Biological Effects of Ionizing RadiationBiological Effects of Ionizing Radiation

Deterministic effectsDeterministic effects

Case history – Case history – GoiâniaGoiânia accident accidentLectureLecture

IAEA Post Graduate Educational Course Radiation Protection and Safe Use of Radiation Sources

IAEA Post Graduate Educational Course Radiation Protection and Safe Use of Radiation Sources

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Introduction - Introduction - Where did the Where did the accident occur?accident occur?

Goiânia - the Capital Goiânia - the Capital of Goiâsof Goiâs State, BrazilState, Brazil

Population - about Population - about one millionone million

Accident area - poor Accident area - poor section of the citysection of the city

FacilityFacility - - abandoned premises abandoned premises of a radiotherapy of a radiotherapy instituteinstitute

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ContentContent

Where did the accident occurWhere did the accident occur What happenedWhat happened Information about the sourceInformation about the source How the accident was discoveredHow the accident was discovered Main actions takenMain actions taken Main consequencesMain consequences Medical managementMedical management Therapeutic procedures for the victims at the Therapeutic procedures for the victims at the

acute stageacute stage Follow-up of the victimsFollow-up of the victims Lessons learnedLessons learned

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Overview - Overview - What What hhappened?appened? End of 1985 a private radiotherapy institute End of 1985 a private radiotherapy institute

moved to new premises, leaving in place a Cs-moved to new premises, leaving in place a Cs-137 teletherapy unit without notifying the 137 teletherapy unit without notifying the licensing authoritylicensing authority

The former premises were subsequently partly The former premises were subsequently partly demolisheddemolished

September 13, 1987 two persons entered the September 13, 1987 two persons entered the premises, removed the source assembly from premises, removed the source assembly from the radiation head of the machinethe radiation head of the machine

They took the source assembly home and tried They took the source assembly home and tried to dismantle itto dismantle it

In the attempt, the source capsule was rupturedIn the attempt, the source capsule was ruptured

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Information about tInformation about the sourcehe source

NuclideNuclide Cs-137Cs-137 Activity (Sept.87)Activity (Sept.87) 50.9 TBq (1375 Ci)50.9 TBq (1375 Ci) Chemical formChemical form CsClCsCl Physical formPhysical form powderpowder CsCl massCsCl mass 93 g93 g Cs-137 massCs-137 mass 19.3 g19.3 g Physical half-lifePhysical half-life 30 years30 years

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How the Accident Was DiscoveredHow the Accident Was Discovered After the source capsule was ruptured, the After the source capsule was ruptured, the

remnants of the assembly were sold as scrap remnants of the assembly were sold as scrap to a junkyardto a junkyard

Fragments of the source the size of rice Fragments of the source the size of rice grains were distributed to several familiesgrains were distributed to several families

In five days a number of people were In five days a number of people were showing gastrointestinal symptoms from showing gastrointestinal symptoms from exposure to radiation exposure to radiation

One of the irradiated persons connected the One of the irradiated persons connected the illnesses with the source capsule, and took illnesses with the source capsule, and took the remnants to the public health departmentthe remnants to the public health department

This action began a chain of events which This action began a chain of events which led to the discovery of the accidentled to the discovery of the accident

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Main Main actions takenactions taken Medical triageMedical triage Monitoring of the people and survey the Monitoring of the people and survey the

environmentenvironment Medical treatment of the irradiated/contaminated Medical treatment of the irradiated/contaminated

personspersons Actions to bring sources of exposure under Actions to bring sources of exposure under

controlcontrol Decontamination of the main sites of Decontamination of the main sites of

contamination (houses, public places, vehicles, contamination (houses, public places, vehicles, etc.)etc.)

Demolition and removal of housesDemolition and removal of houses Removal of contaminated soilRemoval of contaminated soil Clear information to the publicClear information to the public

Basic facts about triage performedBasic facts about triage performedPopulation Triage Period:Population Triage Period:

September 30 - December 21, 1987September 30 - December 21, 1987

Number of personsNumber of persons 112,800112,800Internal/external contaminationInternal/external contamination 129 129Contamination of clothes and shoes 120Contamination of clothes and shoes 120Persons hospitalizedPersons hospitalized 2 200Local radiation injuries 28Local radiation injuries 28Bone marrow depressionBone marrow depression 17 17Acute radiation syndrome Acute radiation syndrome 88DeathsDeaths 4 4

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Radiological triageRadiological triage

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More StatisticsMore Statistics

Decontamination of the city: 730 Decontamination of the city: 730 workers requiredworkers required

Number of houses affected: 98Number of houses affected: 98 41 evacuated41 evacuated 6 demolished6 demolished 53 repaired53 repaired

Number of public places Number of public places decontaminated: 58decontaminated: 58 pavements, squares, shops and barspavements, squares, shops and bars

Number of vehicles decontaminated: 64 Number of vehicles decontaminated: 64

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The ConsequencesThe Consequences

Four early fatalitiesFour early fatalities A large number of persons contaminatedA large number of persons contaminated The environment severely contaminatedThe environment severely contaminated Large quantities of radioactive wastes Large quantities of radioactive wastes

generatedgenerated Significant economic loss and burdenSignificant economic loss and burden Substantial psychological impactSubstantial psychological impact

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Waste generatedWaste generated Waste storage site:Waste storage site:

20 km from the city20 km from the city Designed to accommodate 4,000-5,000mDesigned to accommodate 4,000-5,000m33 of of

waste waste

Types of waste packaging used:Types of waste packaging used: 4,500 metal drums (200L)4,500 metal drums (200L) 1,400 metal boxes (5 tones)1,400 metal boxes (5 tones) 10 shipping containers (32m10 shipping containers (32m33)) 6 sets of concrete packaging6 sets of concrete packaging

Volume of waste stored: 3,500 mVolume of waste stored: 3,500 m33, or , or more than 275 construction lorry loadsmore than 275 construction lorry loads

Medical Management Medical Management duringduring the the Goiania AccidentGoiania Accident

Reverse isolationReverse isolation Dietary management (no uncooked food)Dietary management (no uncooked food) Nail trimming and scrubbingNail trimming and scrubbing Local neomycin in nasal cavitiesLocal neomycin in nasal cavities Gut sterilizationGut sterilization Systemic antibioticsSystemic antibiotics Platelet and RBC infusionsPlatelet and RBC infusions AntiviralAntiviral

Therapeutic Therapeutic pprocedures rocedures dduring the uring the acute phase of the accidentacute phase of the accident

Managing critical period of the ARS, Managing critical period of the ARS, manifested by bone marrow manifested by bone marrow suppressionsuppression

Therapy for local radiation injuryTherapy for local radiation injury Decorporation of cesium-137Decorporation of cesium-137 General support and psychotherapyGeneral support and psychotherapy

Prussian Prussian bblue lue aadministration dministration

46 persons received Prussian Blue46 persons received Prussian Blue Dosage related to internal burdenDosage related to internal burden

InitialInitiallyly 3 g/day 3 g/day ThenThen 4 4-6 g/day in adults exceeding 5 x ALI-6 g/day in adults exceeding 5 x ALI For children initial dose 1-1.5 g/day For children initial dose 1-1.5 g/day thenthen

3 g/day for those exceeding 5 x ALI3 g/day for those exceeding 5 x ALI Some adults with very high burdens received Some adults with very high burdens received

10 g/day10 g/day

Medical Follow-up of the Goiânia Medical Follow-up of the Goiânia accident victimsaccident victims • Status of skin injuries after initial healing

88/28 patients required surgery in 1989 6/28 patients required surgery in 1990 1/28 patients required surgery in ‘91, ‘92, ‘93

• 1 cancer death (1993), 1 suicide (1992)1 cancer death (1993), 1 suicide (1992)• 5 year follow-up of children5 year follow-up of children

nno significant findings (occasional eosinophilia, chronic anemia)

7 exposed in-utero have no abnormalities 10 conceived post-accident born with no abnormalities

• 2 exposed teenage males have fathered children2 exposed teenage males have fathered children• Skin lesions tended to be affected by stress Skin lesions tended to be affected by stress

Psychological Psychological ffollow-up of ollow-up of the Goiânia accident victimsGoiânia accident victims

• Psychological alterationsPsychological alterations• Continuation of some early problemsContinuation of some early problems• Discrimination from the other peopleDiscrimination from the other people• Establishment of illness behaviorEstablishment of illness behavior

• Concern about the consequences of the Concern about the consequences of the

exposureexposure • StigmatizationStigmatization

• VVictims blamed for accident by many citizensictims blamed for accident by many citizens

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Lessons LearnedLessons Learned

Regulatory controls could have prevented Regulatory controls could have prevented this accidentthis accident

An adequate system of information is An adequate system of information is essential to avert panicessential to avert panic

Emergency workers should be instructed Emergency workers should be instructed on how to convey information to the on how to convey information to the populationpopulation

Response to the psychological impact is a Response to the psychological impact is a major element of the response strategymajor element of the response strategy

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Lessons Learned (Cont’d)Lessons Learned (Cont’d)

International assistance can be timely and International assistance can be timely and extremely usefulextremely useful This should be considered at the planning This should be considered at the planning

stagestage Customs regulations should be amended to Customs regulations should be amended to

facilitate the import and return of goodsfacilitate the import and return of goods This will accelerate international assistanceThis will accelerate international assistance

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SummarySummary This lecture presented materials about This lecture presented materials about

GoiâniaGoiânia accident accident The following conclusion could be made:The following conclusion could be made:

Radioactive sources taken out of the regulatory system Radioactive sources taken out of the regulatory system can present a serious hazardcan present a serious hazard

Recognition by the general public of the potential Recognition by the general public of the potential danger of radiation sources is an important factor in danger of radiation sources is an important factor in lessening the likelihood of radiological accidentlessening the likelihood of radiological accident

Good plans can accelerate response and significantly Good plans can accelerate response and significantly reduce health impactsreduce health impacts

Comments are welcomedComments are welcomed

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Where to Get More InformationWhere to Get More Information International Atomic Energy Agency, The International Atomic Energy Agency, The

Radiological Accident in Goiânia, IAEA Radiological Accident in Goiânia, IAEA Report, IAEA, Vienna (1988)Report, IAEA, Vienna (1988)

IAEA IAEA Regional Train-the-Trainers WorkshopRegional Train-the-Trainers Workshop Practical Response to a Radiological Practical Response to a Radiological Emergency,Emergency, November, 2000. Slovenia, November, 2000. Slovenia, Training materialsTraining materials

IAEA IAEA Training Course at Emergency Medical Training Course at Emergency Medical Preparedness and Response.Preparedness and Response. Medical Medical Education and Inter-Regional Harmonization Education and Inter-Regional Harmonization Program for Nuclear Accident Program for Nuclear Accident Preparedness.Preparedness. September, 1999, Budapest, September, 1999, Budapest, Hungary, Training materialsHungary, Training materials