Medical Management of Radiation Injuries

,

• Publisher: International Atomic Energy Agency
• Year: 2020
• ISBN:
  9789201066220
• Topic: Medicine
• Subtopic: Radiology, Radiotherapy & Nuclear Medicine

This publication focuses on the medical management of individuals involved in radiation emergencies, especially those who have been exposed to high doses of ionizing radiation. Its primary objective is to provide practical information, to be used for treatment decisions by medical personnel during a radiation emergency. It also addresses general and specific measures for the medical management of individuals who have been internally contaminated with radionuclides. This publication is complementary to other publications developed by the IAEA in the medical area of radiation emergencies.

1. INTRODUCTION

1.1. Background

According to IAEA Safety Standards Series No. GSR Part 7, Preparedness and Response for a Nuclear or Radiological Emergency [1], an emergency is:

“A non-routine situation or event that necessitates prompt action, primarily to mitigate a hazard or adverse consequences for human life, health, property or the environment. This includes nuclear and radiological emergencies and conventional emergencies such as fires, releases of hazardous chemicals, storms or earthquakes. This includes situations for which prompt action is warranted to mitigate the effects of a perceived hazard.”

Nuclear and radiological emergencies have provided considerable information which has increased the medical knowledge related to the diagnosis, management and treatment of individuals with radiation injuries. For the purposes of this publication, nuclear or radiological emergencies are subsumed under the term ‘radiation emergencies’.

The accident at the Chernobyl Nuclear Power Plant on 26 April 1986 resulted in the hospitalization of 237 patients identified as severely overexposed persons [2]. Acute radiation syndrome (ARS) was diagnosed in 134 persons admitted to the specialized hospitals in Moscow and Kyiv. Among them, 28 died within three months of ARS associated with extensive local radiation burns combined with thermal burns [3]. ARS was not confirmed in another 103 hospitalized patients. Nineteen additional patients died in the period 1987–2004 of various causes; however, their deaths were not directly attributable to radiation exposure. Among the general population exposed to the Chernobyl radioactive fallout, however, the radiation doses were relatively low, and ARS and associated fatalities did not occur [4].

In September 1987, two scrap metal dealers removed a shielded radioactive 137Cs source (50.9 TBq) from the protective housing of an abandoned teletherapy machine in Goiânia, Brazil [5]. Subsequently, the source was ruptured. As a result, many people incurred large doses of radiation by both external exposure and internal/external contamination1. Four people ultimately died from ARS, while 28 people developed local radiation injuries (LRIs) of different levels of severity, some very severe. In the case of one patient, amputation of the right forearm was necessary. A total of 249 cases of contamination were detected. Out of that number, 129 had suffered both internal and external contamination [6]. There was extensive contamination of homes, other buildings and surface soil in the urban area of Goiânia.

In 2000, a severe radiological accident occurred in Samut Prakarn (a suburb of Bangkok), Thailand, when scrap metal dealers removed an abandoned container with a spent 60Co radiotherapy source and sold it at a scrapyard. Ten scrapyard workers were exposed to high radiation doses and developed ARS. Three of them died within three months, and six developed LRIs of different levels of severity. One of the patients was so seriously injured that all fingers of both hands had to be amputated [7].

The IAEA has published detailed reports on radiation safety, medical and emergency management aspects of about two dozen severe radiation accidents.2

1.2. Objective

The objective of this publication is to provide guidelines to health care professionals in carrying out prompt diagnostic measures and medical management of individuals affected by radiation injuries. Experience has shown that the management of radiation emergencies involves a comprehensive team of health care professionals, including medical doctors, nurses, biologists, radiation protection officers, radiopathologists, and health and medical physicists.

1.3. Scope

This publication provides information on the medical management of radiation injuries (diagnosis, assessment, treatment), including LRIs, ARS and contamination (external and internal). It also discusses a multidisciplinary approach to medical preparedness and response to radiation emergencies. Guidance provided here, describing good practices, represents expert opinion but does not constitute recommendations made on the basis of a consensus of Member States.

1.4. Structure

The structure of this publication is based on the technical, logistical and operational aspects of the medical management of radiation injuries. Section 2 summarizes the types of radiation emergency, the types and modes of accidental radiation exposure, as well as principles of their medical management, including clinical and radiological triage. The latter measures are important in establishing priorities for medical treatment and hospitalization. Section 3 describes the clinical consequences and the medical management following a local or whole body external exposure, including diagnosis, assessment, treatment, rehabilitation and medical follow-up of both ARS and LRI patients, with case st...

Table of contents

• 1. INTRODUCTION
• REFERENCES
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW