Follow-up of Persons Exposed to Radiation and Radioactivity

1. Follow-up of Persons Exposed to Radiation and Radioactivity Niel Wald, M.D. and Michael Kuniak, D.O. Dept. of Environmental & Occupational Health University of Pittsburgh, Graduate School of Public Health Pittsburgh, PA 15261

2. Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up2. Examples of Prompt Early Health Follow-up :Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b.Long-term Psychological Stress Reduction

3. 192Iridium Shipping Incident H.P. Participants included: K.Z. Morgan, Oak Ridge National Laboratory R. Zimmerman, Phoenix Technology Corp. B.J. Porter, Louisiana Bureau of Radiation Control M.D. Participants included: N. Wald, University of Pittsburgh C. Huguley, Emory University W. Jensen, George Washington University C.A. Paulsen, University of Washington

4. Normal Source Position in C 10 Cask

5. 69lb 192Iridium Source ExchangerSource Position on Return to Vendor14R/Hr

9. Source Position at Ryan Airportfor about 56 hours

12. Magnitude of the Accident Exposure Locations: Sender and Receiver Sites: 2 Airline Freight Depots: 3 Aircraft: 2 Passengers: 157 Med. exam and CBC: 154 Worst Case Dose: 7 rads Airline and freight employees: 48 Med. Exam and CBC: 48 Chromosome studies: 11 Sperm Counts: 53 ___ Total persons: 205

13. Lesson Learned In a population exposure event, M.D. must initiate triage independent of firm H.P. information to assess possible injury and to meet psychological needs, but the latter is of great value as soon as available.

14. Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up2. Examples of Prompt Early Health Follow-up : Airline Shipment AccidentGoiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b.Long-term Psychological Stress Reduction

15. 454-2

16. Location of Goiania, Brazil 451-1

17. Goiania Accident Source 137Cs teletherapy source capsule: Physical form: CsCl hygroscopic powder with blue fluorescence as it absorbed moisture. Radioactivity: 50.9 TBq (1375Ci) Dose rate @1 m: 4.56 Gy/hr (456 rad/hr)

18. 451-3

19. Goiania Medical Disposition 580-9

20. Goiania Casualty Burial 412-3

21. Goiania Local Injury 454-5

22. Goiania Contaminated Areas 451-2

23. Goiania Population Screening 55-3

24. Goiania Accident Magnitude People monitored: 112,000 Chromosome analyses: 110 Roads monitored: 2,000 Km Remediation workers: 755 Above DL: 38 (Highest: 10 mSv CDE) Homes contaminated: 85 Demolished: 7 Vehicles contaminated: 50 Radwaste created: 3,800 200L drums

25. Lessons Learned Lack of awareness of the detrimental health effects of radiation exposure can impede its recognition on the part of patients and medical practitioners until much damage is done. The alert M.D. who faces an unusual public health problem must find a collaborating H.P. to evaluate its possible radiogenic origin and if confirmed, to help deal with it.

26. Presentation Outline 1. Definitions: Early vs. Long-term Follow-up2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source AccidentChernobyl Reactor Accident 3. a. Examples of Early Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b.Long-term Psychological Stress Reduction

27. Chernobyl: Healthcare Resources Used • Local medical facilities • 400 special medical brigades • M.D., H.P., etc. • 15,000 health workers • 2,000 M.D.’s, 4,000 nurses, med students, etc • 213 mobile laboratories • Special hospitals (Kiev, Moscow)

28. Chernobyl: Healthcare Procedures

29. Lessons Learned • In the USSR highly organized Civil Defense, Health system, Military and other government resources were quickly mobilized. • In the US less centralized resources might currently have more difficulties, although the maturation of the Homeland Security Agency should facilitate such a response.

30. Presentation Outline 1. Definitions: Early vs. Long-term Follow-up2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Early Preparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b.Long-term Psychological Stress Reduction

31. Presentation Outline 1. Definitions: Early vs. Long-term Follow-up2. Examples of Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of EarlyPreparations for Long-term Health Follow-up: ABCC database TMI database Chernobyl database b.Long-term Psychological Stress Reduction

32. Nuclear Weapons Test, Nevada 91-B

33. 91-C

34. Estimated Civilian Casualties within 2000 Meters of the Hypocenter, by City 92-B

35. Types and Magnitude of Injury Among Survivors * Total exceeds 100%, since many had multiple injuries. 98-A

36. Atomic Bomb Casualty Commission 91-J

37. ABCC Medical Program • Purpose: • Compilation of Medical data about Hiroshima and Nagasaki A-bomb survivors to quantitate radiation effects. • Statistical analysis of medical data. • Scope: • Clinical data collection by: • Adult medical project • Pediatric medical project • Ophthalmology project • Hematology project • Pathology project • Clinical laboratory project • Biostatistical analysis 93-F

38. ABCC Pediatric Study Patient 93-H

39. ABCC Leukemia Study Patient (Hiroshima Red Cross Hospital) 96-E

40. A-Bomb Survivors by Age and Sex 98-B

41. 1950 City Residents 2,000 - 10,000 meters Nonexposed Distal Non-exposed Proximal 0 - 2,000 meters Master Sample (Proper Part) Master Sample (Proper + Reserve) 92-F

42. ABCC Shielding Program • Purpose: • Compilation of sufficient historical data about Hiroshima and Nagasaki A-bomb survivors to permit calculation of individual radiation dosages when dosimetry is available. • Scope: • Location of exposed individuals. • Description of shielding structures. • Preparation of three-dimensional maps of cities. • Collection of bomb detonation conditions, height of burst, weather, etc. • Shielding measurements using sources. 93-A

43. ABCC Shielding Study 93-B

44. ABCC Shielding Study E39

45. Early DOSE/DISTANCE curves used for ABCC Patient Exposure Estimation Hiroshima Rads Nagasaki Distance from hypocenter (meters) 94-F

46. ABCC/ORNL Ichiban Dosimetry Project • Purpose: • Compilation of experimental dosimetry data which when used with ABCC shielding information, will permit calculation of individual radiation dosages of A-bomb survivors. • Scope: • Determination of angular distribution of radiations. • Radiation shielding by Japanese houses • Plane slab experiments • Parametric study of houses • Determination of air dose. • Calculation of doses for ABCC cases and documentation of IBM cards. 92-E

47. Correlation Program • Purpose: • Correlation of dose and medical effects data. • Preparation of interim and final reports. • Scope: • Dose-effect correlations including: • Acute radiation death • Premature aging • Shortened life-span • Epilation • Cataracts • Acute hematological changes • Leukemia • Carcinogenesis • Genetic effects 95-F

48. Lesson LearnedEffect of Delayed Database Startup No. of people in city at time of bomb Died of acute effects of bomb (1945) Resident in Same City (1960) Survived acute effects of bomb (to 1946) Migrated from City (1950 - 1960) Died and migrated from city (1946-1950) 1950 city residents Died (1950-1960) 92-D

49. Radiation Risk Estimation Using A-bomb Survivor Data • In the 1950’s, survivors of the A-bombings were interviewed and gave detailed reports of their location at the time of bombing and their experience afterward. • The Atomic Bomb Casualty Commission (ABCC), now the Radiation Effects Research Foundation (RERF), made very detailed engineering drawings of the survivor location. • These drawings are used to determine the ground range and the shielding to assign organ doses from the dosimetry system. • Members of Life Span Study (LSS) are followed for cancer incidence and mortality. • A cohort of LSS, the Adult Health Study (AHS) undergo biennial clinical examinations for health effects studies. • Statistical analysis of dose-dependent frequency is used to estimate radiation risk. 576-4

50. Presentation Outline 1. Definitions: Prompt vs. Long-term Follow-up2. Examples of Prompt Early Health Follow-up : Airline Shipment Accident Goiania Stolen Source Accident Chernobyl Reactor Accident 3. a. Examples of Prompt Preparations for Long-term Health Follow-up: ABCC databaseTMI database Chernobyl database b.Long-term Psychological Stress Reduction