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MEDICAL ASPECTS OF RADIOLOGICAL ACCIDENT IN GILAN, IRAN

MEDICAL ASPECTS OF RADIOLOGICAL ACCIDENT IN GILAN, IRAN. Module XIX. Summary. Morning of 24 July 1996 a worker (KZ) at Gilan Combined Cycle Fossil Power Plant, while carrying insulation material for lagging pipes, noticed a shiny pencil sized metal object beside of trench

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MEDICAL ASPECTS OF RADIOLOGICAL ACCIDENT IN GILAN, IRAN

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  1. MEDICAL ASPECTS OFRADIOLOGICAL ACCIDENT IN GILAN, IRAN Module XIX

  2. Summary • Morning of 24 July 1996 a worker (KZ) at Gilan Combined Cycle Fossil Power Plant, while carrying insulation material for lagging pipes, noticed a shiny pencil sized metal object beside of trench • He put it into his loose overall pocket on right side above chest Module Medical XIX-(16)

  3. Summary-2 • The metal object - “pigtail” of radiograph with iridium-192 source, led to severe haemopoetic syndrome (bone marrow depression) and unusually extended local radiation injury of chest requiring plastic surgery • Surgery successfully performed a month later in Curie Institute, Paris Module Medical XIX-(16)

  4. Source Module Medical XIX-(16)

  5. Module Medical XIX-(16)

  6. Development of symptoms, recognition of accident • At 9.30 am, 1.5 hrs after start of exposure, he experienced dizziness, nausea, lethargy and burning feeling in chest • Believing object cause of symptoms, he put it back into trench • 13:00, KZ told colleagues about strange shiny object and weak, lethargic feeling • 13:30 he was sent for blood sampling Module Medical XIX-(16)

  7. Investigation of accident • Team of AEOI inspectors investigated accident on site next day • Recommended blood checks for all 600 personnel • All samples normal except for KZ’s Module Medical XIX-(16)

  8. Module Medical XIX-(16)

  9. Module Medical XIX-(16)

  10. Module Medical XIX-(16)

  11. Course of lymphocytes Module Medical XIX-(16)

  12. Course of leukocytes Module Medical XIX-(16)

  13. Treatment in Iran • Prophylactic antibiotics • Analgesia • Topical silver sulphadiazine (on chest lesion) • Platelet transfusion (7 units on Day 20) • Cytokine (G-CSF) — Leucomax 400 g 2x/d (subcutaneously) Module Medical XIX-(16)

  14. Bone marrow sampling Module Medical XIX-(16)

  15. Transfer to Paris • Need for bone marrow transplantation ? • Transfer to Radiopathology Unit of the Institut Curie in Paris on Day 24 (16 Aug96). • Findings on examination • Total loss of epidermis on right anterior chest/ upper abdominal wall — 30 x 15 cm — with necrotic epidermis around the edge • Area of moist desquamation on medial side of right antecubital fossa — 6 x 7 cm •  Large hard bulla on palm of left hand — 5 x 5 cm • Small area of increased pigmentation and erythema on anterior middle surface of right thigh — 2 x 2 cm Module Medical XIX-(16)

  16. Module Medical XIX-(16)

  17. Module Medical XIX-(16)

  18. Status in June 2001 Status November 97 (as examined by IAEA medical staff, confirmed June 2001): 1. Chest lesion showed no necrosis but graft was firmly fixed to the chest wall • Fibrosis leading to some retraction, adversely affecting posture Module Medical XIX-(16)

  19. Module Medical XIX-(16)

  20. Status in June 2001 2. Elbow lesion completely healed, but movements restricted in both flexion and extension - from 45o to 135o 3. Some thickening of left palmar observed, but with full function and strong grip Module Medical XIX-(16)

  21. Status in June 2001 4. Right thigh lesion: hard and fibrotic, but completely healed and non-painful 5. Complete recovery of all lymphocyte subpopulations in 18 months Module Medical XIX-(16)

  22. Lessons – medical • For non-homogeneous whole body irradiation (as in most accidents), initiate cytokine treatment at earliest opportunity when bone marrow recovery not detected • G-CSF may be drug of choice, but then direct particular attention to monitoring platelet counts Module Medical XIX-(16)

  23. Lessons - medical • Use thermography, where available, to assess viability of radiation induced skin injuries for potential spontaneous recovery or suitability for grafting • Where dermal tissues are viable after radiation induced skin injury, and spontaneous re-epithelialisztion is likely to be prolonged, consider early skin grafting to reduce physical and psychological morbidity Module Medical XIX-(16)

  24. Lessons - radiation protection • Teachradiographerssafety culture by organizing more training courses for them • Computerize and regularly update records of existing radiation sources, systems, equipment, projects and personnel • Provide psychological support to workers and public affected by any radiological accident Module Medical XIX-(16)

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