RADRADIIOLOGOLOGIICAL ACCCAL ACCIIDENT DENT IIN N GOGOIIÂÂNİANİA

RADRADIIOLOGOLOGIICAL ACCCAL ACCIIDENT DENT IIN N GOGOIIÂÂNİANİA

Module XIX

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137137Cs-accident, GoiCs-accident, Goiâânia, Brazilnia, BrazilSeptember 13, 1987September 13, 1987

GoiâniaRio de Janeiro

Sao PauloAngra NPP

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Accident descriptionAccident description

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SSourceource

137CsCl (caesium chloride) 50.9 TBq (1375 Ci)

main gamma: 0.66 MeVmain beta: 1.17 MeV

T 1/2=30 years

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Radiological triage

112 000 persons monitored249 identified contaminated120 only clothing and shoe contamination129 internal contamination50 subjected to direct medical surveillance

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Technical management of Technical management of accidentaccident

85 residences (houses) had significant level of contamination, 41 evacuated, 4 demolished

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Environmental aspects of Environmental aspects of 137137Cs Cs accident in Goiania accident in Goiania

Initial surveys conducted in suspect homes and work areas

67 km2 urban area of Goiania city monitored using helicopter to identify all hotspots (few mGy/hr to >2 Gy/hr)

2000 m2 contaminated Several household pets (cats and dogs) and some

livestock (pigs) slaughtered Air and water samples negative

3000 m3 contaminated (radioactive) material collected, 50.6 TBq 137Cs recovered; <0.37 TBq remained

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Internal dose assessmentInternal dose assessment

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Dose Dose aassessment by ssessment by ccytogenetic ytogenetic ddosimetryosimetry

Re-estimated dose through cytogenetics (Gy)

Number of individuals

< 0.1 - 0.49 105

0.50 - 0.99 8

1.00 - 1.99 8

2.00 - 2.99 3

3.00 - 3.99 2

4.00 - 4.99 2

5.00 - 5.99 1

Total 129

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Medical Medical aaspectsspects

250 persons exposed

50 persons WB exposure or local radiation injury

14 bone marrow depression 28 local radiation injury

4 died8 ARS

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Therapeutic mTherapeutic measures easures dduring uring ccritical ritical pperioderiod

Managing critical period of ARS, bone marrow suppression

Therapy for local radiation injury Decorporation of caesium-137 General support and psychotherapy

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Treatment of Treatment of haematological haematological syndromesyndrome

8 ARS patients with estimated doses 1 2-4 Gy 5 4-6 Gy 2 >6 Gy received GM-CSF therapy

Four patients died: two of hemorrhage and two of t sepsis from Klebsiella infection

Two patients who received high doses (7.0 and 5.5 Gy) and exhibited bone marrow depression but were not treated with GM-CSF spontaneously recovered and survived

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Radiation Radiation sskin kin iinjuriesnjuries

Radiation induced skin injuries caused by gamma and beta radiations observed in 28 who had handled source housing or fragments of source

12 of the 28 victims had multiple injuries affecting predominantly upper limbs

Injuries did not heal completely and relapsed in 8 patients, who then required surgical debridement, amputation of digital extremities and plastic skin grafts

In 1997 one severely irradiated patient developed a malignant skin lesion on lower limbs which was surgically excised

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Therapeutic management of localized Therapeutic management of localized radiation injuries:radiation injuries:

Goiânia experienceGoiânia experience-ı-ı

Pain management Opioid analgesia, extradural opioid analgesia

Reduction of inflammatory reaction Systemic and local NSAID Extract of aloe vera

Cleaning of wounds and use of antiseptics - prevention of infection Hands and fingers immersed in boric acid solution

reducing skin dryness, pain and itching non-adherent dressing coated with neomycin

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Therapeutic management of localized Therapeutic management of localized radiation injuries:radiation injuries:

Goiânia experienceGoiânia experience-ıı-ıı

Improvement of local microcirculation Pentoxifylline, which decreases blood viscosityused

in two patients, reducing risk of early formation of microthrombi, thus improving blood flow in injured tissues

Hyperbaric oxygen therapy (HOT) hastened granulation at wound edges, reduced ulcerated area considerably increasing local pO2, thus facilitating integration of graft with damaged area

  Surgical treatment Complete excision of damaged tissue Skin graft abdominal flaps Amputation

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Prussian blue therapy for caesium Prussian blue therapy for caesium

decorporationdecorporation BLOOD

LIVERGI TRACT

FECES

PB

PB

Schematic representation of PB action in body

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Prussian blue administration Prussian blue administration in Goiania in Goiania 137137Cs AccidentCs Accident

46 persons received prussian blue Dosage related to internal body burden

Initial 3 g/day then

3-6 g/day in adults exceeding 5 x ALI For children initial dose 1-1.5 g/day then

3 g/day for those exceeding 5 x ALI Five adults with very high burdens received 10

g/day

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Patient follow-up in Patient follow-up in GoianiaGoiania

Medical Cytogenetic Psychological Social Economic

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Medical follow-up of Goiania accident Medical follow-up of Goiania accident victimsvictims

• Status of skin injuries after initial healing

– 8/28 patients required surgery in 1989, and 6/28 in 1990

– One patient required repeated surgery in 1991, ‘92, ‘93

• Skin lesions tended to be affected by stress

• Sperm count in males now normal - 2 exposed in teenage males

have fathered healthy children

• Follow-up of children

- 7 exposed in utero have no abnormalities

– 10 conceived post-accident born with no abnormalities

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Cytogenetic Cytogenetic ffollow-upollow-up (6 years)(6 years)

Tdic=110 d at > 1 Gy Tdic =160 d at 0.3-1 Gy

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Half-life of dicentric chromosomes and centric rings in nine 13-57 year old people overexposed in Goiania

accident

T1/2 = 90-230 days

(Follow-up 7.5 years)

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PsychologicalPsychological and social follow-up and social follow-up of Goiania accident victimsof Goiania accident victims

• Psychological alterations– increase in psychosomatic disorders

– fear of leukaemia and early death

– increased use of alcohol and drugs

– lack of self-confidence

• Discrimination – by others due to fear

– self-discrimination from social contact

• Stigmatization– victims blamed for accident by many citizens

137Cs retention curves of woman contaminated in fourth month of pregnancy and her baby

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Summary of therapeutic measures

8 patients with severe BM syndrome treated with GM-CSF 4 died due to haemorrhage and sepsis

• None received BMT

• All surviving patients - normal blood counts since 1988 (quarterly check ups and CBC)

• 3-10 g/day prussian blue to adults, 1-3 g/day to children

• 28 patients treated surgically for radiation skin injuries relapse in 8 patients leading to fibrosis in 4