Radiologic Terrorism

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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

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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

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Accident at Chernobyl

• Saturday, April 26, 1986 at 012348
• 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. Nature Reviews Cancer
  20022543-549 (01 Jul).

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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 lt 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 gt 1 cGy of radiation.
• Rapid thyroid growth in young children occurs
  with chromosomal rearrangements (PTC1 and PTC3).

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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

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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 lt 1 year
• gt 50 mSv (5 Rem) if unprotected from radioiodine
• lt 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.

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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

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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

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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.

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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

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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.

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Potassium Iodide Doses

• AAP Committee on Environmental Health. Pediatrics
  20031111459

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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.

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Potassium Iodide Safety

• 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

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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

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Radiologic Terrorism Bibliography

• Williams, Dillwyn. Science and society Cancer
  after nuclear fallout lessons from the
  Chernobyl accident. Nature Reviews Cancer
  20022543-549 (01 Jul). Review
• CDC www.bt.cdc.gov/radiation
• AAP Policy Statement. Radiation disasters and
  children. Pediat 2003111(6)1455-1466.
• Mettler FA, Voelz GL. Major radiation exposure
  what to expect and how to respond. NEJM
  20023461554-1561.
• 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 199394(5)524-532. Review
• Nagataki S, Yamashita S, Eds. Nagasaki Symposium
  Radiation Human Health, Elsevier, 1996, p xii.

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