Radiologic Terrorism• Radiation Exposure• Dirty Bombs• Atomic Bombs

Five decades after the first atomic bomb

Terrorist atomic bomb

• Nuclear Power Plants

Three Mile Island accident 1978 in PA

Chernobyl accident, April 26, 1986, in the Ukrainian SSR

• Management of pregnant women and children

Radiologic Terrorism• Radiation Exposure• Dirty Bombs• Atomic Bombs

Five decades after the first atomic bomb

Terrorist atomic bomb

• Nuclear Power Plants

Three Mile Island accident 1978 in PA

Chernobyl accident, April 26, 1986, in the Ukrainian SSR

• Management of pregnant women and children

Accident at ChernobylSaturday, April 26, 1986 at 01:23:48

Chornobyl Nuclear Power Plant, Ukraine, USSR

Total Radioactivity Released by the accident

50-100 x 106 Ci

Total Radioactivity Released into Belarus

70%: 35-70 x 106 CI

Radioactive Materials Released by the Accident

I, Cs, Sr, Co, Xe, Kr, Pu, etc.

Williams D. Science and society: Cancer after nuclear fallout: lessons from

the Chernobyl accident. Nature Reviews Cancer 2002;2:543-549 (01 Jul).

Populations at High Risk for Thyroid Neoplasia from Exposure to Radiation

• Fetus after 12 weeks of gestation in April 1986.• Number of cases dramatically decreased after 2000.

• Children ages < 6 years in April, 1986.• Children ages 0 to 1 year have the highest risk.

• Children living in areas with iodine deficiency.• Greater radioiodine uptake increases the dose of

radiation exposure to the thyroid gland.

• Children exposed to > 1 cGy of radiation.• Rapid thyroid growth in young children occurs with

chromosomal rearrangements (PTC1 and PTC3).

The Carcinogenic Effects of Radiation

• The isotopes of iodine-131, -132, -133

• Chronic exposure to Cesium-137

• Higher tissue exposure to radiation occurs in those tissues that concentrate iodine:

– Thyroid → ↑ incidence of adenoma, carcinoma

– Breast → ↑ incidence of carcinoma

– Salivary gland

– Gastric mucosa

Iodine Prophylaxis in Poland

• Radiation detected 36 hours after initial release.• KI distribution began in the PM on day 3.

– 10.5 million doses of KI given to children– 7 milion doses of KI given to adults

• Exposure to radioiodines in infants age < 1 year– > 50 mSv (5 Rem) if unprotected from radioiodine– < 50 mSv when protected by KI + substituted

milk• KI caused ~ 40% reduction in Rem dose to thyroid.

With early prophylaxis, ~ 60-70% reduction in Rem dose primarily because inhaled 131I is blocked.

• Incidence of 0.2% for medically significant, but not serious side effects.

Radiologic Terrorism• Radiation Exposure• Dirty Bombs• Atomic Bombs

Five decades after the first atomic bomb

Terrorist atomic bomb

• Nuclear Power Plants

Three Mile Island accident 1978 in PA

Chernobyl accident, April 26, 1986, in the Ukrainian SSR

• Management of pregnant women and children

Management of Pregnant Women and Children Exposed to Radiation

• Evacuation– Priority evacuation protocols for pregnant

women, infants and pre-pubertal children– Evacuation to an identified location at least 50

miles from the source of radiation

• Potassium Iodide– KI tablets or liquid administered on

notification by authorities of the possibility of radiation exposure.

– Dose schedules and negligible toxicity

Evacuation of Pregnant Women and Children Exposed to Radiation

• Priority Evacuation– Priority identification signs should be provided

to pregnant women and families of infants and pre-pubertal children to display on the windshield for priority rapid “HOV-lane” emergency evacuation.

– Evacuation routes should be defined in advance.

• Distance from Radiation Source– The radiation plume travels in the direction and

at the speed of the prevailing winds.– Biologically significant radiation exposure may

occur 100-200 miles from the source depending upon the atmospheric conditions.

Management of Pregnant Women and Children Exposed to Radiation

• Evacuation– Priority evacuation protocols for pregnant

women, infants and pre-pubertal children– Evacuation to an identified location at least 50

miles from the source of radiation

• Potassium Iodide– KI tablets or liquid administered on

notification by authorities of the possibility of radiation exposure.

– Dose schedules and negligible toxicity

KI Therapy for Pregnant Women and Children Exposed to Radiation

• Potassium Iodide for Radioiodine Exposure– Pre-packaged, pre-distributed KI tablets or liquid

should be readily available in homes, schools, day care centers and nurseries near reactors.

– On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency.

• KI toxicity– Negligible, minor side effects, and rare in children.

Potassium Iodide Doses

AAP Committee on Environmental Health. Pediatrics 2003;111:1459

KI Therapy for Pregnant Women and Children Exposed to Radiation

• Potassium Iodide for Radioiodine Exposure– Pre-packaged, pre-distributed KI tablets or liquid

should be readily available in homes, schools, day care centers and nurseries near reactors.

– On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency.

• KI toxicity– Negligible except in very rare cases of iodinism.

Potassium Iodide Safety• KI toxicity

– Acute poisoning is uncommon– Hypersensitivity reactions are rare, but dangerous:

• Angioedema and laryngeal edema• Serum-sickness-like reactions

[fever, lymphadenitis, arthralgia, arthritis]• Chronic exposure

– Iodism (parotid pain and swelling); skin rashes– Goiter and primary hypothyroidism on occasion at any age

• Contraindicated during pregnancy and infancy• High dose KI as treatment of Sporotrichosis

– Children: 50 mg/dose tid; ↑ by 50 mg/dose daily– Children: 150-500 mg/dose up to 500-750 mg tid– Older Child: 250 mg tid; Maximum: 1-2 grams/dose tid

Management of Children Exposed to Ionizing Radiation

• Preparation: Supplies of KI, infant formula, powered milkEvacuation routes and locations

• Emergency battery operated communications– Radios– Cellular telephones

• Priority EvacuationDefined routes [HOV Routes]Priority evacuation Identification on vehicles

• Potassium iodidePriority 1: pregnant women and infantsPriority 2: young children

• Monitor TSH in infants and pregnant women

Radiologic Terrorism: Bibliography• Williams, Dillwyn. Science and society: Cancer after

nuclear fallout: lessons from the Chernobyl accident. Nature Reviews Cancer 2002;2:543-549 (01 Jul). [Review]

• CDC: www.bt.cdc.gov/radiation• AAP Policy Statement. Radiation disasters and children.

Pediat 2003;111(6):1455-1466.• Mettler FA, Voelz GL. Major radiation exposure – what to

expect and how to respond. NEJM 2002;346:1554-1561.• www.atomicarchives.com/Example/ExampleStart.shtml• Nauman J, Wolff J. Iodide prophylaxis in Poland after the

Chernobyl reactor accident: Benefits and risks. Am J Med 1993;94(5):524-532. [Review]

• Nagataki S, Yamashita S, Eds. Nagasaki Symposium Radiation & Human Health, Elsevier, 1996, p xii.