Overview of the Radiation Emergency
Assistance Center/Training Site (REAC/TS):
An NNSA Asset
Albert L. Wiley, BNE, MD, PhD,USNR(RET)
albert.wiley@orise.orau.gov
Director,
REAC/TS and WHO Collaborating Center
at Oak Ridge ,TN. USA
AAPM/ACMP Workshop, Va. Beach, Va. May 4,09
1
REAC/TS
A program of the
Oak Ridge Institute for Science & Education (ORISE)
Operated for
the US Department of Energy (DOE)
by
Oak Ridge Associated Universities (ORAU)
A World Health Organization (WHO) Collaborating
Center
and member of the
WHO Radiation Emergency Medical
Planning & Assistance Network (REMPAN)
2
REAC/TS Missions – 24/7
3
REAC/TS’ 24/7 Missions
Provide 24/7 Radiation Medicine advice and consultation
and Health Physics radiation dose assessments.
Provide NNSA 2 Deployable Emergency Response Teams
(ERT 1 & 2) for
on-scene assistance – may transition to
DHS after a major incident
Each team consists of:
Physician
Health Physicist
Nurse/Paramedic
4
Domestic & International
Deployment Capability, per NNSA
CONUS – 4 hours wheels up OCONUS – 6 hours wheels up
5
REAC/TS International
Activities & Emergency Response
Capabilities
Coordinates United States participation in the World Health
Organization’s (WHO) Radiation Emergency Medical
Preparedness and Assistance Network (REMPAN) .
REAC/TS ‘ staff (per IAEA request and NNSA approval) is
available to assist the International Atomic Energy Agency
(IAEA), Vienna, Austria with “on site
radiation accident investigation, medical management, after
action reports, and international planning for response to
radiation emergencies
REAC/TS is available to host 4-6 week IAEA Radiation
Medicine fellowship programs at our Oak Ridge ,TN.
Training Site.
6
International Emergency Response
and/or Training Since 1976
Armenia (training)
Australia (training)
Brazil (response & training)
Canada (training)
Cuba (training)
Egypt (training)
England (training)
Former Soviet Union
(response & training)
Hong Kong (training)
Jamaica (response)
Japan (response & training)
Jordan (training)
Kazakhstan (response &
training)
Lithuania (training)
Malaysia (training)
Mexico (response & training)
Panama (response)
Peru (response)
Poland (training)
Romania (training)
Russia (response & training)
South Korea
Sri Lanka (training)
Taiwan (training)
United Arab Emirates
(training)
Venezuela (response &
training)
7
Other REAC/TS’ Missions
Maintain a Radiation Accident Registry for Radiation
Medicine research
Maintain registry of DTPA (diethylene-triaminepentaacetate or pentatate) and Prussian Blue
therapies
Manage DTPA and Prussian Blue New Drug
Application (NDA) status for the U.S. Food and Drug
Administration (FDA)
8
2008 REAC/TS Activities
REAC/TS CBL participated in an international
interlaboratory Dicentric Chromosome Analysis
collaboration study with Health Canada, specifically
geared toward triage of radiation incident victims.
REAC/TS CBL also began program for FISH
(Fluorescence In-Situ Hybridization) and Micronuclei
Analysis and began collaboration with AFRRI on
Proteomic Biodosimetry studies of radiation accident
victims.
REAC/TS staff participated in multiple international
NNSA/IAEA /WHO meetings/training/exercises (Argentina,
Korea, Mexico, for example) and applied to join IAEA
RANET as an NNSA asset..
9
Official Use Only
9
2008 Training
Off-site course attendance:
•29 outreach programs were provided
TOTAL: 731 participants
Special courses
•CDC: 38 participants
•Radiation Injury Treatment Network (RITN):
26 participants
TOTAL COURSE PARTICIPANTS (2008): 1,032
10
Official Use Only
10
2008 Responses/On Site
Training:
REAC/TS responded to 200 calls, 50 of which were
classified as “calls for assistance”
On-site (Oak Ridge) routine course attendance:
•Pre-hospital : 25 participants
•Radiation Emergency Medicine: 123
participants
•Advanced Radiation Medicine: 32
participants
•Health Physics in Radiation Emergencies: 57
participants
TOTAL: 237 participants
Official Use Only
11
11
REAC/TS’ Continuing Medical
Education Courses
A primary REAC/TS’ Mission is to provide continuing
medical education to health care providers and health
physicists for practical training to strengthen the US
and world capabilities to respond to and manage the
medical aspects of a radiological/nuclear event.
Common to all REAC/TS training:” Emergency Medical
needs always take priority over decontamination
concerns.” (Our on site courses provide a day of
realistic, monitored/evaluated Emergency Room
Drills to insure that the student understands this
priority.)
12
REAC/TS’ Training/CME Mission
Provide US and International Radiation Medicine and
Health Physics courses with Special Instruction on Medical
Management of Internal /External Radionuclide Contamination
*REAC/TS’ hallmark is
integration of health
physics with medicine.
Courses are AMA
CME Catagory 1
accredited.
13
REAC/TS has special experise
and tools for medical management
of internal contamination
DTPA Co-investigators (24)
Maintain Registries of DTPA and PB use in
US
Provide a stock of pharmaceuticals at
REAC/TS and with co- investigators for
treatment of internal contamination:
Prussian Blue
Co-investigators (8)
• Ca- and Zn-DTPA
• Prussian Blue (Radiogardase®)
Through a network of physician co-investigators, special drugs are readily
available in the event of radiation emergencies including nuclear terrorism.
14
Internal Contamination is :
the deposition of radioactive material inside the body.
Common Routes of Entry
• Inhalation
• Ingestion
• Absorption through wounds or skin
• Injection
15
Methods for Assessing Intakes
Whole Body or Lung Counting:
• Feasible for nuclides that emit
penetrating x or gamma rays.
• Useful also for nuclides emitting
energetic beta particles - can be
detected by their bremsstrahlung
radiations.
Bioassay:
• 24 hour Urine collections - most
widely used.
• 24 hour Feces collections
• Excised material from wounds.
Cytogenetic Biodosimetry (? FISH, micronuclei)
16
Inhalation
Mansfield (1997): intakes due to particle
sizes in the 1 to 5 µm AMAD range can be
estimated by assuming that the nasal swab
results are about 5%-10% of the intake.
ICRP 66 (ICRP 1994): the ratio of deposition
between the external nasal passages and the
other respiratory tract compartments is 1 to
4.1 for 5 µm particles (25% of intake in
nares)
17
Dose Magnitude Estimation
(Wounds)
Perform a direct
count of the wound
Convert the reading
to an activity
(MCi/MBq)
Compare the activity
to the ingestion ALI
multiplied by the f1
value
18
Percent Deposited
Uptake of Actinides (Pu, Am,
Cf, etc.) is Remarkably Rapid
100
80
60
Bone
Deposition
40
20
0
0
1
2
Time (Hours)
19
Prompt DTPA Treatment of
239Pu Intake is Highly Effective
Retention (% of Uptake)
Control
DTPA Treated
Liver
14.0
0.47
Skeleton
57.0
5.9
20
Rapid Diagnosis, Internal Dose
Assessment and Prompt
Treatment are All Important !
Incident history/reconstruction with health
physics input are essential
Wound surveys
Facial surveys
Nasal swipes
Nasal blows
Sputum
Spot urine – check for gammas
Stool, if actinides, monitor alpha activity
21
Am-241 Inhalation, Example
Two workers were transferring 241Am from
a shipping barrel to a disposal container.
The workers were wearing respiratory
protection.
But, a supervisor, also present, was not
wearing respiratory protection.
22
Am-241 Example (continued)
On exit, all three workers were noted to
be contaminated – and room air samples
were positive for alpha.
Lung count bioassay was advised and
performed the next day - all 3 patients
were positive.
24 hr urine and fecal bioassay collections
were advised and begun.
23
Initial Intake and Effective Dose
Estimates from Bioassays
Patient #1: 1.8 kBq, 210 mSv
Patient #2: 0.63 kBq, 73 mSv
Patient #3: 0.15 kBq, 17 mSv (?Stop
DTPA?).
Chelation begun on day 2 with Ca-DTPA
for the males and Zn-DTPA for the female,
and continued daily with Zn-DTPA for 5-6
days
24
Averted Doses obtained by Prompt
intra-venous DTPA Treatment
Patient #1:
• w/o DTPA: 210 mSv
• w/ DTPA: 49 mSv
Patient #2:
• w/o DTPA: 73 mSv
• w/ DTPA: 38 mSv
Patient #3:
• w/o DTPA: 17 mSv
• w/ DTPA: 10 mSv
25
Cesium Internal Contamination of A
Mass Population :Goiania Accident
Example
137Cs
(physical half-life, 30 years; biological halflife 109 days) is the dominant radioisotope in
aged fission products
Cs 137 Distributes in body fluids similarly to
potassium
One gram orally three times daily x 3 weeks
reduces the biological half-life to about 1/3 of the
normal value (low ALI). For higher intake, titrate
upward
Goiania Data:
Cs 137 Dose Aversion by PB
Treatment
27
REACTS BIODOSIMETRY TOOLS:
REAC/TS-NNSA -ORISE Cytogenetic Biodosimetry Laboratory
For REAC/TS Routine Operations ,Dicentric Chromosome Analysis is
utilized ;but Micronuclei and FISH Analysis is also under development.
28
Cytogenetic Biodosimetry Capability
Di-Centric Analysis is the “Gold” standard for radiation
biodosimetry assessments
REAC/TS Lab is national NNSA emergency response asset
Utilizes metaphase spreads of Old
lymphocytes to search for
chromosome aberrations (dicentrics)
specific to radiation exposures
Labor Intensive
Automated Cytogenetics Workstation
Karyotype
Slide Feeder
Computer
Output
Microscope
29
Example: Goiania Cytogenetic Dose
Estimates in a Population Exposed to
Dispersed Cs 137
Range [Rem]
No. of Persons
Relative Frequency [%]
0 – 50
43
61.43
50 – 100
8
11.43
100 – 200
6
8.57
200 – 300
5
7.14
300 – 400
0
0
400 – 500
3
4.29
500 – 600
3
4.29
600 – 700
2
2.58
Total
70
100.00
30
Other Biodosimetry: MicroNuclei: Radiation Dose
Response(? for PU)
Wiley, AL and Lee ,TK: Systemic T-Lymphocyte Toxicity from Prostate
Radiotherapy, Endocurietherapy /Hyperthermia Oncology, 12:1-6, 1996.
31
Thanks for your
attention!
QUESTIONS?
albert.wiley@orise.orau.gov
32