http://www.nbcnews.com/id/43529641/ns/health-
health_care/t/nurses-suicide-highlights-twin-
tragedies-medical-errors/#.WDtQK_krJaQ
1985 1986
STANISLAV
PETROV
LAYING BLAME
AND THE
MYSTERIOUS CASE
OF T25
Rules for Mogwai
1.Don't expose them to sunlight
2.Don't expose them to water
3.Don't feed them after midnight
What if Gremlins Rules
Were Run by a Computer?
1985 1986
• Becqurel(Bq) is a measurement of radioactivity
• Bq is the number of atoms in the material that decay per second
NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.
• gray(Gy) is a measurement of absorbed dose
• Gy doesn’t predict harm because different tissues respond differently to exposure
NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.
NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.
• Radiation Absorbed Dose(rad)
• 1 rad = 0.01Gy
• sievert(Sv) is a measure of the health effect on the body
• Weighted by the type of radiation and exposed tissue
NRC, http://www.nrc.gov/about-nrc/radiation/health-effects/measuring-radiation.html, Oct 2014.
1985 1986
1985 1986
Linear Accelerator
Isodose Distribution
25MeV X-Ray Beam
Korevaar, E.W., et. al.; Mixing intensity modulated electron and photon beams: Combining a steep dose fall-off at depth with sharp and depth-independent penumbras and flat beam profiles. Physics in Medicine and Biology 44:9, 1999.
3D Conformational Radiotherapy
Intensity-Modulated Radiotherapy
Proton Therapy
Ling, T.C., et. al. Analysis of IMRT, Proton, and 3D-CRT for reducing perioperative cardiopulmonary complications in esophageal cancer patients. Cancers, 6(4), 2014.
Fort Calhoun Incident
https://orise.orau.gov/reacts/guide/care.htm#Team
http://ansnuclearcafe.org/2014/06/13/pathfinder/
#sthash.c2E8XHJa.dpbs
Pathfinder Project
ED Radiation Treatment
● Exposure – Exposed to radioactive particles but
person doesn't emit radiation (no hazard to EMS)
● Contamination –
Radioactive material on skin
or in body
Ask
● How many victims
● Expose or contaminated
● Identity of contaminant
● ETA
● Advise EMS of special entrance / procedure
Contamination
● Set up a controlled area
● Isolation precautions
– Protective clothing
– Double bag clothing
Protective Clothing
• Surgical Clothing including
shoe covers
• Open seams should be
taped
• Tape inside glove to skin
• Apply second glove over gown
and tape
• Lead aprons not recommended
• Won’t stop most gamma rays
Room Preparation
● Sheet or butcher
paper taped to
the floor
● Document
background
radiation level
● Cover equipment and bed with 2 layers of plastic
https://www.remm.nlm.gov/ext_contamination.htm
Decontamination
• Irrigate wounds first,
then intact skin
• Soap and water for
intact skin/hair
• Soap and water for
intact skin/hair
http://hps.org/physicians/documents/Management_of_Radiation_Exposed_or_Contaminated_Patients.ppt
• Radiation survey after each cycle
• Done when contamination is < 2 x background
radiation level
• Promote Sweating (gloves over hands for a few
hours)
Decontamination
Internal Decontamination
• Iodine-125 or -131 Potassium Iodide
• Strontium-90 Calcium
• Americium-241 Diethylenetriamine Pentaacetate
• Plutonium-239• Cobalt-60
Tse, M. Antidotal treatment for radioactive materials, The Hong Koong Medical Diary, 16:4, 2011.
• Cesium-137 Prussian Blue
Exposure Treatment
● Doses > 1Gy
● Prodromal
● Nausea/Vomiting, diarrhea
● Latency
● Manifest Illness
• Loss of cell lines
• Hemorrhage
• Infections
• Vomiting/Diarrhea
• Mental Status Changes
6-8 Gy Whole-body
1-2 Gy Whole-body
Time phases of acute radiation syndrome, U.S. Dept. of HHS. https://www.remm.nlm.gov/ars_timephases2.htm, 2016.