Getting Prepared for a Radiological Terrorist Event

1. Getting Prepared for a Radiological Terrorist Event David J. Brenner, Ph.D., D.Sc., Center for Radiological Research Columbia University Medical Center djb3@columbia.edu You can view / download this lecture at www.columbia.edu/~djb3

2. Goiânia, Brazil, 1987Population 1.3 million

3. Abandoned medical clinic in Goiânia contained 1,400 Curie radioactive cesium sources The radioactive sources were stolen, broken open, and dispersed

4. Goiânia incident: Equivalent to large-sized dirty-bomb scenario in Manhattan • 130,000 people (10%) came to ER / temporary screening locations • 250 (0.2%) were contaminated • 20 (0.01%) required treatment

5. Topics that we will cover • What is ionizing radiation?How is it harmful? • Radiation threat scenarios • Appropriate medical responses • Psychological aspects • Resources

6. Radioactivity The spontaneous emission ofradiations:alpha rays, beta rays, gamma rays from radioactive materials

7. Radioactivity: Alpha Rays

8. Radioactivity: Beta Rays

9. Radioactivity: Gamma Rays The Electromagnetic Spectrum

10. a b g Interaction of alpha, beta, gamma rays with matter: Ionization

11. Alpha, beta and gamma rays

12. Radiation vs. Radioactive Material • Radiation: energy transported in the form of particles or waves (alpha, beta, gamma, neutrons) • Radioactive Material: material that contains atoms that emit radiation spontaneously

13. Exposure vs. Contamination External Exposure: irradiation of the body from external source Contamination: radioactive material on patient (external) or within patient (internal)

14. Radiation Dose • Measured in milliGray (mGy) (1/1000 joule / kg) • Equivalent dose is measured in milliSievert (mSv) • For our purposes, 1 mGy = 1 mSv • Old units are the rad and the rem • 10 mGy = 1 rad; 10 mSv = 1 rem • Average background radiation dose is 3 mSv/yearA mammogram produces about 0.01 mSv.A CT scan produces about 10 mSv.

15. Radioactivity • The activity (strength) of a radioactive source is measured inCuries (Ci) or Becquerels (Bq) • 1 Bq = 1 radioactive disintegrations / sec • 1 Ci = 37 GBq = 37 thousand million disintegrations/sec

16. The Principal Hazards ofIonizing Radiation • Cancer risks • Hereditary risks • Effects on the developing embryo/fetus

17. Radiation Risks Teratogenic risks Order of magnitude larger than Carcinogenic risks Order of magnitude larger than Hereditary risks

18. The Carcinogenic Effects of Ionizing Radiation

19. Ionizing Radiation and Cancer Most of our information comes from studies ofA-bomb survivors

20. Lifetime cancer mortality risk as a function of age at exposure

21. Individual Susceptibility to Radiation Carcinogenesis • There are likely to be subpopulations of individuals who are significantly more sensitive to ionizing radiation than the average: • Children • ATM heterozygotes(Ataxia Telangiectasia, 1-2% of the population) • BRCA1 • BRCA2

22. Radiation-induced hereditary effects Radiation does not produce new, unique mutations, but simply increases the incidence of the same mutations that occur spontaneously

23. Teratogenic Risks(i.e., to the embryo/fetus, if relevant) Moderate doses of radiation can produce catastrophic effects on the developing embryo and fetus.

24. The principle effects of radiation on the developing embryo and fetus are: • Growth retardation • Embryonic, neonatal, or fetal death • Congenital malformations and functional impairment,such as mental retardation.

25. Radiation Risks Teratogenic risks order of magnitude larger than Carcinogenic risks order of magnitude larger than Hereditary risks

26. Radiation Threat Scenarios • Nuclear device • Damage to nuclear power plant • Dirty bombs

27. Nuclear Device Risk • Exposure to  rays and neutrons • Fallout of fission products (including short-lived iodine isotopes) Outcome • Large number of acute deaths • Long-term carcinogenesis Likelihood • Remote

28. Attack on a nuclear power plant Risk • Attack on the reactor itself: • Attack on stored used fuel elements Release of fission products: I-131, Cs-137, etc Outcome • Unlikely to involve acute deaths • Long-term carcinogenesis Likelihood • Extremely unlikely

29. Dirty Bombs(Radioactive dispersal devices, RDD) Risk • Release of radioactive cesium, cobalt or americium • Small number of contaminated people • Large number of very slightly contaminated people • Psychological chaos (many frightened people) Outcome • Unlikely to result in acute deaths • Risk of long-term carcinogenesis Likelihood • Likely

30. Radioactive material Time fuse Detonator Conventional explosive(e.g. fertilizer, semtex) Radioactive Dispersal Device (RDD)

31. Dirty Bombs How available are the radioactive materials?

32. August 1994 Three people arrested at Munich airport having flown on a Lufthansa flight from Moscow carrying 363 grams of plutonium

33. November1995 Moscow, Russia -- A group of Chechen rebels contacts a Russian TV station to claim that they have buried a cache of radiological materials in Moscow's Ismailovsky Park. There, the authorities find a partially buried container of radioactive cesium.

34. December 1998 Argun, Chechnya – A container filled with radioactive materials found attached to an explosive mine hidden near a railway line. It is safely defused. The location is Argun, near the Chechen capital of Grozny, where a Chechen group, led by Shamil Basayev, operated an explosives workshop.

35. June 2002 Chicago, Illinois -- Jose Padilla, a US citizen with links to Al Qaeda, is arrested in Chicago airport on suspicion of planning to build and detonate a dirty bomb. F.B.I agents suspect Padilla had recently undergone training in Pakistan, where he allegedly studied the mechanics of dirty-bomb construction, including how to wire explosive devices and how to optimize bombs for radiological dispersion.

36. January 2003 Herat, Afghanistan -- Based on evidence uncovered in Herat, including detailed diagrams and computer files, British intelligence agents conclude that Al Qaeda has succeeded in constructing a small dirty bomb, though the device has not been found. A collage of dirty bomb plans journalists recently discovered in Afghanistan

37. March 1998 Greensboro, North Carolina -- Nineteen small tubes of cesium are taken from a locked safe in Moses Cone Hospital. The total activity was 22 Gbq (0.6 Ci). Each tube was three-quarters of an inch long by one-eighth of an inch wide and were used in the treatment of cervical cancer. The cesium is never recovered. Cesium tubes similar to the ones missing from Greensboro

38. March 2002Nucor Steel Mill, Hertford, NC • 2 Ci cesium industrial gauge found on scrap metal conveyer belt • Traced back to a batch of four belonging to a bankrupt Baltimore chemical company. Three have been located....

39. Moisture Density Gauges, contain small quantities of americium-241 and cesium-237About 22,000 in use in the US. About 50 per year reported as missing

40. August 2004 London:Islamic terrorist cell, led by Dhiren Barot, raided. Large cache of household smoke detectors found, each containing small quantities of americium-241

41. Small and large dirty bombs (RDD: Radioactive dispersal device) • Small RDD:High explosives dispersing 0.1 to 10 Curies • Intermediate RDDHigh explosives dispersing 10 to 1,000 Ci • Large RDD:High explosive dispersing 1,000 to 10,000 Ci

42. Small Dirty Bomb (RDD): 2 Ci cesium source + 10 lb TNT Inner Ring:One cancer death per 100 people due to remaining radiation(typical dose 25 cGy) Middle Ring: One cancer death per 1,000 people due to remaining radiation(typical dose 2 cGy) Outer Ring: One cancer death per 10,000 people due to remaining radiation(typical dose 0.2 cGy)EPA suggests decontamination

43. Intermediate RDD: 2,000 Ci of cesium chloride, from a seed irradiator, and 10 lb of Semtex

44. Large RDD: 10,000 Ci cobalt source (food irradiator rod) • Inner Ring:One cancer death per 100 people due to residual contamination (typical dose 25 cGy) • Middle Ring:One cancer death per 1,000 people due to residual contamination (typical dose 2 cGy) • Outer Ring:One cancer death per 10,000 people due to residual contamination (typical dose 0.2 cGy)

45. Large RDD: 10,000 Ci cobalt source (food irradiator rod) • Inner Ring: Same radiation level as permanently closed zone around Chernobyl • Middle Ring: Same radiation level as permanently controlled zone around Chernobyl • Outer Ring: Same radiation level as periodically controlled zone around Chernobyl

46. Immediate Medical Management Issues You need to be part of a radiation casualty • Health providers • Physicists • Social workers / administrators team

47. Immediate Medical Management Issues • Triage • Decontamination • Initial stabilization and treatment of life-threatening injury • Health care provider health and safety • Surge capacity: availability of staff (quantity and specialists), supplies, space

48. Almost all the individual presenting at ER / clinic will not have a measurable radiation exposure • Goiânia • 99.8% of individuals at ER/clinic not contaminated • 8% had “psychosomatic reactions which mimicked radiation exposure” • Israel, attacked by Scud missiles during 1991 Gulf war • 51% of individuals at ER were “stress casualties”

49. The job of the radiation physicists • Determining / documenting radioactivity levels, and radiation dose levels • Collecting samples to document contamination • Assisting in decontamination procedures • Disposing of radioactive waste

50. Staff radiation protection • Fundamental Principles - Time - Distance - Shielding • Personnel Protective Equipment • Contamination Control