Transcript The Radiological Accident in Goiana

RADIOLOGICAL ACCIDENT IN
GOIÂNİA
Module XIX
137Cs-accident,
Goiânia, Brazil
September 13, 1987
Goiânia
Rio de Janeiro
Angra NPP
Sao Paulo
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Accident description
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Source
137CsCl
(caesium chloride)
50.9 TBq (1375 Ci)
main gamma: 0.66 MeV
main beta: 1.17 MeV
T 1/2=30 years
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Radiological triage
112 000 persons monitored
249 identified contaminated
120 only clothing and shoe contamination
129 internal contamination
50 subjected to direct medical surveillance
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Technical management of
accident
85 residences (houses) had significant level
of contamination, 41 evacuated, 4 demolished
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Environmental aspects of 137Cs
accident in Goiania
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Initial surveys conducted in suspect homes and
work areas
67 km2 urban area of Goiania city monitored using
helicopter to identify all hotspots (few mGy/hr to >2
Gy/hr)
2000 m2 contaminated
Several household pets (cats and dogs) and some
livestock (pigs) slaughtered
Air and water samples negative
3000 m3 contaminated (radioactive) material
collected, 50.6 TBq 137Cs recovered; <0.37 TBq
remained
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Internal dose assessment
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Dose assessment by
cytogenetic dosimetry
Re-estimated dose through
cytogenetics (Gy)
< 0.1 - 0.49
Number of individuals
0.50 - 0.99
8
1.00 - 1.99
8
2.00 - 2.99
3
3.00 - 3.99
2
4.00 - 4.99
2
5.00 - 5.99
1
Total
129
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Medical aspects
250 persons exposed
50 persons WB exposure or local radiation injury
14 bone marrow depression
8 ARS
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28 local radiation injury
4 died
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Therapeutic measures during
critical period
Managing critical period of ARS,
bone marrow suppression
 Therapy for local radiation injury
 Decorporation of caesium-137
 General support and psychotherapy
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Treatment of haematological
syndrome
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8 ARS patients with estimated doses
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1  2-4 Gy
5  4-6 Gy
2  >6 Gy received GM-CSF therapy
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Four patients died: two of hemorrhage and two of t
sepsis from Klebsiella infection
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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
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Radiation skin injuries
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Radiation induced skin injuries caused by gamma and
beta radiations observed in 28 who had handled
source housing or fragments of source
12 of the 28 victims had multiple injuries affecting
predominantly upper limbs
Injuries did not heal completely and relapsed in 8
patients, who then required surgical debridement,
amputation of digital extremities and plastic skin
grafts
In 1997 one severely irradiated patient developed a
malignant skin lesion on lower limbs which was
surgically excised
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Therapeutic management of localized
radiation injuries:
Goiânia experience-ı
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Pain management
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Reduction of inflammatory reaction
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Opioid analgesia, extradural opioid analgesia
Systemic and local NSAID
Extract of aloe vera
Cleaning of wounds and use of antiseptics prevention of infection
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Hands and fingers immersed in boric acid solution
reducing skin dryness, pain and itching
non-adherent dressing coated with neomycin
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Therapeutic management of localized
radiation injuries:
Goiânia experience-ıı
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Improvement of local microcirculation
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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
Surgical treatment
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Complete excision of damaged tissue
Skin graft abdominal flaps
Amputation
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Prussian blue therapy for caesium
decorporation
BLOOD
PB
PB
GI TRACT
LIVER
FECES
Schematic representation of PB action in body
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Prussian blue administration
in Goiania 137Cs Accident
46 persons received prussian blue
 Dosage related to internal body burden
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Initial 3 g/day then
3-6 g/day in adults exceeding 5 x ALI
 For children initial dose 1-1.5 g/day then
3 g/day for those exceeding 5 x ALI
 Five adults with very high burdens received 10
g/day
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Patient follow-up in
Goiania
Medical
 Cytogenetic
 Psychological
 Social
 Economic
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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
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Cytogenetic follow-up
(6 years)
Tdic=110 d at > 1 Gy
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Tdic =160 d at 0.3-1 Gy
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Half-life of dicentric chromosomes
and centric rings in nine 13-57 year
old people overexposed in Goiania
accident
T1/2 = 90-230 days
(Follow-up 7.5 years)
Psychological and social follow-up
of Goiania accident victims
• Psychological alterations
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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
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Cs retention curves of woman contaminated in fourth
month of pregnancy and her baby
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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
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