1 / 31

Goiânia Radiological Accident: Medical Management & Therapeutic Measures

A detailed overview of the 1987 Goiânia radiological accident, including medical aspects, radiation skin injuries, therapeutic management, dose assessments, and follow-up protocols for the affected individuals.

biller
Download Presentation

Goiânia Radiological Accident: Medical Management & Therapeutic Measures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. RADIOLOGICAL ACCIDENT IN GOIÂNİA Module XIX

  2. 137Cs-accident, Goiânia, Brazil September 13, 1987 Goiânia Rio de Janeiro Angra NPP Sao Paulo Module Medical XIX-(18)

  3. Accident description Module Medical XIX-(18)

  4. Source 137CsCl (caesium chloride) 50.9 TBq (1375 Ci) main gamma:0.66 MeV main beta: 1.17 MeV T 1/2=30 years Module Medical XIX-(18)

  5. Radiological triage 112 000 persons monitored 249 identified contaminated 120 only clothing and shoe contamination 129 internal contamination 50 subjected to direct medical surveillance Module Medical XIX-(18)

  6. Technical management of accident 85 residences (houses) had significant level of contamination, 41 evacuated, 4 demolished Module Medical XIX-(18)

  7. Environmental aspects of 137Cs accident in Goiania • Initial surveys conducted in suspecthomes and work areas • 67 km2 urban area of Goiania city monitored using helicopter to identify all hotspots (few mGy/hr to >2 Gy/hr) • 2000 m2contaminated • Several household pets (cats and dogs) and some livestock (pigs) slaughtered • Air and water samples negative 3000 m3 contaminated (radioactive) material collected, 50.6 TBq 137Cs recovered; <0.37 TBq remained Module Medical XIX-(18)

  8. Internal dose assessment Module Medical XIX-(18)

  9. Re-estimated dose through cytogenetics(Gy) Number of individuals < 0.1 - 0.49 105 0.50 - 0.99 8 1.00 - 1.99 8 2.00 - 2.99 3 3.00 - 3.99 2 4.00 - 4.99 2 5.00 - 5.99 1 Total 129 Dose assessment by cytogenetic dosimetry Module Medical XIX-(18)

  10. Medical aspects 250 persons exposed 50 persons WB exposure or local radiation injury 28 local radiation injury 14 bone marrow depression 8 ARS 4 died Module Medical XIX-(18)

  11. Therapeutic measures during critical period • Managing critical period of ARS, bone marrow suppression • Therapy for local radiation injury • Decorporation of caesium-137 • General support and psychotherapy Module Medical XIX-(18)

  12. Treatment of haematological syndrome • 8 ARS patients with estimated doses • 1  2-4 Gy • 5  4-6 Gy • 2  >6 Gyreceived GM-CSF therapy • Four patients died: two of hemorrhage and two of t sepsis fromKlebsiella infection • Two patients who received high doses (7.0 and 5.5 Gy) and exhibited bone marrow depression but were not treated with GM-CSF spontaneously recovered and survived Module Medical XIX-(18)

  13. Radiation skin injuries • Radiation induced skin injuries caused by gamma and beta radiations observed in 28 who had handled source housing or fragments of source • 12 of the 28 victims had multiple injuries affecting predominantly upper limbs • Injuries did not heal completely and relapsed in 8 patients, who then required surgical debridement, amputation of digital extremities and plastic skin grafts • In 1997 one severely irradiated patient developed a malignant skin lesion on lower limbs which was surgically excised Module Medical XIX-(18)

  14. Module Medical XIX-(18)

  15. Module Medical XIX-(18)

  16. Module Medical XIX-(18)

  17. Module Medical XIX-(18)

  18. Module Medical XIX-(18)

  19. Therapeutic management of localized radiation injuries:Goiânia experience-ı • Pain management • Opioid analgesia, extradural opioid analgesia • Reduction of inflammatory reaction • Systemic and local NSAID • Extract of aloe vera • Cleaning of wounds and use of antiseptics - prevention of infection • Hands and fingers immersed in boric acid solution reducing skin dryness, pain and itching • non-adherent dressing coated with neomycin Module Medical XIX-(18)

  20. Therapeutic management of localized radiation injuries:Goiânia experience-ıı • Improvement of local microcirculation • Pentoxifylline, which decreases blood viscosityused in two patients, reducing risk of early formation of microthrombi, thus improving blood flow in injured tissues • Hyperbaric oxygen therapy (HOT)hastened granulation at wound edges, reduced ulcerated area considerably increasing local pO2, thus facilitating integration of graft with damaged area • Surgical treatment • Complete excision of damaged tissue • Skin graft abdominal flaps • Amputation Module Medical XIX-(18)

  21. Module Medical XIX-(18)

  22. Figure 5.1 - Schematic representation of the PB action in the body. Prussian blue therapy for caesium decorporation PB Schematic representation of PB action in body Module Medical XIX-(18)

  23. Prussian blue administration in Goiania 137Cs Accident • 46 persons received prussian blue • Dosage related to internal body burden • Initial 3 g/day then 3-6 g/day in adults exceeding 5 x ALI • For children initial dose 1-1.5 g/day then 3 g/day for those exceeding 5 x ALI • Five adults with very high burdens received 10 g/day Module Medical XIX-(18)

  24. Patient follow-up in Goiania • Medical • Cytogenetic • Psychological • Social • Economic Module Medical XIX-(18)

  25. Medical follow-up of Goiania accident victims • Status of skin injuries after initial healing • 8/28 patients required surgery in 1989, and 6/28 in 1990 • One patient required repeated surgery in 1991, ‘92, ‘93 • Skin lesions tended to be affected by stress • Sperm count in males now normal - 2 exposed in teenage males have fathered healthy children • Follow-up of children - 7 exposed in utero have no abnormalities • 10 conceived post-accident born with no abnormalities Module Medical XIX-(18)

  26. Cytogenetic follow-up(6 years) Tdic=110 d at > 1 Gy Tdic =160 d at 0.3-1 Gy Module Medical XIX-(18)

  27. Module Medical XIX-(18)

  28. Half-life of dicentric chromosomes and centric rings in nine 13-57 year old people overexposed in Goiania accident T1/2 = 90-230 days (Follow-up 7.5 years)

  29. Psychological and social follow-up of Goiania accident victims • Psychological alterations • increase in psychosomatic disorders • fear of leukaemia and early death • increased use of alcohol and drugs • lack of self-confidence • Discrimination • by others due to fear • self-discrimination from social contact • Stigmatization • victims blamed for accident by many citizens Module Medical XIX-(18)

  30. 137Cs retention curves of woman contaminated in fourth month of pregnancy and her baby

  31. Summary of therapeutic measures • 8 patients with severe BM syndrome treated with GM-CSF 4 died due to haemorrhage and sepsis • None received BMT • All surviving patients - normal blood counts since 1988 (quarterly check ups and CBC) • 3-10 g/day prussian blue to adults, 1-3 g/day to children • 28 patients treated surgically for radiation skin injuries relapse in 8 patients leading to fibrosis in 4 Module Medical XIX-(18)

More Related