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  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)