MEDICAL ASPECTS OF RADIOLOGICAL ACCIDENT IN GILAN, IRAN

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MEDICAL ASPECTS OF RADIOLOGICAL
ACCIDENT IN GILAN, IRAN

• Module XIX

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Summary

• Morning of 24 July 1996 a worker (KZ) at Gilan
  Combined Cycle Fossil Power Plant, while carrying
  insulation material for lagging pipes, noticed
  a shiny pencil sized metal object beside of
  trench
• He put it into his loose overall pocket on right
  side above chest

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Summary-2

• The metal object - pigtail of radiograph with
  iridium-192 source, led to severe haemopoetic
  syndrome (bone marrow depression) and unusually
  extended local radiation injury of chest
  requiring plastic surgery
• Surgery successfully performed a month later in
  Curie Institute, Paris

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Source
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Development of symptoms, recognition of accident

• At 9.30 am, 1.5 hrs after start of exposure, he
  experienced dizziness, nausea, lethargy and
  burning feeling in chest
• Believing object cause of symptoms, he put it
  back into trench
• 1300, KZ told colleagues about strange shiny
  object and weak, lethargic feeling
• 1330 he was sent for blood sampling

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Investigation of accident

• Team of AEOI inspectors investigated accident on
  site next day
• Recommended blood checks for all 600 personnel
• All samples normal except for KZs

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Course of lymphocytes
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Course of leukocytes
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Treatment in Iran

• Prophylactic antibiotics
• Analgesia
• Topical silver sulphadiazine (on chest lesion)
• Platelet transfusion (7 units on Day 20)
• Cytokine (G-CSF) Leucomax 400 ?g 2x/d
  (subcutaneously)

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Bone marrow sampling
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Transfer to Paris

• Need for bone marrow transplantation ?
• Transfer to Radiopathology Unit of the Institut
  Curie in Paris on Day 24 (16 Aug96).
• Findings on examination
• Total loss of epidermis on right anterior chest/
  upper abdominal wall 30 x 15 cm with necrotic
  epidermis around the edge
• Area of moist desquamation on medial side of
  right antecubital fossa 6 x 7 cm
•  Large hard bulla on palm of left hand 5 x 5 cm
  
• Small area of increased pigmentation and
  erythema on anterior middle surface of right
  thigh 2 x 2 cm

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Status in June 2001

• Status November 97 (as examined by IAEA medical
  staff, confirmed June 2001)
• 1. Chest lesion showed no necrosis but graft was
  firmly fixed to the chest wall
• Fibrosis leading to some retraction, adversely
  affecting posture

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Status in June 2001

• 2. Elbow lesion completely healed, but movements
  restricted in both flexion and extension - from
  45o to 135o
• 3. Some thickening of left palmar observed, but
  with full function and strong grip

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Status in June 2001

• 4. Right thigh lesion hard and fibrotic, but
  completely healed and non-painful
• 5. Complete recovery of all lymphocyte
  subpopulations in 18 months

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Lessons medical

• For non-homogeneous whole body irradiation (as in
  most accidents), initiate cytokine treatment at
  earliest opportunity when bone marrow recovery
  not detected
• G-CSF may be drug of choice, but then direct
  particular attention to monitoring platelet counts

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Lessons - medical

• Use thermography, where available, to assess
  viability of radiation induced skin injuries for
  potential spontaneous recovery or suitability for
  grafting
• Where dermal tissues are viable after radiation
  induced skin injury, and spontaneous
  re-epithelialisztion is likely to be prolonged,
  consider early skin grafting to reduce physical
  and psychological morbidity

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Lessons - radiation protection

• Teach radiographers safety culture by organizing
  more training courses for them
• Computerize and regularly update records of
  existing radiation sources, systems, equipment,
  projects and personnel
• Provide psychological support to workers and
  public affected by any radiological accident