Effects of Nuclear Accidents on Respiratory System

Prof. Dr. Fatma Evyapan

Pamukkale Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı

Conflict of Interest

• None

Main Topics

• General aspects of radiation physics

• Lung effects of irradiation

• Radiation exposure during daily life

• Effects of NPP accidents on lung health– Tchernobyl– Fukushima

• Methodological issues

• Consequences

There is no threshold for the harmful effects of ionizing radiaton on health.Minimal

increase of radiation dose will cause determinative or stochastic

changes on helath

Yablokov Ann NY Acad Sci 1181:31-

Basic Principles of Radiation Physics

• X or beams are used in therapeutic external radiotherapy

• X rays are interacted with electron cloud or nucleus this interaction is called Compton effect

• The main radiation unit used in radiotherapy: – Gray (Gy): Energy absorbed by kilogram of tissue

1Gy = 1 J/kg– rad (radiation adsoprsion dose)

• 1Gy= 100 rad

– Milisievert (mSv): Energy absorbed by kilogram of tissue X k

Roberts KB, Rockwell S Radiation pneumonitis. In Fishman AP ed.Fishman’s pulmonary diseases and disorders vol 1 1173

Historical Perspectives

• 1895 Roentgen: X rays• 1898 Pierre ve Marie Curie: Radium• Production of vacuum radioactive tubes • 1896’da treatment of cancer patients• First adverse effects:

– Erythema, chronic dermatitis, ulceration, alopecia, ocular damage

– 1922: Occurence of dyspnea,cough and fever few months following irradiation

– 1925: Description of radiation fibrosis and radiation pneumonitis

Roberts KB, Rockwell S Radiation pneumonitis. In Fishman AP ed.Fishman’s pulmonary diseases and disorders vol 1 1173

X Rays-Tissue Interaction

• X rays might have primary and secondary ionization upon entering the tissues

• Consequently ROI are generated:H., OH., H2O+,H3O+

• DNA damage is the main consequence of irradiation– DNA strand breaks – Loss or damage of bases– Chromosomal breaks – Chromosomal rearrangements

• Mutations

• Chromosomal abnormalities causing cell death or functional changes

Mc Bride WH, Biologic basis of radiation therapy.In: Perez CA, Brady LW eds. Principles and practice of radiation oncology

Effects of Radiation on Health

• Determinisitc Effects: – Early tissue reactions– Due to the death or dysfcuntions of cellular

populations – They occur over a threshold limit– May differ among people– They occur in high dose dose↑severity ↑ – E.g: Hair and dermal effects

Mc Bride WH, Biologic basis of radiation therapy.In: Perez CA, Brady LW eds. Principles and practice of radiation oncology

• Stochastic (probable) Effects– Don’t occur after a specific threshold– Repetitive lower dose exposure (radiological ,

security etc…)– Mutation and genetic changes

• Cancer – Leukemias: 2 years of latent period– Solid tumors 5-10 years of latent period

Effects of Radiation on Health

EFFECTS OF RADIDATION ON LUNGS

• Lungs responds relatively late to radiation• Surfactan increase in BAL in few hours• Tip I pneumocytes are relatively resistant • Tip II pneumocytes: distended in early

phase and secrete surfactant early marker of radiation exposure

• Endothelial cells: Loss of intercellular adhesions, vacuolization, distension basal membran detachment, pleomorphisms, increase in permeability microtrombi formation, capillary occlusion.

• Late response: Fibrosis

Travis EJ, Komaki R Treatment related lung damage. In Lung cancer: principles and practice 1996;

Some Potential Source of Radiation Exposure

Source Typical dose mSv Standard chest X ray

Standard chest X Ray 0,02 1

Standard chest X Ray

and lateral

0,10 5

New-York New Orleans plane trip 0,02 1

Secuirty screening in airport 0,001 1/20

Mammography 0,7 35

Cerebral CT 2 100

Annual baseline radiation 3 150

Abdominal CT 10 500

Mean yearly ecposure limit (ICRP) 20 1000

Dual isotop helical MPI or helical coroner angiography

25 1250

Tchernobyl cleaner liquidators 130 6200

Max dose recieved by Fukushima workers

250 12500

Einstein A J Am Coll Cardiol:

Einstein A J Am Coll Cardiol:

Nuclear Accidents

• Accidents which might cause the high radiation exposures– Nuclear Power Plant accidents– Accidents or lekeage in research institutions

working with radioactive substances– Protection of radioactive substances in

inappropriate conditions– Terrorist attacks

Mc Vittie T Stem Cells 1997; 15: 263

Phases of Radiation Accidents

• The amplitude of the effects is largely based on the dose of the radiation

• Early Phase: Few hours after the radiation emission

• Intermediate Phase: 1-2 days after the accident

• Late Phase: Few weeks to years (centuries?)

WHO report Health Consequences of radiation

Acute Radiation Injury

• Cerebrovascular and cardiovascular symptoms

• Gastrointestinal syndrom

• Hematopoetic syndrom

• Skin lesions

• Infections

• Respiratory syndrom – ARDS and severe hypoxemia

Ishii T J Radiat Res 2001; 42 Suppl S167-

Previous Nuclear Accidents and Lung Effects

Medhora M Respirology 2012; 11: 66

Chernobyl

Chernobyl Nuclear Power Plant Catastrophe

• In 26 April 1986 the explosion of reactor no: 4 led to the total collaps of this reactor

• The biggest environmental catastrophe in the world • Radiation cloud around the power plant has dispersed thruought the

world and resulting radioactive rains contaminated the soil • Ukrain, Belarus, Russia (the most contaminated)

– Finland,Sweden, Norway, Austria, Bulgary, Turkey• I 131 (earliest) half life 8 days• Cs 137,Cs 134, St 90, Te132,Ru 103, Ru 106,Sr 90, during months• Cs 137, Sr 90, Pu ve Am activity during years • Around 400 milyon people are exposed to high dose radiation

between 26 April and 5 June • Nowadays still more than 5 million persons( 1million children) are

still exposed to radiation remaining from Chernobyl

Moysich K Lancet Oncol 2002; 269

• There are 2 main exposure route :– External: Radioactive clouds, surfaces

vs….– Internal:Intake of contaminated food:

meat, milk, potatoes

• Especially people living rural and forrestrial area have recieved highest amounts of radiation

• Survivors exposed to high radiation have worked as cleaners and a sarcophagus constructors, also expericenced further exposures between 1986 and 1987

Moysich K Lancet Oncol 2002; 269

Chernobyl Nuclear Power Plant Catastrophe

Respiratory Effects of Chernobyl Dust

• “Hot particles” or “Chernobyl Dust“– Generated from burning and subsequent collapsing of

nuclear ractor– Radyonükleer contaminators: I131, Ru-106,Ce 144– Metal construction materials– Soil etc– External irradiation

• Nasal bleeding, throath irriation• Retrosternal pain• Dyspnea

Yablokov Ann NY Acad Sci 1181:31-

Airways Involvemet After Chernobyl Accidents

• Tracheobronchial mucosa atrophy • Mucosal thickening and fibrosis in distal airways • Dysplasia and metaplasia in ciliary epithel • Tracheobronchial deformities• Persistence of radioactive material respiratory system

after the 6-10 years of exposure

Yablokov Ann NY Acad Sci 1181:31-

Chronic Airways Diseases in Ukarnian Liquidators

Yablokov Ann NY Acad Sci 1181:31-

• 43 liquidators (36 NS)

• 44 Control subjects (23 NS,21 S)

• Bronchial biopsies: 1992-2001 (6-15 years later after the accident)

• kras mutation p 16 INK4A hypermetilation and microsatellit alterations

• BAL

Sonuçlar

• Presence of Chernobil dusts in BAL 91% of the liquidators.

• Presence radioactive material in 32% of macrophages• Coexistence of radioactivity and kras mutation, p16INK4A

hypermetilation and microsatellite alterations

• 6000 Litvanian liquidators cleaning the Chernobly NPP in are investigated to the quantitative radiation exposure, additional harmful exposures

• They are followed for the occurence of diseases

Average No of Diseases in Latvian Chernobyl Cleaners

• Radyasyon dozu: 0,1 mSv-500 mSv

Diseases of Different Systems in Latvian Chernobyl Cleaners

Oncological Diseases in Latvian Cleaners

Eglite ME Immunopharmacol 2009; 17: 168

Health Effects of Chernobyl Disaster: Methodological Challenges

• Most of the epidemiological studies are descriptives Latent period between the accident and cancer occurence has not been investigated

• Increased risk between pre and post cathastroph could be due to the biased approach such as:– Keeping the medical records complete and accurate after the

disaster– Or in the more seriously affected rural area the records might

underestimate the number of cases – Cancer registry:– In Chernobyl region the cancer cases were actively reported

non- Chernobyl regions cancer reports were passive – Exposure assessment Previous conditions The previous

exposures, immigration to the region were not taken into account

Moysich K Lancet Oncol 2002; 269

Chernobyl Catastrophe and Turkey

Çernobil Kazasından Sonra Türkiye’de Kanser İnsidensi

Fukushima Nuclear Disaster

• In 11 March the earthquake of 9 amplitude has been occured in Tohuku. Following the earthquake, 11 m hight of Tsunamı waves caused flooding the nuclear reactor Fukushima followed to electrical interruption whic resulted explosion of the power plant Çernobil’den sonra dünyanın en büyük çevre felaketi

• Radipactive material dispersed was composed of :– %43 Cs 137,Cs 136 ve Cs 134– %17 I 131– %13 Te 132/I 132– %10,5 Ru 103/Rh 103– %9,5 Ba 140/La 140– %4 Ny 95

IRSN Report DRPH 2011-10

Population and Area Affected by Nuclear Disaster

• The most contaminated area beyond the 20 km radius of the plant is 8% of Chernoby (874 km2/10 300 km/2)

• But the people affected is %26 of Chernobyl (69 400/270 000): 0-14 the rate of children 0-14 age %13,7

• External collective radiation dose for Fukushima 4400 personSv for Chernobyl 7300 personSv

• If those area are not evacuated in next 4 years it is estimated that external radiation exposure will be 60% of Chernobyl

• Those estimates are for external radiation dose• Internal radiation taken by water and foods are not

included

IRSN Report DRPH 2011-10

Conclusions

• There is no threshold limit for the harmful effects of radiation on health

• Radiation exposure during radiotherapy and nuclear accidents are not comparable

• The effects resulting of a nuclear accidents may affect large area, involve a million of people and many generations

• There is no agent profilacting, mitigating or reversing the harmful effects of radiation.

• In acute radiation syndrome the treatment directed to the each damaged organ is expsensive, not effective and reserved to the limited number of victims of relatively local power plant accident rather than great catastrophes involving masses

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