1 1 Overview of the Radiation Emergency Overview of the Radiation Emergency Assistance Center/Training Site (REAC/TS): Assistance Center/Training Site (REAC/TS): An NNSA Asset An NNSA Asset Albert L. Wiley, BNE, MD, Albert L. Wiley, BNE, MD, PhD,USNR(RET PhD,USNR(RET ) ) [email protected][email protected]Director, Director, REAC/TS and WHO Collaborating Center REAC/TS and WHO Collaborating Center at Oak Ridge ,TN. USA at Oak Ridge ,TN. USA AAPM/ACMP Workshop, Va. Beach, Va. May 4,09 AAPM/ACMP Workshop, Va. Beach, Va. May 4,09
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Overview of the Radiation Emergency Overview of the Radiation Emergency Assistance Center/Training Site (REAC/TS): Assistance Center/Training Site (REAC/TS):
An NNSA AssetAn NNSA Asset
Albert L. Wiley, BNE, MD, Albert L. Wiley, BNE, MD, PhD,USNR(RETPhD,USNR(RET))[email protected]@orise.orau.gov
Director, Director, REAC/TS and WHO Collaborating Center REAC/TS and WHO Collaborating Center
at Oak Ridge ,TN. USAat Oak Ridge ,TN. USAAAPM/ACMP Workshop, Va. Beach, Va. May 4,09AAPM/ACMP Workshop, Va. Beach, Va. May 4,09
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REAC/TSREAC/TSA program of the A program of the
Oak Ridge Institute for Science & Education (ORISE)Oak Ridge Institute for Science & Education (ORISE)
Operated for Operated for the US Department of Energy (DOE) the US Department of Energy (DOE)
by by Oak Ridge Associated Universities (ORAU)Oak Ridge Associated Universities (ORAU)
A World Health Organization (WHO) Collaborating A World Health Organization (WHO) Collaborating Center Center
and member of theand member of theWHO Radiation Emergency Medical WHO Radiation Emergency Medical
Provide 24/7 Radiation Medicine advice and consultationProvide 24/7 Radiation Medicine advice and consultation
and Health Physics radiation dose assessments.and Health Physics radiation dose assessments.
Provide NNSA 2 Deployable Emergency Response Teams Provide NNSA 2 Deployable Emergency Response Teams (ERT 1 & 2) for (ERT 1 & 2) for onon--scene assistance scene assistance –– may transition to may transition to DHS after a DHS after a major incidentmajor incidentEach team consists of:Each team consists of:
PhysicianPhysicianHealth Physicist Health Physicist Nurse/ParamedicNurse/Paramedic
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Domestic & International Domestic & International Deployment Capability, per NNSADeployment Capability, per NNSACONUS CONUS –– 4 hours wheels up OCONUS 4 hours wheels up OCONUS –– 6 hours wheels up6 hours wheels up
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REAC/TS International REAC/TS International Activities & Emergency Response Activities & Emergency Response
CapabilitiesCapabilities�� Coordinates United States participation in the World Health Coordinates United States participation in the World Health
OrganizationOrganization’’s (WHO) Radiation Emergency Medical s (WHO) Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) .Preparedness and Assistance Network (REMPAN) .
�� REAC/TS REAC/TS ‘‘ staff (per IAEA request and NNSA approval) is staff (per IAEA request and NNSA approval) is available to assist the International Atomic Energy Agency available to assist the International Atomic Energy Agency (IAEA), Vienna, Austria with (IAEA), Vienna, Austria with ““on siteon site
�� radiation accident investigation, medical management, after radiation accident investigation, medical management, after action reports, and international planning for response to action reports, and international planning for response to radiation emergenciesradiation emergencies
�� REAC/TS is available to host 4REAC/TS is available to host 4--6 week IAEA Radiation 6 week IAEA Radiation Medicine fellowship programs at our Oak Ridge ,TN. Medicine fellowship programs at our Oak Ridge ,TN. Training Site.Training Site.
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International Emergency Response International Emergency Response and/or Training Since 1976and/or Training Since 1976
�� Armenia (training)Armenia (training)�� Australia (training)Australia (training)�� Brazil (response & training)Brazil (response & training)�� Canada (training)Canada (training)�� Cuba (training)Cuba (training)�� Egypt (training)Egypt (training)�� England (training)England (training)�� Former Soviet Union Former Soviet Union
(response & training)(response & training)�� Hong Kong (training)Hong Kong (training)�� Jamaica (response)Jamaica (response)�� Japan (response & training)Japan (response & training)�� Jordan (training) Jordan (training) �� Kazakhstan (response & Kazakhstan (response &
�� Malaysia (training)Malaysia (training)�� Mexico (response & training)Mexico (response & training)�� Panama (response)Panama (response)�� Peru (response)Peru (response)�� Poland (training)Poland (training)�� Romania (training)Romania (training)�� Russia (response & training)Russia (response & training)�� South KoreaSouth Korea�� Sri Lanka (training)Sri Lanka (training)�� Taiwan (training)Taiwan (training)�� United Arab Emirates United Arab Emirates
�� Maintain a Radiation Accident Registry for Radiation Maintain a Radiation Accident Registry for Radiation Medicine Medicine researchresearch
�� Maintain registry of DTPA (diethyleneMaintain registry of DTPA (diethylene--triaminetriamine--pentaacetate or pentatate)pentaacetate or pentatate) and Prussian Blue and Prussian Blue therapiestherapies
�� Manage DTPA and Prussian Blue New Drug Manage DTPA and Prussian Blue New Drug Application (NDA) status for the U.S. Food and Drug Application (NDA) status for the U.S. Food and Drug Administration (FDA)Administration (FDA)
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�� REAC/TS CBL participated in an international REAC/TS CBL participated in an international interlaboratoryinterlaboratory DicentricDicentric Chromosome Analysis Chromosome Analysis collaboration study with Health Canada, specifically collaboration study with Health Canada, specifically geared toward triage of radiation incident victims. geared toward triage of radiation incident victims. �� REAC/TS CBL also began program for FISH REAC/TS CBL also began program for FISH (Fluorescence In(Fluorescence In--Situ Hybridization) and Micronuclei Situ Hybridization) and Micronuclei Analysis and began collaboration with AFRRI on Analysis and began collaboration with AFRRI on Proteomic Proteomic BiodosimetryBiodosimetry studies of radiation accident studies of radiation accident victims.victims.�� REAC/TS staff participated in multiple international REAC/TS staff participated in multiple international NNSA/IAEA /WHO meetings/training/exercises (Argentina, NNSA/IAEA /WHO meetings/training/exercises (Argentina, Korea, Mexico, for example) and applied to join IAEA Korea, Mexico, for example) and applied to join IAEA RANET as an NNSA asset..RANET as an NNSA asset..
Official Use Only 9
2008 REAC/TS Activities2008 REAC/TS Activities
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2008 Training 2008 Training ��OffOff--site course attendance:site course attendance:
••29 outreach programs were provided29 outreach programs were provided��TOTAL: 731 participantsTOTAL: 731 participants
TOTAL COURSE PARTICIPANTS (2008): 1,032TOTAL COURSE PARTICIPANTS (2008): 1,032
Official Use Only 10
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2008 Responses/On Site 2008 Responses/On Site Training:Training:
�� REAC/TS REAC/TS responded to 200 calls, 50 of which were responded to 200 calls, 50 of which were classified as classified as ““calls for assistancecalls for assistance””
��TOTAL: 237 participantsTOTAL: 237 participantsOfficial Use Only 11
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REAC/TSREAC/TS’’ Continuing Medical Continuing Medical Education CoursesEducation Courses
�� A primary REAC/TSA primary REAC/TS’’ Mission is to provide continuing Mission is to provide continuing medical education to health care providers and health medical education to health care providers and health physicists for practical training to strengthen the US physicists for practical training to strengthen the US and world capabilities to respond to and manage the and world capabilities to respond to and manage the medical aspects of a radiological/nuclear event.medical aspects of a radiological/nuclear event.
�� Common to all REAC/TS training:Common to all REAC/TS training:”” Emergency Medical Emergency Medical needs always take priority over decontamination needs always take priority over decontamination concerns.concerns.”” (Our on site courses provide a day of (Our on site courses provide a day of realistic, monitored/evaluated Emergency Room realistic, monitored/evaluated Emergency Room Drills to insure that the student understands this Drills to insure that the student understands this priority.)priority.)
�� Provide US and International Radiation Medicine and Provide US and International Radiation Medicine and Health Physics courses with Special Instruction on Medical Health Physics courses with Special Instruction on Medical Management of Internal /External Radionuclide Contamination Management of Internal /External Radionuclide Contamination
*REAC/TS*REAC/TS’’ hallmark is hallmark is integration of health integration of health
physics with medicine. physics with medicine.
Courses are AMA Courses are AMA CME CME CatagoryCatagory 1 1
accredited.accredited.
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REAC/TS has special REAC/TS has special experiseexperiseand tools for medical management and tools for medical management
of internal contaminationof internal contamination
�� Maintain Registries of DTPA and PB use in Maintain Registries of DTPA and PB use in US US
�� Provide a stock of pharmaceuticals at Provide a stock of pharmaceuticals at REAC/TS and with coREAC/TS and with co-- investigators for investigators for treatment of internal contamination:treatment of internal contamination:•• CaCa-- and Znand Zn--DTPADTPA•• Prussian Blue (Prussian Blue (RadiogardaseRadiogardase®®))
DTPA Co-investigators (24)
Through a network of physician co-investigators, special drugs are readily available in the event of radiation emergencies including nuclear terrorism.
Prussian Blue Co-investigators (8)
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Internal Contamination is :Internal Contamination is :
the deposition of radioactive material inside the body.the deposition of radioactive material inside the body.
Common Routes of Entry• Inhalation• Ingestion• Absorption through wounds or skin • Injection
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Methods for Assessing IntakesMethods for Assessing Intakes�� Whole Body or Lung Counting:Whole Body or Lung Counting:
•• Feasible for nuclides that emit Feasible for nuclides that emit penetrating x or gamma rays.penetrating x or gamma rays.
•• Useful also for nuclides emitting Useful also for nuclides emitting energetic beta particles energetic beta particles -- can be can be detected by their bremsstrahlung detected by their bremsstrahlung radiations.radiations.
�� Bioassay:Bioassay:
•• 24 hour Urine collections 24 hour Urine collections -- most most widely used.widely used.
•• 24 hour Feces collections24 hour Feces collections•• Excised material from wounds.Excised material from wounds.
InhalationInhalation�� Mansfield (1997): intakes due to particle Mansfield (1997): intakes due to particle
sizes in the 1 to 5 sizes in the 1 to 5 µµmm AMAD range can be AMAD range can be estimated by assuming that the nasal swab estimated by assuming that the nasal swab results are about 5%results are about 5%--10% of the intake.10% of the intake.
�� ICRP 66 (ICRP 1994): the ratio of deposition ICRP 66 (ICRP 1994): the ratio of deposition between the external nasal passages and the between the external nasal passages and the other respiratory tract compartments is 1 to other respiratory tract compartments is 1 to 4.1 for 5 4.1 for 5 µµmm particles (25% of intake in particles (25% of intake in naresnares))
�� Perform a direct Perform a direct count of the woundcount of the wound
�� Convert the reading Convert the reading to an activity to an activity ((µµCi/MBqCi/MBq))
�� Compare the activity Compare the activity to the ingestion ALI to the ingestion ALI multiplied by the fmultiplied by the f1 1 valuevalue
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Uptake of Actinides (Uptake of Actinides (PuPu, Am, , Am, CfCf, etc.) is Remarkably Rapid, etc.) is Remarkably Rapid
BoneDeposition
Time (Hours)0 1 2
10080
60
40
20
0Per
cen
t D
epos
ited
2020
Prompt DTPA Treatment of Prompt DTPA Treatment of 239239Pu Intake is Highly EffectivePu Intake is Highly Effective
Retention (% of Uptake)Retention (% of Uptake)
5.95.957.057.0SkeletonSkeleton
0.470.4714.014.0LiverLiver
DTPA TreatedDTPA TreatedControlControl
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Rapid Diagnosis, Internal Dose Rapid Diagnosis, Internal Dose Assessment and Prompt Assessment and Prompt
Treatment are All Important !Treatment are All Important !�� Incident history/reconstruction with health Incident history/reconstruction with health
physics input are essential physics input are essential �� Wound surveys Wound surveys �� Facial surveysFacial surveys�� Nasal swipes Nasal swipes �� Nasal blowsNasal blows�� SputumSputum�� Spot urine Spot urine –– check for gammascheck for gammas�� Stool, if actinides, monitor alpha activityStool, if actinides, monitor alpha activity
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AmAm--241 Inhalation, Example241 Inhalation, Example
�� Two workers were transferring Two workers were transferring 241241Am from Am from a shipping barrel to a disposal container.a shipping barrel to a disposal container.
�� The workers were wearing respiratory The workers were wearing respiratory protection.protection.
�� But, a supervisor, also present, was not But, a supervisor, also present, was not wearing respiratory protection.wearing respiratory protection.
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AmAm--241 Example (continued)241 Example (continued)�� On exit, all three workers were noted to On exit, all three workers were noted to
be contaminated be contaminated –– and room air samples and room air samples were positive for alpha.were positive for alpha.
�� Lung count bioassay was advised and Lung count bioassay was advised and performed the next day performed the next day -- all 3 patients all 3 patients were positive.were positive.
�� 24 hr urine and fecal bioassay collections 24 hr urine and fecal bioassay collections were advised and begun.were advised and begun.
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Initial Intake and Effective Dose Initial Intake and Effective Dose Estimates from BioassaysEstimates from Bioassays
�� ChelationChelation begun on day 2 with Cabegun on day 2 with Ca--DTPA DTPA for the males and Znfor the males and Zn--DTPA for the female, DTPA for the female, and continued daily with Znand continued daily with Zn--DTPA for 5DTPA for 5--6 6 daysdays
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Averted Doses obtained by Prompt Averted Doses obtained by Prompt intraintra--venous DTPA Treatmentvenous DTPA Treatment
life 109 days) is the dominant radioisotope in life 109 days) is the dominant radioisotope in aged aged fission productsfission products
�� Cs 137 Distributes in body fluids similarly to Cs 137 Distributes in body fluids similarly to potassiumpotassium
�� One gram orally three times daily x 3 weeks One gram orally three times daily x 3 weeks reduces the biological halfreduces the biological half--life to about 1/3 of the life to about 1/3 of the normal value (low ALI). For higher intake, titrate normal value (low ALI). For higher intake, titrate upwardupward
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Goiania Data:Goiania Data:Cs 137 Dose Aversion by PB Cs 137 Dose Aversion by PB
