Countermeasure Development :Radiation Protection for civic population and military personnel after Local Major Nuclear Accident.

Radiation Protection

Countermeasure Development :Radiation Protection for civic population and military personnel after Local Major Nuclear Accident.

Dmitri Popov. PhD, Radiobiology. MD (Russia)Advanced Medical Technology and Systems Inc..

Medical Management and Radiation Protection.DOI:10.13140/RG.2.1.1096.3927

Medical Management and Radiation Protection.

Military doctrine supports an integrated management health care services and specialized system to evaluation, diagnosis, treatment, evacuation, and return the irradiated and injured civilians or military personnel, after major nuclear accident. The medical management system for irradiated civilians and military personnel begins on the irradiated battlefield or irradiated territory and ends in specialized hospitals located outside of battlefield.

Medical Management and Radiation Protection.External Irradiation Prophylaxis and therapy with Anti - Radiation Vaccine. Treatment with Anti Radiation Antidote, Proteases Inhibitors, Antihistamine medicines. Antioxidants are not radio-protectors. Antioxidants can not be used alone for treatment of Acute Radiation Disease after moderate and high doses of radiation. Antioxidant therapy alone after moderate and high doses of radiation can increase mortality rate. However, Specific Immunotherapy of ARD and antioxidants use for medical management together more efficient. Immune - Prophylaxis with Anti Radiation Vaccine prophylactic vaccination. Nuclear Aerosol Individual Protection.

Medical Management and Radiation Protection.Nuclear Aerosol Individual Protection. NUCLEAR AEROSOL BEHAVIOR DURING REACTOR ACCIDENTSM. M. R. WILLIAMS Nuclear Engineering Department, The University of Michigan, Ann Arbor, M[, 48109, U.S.A. Disposable Chemical Resistant Protective Clothing. Example: https://www.northernsafety.com/Search?i=1;q1=Personal+Safety;q2=Clothing;q3=Chemical+Resistant+Clothing+and+Accessories;sp_pr=v2;x1=category-1;x2=category-2;x3=category-3https://www.northernsafety.com/safety/personal-safety/respiratory-protection

Medical management and Radiation Protection. Nuclear aerosol protection. Airway Protection. Example. https://www.northernsafety.com/safety/personal-safety/respiratory-protectionhttps://www.northernsafety.com/Product/20096/3M-7500-Series-Half-Mask-Respirator

Medical Management and Radiation Protection. Nuclear aerosol protection.Eye protection. Example:https://www.northernsafety.com/safety/personal-safety/eye-protectionHand Protection. Example.https://www.northernsafety.com/safety/personal-safety/hand-protectionHearing protection. Example.https://www.northernsafety.com/safety/personal-safety/hearing-protection

Medical Management and Radiation Protection. Radionuclide Iodine.Iodine-131(131I), also loosely and non specifically calledradioiodine, is an importantradioisotopeofiodine. Iodine-131 plays a major role as a radioactive isotope present innuclear fissionproducts, and was a significant contributor to the health hazards from open-air atomic bomb testing in the 1950s, and from theChernobyl disaster, as well as being a large fraction of the contamination hazard in the first weeks in theFukushima nuclear crisis.https://en.wikipedia.org/wiki/Iodine-131

Medical Management and Radiation Protection. iodine-131 is notable for causingmutationand death in cells that it penetrates, and other cells up to several millimeters away. For this reason, high doses of the isotope are sometimes less dangerous than low doses, since they tend to killthyroidtissues that would otherwise become cancerous as a result of the radiation.

Medical Management and Radiation Protection. Treatment. Potassium Iodide Potassium iodideis aninorganic compoundwith thechemical formulaKI. This whitesaltis the most commercially significant iodide compound, with approximately 37,000 tons produced in 1985. It is lesshygroscopic(absorbs water less readily) thansodium iodide, making it easier to work with. Potassium iodide occurs naturally inkelp.[1]Kelp's iodide content can range from 89g/g to 8165g/g.

Medical Management and Radiation Protection. Potassium iodide is medicinally used forthyroid blockade,thyroid stormand also as anexpectorant.In 1982, the U.S.Food and Drug Administrationapproved potassium iodide to protectthyroidglands fromradioactive iodineinvolving accidents or fission emergencies.

Medical Management and Radiation Protection. Plutonium Plutoniumis atransuranicradioactivechemical elementwithsymbolPuandatomic number94. It is anactinidemetalof silvery-gray appearance thattarnisheswhen exposed to air, and forms a dull coating whenoxidized. The element normally exhibits sixallotropesand fouroxidation states. It reacts withcarbon,halogens,nitrogen,siliconandhydrogen. When exposed to moist air, it formsoxidesandhydridesthat expand the sample up to 70% in volume, which in turn flake off as a powder that ispyrophoric. It isradioactiveand can accumulate inbones, which makes the handling of plutonium dangerous.

Medical Management and Radiation Protection.Human radiation experimentsstudying plutonium were conducted withoutinformed consent, and severalcriticality accidents, some lethal, occurred after the war. Disposal ofplutonium wastefromnuclear power plantsanddismantled nuclear weaponsbuilt during theCold Waris anuclear-proliferationand environmental concern. Other sources ofplutonium in the environmentarefalloutfrom numerous above-ground nuclear tests, nowbanned.

Medical Management and Radiation Protection.There are two aspects to the harmful effects of plutonium: the radioactivity and theheavy metal poisoneffects. Isotopes and compounds of plutonium are radioactive and accumulate inbone marrow. Contamination by plutonium oxide has resulted fromnuclear disasters and radioactive incidents, including military nuclear accidents where nuclear weapons have burned.

Medical Management and Radiation Protection.Plutonium is more dangerous when inhaled than when ingested. The risk oflung cancerincreases once the total radiationdose equivalentof inhaled plutonium exceeds 400mSv.

Medical Management and Radiation Protection.Ca DTPA DTPA (Diethylenetriamine pentaacetate) is a medicine that can bind to radioactiveplutonium,americium.Ca-DTPA forms stable chelates with metal ions by exchanging calcium for a metal of greater binding capacity. The radioactive chelates are then excreted by glomerular filtration into the urine. In animal studies, Ca-DTPA forms less stable chelates with uranium and neptunium in vivo resulting in the deposition of these elements in tissues including the bone. Ca-DTPA treatments are not expected to be effective for uranium and neptunium. Radioactive iodine is not bound by DTPA.https://orise.orau.gov/files/reacts/Calcium-DTPA-package-insert.pdf

Medical Management and Radiation Protection.Zn DTPAPentetate zinc trisodium injection contains the sodium salt of zinc diethylenetriaminepentaacetate. Pentetate zinc trisodium is also known as trisodium zinc diethylenetriaminepentaacetate and is commonly referred to as ZnDTPA. It has a molecular formula of Na3ZnC14H18N3O10 and a molecular weight of 522.7 Daltons. https://orise.orau.gov/files/reacts/Zinc-DTPA-package-insert.pdf

Medical Management and Radiation Protection.INDICATIONS AND USAGE. Zn-DTPA is indicated for treatment of individuals with known or suspected internal contamination with plutonium, americium, or curium to increase the rates of elimination. Pharmacodynamics In a study of rodents internally contaminated with plutonium, the rate of plutonium elimination was measured after treatment with Ca-DTPA and Zn-DTPA given intravenously as a single dose of 10 to 1,000 mol/kg (0.54 54 x maximum human dose, MHD). When treated within one hour of internal contamination, Ca-DTPA resulted in about a 10- fold higher rate of elimination of plutonium in the urine as compared to Zn-DTPA. The chelating capacity of Ca-DTPA is greatest immediately and up to approximately 24 hours after internal contamination when the radiocontaminant is still circulating and readily available for chelation. https://orise.orau.gov/files/reacts/Zinc-DTPA-package-insert.pdf

Medical Management and Radiation Protection.In another study, rodents contaminated with aerosolized plutonium and americium were treated with Ca-DTPA and Zn-DTPA. The treatment schedule involved inhalation of Ca-DTPA 2 mol/kg (0.11 MHD) 30 minutes after contamination followed by inhalation of Zn-DTPA 2 mol/kg at approximately 6 hours, 1, 2, 3, and 6 days, then twice weekly to day 26 or day 27. The treatment regime reduced the lung deposit of plutonium and americium to 1-2% of that in untreated animals. Systemic deposit in liver and skeleton were reduced by half.https://orise.orau.gov/files/reacts/Zinc-DTPA-package-insert.pdf

Medical Management and Radiation Protection. Cesium Caesium-137(13755Cs, Cs-137),cesium-137, orradiocaesium, is aradioactiveisotopeofcaesiumwhich is formed as one of the more commonfission productsby thenuclear fissionofuranium-235and otherfissionableisotopesinnuclear reactorsandnuclear weapons. It is among the most problematic of the short-to-medium-lifetime fission products because it easily moves and spreads in nature due to the high water solubility of caesium's most common chemical compounds, which aresalts.

Medical Management and Radiation Protection.Caesium-137 has ahalf-lifeof about 30.17 years.Caesium-137 reacts with water producing a water-soluble compound (caesium hydroxide). The biological behavior of caesium is similar to that ofpotassiumandrubidium. After entering the body, caesium gets more or less uniformly distributed throughout the body, with the highest concentrations insoft tissue.[9] Thebiological half-lifeof caesium is rather short at about 70 days.A 1972 experiment showed that when dogs are subjected to awhole body burdenof 3800Ci/kg (140MBq/kg, or approximately 44g/kg) of caesium-137 (and 950 to 1400rads), they die within thirty-three days, while animals with half of that burden all survived for a year.[11]Accidental ingestion of caesium-137 can be treated withPrussian blue, which binds to it chemically and reduces the biological half-life to 30 days

Medical Management and Radiation Protection.Prussian blueis a dark bluepigmentwith the idealizedchemical formulaFe7(CN)18. To better understand the binding situation in this complex compound the formula can also be written as Fe4[Fe(CN)6]3 x H2O.In medicine, Prussian blue is used as anantidotefor certain kinds ofheavy metal poisoning, e.g., bythalliumand radioactive isotopes ofcaesium. In particular it was used to absorb137Cs+from those poisoned in theGoinia accident.[1]Prussian blue is orally administered. The therapy exploits Prussian blue's ion exchange properties and high affinity for certain "soft" metal cations.

Medical Management and Radiation Protection.Following the attacks on the US on September 11, 2001, potentially millions of people might experience contamination from radioactive metals. However, before the specter of such accidents arose, Prussian blue was known only as an investigational agent for accidental thallium and cesium poisoning. The purpose of this review is to update the state of the art concerning use of Prussian blue as an effective and safe drug against possible bioterrorism attacks and to disseminate medical information in order to contribute to the production of Prussian blue as a biodefense drug. https://www.dovepress.com/prussian-blue-as-an-antidote-for-radioactive-thallium-and-cesium-poiso-peer-reviewed-article-ODRR

Medical Management and Radiation Protection. Uraniumis achemical elementwith symbolUandatomic number92. It is a silvery-whitemetalin theactinideseries of theperiodic table. A uranium atom has 92protonsand 92electrons, of which 6 arevalence electrons. Uranium is weaklyradioactivebecause all itsisotopesare unstable (with half-lives of the 6 naturally known isotopes, uranium-233 to uranium-238, varying between 69 years and 4.5 billion years). The most common isotopes of uranium areuranium-238(which has 146neutronsand accounts for almost 99.3% of the uranium found in nature) anduranium-235(which has 143 neutrons, accounting for 0.7% of the element found naturally)

Medical Management and Radiation Protection.A person can be exposed to uranium (or its radioactive daughters, such asradon) by inhaling dust in air or by ingesting contaminated water and food. The amount of uranium in air is usually very small; however, people who work in factories that processphosphatefertilizers, live near government facilities that made or tested nuclear weapons, live or work near a modern battlefield where depleted uraniumweaponshave been used, or live or work near acoal-fired power plant, facilities that mine or process uranium ore, or enrich uranium for reactor fuel, may have increased exposure to uranium.

Medical Management and Radiation Protection. Most ingested uranium is excreted duringdigestion. Only 0.5% is absorbed when insoluble forms of uranium, such as its oxide, are ingested, whereas absorption of the more solubleuranylion can be up to 5%.[25]However, soluble uranium compounds tend to quickly pass through the body, whereas insoluble uranium compounds, especially when inhaled by way of dust into thelungs, pose a more serious exposure hazard. After entering the bloodstream, the absorbed uranium tends tobioaccumulateand stay for many years inbonetissue because of uranium's affinity for phosphates.Uranium is not absorbed through the skin, andalpha particlesreleased by uranium cannot penetrate the skin. https://en.wikipedia.org/wiki/Uranium#Human_exposure

Medical Management and Radiation Protection. Normal functioning of thekidney,brain,liver,heart, and other systems can be affected by uranium exposure, because, besides being weakly radioactive, uranium is atoxic metal.Uranium is also a reproductive toxicant. Radiological effects are generally local because alpha radiation, the primary form of238U decay, has a very short range, and will not penetrate skin.Uranyl(UO2+2) ions, such as fromuranium trioxideor uranyl nitrate and other hexavalent uranium compounds, have been shown to cause birth defects and immune system damage in laboratory animals.While the CDC has published one study that no humancancerhas been seen as a result of exposure to natural or depleted uranium,[100]exposure to uranium and its decay products, especiallyradon, are widely known and significant health threats.

Medical Management and Radiation Protection. Renal damage - Elevated levels of protein excretion, urinary catalase and diuresis - Damage to proximal convoluted tubules, necrotic cells cast from tubular epithelium, glomerular changes (renal failure).Brain/CNS damage - Decreased performance on neurocognitive tests - Acute cholinergic toxicity; Dose-dependent accumulation in cortex, midbrain, and vermis; Electrophysiological changes in hippocampus.

Medical Management and Radiation Protection.DNA damage - Increased reports of cancers - Increased mutagenicity (in mice) and induction of tumors.

Reproductive System damage . Uranium miners have more first born female childrenModerate to severe focal tubular atrophy; vacuolization of Leydig cells

Medical Management and Radiation Protection. Lungs/respiratory damage. No adverse health effects reported for humanSevere nasal congestion and hemorrhage, lung lesions and fibrosis, edema and swelling, lung cancer animal study.

Medical Management and Radiation Protection. Gastrointestinal system damageVomiting, diarrhea, albuminuria human study.

Immune system suppression. Chronic fatigue, rash, ear and eye infections, hair and weight loss, cough. May be due to combined chemical exposure rather than DU alone

Cardiovascular system damage. Myocarditis resulting from the uranium ingestion, which ended six months after ingestion

Medical Management and Radiation Protection. Liver damageNo effects seen at exposure dose human study ? Fatty livers, focal necrosisNo studiesSkin damageNo exposure assessment data available ?Swollen vacuolated epidermal cells, damage to hair follicles and sebaceous glands

Radiation protection and Medical Management. https://en.wikipedia.org/wiki/Uranium#Human_exposurehttp://www.atsdr.cdc.gov/csem/csem.asp?csem=16&po=13Treatment : Bicarbonate - Daily urine samples should be collected after large accidental overexposures [Diamond 1989; Howland 1949], and should continue for at least 2 weeks. The collection of 24-hour urine samples whenever possible is recommended. These samples can be used for both assessment of uranium excretion and for clinical urinalysis.For acute uranium nephrotoxicity, oral dose or infusions of sodium bicarbonate can be administered to maintain alkaline urine [Lincoln and Voelz 1990; MacNider 1916] with frequent monitoring of urine pH. Alkaline urine prevents dissociation of the uranium-bicarbonate complex that protects the renal tubular epithelium from exposure to the reactive uranyl ion. Forcing fluids to increase urinary output is recommended.

Radiation protection and Medical Management.The use of chelation drugs for acute uranium overexposures is considered a controversial practice in the United States. No human cases of uranium overexposure have been reported as being treated with chelation in the Western world. Soviet research indicates that chelating agents can significantly reduce the risk of acute uranium injury to the kidneys [Ivannikov 1987]. However, chelation must begin within 4 hours of exposure to be effective, and it is most effective if given within a few minutes of the exposure. Some authors have advised against the use of chelation because precipitation of uranium in the kidney may cause additional damage. The avoidance of calcium DTPA for chelation is mentioned, as it can increase bone deposition.http://www.atsdr.cdc.gov/csem/csem.asp?csem=16&po=13

Medical Management and Radiation Protection. Tritium(/trtim/or/trim/; symbolTor3H, also known ashydrogen-3) is a radioactiveisotope of hydrogen. Thenucleusof tritium (sometimes called atriton) contains oneprotonand twoneutrons, whereas the nucleus ofprotium(by far the most abundant hydrogen isotope) contains one proton and no neutrons. Naturally occurring tritium is extremely rare on Earth, where trace amounts are formed by the interaction of the atmosphere withcosmic rays.

Medical Management and Radiation Protection. Tritium is an important component in nuclear weapons. It is used to enhance the efficiency and yield offission bombsand the fission stages ofhydrogen bombsin a process known as "boosting" as well as inexternal neutron initiatorsfor such weapons.

Medical Management and Radiation Protection. https://www.nirs.org/factsheets/tritiumbasicinfo.pdfThe body does not readily absorb H2, HT, HD, D2, DT, or T2 from inhaled gases or through the skin. If inhaled in elemental form, almost all tritium in the gas is exhaled. Only a very small fraction is retained in the lungs. Tritium in the form of water (HTO, DTO, and T2O) is adsorbed through the skin and in the lungs from inhaled gases. Tritium in water form is readily retained in the body and remains with a biological half-life of approximately 10 days. Due to the body's ready adsorption of tritium in the form of tritiated water, exposure to tritiated water in air is on the order of 15,000 to 25,000 times more hazardous than exposure to gaseous tritium (HT, DT, and T2) [USDOE; DOE Handbook Tritium Handling and Safe Storage DOE-HDBK-11290YrXXXX-YR p. 5 (December 1991). Available from, as of July 29, 2006:http://www.eh.doe.gov/techstds/tsdrafts/doe-hdbk-1129-yr.pdf

Medical Management and Radiation Protection.The median lethal dose (LD50) of tritium assimilated by the body is estimated to be 370 GBq (10 Ci). Higher doses can be tolerated with forced fluid intake to reduce the biological half life.

http://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+6467INGESTION: Patients who ingested any radioactive matter should receive aluminum hydroxide or magnesium carbonate antacids to reduce absorption. Treat patients with persistent nausea and vomiting with granisetron or ondansetron. Early oral feedings are recommended to maintain gut function. All emesis should be collected for the first few days, saving for later analysis. Antidiarrheals may be used to control diarrhea. Internal contamination may require treatment with radiation countermeasure agents such as potassium iodide (radioactive iodine exposure), prussian blue (cesium and thallium exposure), or chelating agents (plutonium, americium, curium exposure). However, these agents do not protect against external radiation absorption and acute radiation syndrome.

Radiation Protection and Medical Management. http://www.slideshare.net/dlpopov/antiradiation-vaccine-protection-and-prophylaxis-radiofrequencymicrowave-biological-effects-toxicity-radiation-injury-40509572http://www.ncbi.nlm.nih.gov/pubmed/17867496http://www.slideshare.net/dlpopov/preclinical-evaluation-and-clinical-application-of-novel-crossmodal-multidisciplinary-biotechnology-with-antiradiation-prophylaxis-antiradiation-vaccine-and-therapy-regimens-antiradiation-antidote-and-anticancer-postradiation-prophylaxis