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Transcript of Radiation Injury From A Nuclear Accident Or Terrorist Attacknebraskasurgicalresearch.com/s...
Mark A. Carlson, MD
Department of SurgeryUniversity of Nebraska Medical Center
Omaha VA Medical CenterOmaha, Nebraska
USA
Radiation Injury From A Nuclear Accident Or Terrorist Attack
UNMC Dept Surgery Grand Rounds, April 2, 2008
Overview—Radiation Injury
1. Impetus: Radiation Research
2. Ionizing Radiation (IR) Primer
3. Nuclear Blast Effects
4. Events: Past & Future
5. Pathophysiology of IR Exposure
6. IR Exposure: Dx & Rx
Trinity (first nuclear test)Jornada del Muerto, New Mexico
July 16, 1945
1. Impetus For Radiation Research
• Risk of Nuclear Terrorist Event• Project Bioshield• Centers for Medical Countermeasures against Radiation• National Strategy for Homeland Security• NIH Requests For Applications
Nuclear fireballt ~ 10-4 sec
radius ~ 30 m
Impetus:Risk of Nuclear Terrorist Event
• Estimation of risk depends onwho is talking
• Most agree risk is “elevated”
• Little agreement on whatshould be done
• IAEA (1957); NPT (1968)
• Concern: nuclear materials inthe FSU
• Concern: “other” nuclearpowers (Pakistan, India, N.Korea, Israel)
Five "nuclear weapons states" from the Nuclear Nonproliferation TreatyOther known nuclear powersStates formerly possessing nuclear weaponsStates suspected of being in the process of developing nuclear weapons
and/or nuclear programsStates which at one point had nuclear weapons and/or nuclear weapons
research programsStates that possess nuclear weapons, but have not widely adopted them
Worldwide Nuclear Weapons Status
Wikipedia
Impetus:Project Bioshield
• Signed into law 2004
• Part of broader strategy to counter WMD
• Increases funding for bioterror research (includingchemical, biological, radiological, and nuclear threats)
• Provides fed market for bioterror countermeasures
• Permits emergency use of unapproved countermeasures
Impetus:Centers for Medical Countermeasures against Radiation
(CMCRs)
• Established by NIH/NIAID in 2005
• Response to Project Bioshield
• Research on triage, prevention, andtreatment of radiation injury
CMCRs
1. Columbia Univ2. Dana Farber Canc Inst3. Duke Univ4. Fred Hutchinson Canc Ctr5. Med Coll Wisconsin6. UCLA7. Univ Pittsburgh8. Univ Rochester
Natl Inst Allergy Infectious Diseases
Impetus:National Strategy for Homeland Security
• Executive Office/Dept Homeland Security 2007
• To improve protection & response against bothnatural & man-made disasters
• Emphasis on development of countermeasuresfor nuclear and other WMDs
• Demonstrates seriousness in which the ExecutiveOffice perceives WMD threat
Impetus:NIH Requests For Applications, Fall 2007
1. RFA-AI-07-036: Medical Countermeasures to Enhance Platelet Regeneration and IncreaseSurvival Following Radiation Exposure (Sep 27, 2007)
2. RFA-AI-07-037: BARDA/NIAID Medical Countermeasures to Mitigate and/or Treat IonizingRadiation-Induced Cutaneous Injury (Dec 27, 2007)
3. RFA-AI-07-038: Radiation Combined Injury: Radiation Exposure in Combination with Burn,Wound, Trauma or Infection (Sep 27, 2007)
4. RFA-AI-07-039: Mechanisms, Diagnosis and Treatment of Radiation Injury from a NuclearAccident or Terrorist Attack (Oct 1, 2007)
5. RFA-AI-07-040: BARDA/NIAID Medical Countermeasures to Mitigate and/or Treat IonizingRadiation-Induced Pulmonary Injury: Project Bioshield (Dec 18, 2007)
☞
Natl Inst Allergy
Infectious Diseases
2. Ionizing Radiation Primer
Ionizing Radiation = high energy particles or waves that canionize (remove) electrons from an atom
Types: alpha, beta, neutron, gamma (= high energy photons)
Biologic Effects: disruption of chemical bonds, resulting indamage to protein, DNA, lipids, etc.
Units: one gray (Gy) = 1 Joule of radiation energy absorbed byone kilogram of matter
What is a Gy?10 kg
• Lethal total body dose in humans is ~10 Gy
• For a 70 kg person, this is equivalent to 700 J
• 700 J: equivalent to energy contained in 50 mgdextrose (1 gm dextrose = 3.4 kcal = 14,200 J)
• 700 J: equivalent to energy released by dropping10 kg weight from height of 7.1 meters
3. Nuclear Blast Effects
• Fireball = 107 ˚C = total incineration. Emits IR, vis, UV, neutron, gamma
radiation
3. Nuclear Blast Effects
• Fireball = 107 ˚C = total incineration. Emits IR, vis, UV, neutron, gamma
radiation
• Flash: intense visible & UV light which can injure retinas
3. Nuclear Blast Effects
• Fireball = 107 ˚C = total incineration. Emits IR, vis, UV, neutron, gamma
radiation
• Flash: intense visible & UV light which can injure retinas
• Heat: infrared radiation, produces partial/full thickness burns at great
distances
3. Nuclear Blast Effects
• Fireball = 107 ˚C = total incineration. Emits IR, vis, UV, neutron, gamma
radiation
• Flash: intense visible & UV light which can injure retinas
• Heat: infrared radiation, produces partial/full thickness burns at great
distances
• Sonic wave: hearing loss
3. Nuclear Blast Effects
• Fireball = 107 ˚C = total incineration. Emits IR, vis, UV, neutron, gamma
radiation
• Flash: intense visible & UV light which can injure retinas
• Heat: infrared radiation, produces partial/full thickness burns at great
distances
• Sonic wave: hearing loss
• Ionizing radiation, from blast and/or fallout: acute & chronic radiation
syndromes; cancer
3. Nuclear Blast Effects
• Fireball = 107 ˚C = total incineration. Emits IR, vis, UV, neutron, gamma
radiation
• Flash: intense visible & UV light which can injure retinas
• Heat: infrared radiation, produces partial/full thickness burns at great
distances
• Sonic wave: hearing loss
• Ionizing radiation, from blast and/or fallout: acute & chronic radiation
syndromes; cancer
• Overpressure & wind: destroys structures (traumatic injuries)
Atomic Cannon (15 kt)Test Area 5, Nevada
May 25, 1953
Overpressure & Wind Radioactive Fallout
Operation Crossroads (21 kt)Bikini Lagoon, Marshall Islands
July 25, 1946
3. Nuclear Blast Effects
[go to movie file:“Vid2_AtomicCannon.mp4”]
[go to movie file:“Vid3_Fallout.mp4”]
Hiroshima: Monday, August 6, 1945, 8:15 AM
Past Event:Hiroshima
• Yield ~15 kt• Detonated 600 m above city• 1 day mortality ~70,000• 3 month mortality ~140,000• Radius of LD50 ~1250 m• Secondary fires• Another ~50,000 dead from
cancer by 1950
Nagasaki: Thursday, August 9, 1945, 11:02 AM
Past Event:Nagasaki
• Yield ~20 kt• Detonated 3 km off-target• 1 day mortality ~40,000• 3 month mortality ~80,000• Radius of LD50 ~1300 m• Secondary fires
Past Event:Tsar BombaOctober 30, 1961
• Weight = 30 tons• Yield ~50 megaton, or > 10x all
ordnance exploded in WWII• Heat felt at 800 km• Fireball visible at 2,500 km• Blast nearly killed crew of the Tu-95• Broke windows in Finland• Chicxulub event 2 mil x more powerful
Past Event:Chernobyl, Ukraine 1986
• Worst nuclear plant accident ever• Reactor explosion with fallout plume• Initial Soviet cover-up• 336,000 people resettled (Chernobyl abandoned)• 47 workers killed by radiation during firefighting &
clean-up• Fallout spread over Europe & reached the USA• Plant covered with a concrete sarcophagus (now
scheduled for replacement)
Past Event: Nation of Georgia, 2000
• Minor incident, but a “sentinel” event• Three woodcutters in Georgia, FSU• Found “warm” canisters in woods• Suffered severe radiation burns• Canisters contained 90Sr for remote beacons• Reminded authorities (like the IAEA) about
noncontrolled nuclear materials in FSU
Future Events:Nuclear Weapon Simulation
• 1 kt weapon (“briefcase bomb”)
• Yield Comparison: 1 kt — 50 mt
☞
?
1 kiloton A-bomb simulation: Omaha, NE
Dodge
South Saddle Creek
King Kong restaurant
BOMB
Farnam
Douglas
South 44th
COMPLETE DESTRUCTION (1 kiloton A-bomb)
d = 900 m
Lied Transplant Center
Joslyn Castle
fireball
Dept Surgery offices
LETHAL RADIATION (1 kiloton A-bomb)
d = 2.2 km
destroyed
FB
Memorial Park
Masonic Manor
Field Club
Mutual of Omaha
Kiewit Plaza
SHATTERED WINDOWS (1 kiloton A-bomb)
d = 6.0 km
FB
destroyed
XRT
burns downtown
Elmwood Park
72nd & Dodge
Greek Islandsrestaurant
Comparison of weapon yields
1 kt = briefcase bomb15 kt = Hiroshima bomb1 mt = Minuteman missile
50 mt = Tsar Bomba
yield
(kt) example fireball (m)
complete
destruction
(km)
lethal
radiation
(km)
severe
burns
(km)
shattered
windows
(km)
1terrorist
weapon100 0.45 1.1 1.5 3.0
15Hiroshima
bomb400 1.12 1.5 3.5 7.4
1,000Minuteman
missile1,000 4.55 3.1 15 30
50,000Tsar
Bomba3,200 16.8 6.6 75 111
Radius of Effect
0
10,000
20,000
30,000
40,000
50,000
kilot
on
Tsar
Bom
ba
Minu
tem
an
Hiro
shim
a
Brief
case
FIREBALL COMPARISON: Omaha, NE
50 mt (Tsar Bomba)r = 3.2 km
1 mt (Minuteman)
15 kt (Hiro)
1 kt
NE Furniture Martdowntown
Rosenblatt Stadium
Ford birthplace
Zoo
LETHAL RADIATION COMPARISON: Omaha, NE
50 mt (Tsar Bomba)r = 6.6 km
1 mt (Minuteman)
15 kt (Hiro)
1 kt
Eppley Airfield
Council Bluffs
114th & Dodge
Satellite Motel
Lynch’s house
COMPLETE DESTRUCTION COMPARISON: Omaha, NE
50 mt (Tsar Bomba)r = 17 km
1 mt (Minuteman)
15 kt (Hiro)
1 kt
Offutt AFB
Council Bluffs
Carlson’s house
Thompson’s house
Sasson’s house
SEVERE BURN COMPARISON: Omaha, NE
50 mt (Tsar Bomba)r = 75 km
1 mt (Minuteman)
15 kt (Hiro)
Missouri Valley
Fremont
Nebraska City
Lincoln
SHATTERED WINDOW COMPARISON: Omaha, NE
50 mt (Tsar Bomba)r = 110 km
1 mt (Minuteman)
15 kt (Hiro)
Lincoln
Sioux City
Grand Island
Nebraska City
1 kt
Johnny Carsonbirthplace
Des Moines
Excerpted from “Duck & Cover” ©1952, Federal Civil Defense Administration and Archer Productions
Radiation Injury: Early Countermeasure Effort
[go to movie file: “Vid5_Duck&Cover.mp4”]
5. Acute & Subacute Pathophysiology of IR Exposure[Note shift in focus]
• CNS & cardiac: 20+ Gy, death in1-2 days
• GI: ~10 Gy, death in about oneweek (LD50/7)
• Hematologic: 3-4 Gy, death inabout one month (LD50/30)
• Cutaneous
• Polytrauma
Organ System, Dose, and Acute Mortality
(Values derived mostly from nontreated victims)
Figure 1. Percent mortality vs. TBI dose (in rads) in male vs.female Swiss Albino mice (NMRI strain), age 60-80 days.(Reproduced from Chapman, Radiat Res 1955;2:502.)
dose-mortality curve
5. Acute & Subacute Pathophysiology of IR Exposure
Subacute (& Chronic) Disease
• Radiation pneumonitis & pulmonary fibrosis• Radiation nephropathy & renal failure• Leukemia and other cancers
As supportive care for GI & BM syndromes improves,more victims will be susceptible to the above complications
☞
5. Diagnosis and Intervention for IR Exposure:
Dosimetry: are there any Dx techniques? Not really.
• Has patient been exposed?
• What was the absorbed dose?
• What is the patient’s prognosis?
Prophylaxis: available, but questionable relevance.
Mitigation: after exposure, before seriousmanifestations. Few; modestly effective (GF, ACEI).
Treatment: after exposure, with signs & symptoms ofillness. Mainly supportive care.
The Money $lide
“counte
rmea
sure
s”