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RADIOLOGIC INCIDENTS

DECORPORATION DRUGS TO TREAT INTERNAL RADIONUCLIDE CONTAMINATION* *ADAPTED from Carol S. Marcus, Ph.D., MD PowerPoint Presentation. RADIOLOGIC INCIDENTS . Accidents in the USA and Canada are unusual Generally contained; involve few individuals Terrorist incidents would not be contained

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RADIOLOGIC INCIDENTS

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  1. DECORPORATION DRUGS TO TREAT INTERNAL RADIONUCLIDE CONTAMINATION**ADAPTED from Carol S. Marcus, Ph.D., MD PowerPoint Presentation

  2. RADIOLOGIC INCIDENTS • Accidents in the USA and Canada are unusual • Generally contained; involve few individuals • Terrorist incidents would not be contained • Could involve tens of thousands of people • Physician involvement • Few have significant experience • Generally limited to KI to decrease thyroid uptake of I-131 from various radiopharmaceuticals

  3. DISPERSION DEVICES • RADIOLOGICAL DISPERSION DEVICE (RDD) EVENTS • Explosive (“dirty bomb”) • Surreptitious (unnoticed spread) • Destruction of site containing radioactive material, sealed and/or unsealed (e.g. nuclear power plant, hospital) • Detonation of nuclear weapon

  4. MEDICAL PERSONNEL • MAY BE FACED WITH: • External contamination • Inhaled contamination • Ingested contamination • Wound contamination (e.g. radioactive shrapnel)

  5. THERAPY REQUIREMENTS • INSTITUTION OF DECORPORATION THERAPY REQUIRES: • Identification of radionuclide(s) • Screening of victims • Quantitation of internal contamination • Therapy thresholds • Stockpiled pharmaceuticals

  6. PRINCIPAL CONCERNS • MAIN RADIONUCLIDES FROM RDD’S • Strontium (Sr)-90 • Yttrium (Y)-90 • Cesium (Cs)-137 • Iridium (Ir)-192 • Cobalt (Co)-60 • Americium (Am)-241 • Iodine (I)-125 and 131

  7. RDD’S CONT’D • RADIONUCLIDES FROM RDD’S • Uranium (U)-234, 235, 238 • Plutonium (Pu)-239 • Radium (Ra)-226 • Tritium (H)-3 • Phosphorus (P)-32 • Palladium (Pd)-103 • Mixtures

  8. IDENTIFICATION • METHODS TO IDENTIFY • Gamma ray spectra • Beta emitters • Alpha emitters • Clues from site explosion • Role of radiation regulators, DOE, and nuclear professionals

  9. THRESHOLDS • THERAPY THRESHOLDS • May use “allowable levels of intake” for workers (ALI’s) • May use higher contamination thresholds based on deterministic effects • Political pressure for very low thresholds

  10. ACCESS • DECORPORATION DRUG ACCESS • FDA-approved drugs, approved indications • FDA-approved drugs, unapproved indications • FDA-unapproved drugs, available from a compounding pharmacy • OTC drugs

  11. STOCKPILE EXAMPLE • LOS ANGELES COUNTY DEPT. OF HEALTH SERVICES-EMERGENCY MEDICAL SERVICES AGENCY STOCKPILE • Prussian blue • Ca/Zn-DTPA • Ca gluconate • Na alginate • D-penicillamine • Ammonium chloride • Na bicarbonate • Dimercaprol (BAL)

  12. TREATMENTOVERVIEW • RADIOELEMENT AND DECORPORATION TREATMENT OVERVIEW • Americium: parenteral Ca/Zn-DTPA • Cesium: oral Prussian blue • Cobalt: nothing too good, but oral penicillamine worth trying • Iodine: KI within about first 4 hours; consider PTU • Iridium: unknown; try penicillamine

  13. TREATMENTOVERVIEW • TREATMENT OVERVIEW • Palladium: unknown; try oral penicillamine • Phosphorus: oral Na or K phosphate • Plutonium: parenteral Ca/Zn-DTPA • Radium: oral Ca, alginates

  14. TREATMENTOVERVIEW • TREATMENT OVERVIEW • Strontium: i.v. Ca gluconate, oral ammonium chloride, alginates • Tritium: force water to promote diuresis • Uranium: Ca/Zn-DTPA within 4 hrs only; Na bicarbonate • Yttrium: parenteral Ca/Zn-DTPA

  15. ALI’S • THE ALLOWABLE LEVELS OF INTAKE (ALI’S) FOR RADIATION WORKERS: • Found in 10 CFR Part 20 • By ingestion and inhalation • By halflife of chemical compound (days, weeks, or years)

  16. REFERENCES • NCRP Report No. 65, Management of Persons Accidentally Contaminated with Radionuclides, April 15, 1980. Order on line at www.ncrp.com for $50.00. • 10 CFR Part 20 • REAC/TS website for information on Prussian blue, Ca/Zn-DTPA: www.orau.gov/reacts/ • Medical Management of Radiological Casualties, 2nd ed., Apr., 2003. AFRRI, Bethesda, MD.

  17. KI CANADA LTD • For more information, please contact: • Tom Gottlieb • Senior VP Research • KI Canada ltd, • 707 AlnessStreet • Toronto Ontario M3J 2H8 • 416 661 1818 FAX 416 661 1816

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