roentggqen Equivalent Man: measures biologic damage of radiation; takes into Mild acute ra diat ion syn drome 100, 000 mrem account dose and type of radiation involved • In most situations, 1 Rem = 1 Rad LD50/60 for humans 350,000 mrem (bone marrow dose) • 1 Gray (Gy) = 100 Rads • 1 cGy = 1 Rad Radiation therapy 6,000,000 mrem (localized & fractionated) • 1 Sievert = 100 Rems • 1 millisievert = 0.1 Rem 8 Radioactive Material Radiation Exposure Types • Radioactive material consists of atoms External Internal with unstable nuclei Irradiation Contamination Contamination • The atoms spontaneously change (decay) to more stable forms and emit radiation ** • A person who is contaminated has * radioactive material on their skin or * inside their body (e.g., inhalation, ingestion, shrapnel, or wound * contamination) *** • A person exposed to radiation may, or may not, be contaminated. • Not all radioactive materials are equal Types of Radiation Hazards Examples of Radioactive Materials • External Exposure - Physical Internal Radionuclide Half-Life Activity Use whole-body or partial-body Contamination (no radiation hazard to ED Cesium-137 30 yrs 1.5x106 Ci Industrial radiography External staff) Contamination Cobalt-60 5 yrs 15,000 Ci Cancer Therapy • Contaminated - Plutonium-239 24,000 yrs 600 Ci Nuclear Weapon External Iridium-192 74 days 100 Ci Industrial Radiography – external radioactive Exposure material: on the skin Hydrogen-3 12 yrs 12 Ci Exit Signs Strontium-90 29 yrs 0.1 Ci Eye Therapy Device – internal radioactive material: inhaled, Iodine-131 8 days 0.015 Ci Nuclear Medicine swallowed, absorbed Therapy through skin or wounds Technetium-99m 6 hrs 0.025 Ci Diagnostic Imaging Americium-241 432 yrs 0.000005 Ci Industrial radiography Radon-222 4 days 1 pCi/l Environmental Level 9 ARS - Phases 1. Prodromal Phase - occurs in the first 48 to Medical Aspects of Radiation 72 fours post-exposure and is characterized by nausea, vomiting, malaise and anorexia. At doses below about 500 rads last 2 to 4 days. The earlier the symptoms, the worse the exposure Richard Nelson, MD Vice Chair 2. Latent Phase - follows the prodromal phase Department of Emergency Medicine and lasts for approximately 2 to 2 1/2 weeks. During this time, critical cell populations The Ohio State University (leukocytes, platelets) are decreasing as a result of bone marrow insult. The time interval decreases as the dose increases. Acute Radiation Syndrome ARS - Phases (ARS) • Group of symptoms that develop after 3. Illness Phase - period when overt illness develops total body irradiation ( > 100 rads) • May occur from either internal or 4. Recovery or Death Phase - may take external radiation weeks or months • Four important factors are: – High Dose – High Dose Rate – Whole Body Exposure – Penetrating Radiation 10 Prodromal Phase and Prognosis ARS - Skin • If time to emesis is <4 hours: exposure at least 3.5 Gy sis amation oist o u • If time to emesis is < 1 hour: exposure M at least 6.5 Gy Response Desq Necr 300 600 1000 >1500 >5000 Dose Acute Radiation Sickness • Skin/hair • Gastrointestinal tract • Hematopoietic system • Central nervous system 11 12 ARS - Hematopoietic Syndrome /L) 9 3.0 2.5 Normal Range ytes (10 2.0 c 1.5 Moderate 1.0 Patient Severe Injury 0.5 Very Severe 0.1 Lethal 0361724 48 hrs Absolute Lympho ARS - Gastrointestinal ARS Blood Counts Syndrome • 48 hour absolute lymphocyte count > • Radiation > 600 rads 1200: good prognosis; 300 - 1200: • Damages intestinal lining significant radiation
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