State of Connecticut Radiation Professional Volunteer Program (CT-RPVP)

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State of Connecticut Radiation Professional Volunteer Program (CT-RPVP)

LESSON 1

Principles of Radiation and Radiation Protection

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• Describe the two forms of radiation and give examples of each

• Distinguish between radiation exposure and radioactive contamination

• Describe the relationships between radiation exposure, radiation absorbed dose, and dose equivalent

• Understand how time, distance and shielding are used to minimize radiation exposure

Objectives

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Photon and Particle Radiation

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• Radiation, as the term is used in this course, consists of:

‒ photons

and

‒ subatomic particles

• Radiation is emitted from the nuclei of radioactive atoms (or radioisotopes) and is capable of causing the ionization of atoms. For this reason, this type of radiation is often referred to as “ionizing radiation”

Photon

Radiation

Particle

Radioactive Atom

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• X- and gamma rays are released from the nuclei of a radioactive atoms as packets of energy, or photons

• X rays are similar to gamma but have lower energy

Photon Radiation

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Subatomic Particle Radiation

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++

Alpha (α) Beta (β) Neutron (N)

(N)

• Alpha, and beta radiations are subatomic particles ejected from the nuclei of atoms undergoing radioactive decay

• Neutron radiation consists of free neutrons produced during nuclear fission, a reaction which takes place in reactors of nuclear power plants and atomic bombs following detonation

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• Which of the following can be used to in place of “radioactive atom”

A) Radiation

B) Radioisotope

C) Photon

D) Subatomic Particle

Test Your knowledge

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Sources of Radiation

• Man-Made, such as x-rays generated from a medical x-ray machine, and gamma rays from radiation therapy equipment

or

• Naturally-Occurring, such as cosmic rays from space, and gamma radiation from radon gas

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α

β

X, γ and n

Skin, paper, 1 to 4 inches of air

Less than ¼ inch metal, glass, concrete, 1 to 18 feet air

2 to 12 inches lead, 3 to 18 inches steel, 1 to 6 feet of concrete, tens to hundreds of yards in air

[Alpha]

[Beta]

[X-, Gamma rays and

Neutrons]

• Protective shielding varies with the type of radiation

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Shielding from Radiation

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Cannot be seen Cannot be smelled But, can be

Cannot be felt Cannot be tasted

easily detected by instruments

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Radiation Detection

http://www.geigercounters.com/Detector.htm

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Exposure vs. Contamination

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• Exposure to radiation occurs after entering an area in which there is a radiation source

• After leaving the area, the exposure no longer happens

• Contamination occurs when radioactive material is on the body surface (external contamination) or is in the body (internal contamination)

• Decontamination of external areas is accomplished by removing clothing and washing the affected areas

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• Exposure to radiation results in the absorption of a radiation dose

– The unit for exposure is the roentgens (R)

– The unit for absorbed dose is the Radiation Absorbed Dose (rad)

– The unit for dose equivalent is the Roentgen equivalent man (rem)

• For practical purposes, 1 R (exposure) = 1 rad (absorbed dose) = 1 rem or 1000 mrem (dose equivalent)

Measuring Radiation

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Normal annual exposure from man-made radiation

Normal annual exposure from natural radiationApprox. 0.3 rem/yr

• Radon gas 0.165 rem• Human body 0.03 rem • Rocks, soil 0.02 rem• Cosmic rays 0.02 rem

Between 0.030 - 0.070 rem/yr• 1 chest X-ray 0.010 rem• Consumer products 0.010 rem• Air travel round trip (NY-LA) 0.005 rem• Watching color TV 0.001 rem• Nuclear industry < 0.001 rem

Daily sources of radiation

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Test You knowledge

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Radon gas can enter homes from surrounding soil. Radon cannot be seen and has no odor, but at elevated levels, radon in homes presents a serious health risks.

Radiation emitted by radon in homes is an example of:

A) Man-made radiationB) Naturally occurring radiation

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Minimizing Radiation Doses - ALARA

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• ALARA stands for As Low As is Reasonably Achievable

• The purpose of ALARA is to minimize risk as a result of exposure to radiation or radioactive material to a level that is As Low As is Reasonably Achievable

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Minimize Time

Maximize Distance

Maximize Shielding

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Mitigating External Radiation Doses

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Dose Limits for Responders Performing Emergency Services

ICRP (1991), NCRP Report No. 116 and NCRP Report No. 138, DHS (2007)

Dose Limit (rem) Activity Condition5 All

10 Protecting valuable property

lower dose not practicable

25 Life-saving or protection of large

populations

lower dose not practicable

> 25 Life-saving or protection of large

populations

Only on a voluntary basis to persons fully aware of

the risks involved

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Summary

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• Radiation is composed of subatomic particles or high-energy photons

• Contamination results form the presence of radioactive material on or in the body, whereas radiation exposure results form being in the presence of a radiation source

• R, rad and rem are units used to measure radiation exposure, absorbed dose and dose equivalent

• ALARA is a radiation safety principle for minimizing radiation doses and releases of radioactive materials by employing all reasonable methods

• Three basic rules of thumb for minimizing radiation exposure are time, distance and shielding

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Lesson 2

Radiation and Nuclear Threats and Vulnerabilities

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• Describe the radiological and nuclear threats faced by the U.S.

• Understand the risks of contamination and exposure to volunteers when screening individuals involved in a radiological or nuclear incident

Objectives

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Intentional Nuclear/Radiological Threats to the US

• Radiation Emission Device (RED)

• “Dirty” Conventional Bomb (RDD)

• Improvised Nuclear Device (IND)

• 1kT “Suitcase Nuke”

• Ballistic Missile Attack

• 250 kT Nuclear Weapon – “City Killer”

Nuclear Weapon, IND

LikelihoodLess MoreLe

ssIm

pact

/Dam

age

Mor

e

Dirty Bomb

RED

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• Radiation Emission Device (RED) - concealed at high-traffic area: ~ 60 to 250 deaths and ~ 130 cases of radiation sickness requiring public health follow-up for 30 years; psychological trauma

Community recovery timeline: Months to years

Source: Tofani A, Bartolozzi M. Ranking nuclear and radiological terrorism scenarios: The Italian case. Risk Analysis 2008;28(Oct):1431-44.

Possible Terrorist-Related Scenario

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• Radiation Dispersal Device (RDD) - explodes at busy street corner: ~ 30 to 180 deaths

• Few in any radiation-related injuries

• Decontamination efforts for people and objects

• Significant financial cost for decontamination of property in the affected area



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• Improvised nuclear device (IND) - explosion of 10 kilotons, in center of a city, such as Coleman Dock, Seattle, WA

• Approximately 50,000 deaths

• Infrastructure damage out to 1 mile

• Contamination ~3,000 sq. miles

• $100+ billion in costs

• Community recovery time: Years



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Risk to Volunteers from Screening Individuals of a Radiological or Nuclear Incident

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• What is the risk of exposure or contamination to volunteers performing radiological surveys of people involved in a radiological or nuclear event?

• Depends on the nature of the event:

• Contamination for RED: None Exposure only (such as in an RED incident) Acute radiation syndrome in exposed individuals

• No risk of exposure or contamination to volunteers

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Contamination (Radiation Dispersal Device ) • Individual’s person, articles of clothing, other belongings may be contaminated• Removing contaminated clothing will eliminate 80 - 90% of contamination• Individuals may be internally contaminated• Individuals with minor injuries may self-refer to screening centers• Relatively low risk for contamination to volunteers; very low level exposures

possible (varies with degree of individuals’ levels of contamination)

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Contamination (Nuclear Power Plant Incident) • Individual’s person, articles of clothing, other belongings may be contaminated• Individuals may be internally contaminated • Relatively low risk for contamination to volunteers; very low level exposures

possible (varies with degree of individuals’ levels of contamination)

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Contamination from Fall-Out, and High-Level Exposures (Nuclear detonation) • Individuals’ persons, articles of clothing, and other belongings may be contaminated• Individuals may be internally contaminated• Individuals may incur radiation doses up to several hundred rads are possible (acute radiation

syndrome)• Individuals with minor injuries may self-refer • Relatively low risk for contamination to volunteers; very low level exposures possible (varies with

degree of individuals’ levels of contamination)• Incident-related psychological stress/trauma among volunteers

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Test your knowledge

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Which of the following are the most likely terrorist-related threats to the U.S are:

A) 250 kT nuclear weapon and an IND detonation B) Ballistic missile attack and an IND detonationC) Dirty bomb detonation and deployment of an REDD) Detonation of a RDD and INDE) No threat

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Test your knowledge

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Which of the following is true:

A) The impact of an IND is greater than that of a 250 kT bomb B) With respect to a terrorist attack, the probability of an RDD

detonation is greater than that of a IND detonationC) A dirty bomb detonation is likely to cause radiation

injury, deaths and contamination of a small areaD) The risk of radiation exposure and contamination to volunteers who may

be called upon to screen victims of an RED is zeroE) The risk of radiation exposure and contamination to volunteers who may

be called upon to screen victims of an RDD is zero

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• Threats to the U.S. involving the release of radiation and radioactive materials are the use of REDs, RDDs, INDs, and nuclear weapons with yields varying from 1 – 250 kT

• Volunteers screening individuals impacted by an RDD have no risk of exposure or contamination

• Volunteers screening individuals impacted by a dirty bomb or a nuclear weapon, including an IND, have a low risk of contamination, or radiation exposure

Summary

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Lesson 3

Biological and Clinical features of Radiation injuries

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• Distinguish between acute and chronic radiation exposure

• State three types of DNA changes resulting from radiation exposure

• Identify symptoms of acute radiation syndrome

Objectives

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• Acute radiation exposure is exposure to a large, single dose of radiation, over a short period of time (seconds)

• A large acute exposure to radiation may result in immediate clinical effects (e.g., acute radiation syndrome) as well as long-term effects (e.g., cancer)

Acute Radiation Exposure

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• Chronic radiation exposure involves exposure to low levels of radiation over a long period of time (months – years)

• Chronic radiation exposure may result in increased risk of developing cancer

• Exposure to radiation emitted by radon gas present in many homes is an example of chronic radiation exposure

Chronic Radiation Exposure

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Test your knowledge

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True or False: Unlike acute radiation exposure, chronic radiation exposure may result in the development of cancer

A) TrueB) False

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Test your knowledge

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Of the following, which is a example of acute radiation exposure

A) Radiation incurred on a round-trip flight from New York City to Los Angles

B) Radiation incurred from a one-time chest x-rayC) Eating foods over one’s lifetime that contain high levels of

potassium-40 (radioactive isotope)D) Living in high-altitude areas

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Radiation Targets All Cellular Components

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Janice Brock

University RPO

Deoxyribonucleic Acid -

Types of DNA Damage Caused by Radiation

Radiation can damage DNA resulting in:

DNA mutations and DNA breaks

Gross structural rearrangements or chromosomal aberrations, to the DNA can also occur

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Janice Brock

University RPO


DNA Damage Caused By Radiation

Radiation damages DNA may result in:

DNA mutations may not kill the cell; however over time, these mutations may transform the cell into a cancerous cell

This transformation is random (stochastic) and take place over several years

The higher the radiation dose, the greater the chance of developing cancer

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Janice Brock

University RPO


DNA is the most important Target of Radiation

Radiation damages DNA which result in:

• Unrepaired DNA breaks and gross structural changes to the DNA almost always lead to cell death

• High radiation doses, delivered quickly (seconds) and to a large area of the body, result in widespread cell death, causing:

o Tissue and organ failure which manifest as acute radiation syndrome (ASR)

• The occurrence of these biological events and clinical manifestations are predictable (or non-stochastic) and take place relatively quickly

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Nausea Vomiting WBC

25 – 50 rads 250 rads 650 rads

Severe Vomiting (100%)Diarrhea CrampsBleeding - mouth, kidneys

1000 rads

Effects of Acute Radiation Exposure (High Dose, High Dose Rate)

100 rads

WBC

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Test your knowledge

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Which is true of acute radiation syndrome:A. Affects more males than femalesB. Varies in severity according to the absorbed dose of

radiationC. Can be treated with potassium iodide D. All of the above

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Summary

• Acute radiation exposure is exposure to a large, single dose of radiation, over a short period of time

• Chronic radiation exposure involves exposure to low levels of radiation over a long period of time

• Both, acute and chronic radiation exposures can result in cancer

• The most important cellular target of radiation is DNA. Radiation-induced damage to DNA include DNA mutations and chromosomal aberrations

• The severity of ARS is directly proportional to dose

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Lesson 3

External Decontamination

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• Describe the purpose and goal of decontamination

• List some key concepts of decontamination

• Provide an overview of the decontamination process for removing radioactive contaminants present on body surfaces, including hair

Objectives of this Section

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• The purpose of the external decontamination is to remove or reduce radioactive contaminants from the surfaces of individuals and pets

– Skin

– Hair

• Goal is < 2 times background or 2 decontamination attempts

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Decontamination Concepts

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• Decontamination, if required or advisable, follows immediately after the screening process

• If survey readings are:

> 2 - 3x background, decontamination is advisable (EPA/NCRP) > 20- 30x background, decontamination is required (EPA/NCRP)

Decontamination

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Decontamination Concepts for Reception Centers

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• Decontamination of individuals should continue until survey readings indicate levels below 2 times background

A. TrueB. False

Test your knowledge

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• Individuals (and pets) with contamination levels > 2x background, as per GM survey

• Decontamination is repeated until survey readings are < 2x background or until additional rounds of decontamination do not reduce contamination levels by more than 10% (CDC)

• After each round of decontamination, individuals are resurveyed

Decontamination Concepts for Reception Centers

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• All contaminated clothing and valuables are placed in a plastic bag

Removing clothing will eliminate 80 – 90% of contamination

• Items that cannot be decontaminated (e.g., porous materials) should be discarded in waste bins for contaminated items

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Decontamination Process for Reception Centers

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• If contamination is limited to a small body surface (e.g., hand, face) it may be possible to decontaminate the area without showering

• Cover wounds with bandages

• Wash with warm water

• Begin with the least aggressive techniques and mildest agents (e.g., soap and water)

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Decontamination Process for Local Surface Contamination

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• Use the mechanical action of flushing or friction of cloth, sponge, or soft brush

• Keep materials out of eyes, nose, and mouth,

• Avoid causing mechanical, chemical, or thermal damage to skin

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Decontamination Process for Local Surface Contamination

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Decontamination Process for Extensive Body Contamination

• If contamination is present on the majority of the body surface contamination may be removed by showering

• Shower with warm water and mild soap

• Begin with the head, bending it forward to direct wash-water away from body

• Keep water out of eyes, nose, mouth, and wounds

• Use mechanical action of a cloth or sponge but avoid abrading the skin

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• Separate male and female decontamination showers

• If possible, parent(s) should assist children with washing

• Keep families together

• Decontaminate pets in an area separate

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Considerations for Decontamination Process

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• Have on-hand replacement clothing or disposable gowns

• For large-scale events, it may not be feasible to collect contamination from runoff

• Provide for the security of items of personal value

• Individuals with medical dependencies or with other special needs, older adults and children will require additional help with decontamination

• Medical care for life-threatening injuries must not be delayed in favor of decontamination

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Considerations for Decontamination Process

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All of the following statements are true except:a. Radioactive contamination may be removed, or reduced to acceptable levels simply by washing the contaminated areas with warm water and mild soap

b. Removing a contaminated individual’s clothing eliminates 80 – 90% of radioactive contamination

c. Treatment of minor cuts or abrasions should never be delayed in favor of decontaminated

d. To the extent possible, family members should not be separated during the decontamination process

Test your Knowledge

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• The goal of the decontamination process is to reduce or remove contamination from body surfaces

• Ideally decontamination is performed until survey readings indicate levels below those of 2 times background

• Removing clothing eliminates 80 – 90% of contamination• It may not be possible to decontaminate all personal

belongings• External contamination may be removed by washing with

warm water and mild soap

Summary

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• Do not abrading skin, and avoid internalizing water runoff during showering

• Do not separate families, particularly, children from parents • Make provisions to assist individuals with medical

dependencies or other special needs as well as older adults with decontamination

• Never delay the delivery of emergency care in favor of decontamination

Summary

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Lesson 4

Behavioral Responses to Radiological/Nuclear Incidents

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• Define psychological stress

• Present the range of psychological responses elicited by radiation and nuclear incidents

• Describe elements for managing psychological stress produced by radiation and nuclear incidents

Objectives

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• For this lesson, psychological stress is the individual's response when demands go beyond coping resources to deal with a radiological or nuclear incident

What is Psychological Stress?

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Reactions Following Radiation Incidents

• Radiation and nuclear incidents may cause psychological stress, with both short and long-term effects

• Extend beyond the individuals directly affected

• Situations with a high degree of uncertainty, regarding potential future health effects, may be more psychologically traumatic than others

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• Tasteless

• Odorless

• Colorless

• Association to malignant disease

• Visuals of Hiroshima and Nagasaki

Osteosarcoma in a radium dial factory worker (circa 1920)

Hiroshima: A boy who received radiation burns on his whole body following the atomic bomb explosion

Fear Is the Initial Response

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Reactions Following Radiation Incidents

“When people are confused about their actual health risks, some will assume incorrectly that they

have been exposed and will develop physical reactions.”

National Child Traumatic Stress Network (NCTSN) 2010

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• A Cesium-137 capsule was stolen from a discarded radiation therapy instrument and opened

• 250 people came in contact with Cs-137– Fear caused 112,000 people to request screening

for contamination

– Of the first 60,000 screened, 5,000 individuals had psychosomatic symptoms that mimicked those of radiological exposure

Goiania, Brazil (1987)

Stress Reactions Mimic Physical Injury or Illness

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Lack of Accurate Information Fuels Fear

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Fear

Myths

Knowledge

Facts

Inaccurate or insufficient information

Accurate information at a local level

Fear and anxiety of radiation exposure are as debilitating as the actual physical health effects One role of population monitoring volunteers is to reassure individuals by providing accurate information

about radiation

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Test Your Knowledge

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Which fact about radiation contributes to its fear?A. Causes severe sunburns and other skin rashes B. Damages cellphonesC. Cannot be detected by the human sensesD. Leads to birth defects such as two-headed cows

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Responders’ Concerns and Emotional Reactions

Medical professionals, First Responders and Volunteers

• Have limited experience in managing casualties from radiation events

• May experience fear, shock, anger, helplessness and worry

• May be concerned about exposing family/friends

Psychological support services, education and training may mitigate the psychological stress exhibited by emergency responders

Responders’ Concerns to Radiation Incidents

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indecisiveness, worry, confusion,

reduced attention span, trouble concentrating

distrust, conflict, work/school problems,

irritability, loss of intimacy,

feeling abandoned,withdrawn

tension, fatigue, edginess, insomnia, bodily aches pain,

startling easily, racing heartbeat, nausea, change in appetite

shock, fear, grief, anger, guilt, shame,

feeling helpless, feeling numb,

sadness

Range of Psychological Stress

Emotional BehavioralCognitive

changes in one’s belief in God,

changes in assumptions

about good and evil

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SpiritualPhysical

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• Prompt, safe and dignified provision of assistance– Medical care– Screening and decontamination of affected individuals

• Clear and credible information pertinent to:– Incident status– Protective actions

• Public health follow-up– Tracking of chronic health effects– Education on health risks

Managing the Psychological Responses to a radiological or Nuclear Incident

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Test Your Knowledge

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Which of these is not a strategy for mitigating psychological stress during a radiological or nuclear incident?

A. Provide clear and credible information about the incident

B. Minimize the incident as not to worry the community

C. Provide education on the health risk of radiation

D. Provide medical assistance to those affected by the incident

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• Radiological and nuclear incidents cause psychological stress to people directly and indirectly affected by the incidents.

• Fear is the first psychological response to a radiological or nuclear incidents, and perhaps the debilitating of the psychological reactions

• Fear may cause individuals to exhibit symptoms which resemble those of radiation exposure, and act in extreme and sometimes irrational ways to avoid the perceived or real threat

• Medical professionals, first responders and volunteers may also experience the same psychological stresses as those experienced by the general public

Summary

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• Individuals impacted by radiological or nuclear incidents may exhibit alterations in emotional, cognitive behavioral, physical and spiritual reactions

• Strategies for managing psychological stress in the after math of a radiological or nuclear incident are to provide prompt assistance to the affected population, disseminate clear information by credible sources about the status of the situation and instructions for protecting the public, and ensure that governmental agencies establish a means for tracking the effects of the event and provide health risk management information.

Summary

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Lesson 5

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Roles and Responsibility of Local, State and Federal Agencies

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• SETH TO DEVELOP

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State of Connecticut Radiation Professional Volunteer Program (CT-RPVP)

Documents

alpha radiation

forms of radiation

principles of radiation

org5particle radiation

radiation protection

type of radiation

beta particles

nuclei of radioactive