radiologic terrorism n.
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Radiologic Terrorism

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  1. Radiologic Terrorism • Radiation Exposure • Dirty Bombs • Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb • Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR • Management of pregnant women and children

  2. Radiologic Terrorism • Radiation Exposure • Dirty Bombs • Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb • Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR • Management of pregnant women and children

  3. Accident at Chernobyl Saturday, April 26, 1986 at 01:23:48 Chornobyl Nuclear Power Plant, Ukraine, USSR Total Radioactivity Released by the accident 50-100 x 106 Ci Total Radioactivity Released into Belarus 70%: 35-70 x 106 CI Radioactive Materials Released by the Accident I, Cs, Sr, Co, Xe, Kr, Pu, etc. Williams D. Science and society: Cancer after nuclear fallout: lessons from the Chernobyl accident. NatureReviewsCancer 2002;2:543-549 (01 Jul).

  4. Populations at High Risk for Thyroid Neoplasia from Exposure to Radiation • Fetus after 12 weeks of gestation in April 1986. • Number of cases dramatically decreased after 2000. • Children ages < 6 years in April, 1986. • Children ages 0 to 1 year have the highest risk. • Children living in areas with iodine deficiency. • Greater radioiodine uptake increases the dose of radiation exposure to the thyroid gland. • Children exposed to > 1 cGy of radiation. • Rapid thyroid growth in young children occurs with chromosomal rearrangements (PTC1 and PTC3).

  5. The Carcinogenic Effects of Radiation • The isotopes of iodine-131, -132, -133 • Chronic exposure to Cesium-137 • Higher tissue exposure to radiation occurs in those tissues that concentrate iodine: • Thyroid → ↑ incidence of adenoma, carcinoma • Breast → ↑ incidence of carcinoma • Salivary gland • Gastric mucosa

  6. Iodine Prophylaxis in Poland • Radiation detected 36 hours after initial release. • KI distribution began in the PM on day 3. • 10.5 million doses of KI given to children • 7 milion doses of KI given to adults • Exposure to radioiodines in infants age < 1 year • > 50 mSv (5 Rem) if unprotected from radioiodine • < 50 mSv when protected by KI + substituted milk • KI caused ~ 40% reduction in Rem dose to thyroid. With early prophylaxis, ~ 60-70% reduction in Rem dose primarily because inhaled 131I is blocked. • Incidence of 0.2% for medically significant, but not serious side effects.

  7. Radiologic Terrorism • Radiation Exposure • Dirty Bombs • Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb • Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR • Management of pregnant women and children

  8. Management of Pregnant Women and Children Exposed to Radiation • Evacuation • Priority evacuation protocols for pregnant women, infants and pre-pubertal children • Evacuation to an identified location at least 50 miles from the source of radiation • Potassium Iodide • KI tablets or liquid administered on notification by authorities of the possibility of radiation exposure. • Dose schedules and negligible toxicity

  9. Evacuation of Pregnant Women and Children Exposed to Radiation • Priority Evacuation • Priority identification signs should be provided to pregnant women and families of infants and pre-pubertal children to display on the windshield for priority rapid “HOV-lane” emergency evacuation. • Evacuation routes should be defined in advance. • Distance from Radiation Source • The radiation plume travels in the direction and at the speed of the prevailing winds. • Biologically significant radiation exposure may occur 100-200 miles from the source depending upon the atmospheric conditions.

  10. Management of Pregnant Women and Children Exposed to Radiation • Evacuation • Priority evacuation protocols for pregnant women, infants and pre-pubertal children • Evacuation to an identified location at least 50 miles from the source of radiation • Potassium Iodide • KI tablets or liquid administered on notification by authorities of the possibility of radiation exposure. • Dose schedules and negligible toxicity

  11. KI Therapy for Pregnant Women and Children Exposed to Radiation • Potassium Iodide for Radioiodine Exposure • Pre-packaged, pre-distributed KI tablets or liquid should be readily available in homes, schools, day care centers and nurseries near reactors. • On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency. • KI toxicity • Negligible, minor side effects, and rare in children.

  12. AAP Committee on Environmental Health. Pediatrics 2003;111:1459 Potassium Iodide Doses

  13. KI Therapy for Pregnant Women and Children Exposed to Radiation • Potassium Iodide for Radioiodine Exposure • Pre-packaged, pre-distributed KI tablets or liquid should be readily available in homes, schools, day care centers and nurseries near reactors. • On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency. • KI toxicity • Negligible except in very rare cases of iodinism.

  14. KI toxicity Acute poisoning is uncommon Hypersensitivity reactions are rare, but dangerous: Angioedema and laryngeal edema Serum-sickness-like reactions [fever, lymphadenitis, arthralgia, arthritis] Chronic exposure Iodism (parotid pain and swelling); skin rashes Goiter and primary hypothyroidism on occasion at any age Contraindicated during pregnancy and infancy High dose KI as treatment of Sporotrichosis Children: 50 mg/dose tid; ↑ by 50 mg/dose daily Children: 150-500 mg/dose up to 500-750 mg tid Older Child: 250 mg tid; Maximum: 1-2 grams/dose tid Potassium Iodide Safety

  15. Management of Children Exposed to Ionizing Radiation • Preparation: Supplies of KI, infant formula, powered milk Evacuation routes and locations • Emergency battery operated communications • Radios • Cellular telephones • Priority Evacuation Defined routes [HOV Routes] Priority evacuation Identification on vehicles • Potassium iodide Priority 1: pregnant women and infants Priority 2: young children • Monitor TSH in infants and pregnant women

  16. Radiologic Terrorism: Bibliography • Williams, Dillwyn. Science and society: Cancer after nuclear fallout: lessons from the Chernobyl accident. NatureReviewsCancer 2002;2:543-549 (01 Jul). [Review] • CDC: www.bt.cdc.gov/radiation • AAP Policy Statement. Radiation disasters and children. Pediat 2003;111(6):1455-1466. • Mettler FA, Voelz GL. Major radiation exposure – what to expect and how to respond. NEJM 2002;346:1554-1561. • www.atomicarchives.com/Example/ExampleStart.shtml • Nauman J, Wolff J. Iodide prophylaxis in Poland after the Chernobyl reactor accident: Benefits and risks. Am J Med 1993;94(5):524-532. [Review] • Nagataki S, Yamashita S, Eds. Nagasaki Symposium Radiation & Human Health, Elsevier, 1996, p xii.