Radiation Injury From A Nuclear Accident Or Terrorist Attacknebraskasurgicalresearch.com/s NSR/presentation_pdf/2008... · Radiation Injury From A Nuclear Accident Or Terrorist Attack

©1957, Universal Newsreels

Introduction

[go to movie file “Vid1_Intro.mp4”]

Mark A. Carlson, MD

Department of SurgeryUniversity of Nebraska Medical Center

Omaha VA Medical CenterOmaha, Nebraska

USA

Radiation Injury From A Nuclear Accident Or Terrorist Attack

UNMC Dept Surgery Grand Rounds, April 2, 2008

Overview—Radiation Injury

1. Impetus: Radiation Research

2. Ionizing Radiation (IR) Primer

3. Nuclear Blast Effects

4. Events: Past & Future

5. Pathophysiology of IR Exposure

6. IR Exposure: Dx & Rx

Trinity (first nuclear test)Jornada del Muerto, New Mexico

July 16, 1945

1. Impetus For Radiation Research

• Risk of Nuclear Terrorist Event• Project Bioshield• Centers for Medical Countermeasures against Radiation• National Strategy for Homeland Security• NIH Requests For Applications

Nuclear fireballt ~ 10-4 sec

radius ~ 30 m

Impetus:Risk of Nuclear Terrorist Event

• Estimation of risk depends onwho is talking

• Most agree risk is “elevated”

• Little agreement on whatshould be done

• IAEA (1957); NPT (1968)

• Concern: nuclear materials inthe FSU

• Concern: “other” nuclearpowers (Pakistan, India, N.Korea, Israel)

Five "nuclear weapons states" from the Nuclear Nonproliferation TreatyOther known nuclear powersStates formerly possessing nuclear weaponsStates suspected of being in the process of developing nuclear weapons

and/or nuclear programsStates which at one point had nuclear weapons and/or nuclear weapons

research programsStates that possess nuclear weapons, but have not widely adopted them

Worldwide Nuclear Weapons Status

Wikipedia

Impetus:Project Bioshield

• Signed into law 2004

• Part of broader strategy to counter WMD

• Increases funding for bioterror research (includingchemical, biological, radiological, and nuclear threats)

• Provides fed market for bioterror countermeasures

• Permits emergency use of unapproved countermeasures

Impetus:Centers for Medical Countermeasures against Radiation

(CMCRs)

• Established by NIH/NIAID in 2005

• Response to Project Bioshield

• Research on triage, prevention, andtreatment of radiation injury

CMCRs

1. Columbia Univ2. Dana Farber Canc Inst3. Duke Univ4. Fred Hutchinson Canc Ctr5. Med Coll Wisconsin6. UCLA7. Univ Pittsburgh8. Univ Rochester

Natl Inst Allergy Infectious Diseases

Impetus:National Strategy for Homeland Security

• Executive Office/Dept Homeland Security 2007

• To improve protection & response against bothnatural & man-made disasters

• Emphasis on development of countermeasuresfor nuclear and other WMDs

• Demonstrates seriousness in which the ExecutiveOffice perceives WMD threat

Impetus:NIH Requests For Applications, Fall 2007

1. RFA-AI-07-036: Medical Countermeasures to Enhance Platelet Regeneration and IncreaseSurvival Following Radiation Exposure (Sep 27, 2007)

2. RFA-AI-07-037: BARDA/NIAID Medical Countermeasures to Mitigate and/or Treat IonizingRadiation-Induced Cutaneous Injury (Dec 27, 2007)

3. RFA-AI-07-038: Radiation Combined Injury: Radiation Exposure in Combination with Burn,Wound, Trauma or Infection (Sep 27, 2007)

4. RFA-AI-07-039: Mechanisms, Diagnosis and Treatment of Radiation Injury from a NuclearAccident or Terrorist Attack (Oct 1, 2007)

5. RFA-AI-07-040: BARDA/NIAID Medical Countermeasures to Mitigate and/or Treat IonizingRadiation-Induced Pulmonary Injury: Project Bioshield (Dec 18, 2007)

☞

Natl Inst Allergy

Infectious Diseases

2. Ionizing Radiation Primer

Ionizing Radiation = high energy particles or waves that canionize (remove) electrons from an atom

Types: alpha, beta, neutron, gamma (= high energy photons)

Biologic Effects: disruption of chemical bonds, resulting indamage to protein, DNA, lipids, etc.

Units: one gray (Gy) = 1 Joule of radiation energy absorbed byone kilogram of matter

What is a Gy?10 kg

• Lethal total body dose in humans is ~10 Gy

• For a 70 kg person, this is equivalent to 700 J

• 700 J: equivalent to energy contained in 50 mgdextrose (1 gm dextrose = 3.4 kcal = 14,200 J)

• 700 J: equivalent to energy released by dropping10 kg weight from height of 7.1 meters


• Fireball = 107 ˚C = total incineration. Emits IR, vis, UV, neutron, gamma

radiation



radiation

• Flash: intense visible & UV light which can injure retinas



radiation


• Heat: infrared radiation, produces partial/full thickness burns at great

distances



radiation



distances

• Sonic wave: hearing loss



radiation



distances


• Ionizing radiation, from blast and/or fallout: acute & chronic radiation

syndromes; cancer



radiation



distances


• Ionizing radiation, from blast and/or fallout: acute & chronic radiation

syndromes; cancer

• Overpressure & wind: destroys structures (traumatic injuries)

Atomic Cannon (15 kt)Test Area 5, Nevada

May 25, 1953

Overpressure & Wind Radioactive Fallout

Operation Crossroads (21 kt)Bikini Lagoon, Marshall Islands

July 25, 1946


[go to movie file:“Vid2_AtomicCannon.mp4”]

[go to movie file:“Vid3_Fallout.mp4”]

4. Events: Past & Future

• Hiroshima• Nagasaki• Tsar Bomba• Chernobyl• Georgia

Select Past Events

Hiroshima: Monday, August 6, 1945, 8:15 AM

Past Event:Hiroshima

• Yield ~15 kt• Detonated 600 m above city• 1 day mortality ~70,000• 3 month mortality ~140,000• Radius of LD50 ~1250 m• Secondary fires• Another ~50,000 dead from

cancer by 1950

Nagasaki: Thursday, August 9, 1945, 11:02 AM

Past Event:Nagasaki

• Yield ~20 kt• Detonated 3 km off-target• 1 day mortality ~40,000• 3 month mortality ~80,000• Radius of LD50 ~1300 m• Secondary fires

Past Event:Tsar BombaOctober 30, 1961

• Weight = 30 tons• Yield ~50 megaton, or > 10x all

ordnance exploded in WWII• Heat felt at 800 km• Fireball visible at 2,500 km• Blast nearly killed crew of the Tu-95• Broke windows in Finland• Chicxulub event 2 mil x more powerful

Tsar Bomba

[go to movie file: “Vid4_TsarBomba.mp4”]

Past Event:Chernobyl, Ukraine 1986

• Worst nuclear plant accident ever• Reactor explosion with fallout plume• Initial Soviet cover-up• 336,000 people resettled (Chernobyl abandoned)• 47 workers killed by radiation during firefighting &

clean-up• Fallout spread over Europe & reached the USA• Plant covered with a concrete sarcophagus (now

scheduled for replacement)

Past Event: Nation of Georgia, 2000

• Minor incident, but a “sentinel” event• Three woodcutters in Georgia, FSU• Found “warm” canisters in woods• Suffered severe radiation burns• Canisters contained 90Sr for remote beacons• Reminded authorities (like the IAEA) about

noncontrolled nuclear materials in FSU

Future Events:Nuclear Weapon Simulation

• 1 kt weapon (“briefcase bomb”)

• Yield Comparison: 1 kt — 50 mt

☞

?

1 kiloton A-bomb simulation: Omaha, NE

Dodge

South Saddle Creek

King Kong restaurant

BOMB

Farnam

Douglas

South 44th

FIREBALL (1 kiloton A-bomb)

Dodge

Saddle Creek

d = 200 m

Farnam

Douglas

South 44th

COMPLETE DESTRUCTION (1 kiloton A-bomb)

d = 900 m

Lied Transplant Center

Joslyn Castle

fireball

Dept Surgery offices

LETHAL RADIATION (1 kiloton A-bomb)

d = 2.2 km

destroyed

FB

Memorial Park

Masonic Manor

Field Club

Mutual of Omaha

Kiewit Plaza

SEVERE BURNS (1 kiloton A-bomb)

destroyed

FB

d = 3.0 km

XRT

Memorial Park

VAMC

CUMC

Shaw’s house

SHATTERED WINDOWS (1 kiloton A-bomb)

d = 6.0 km

FB

destroyed

XRT

burns downtown

Elmwood Park

72nd & Dodge

Greek Islandsrestaurant

Comparison of weapon yields

1 kt = briefcase bomb15 kt = Hiroshima bomb1 mt = Minuteman missile

50 mt = Tsar Bomba

yield

(kt) example fireball (m)

complete

destruction

(km)

lethal

radiation

(km)

severe

burns

(km)

shattered

windows

(km)

1terrorist

weapon100 0.45 1.1 1.5 3.0

15Hiroshima

bomb400 1.12 1.5 3.5 7.4

1,000Minuteman

missile1,000 4.55 3.1 15 30

50,000Tsar

Bomba3,200 16.8 6.6 75 111

Radius of Effect

0

10,000

20,000

30,000

40,000

50,000

kilot

on

Tsar

Bom

ba

Minu

tem

an

Hiro

shim

a

Brief

case

FIREBALL COMPARISON: Omaha, NE

50 mt (Tsar Bomba)r = 3.2 km

1 mt (Minuteman)

15 kt (Hiro)

1 kt

NE Furniture Martdowntown

Rosenblatt Stadium

Ford birthplace

Zoo

LETHAL RADIATION COMPARISON: Omaha, NE

50 mt (Tsar Bomba)r = 6.6 km

1 mt (Minuteman)

15 kt (Hiro)

1 kt

Eppley Airfield

Council Bluffs

114th & Dodge

Satellite Motel

Lynch’s house

COMPLETE DESTRUCTION COMPARISON: Omaha, NE

50 mt (Tsar Bomba)r = 17 km

1 mt (Minuteman)

15 kt (Hiro)

1 kt

Offutt AFB

Council Bluffs

Carlson’s house

Thompson’s house

Sasson’s house

SEVERE BURN COMPARISON: Omaha, NE


1 mt (Minuteman)

15 kt (Hiro)

Missouri Valley

Fremont

Nebraska City

Lincoln

SHATTERED WINDOW COMPARISON: Omaha, NE


1 mt (Minuteman)

15 kt (Hiro)

Lincoln

Sioux City

Grand Island

Nebraska City

1 kt

Johnny Carsonbirthplace

Des Moines

Excerpted from “Duck & Cover” ©1952, Federal Civil Defense Administration and Archer Productions

Radiation Injury: Early Countermeasure Effort

[go to movie file: “Vid5_Duck&Cover.mp4”]

5. Acute & Subacute Pathophysiology of IR Exposure[Note shift in focus]

• CNS & cardiac: 20+ Gy, death in1-2 days

• GI: ~10 Gy, death in about oneweek (LD50/7)

• Hematologic: 3-4 Gy, death inabout one month (LD50/30)

• Cutaneous

• Polytrauma

Organ System, Dose, and Acute Mortality

(Values derived mostly from nontreated victims)

Figure 1. Percent mortality vs. TBI dose (in rads) in male vs.female Swiss Albino mice (NMRI strain), age 60-80 days.(Reproduced from Chapman, Radiat Res 1955;2:502.)

dose-mortality curve

5. Acute & Subacute Pathophysiology of IR Exposure

Limits of Radiation Tolerance in Human Tissue


Bone Marrow Syndrome


Gastrointestinal Syndrome


Subacute (& Chronic) Disease

• Radiation pneumonitis & pulmonary fibrosis• Radiation nephropathy & renal failure• Leukemia and other cancers

As supportive care for GI & BM syndromes improves,more victims will be susceptible to the above complications

☞

Pathophysiology: Hiroshima & Nagasaki Autopsy Findings

5. Diagnosis and Intervention for IR Exposure:

Dosimetry: are there any Dx techniques? Not really.

• Has patient been exposed?

• What was the absorbed dose?

• What is the patient’s prognosis?

Prophylaxis: available, but questionable relevance.

Mitigation: after exposure, before seriousmanifestations. Few; modestly effective (GF, ACEI).

Treatment: after exposure, with signs & symptoms ofillness. Mainly supportive care.

The Money $lide

“counte

rmea

sure

s”

Excerpted from “Dr. Strangelove”

©1964, Hawk Films

“We’ll Meet Again”

Written by Ross Parker & Hughie Charles, sung by Vera Lynn (1939)

Conclusions

[go to movie file: “Vid6_Strangelove.mp4”]

Documents

Radiation Injury From A Nuclear Accident Or Terrorist Attacknebraskasurgicalresearch.com/s NSR/presentation_pdf/2008... · Radiation Injury From A Nuclear Accident Or Terrorist Attack