Dosimetric and medical aspects of the radiological accident in Goiânia in 1987

102 Pages·2002·10.69 MB·English

IAEA TECDOC-1009
Dosimetric and
medical aspects of the
radiological accident in
Goiânia in 1987
AEA
iNTSRNATtONAl ATOMIC ENERGY AGENCY
June 1998
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DOSIMETRIC AND MEDICAL ASPECTS OF THE
RADIOLOGICAL ACCIDENT IN Goiânia
IAEA, VIENNA, 1998
IAEA-TECDOC-1009
ISSN 1011-4289
©IAEA, 1998
Printed by the IAEA in Austria
June 1998
FOREWORD
In September 1987 a l37Cs medical teletherapy source was stolen, removed from its
shield and ruptured, causing a radiological accident in Goiânia, Brazil. The causes and
consequences of the accident were reported by the IAEA in 'The Radiological Accident in
Goiânia" (IAEA, Vienna, 1988).
Now, ten years after the accident, this TECDOC describes the experience of some of the
scientists and physicians who were involved in the management, monitoring and treatment of
the victims of the Goiânia accident. Many scientific papers have been published on the
subject in different journals. This publication compiles up to date conclusions on the ten year
follow-up of the health effects of the Goiânia accident and summarizes the experience that
was acquired. It consists of material prepared primarily at the Institute of Radiation Protection
and Dosimetry of the National Nuclear Energy Commission of Brazil, under the supervision
of D.R. Melo and J.L. Lipsztein.
The IAEA wishes to thank all those involved in the compilation of this publication. The
IAEA officers responsible for the review and preparation of this TECDOC were
M. Gustafsson and I. Turai of the Division of Radiation and Waste Safety.
EDITORIAL NOTE
n preIpare iepnae ghIgh AethEhst itAfsr t ophmu pa br vlfepiu coromaestaisfdo, e nsta ff
original manuscripe th(vTsi)e. ws exprt oenns esoecdde ssarily reflect te hhItoA fsoEeeh At,
governments of the nominating Member States or the nominating organizations.
Throughout the text names of Member States are retained as they were when the text was
compiled.
Te sohufe particular designations of countrir eotse rritories dot oienms y jnpualdy gemeynbt
the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and
institutions or of the delimitation of their boundaries.
The mention of names of specific companies or products (whether or not indicated as
registered) does not imply any intention to infringe proprietary rights, nor should it be construed as
an endorsement or recommendation on the part of the IAEA.
CONTENTS
1.1. Background......................................................................^^ 1
1.2. Objective........................................................................................................................ 1
1.3. Scope.........................................................................................................................1.... .
1.4. Stracture......................................................................................................................... 2
2. DESCRIPTION OF THE ACCIDENT................................................................................. 3
2.1. Detection of the accident................................................................................................ 3
2.2. Contae emnhvinti raoftinoomn ent with I37Cs. ......... ................................................4.... .
2.3. Technical managemente ht fo accident..........................................................................4
References.............................................................................................................7............. ...
N VII VN DVOI3IN TB .RAIOO ASSAY..........................................................................8.... .
3.1. Introduction.................................................................................................................... 8
3.2n vI. itro measurements...................................................................................................8.
3.2.1. Sample preparation....................................................................... ........................ 9
3.2.2. Measurement system ........................................................................................9....
3.3. In vivo measurements ....................................................................................................10
3.3.1. Conse tmrhuetca tsfiuoorn ement system.......................... .............................1... .1..
3.3.2. System calibration ................................................................................................ 1 1
3.3.3. Measurement procedures...................... .............................................................. ..14
3.3.4. System relocation ................................................................................................41.
3.3.5. System optimizationr onf ewborn measurements.................................................51
3.3.6. Operational adjustments ....................................................................................... 16
3.3.7. Implementation of a multiple geometry system for whole-body
measurements ...................................................................................................8..1..
3.4. Comparison between in vivo and in vitro bioassay methods......................................... 18
3.5. Simplified meto heosttd imate actif vinoitcy orporated l37Cs........................................21
3.6. In vivo measurements for specific regions of the body.................... ........................... ...22
3.6.1.n Iv ivo measuremente shst ni car tissues......................... .................................. ...23
3.6.2n .Iv ivo measurements fol 37Cs distributioe hbtn noi da y lnio ng period
after intake......................................................................................................... ...23
3.7. Conclusions.................................................................................................................. ..25
References ............................................................................................................................. 25
4. CAESIUM BIOKINETICMODEL......................................................................................27
4.1. Introduction....................... ............................................................................................. 27
4.2. Caesium biokinetic model.................................................. ........................................ ....28
4.2.1. First term of the retention equation ......................................................................28
4.2.2. Second terme ht for etention equation....................................... ...........................03
4.2.3. Third tere rhmte fot ention equation ....................................................................33
4.3. Conclusion ................................................................................................................ .....33
References......................................................................................................................... ....35
5. EFFICACY OF PRUSSIAN BLUE THERAPY FOR DECORPORATION OF
CAESIUM.....................................................................................................................
5.2. Data from people internally contaminated in theGoiânia accident...............................38
5.3. Experiment with dogs ....................................................................................................41
5.4. Further related human data ............................................................................................44
5.5. Conclusions obtained from both sources of data...........................................................45
References.............................................................................................................................46
6. CAESIUM METABOLISM IN PREGNANT WOMEN .....................................................47
6.1. Introduction....................................................................................................................47
6.2. First case — Internal contamination with 137Cs in the fourth month of pregnancy .......48
6.3. Second case — Pregnancy three years and eight months after the l37Cs intake ............50
6.4. Conclusion.....................................................................................................................52
References.............................................................................................................................52
7. INTERNAL DOSE ASSESSMENT.....................................................................................53
7.1.Introduction....................................................................................................................53
7.2. Dose calculation.............................................................................................................53
7.3. Conclusions....................................................................................................................55
References.............................................................................................................................56
8. DOSE ASSESSMENTS AND CYTOGENETIC FOLLOW-UP.........................................57
8.1. Introduction....................................................................................................................57
8.2. Methodology..................................................................................................................58
8.2.1. Chromosome analysis...........................................................................................58
8.2.2. Calibration curve and reestimates of dose............................................................59
8.3. Results............................................................................................................................59
8.3.1. Reestimates of dose..............................................................................................59
8.3.2. Cytogenetic follow-up..........................................................................................60
8.3.2.1. Six year study..........................................................................................60
8.3.2.2. Mean functions of disappearance of unstable aberrations ......................64
8.3.2.3. Seven-and-a-half year study ....................................................................65
8.4. Discussion......................................................................................................................66
References.............................................................................................................................67
9. CLINICAL ASPECTS AND TREATMENT OF LOCALIZED RADIATION-
INDUCED LESIONS...........................................................................................................70
9.1.Introduction....................................................................................................................70
9.2. Clinical aspects of localized radiation-induced injuries in general................................70
9.3. Therapeutic management of localized radiation injuries: the Goiânia experience ........76
9.3.1. Clinical treatment.................................................................................................76
9.3.1.1. Pain management....................................................................................76
9.3.1.2. Reduction of inflammatory reaction .......................................................77
9.3.1.3. Healing acceleration................................................................................??
9.3.1.4. Cleaning of wounds and use of antiseptics — Prevention of infection ..77
9.3.1.5. Improvement of local microcirculation...................................................78
9.3.2. Surgical treatment ................................................................................................78
9.4. Lessons learned..............................................................................................................79
9.5. Conclusions....................................................................................................................80
9.6. Final remarks..................................................................................................................81
10. THE INFECTIOUS COMPLICATIONS AND HEMATOLOGICAL DISORDERS
IN THE Goiânia RADIATION ACCIDENT VICTIMS ................................................83
10.1. Introduction.................................................................................................................83
10.2. Patients........................................................................................................................83
10.2.1. Hematologicalsyndrome..................................................................................84
10.2.2. Infectious complications...................................................................................85
10.3. Conclusions.................................................................................................................86
References.............................................................................................................................86
11. THE MEDICAL FOLLOW-UP (1990-1997) ....................................................................88
ll.l.Introduction.................................................................................................................88
11.2. Preliminary triage of the radiation exposed population ..............................................88
11.3. The plan for levels of patient care...............................................................................88
11.4. Clinical and laboratorial evaluation............................................................................89
11.5. Therapeutic measures..................................................................................................89
11.6. Hematological aspects.................................................................................................89
11.7. Radiation skin injuries ................................................................................................89
11.8. Clinical aspects — update (1990-1997) .....................................................................90
11.9. Psychological aspects..................................................................................................91
References.............................................................................................................................92
CONTRIBUTORS TO DRAFTING AND REVIEW ..............................................................93
1. INTRODUCTION
1.1. BACKGROUND
In September 1987, in Goiânia, a city of one million inhabitants and capital of the
Brazilian State of Goias, a rotating assembly of the shielding head of a teletherapy unit was
removed and the capsule containing 50.9 TBq (1375 Ci) of l37Cs was dismantled. This
serious radiological accident resulted hi four fatalities, injuries to many people, and the
widespread contamination of the central part of Goiânia.
The accident yielded lessons that cover the pre-accident period, the response and the
post-accident phases. It is important to know about the operational difficulties that were faced
in Goiânia including the differences between the technical evaluation and public opinion in
order to inform individuals and organizations that may face similar emergency situations.
The accident also had several adverse effects that are not mentioned in publications
concerned with emergency planning and preparedness. These include psychological aspects,
such as fear and depression amongst the population, and discrimination against the victims
and important products of the local economy. All these lessons must be analysed in terms of
the implications for safety culture and the experience gained. There is still much to be learned
from the radiological accident in Goiânia.
A complete internal dosimetry study was conducted, which included six years of in vitro
and in vivo bioassay monitoring. This study included data on people who had ingested
radionuclides as a result of the accident and were treated with Prussian Blue (PB), a drug
given to enhance the elimination of caesium form the body, and on others who were not
treated with the drug. A 7.5 years cytogenetic follow-up of unstable chromosomal aberrations
was also conducted for the most exposed patients. In March 1988, a medical follow-up
protocol was established between the National Nuclear Energy Commission of Brazil and the
Leide das Neves Foundation, hi Goiânia, in order to assist the victims of the accident. For ten
years, the patients have been examined and treated by physicians from the Leide das Neves
Foundation, in collaboration with the team responsible for the early medical response.
1.2. OBJECTIVE
This TECDOC describes the dosimetric and medical aspects of the Goiânia accident,
including the experience of some of the scientists and physicians who were involved in the
management, monitoring and treatment of the victims. Many scientific papers have been
published on the subject in different journals. This publication compiles up to date
conclusions on the 10 year follow-up of the Goiânia accident victims, and summarizes the
experience that was acquired.
1.3. SCOPE
This publication is intended for institutions, radiation protection specialists, physicians
specialized in the treatment of radiological or nuclear accident patients and emergency
response groups. It provides useful information for the handling of accidents involving
internally contamination with radiocaesium, for the implementation of monitoring and
medical intervention procedures, and dose assessment.
1.4. STRUCTURE
Chapter 2 is a brief description of the accident. Detailed technical information is
provided in eight sections, describing the methods and results of bioassay, dosimetry, and
treatment, as well as the complications observed. Each section has conclusions and
references. Chapter 11 summarizes the ten year experience of dosimetry and medical aspects
of the Goiânia accident, including an update of the medical follow-up for the period of 1990-
1997.