06 A Radiological
06 A Radiological
06 A Radiological
1
Objectives
• To identify 4 radiation protection
principles
• To describe differences between
radiological exposure and
contamination
• To identify key hospital contacts in
the event of radiologically
contaminated patients
2
Nuclear and Radiological Risks
• Radiological Dispersal Device
– Aka: Dirty Bomb
• Greatest risk
• Simple radiological sources
– Transportation of radioactive material,
– Likely-Not expected to be mass casualty event
• Nuclear irradiation
– Bomb (terrorism)
– Leak (reactor)
3
Radiation Basics
• Ionizing radiation is electromagnetic energy, or
energy containing particles emitted from a
source.
4
Radiological Detection
• Detecting Radiation
– Cannot be sensed by humans
• Taste, smell, sight etc.
– Detectors needed
• Geiger counters
• Dosimeters
• Alpha meters
• Ionizing chambers
5
Radiation Measurements
Measurements:
• counts per minute
• rads: measure of energy absorbed
• rems: measure of potential biological damage
International Units:
• 1 gray (Gy) = 100 rads
• 1 sievert (Sv) = 100 rems
Typical Range:
• 1 mrad = 10 μGy
• 1 mrem = 10 μSv
6
Radiation Experts
Hospitals are well prepared for a radiological event
• Experts abound
– Radiologists, Nuclear Med, Radiation Safety Officers, etc.
• Detection methods already in place & they know how to
use them!
7
Radiation Surrounds Us
Natural background and manmade radiation (year) 360 mrem
Flight from LA to Paris 4.8 mrem
Diagnostic chest x-ray 10 mrem
Occupation exposure limit, annual 5,000 mrem
Smoking 1.5 ppd - 1 year dose 16,000 mrem
Heart catheterization 45,000 mrem
Lifesaving exposure guideline 50,000 mrem
Mild acute radiation sickness 200,000 mrem
Lethal dose for irradiation (approx) 450,000 mrem
• Distance • Quantity
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Time
12
9 3 Result Dose
25 mrem
Source
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1 meter 1 meter
Dose Rate
Source
• Alpha Particle
•Stopped by thin paper or clothing
•Travels several cm. In air with
few microns in tissue
• Beta Particle
•Some protection by PPE
•Travels up to a few meters in air,
millimeters in tissue
• Gamma Rays
•PPE will not protect against
•Very difficult to shield against, very penetrating
Quantity
Contaminated
Clothing from 1
Victim
Contaminated Clothing
13 from 50 Victims
Radiation Protection Principles
• Practical applications of the 4 principles
– If standard working PPE is inadequate as shielding,
use the following to make a bad situation safer
– Limit time in area
• Decrease time dealing with the disaster
– Increase working distances
• Use long handled tools and grabbers
– Don’t allow contaminated clothing bags to accumulate
in quantity
• Spread out contained materials over a large area
14
Exposure Vs. Contamination
• Exposure to radiation does NOT necessarily
make victims contaminated or radioactive!
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Contamination
• External Contamination
– Material deposited on skin, clothes, hair
• Dirty bomb – material exploded into air
– Decontamination necessary
– Victims are NOT radioactive, but the ‘dust’ is
• Internal Contamination
– Material becomes integral part of the body
• Ingestion-DO NOT lick lips
• Absorption from mucous membrane
– DO NOT touch eyes, mouth nose
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Management of Radiation Victims
• At patient arrival
– Treat life-threatening conditions first!
– Consider irradiation/contamination second
– Survey patient for radiation ASAP
– Use usual triage methods based on complaints
– Remove and bag victim’s clothing
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Management of Radiation Victims
• Decontamination
– If there is an open wound decontaminate first, then
rest of skin
– Cover wound with sterile dressing
– Soap/water decon (including hair)
– Re-survey patient for radiation
• If radiation present, send back through decon
– Refer for needed surgery
19
Management of Internal Contamination
• Various medications available for limiting uptake
or facilitate removal of radioactive material
– KI
– Radiogardase (Prussian blue)
– DTPA
– Bicarbonate
• Now part of response stockpiles
20
Why Radiation Makes You Sick
• Some cells in your body have a short life cycle
(they reproduce and die rapidly).
• Radiation most affects the rapidly reproducing
cells which are in the gut, bone marrow and
skin/hair.
• Once these cells are damaged by radiation, they
are unable to reproduce.
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Acute Radiation Syndrome (ARS)
• Follows a predictable course over a few hours to
several weeks
• Group of symptoms that develop after total body
irradiation (> 100 rems)
• Patients are classified in three categories based
on signs and symptoms:
– Survival probable: < 100 rems
– Survival possible: 200 - 800 rems
– Survival improbable: > 800 rems
22
ARS - Phases
Prodromal Phase - occurs in the first 48 to 72 hours post-
exposure and is characterized by nausea, vomiting, and
anorexia. At doses below about 500 rems this lasts 2 to
4 days.
25
ARS - Gastrointestinal Syndrome
• Radiation dose > 600 rems
• Damages intestinal lining
• Nausea and vomiting within
the first 2 - 4 hours
• May develop diarrhea
• Associated with severe
infections
• Bloody diarrhea and
persistent high fever are an
ominous sign
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ARS - Central Nervous System
• Radiation dose > 1,000 rems
• Brain bleeding and swelling
• Very disoriented or
unconsciousness
• Death within hours
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ARS - Skin
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Hospital Considerations
• Time-Distance-Shielding-Dose
• Do not delay treatment for life threatening
injuries or illnesses for decontamination
• Universal fear of radiation can lead to panic &
misunderstandings
– Accurate public information essential!
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Hospital Considerations
• Long-term care and resources may be needed
to care for these patients
• Internally contaminated victims may need to be
isolated from other patients
• Most victims will be able to be decontaminated,
treated and sent home
31
Additional Resources
• H&HS: Radiation Event Medical Management:
remm.nlm.gov
• Oak Ridge Institute for Science and Education
orise.orau.gov
• CDC
bt.cdc.gov/radiation
• Los Angeles County:
MARRP
(Multi-Agency Radiation Response Plan)
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Summary
• Radiation Protection:
Time. Distance, Shielding, Quantity
• Radiation exposure alone does not usually
result in contamination.
• Do not delay life-saving treatment to
decontaminate radiologically contaminated
victims.
• Identify your local radiological experts.
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Questions
?
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