RADIOLOGICAL ACCIDENT IN GOIÂNİA RADIOLOGICAL ACCIDENT IN GOIÂNİA Module XIX

Module Medical XIX-(18) Cs-accident, Goiânia, Brazil September 13, 1987 Goiânia Rio de Janeiro Sao Paulo Angra NPP

Module Medical XIX-(18) - 3 Accident description

Module Medical XIX-(18) - 4 Source 137 CsCl (caesium chloride) 50.9 TBq (1375 Ci) main gamma: 0.66 MeV main beta: 1.17 MeV T 1/2 =30 years

Module Medical XIX-(18) - 5 Radiological triage persons monitored 249 identified contaminated 120 only clothing and shoe contamination 129 internal contamination 50 subjected to direct medical surveillance

Module Medical XIX-(18) - 6 Technical management of accident 85 residences (houses) had significant level of contamination, 41 evacuated, 4 demolished

Module Medical XIX-(18) - 7 Environmental aspects of 137 Cs accident in Goiania l Initial surveys conducted in suspect homes and work areas l 67 km 2 urban area of Goiania city monitored using helicopter to identify all hotspots (few mGy/hr to >2 Gy/hr) l 2000 m 2 contaminated l Several household pets (cats and dogs) and some livestock (pigs) slaughtered l Air and water samples negative 3000 m 3 contaminated (radioactive) material collected, 50.6 TBq 137 Cs recovered; <0.37 TBq remained

Module Medical XIX-(18) - 8 Internal dose assessment

Module Medical XIX-(18) - 9 Dose assessment by cytogenetic dosimetry Re-estimated dose through cytogenetics (Gy) Number of individuals < Total129

Module Medical XIX-(18) - 10 Medical aspects 250 persons exposed 50 persons WB exposure or local radiation injury 14 bone marrow depression 28 local radiation injury 4 died 8 ARS

Module Medical XIX-(18) - 11 Therapeutic measures during critical period Therapeutic measures during critical period l Managing critical period of ARS, bone marrow suppression l Therapy for local radiation injury l Decorporation of caesium-137 l General support and psychotherapy

Module Medical XIX-(18) - 12 Treatment of haematological syndrome l 8 ARS patients with estimated doses 1  2-4 Gy 5  4-6 Gy 2  >6 Gy received GM-CSF therapy l Four patients died: two of hemorrhage and two of t sepsis from Klebsiella infection l Two patients who received high doses (7.0 and 5.5 Gy) and exhibited bone marrow depression but were not treated with GM-CSF spontaneously recovered and survived

Module Medical XIX-(18) - 13 Radiation skin injuries l Radiation induced skin injuries caused by gamma and beta radiations observed in 28 who had handled source housing or fragments of source l 12 of the 28 victims had multiple injuries affecting predominantly upper limbs l Injuries did not heal completely and relapsed in 8 patients, who then required surgical debridement, amputation of digital extremities and plastic skin grafts l In 1997 one severely irradiated patient developed a malignant skin lesion on lower limbs which was surgically excised

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Module Medical XIX-(18) - 19 Therapeutic management of localized radiation injuries: Goiânia experience-ı l Pain management Opioid analgesia, extradural opioid analgesia l Reduction of inflammatory reaction Systemic and local NSAID Extract of aloe vera l Cleaning of wounds and use of antiseptics - prevention of infection Hands and fingers immersed in boric acid solution reducing skin dryness, pain and itching non-adherent dressing coated with neomycin

Module Medical XIX-(18) - 20 Therapeutic management of localized radiation injuries: Goiânia experience-ıı l Improvement of local microcirculation Pentoxifylline, which decreases blood viscosityused in two patients, reducing risk of early formation of microthrombi, thus improving blood flow in injured tissues Hyperbaric oxygen therapy (HOT) hastened granulation at wound edges, reduced ulcerated area considerably increasing local pO2, thus facilitating integration of graft with damaged area l Surgical treatment Complete excision of damaged tissue Skin graft abdominal flaps Amputation

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Module Medical XIX-(18) - 22 Prussian blue therapy for caesium decorporation Figure Schematic representation of the PB action in the body. PB Schematic representation of PB action in body

Module Medical XIX-(18) - 23 Prussian blue administration in Goiania 137 Cs Accident l 46 persons received prussian blue l Dosage related to internal body burden Initial 3 g/day then 3-6 g/day in adults exceeding 5 x ALI For children initial dose g/day then 3 g/day for those exceeding 5 x ALI Five adults with very high burdens received 10 g/day

Module Medical XIX-(18) - 24 Patient follow-up in Goiania l Medical l Cytogenetic l Psychological l Social l Economic

Module Medical XIX-(18) - 25 Medical follow-up of Goiania accident victims Status of skin injuries after initial healing –8/28 patients required surgery in 1989, and 6/28 in 1990 –One patient required repeated surgery in 1991, ‘92, ‘93 Skin lesions tended to be affected by stress Sperm count in males now normal - 2 exposed in teenage males have fathered healthy children Follow-up of children - 7 exposed in utero have no abnormalities –10 conceived post-accident born with no abnormalities

Module Medical XIX-(18) - 26 Cytogenetic follow-up (6 years) T dic =110 d at > 1 GyT dic =160 d at Gy

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Half-life of dicentric chromosomes and centric rings in nine year old people overexposed in Goiania accident T 1/2 = days (Follow-up 7.5 years)

Module Medical XIX-(18) - 29 Psychological and social follow-up of Goiania accident victims Psychological alterations –increase in psychosomatic disorders –fear of leukaemia and early death –increased use of alcohol and drugs –lack of self-confidence Discrimination –by others due to fear –self-discrimination from social contact Stigmatization –victims blamed for accident by many citizens

137 Cs retention curves of woman contaminated in fourth month of pregnancy and her baby

Module Medical XIX-(18) - 31 Summary of therapeutic measures 8 patients with severe BM syndrome treated with GM-CSF 4 died due to haemorrhage and sepsis None received BMT All surviving patients - normal blood counts since 1988 (quarterly check ups and CBC) 3-10 g/day prussian blue to adults, 1-3 g/day to children 28 patients treated surgically for radiation skin injuries relapse in 8 patients leading to fibrosis in 4