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Dainiak N.,Radiation Emergency Assistance Center Training Site | Dainiak N.,Yale University
Health Physics | Year: 2016

The combined expertise of radiation epidemiologists and laboratory experimentalists is required to accurately define health risks from exposure to a low/very low radiation dose. Although stochastic risk can be estimated when a known threshold dose is exceeded, risk must be inferred from data transference at sub-threshold doses. The clinician's dilemma is evident when complying with accepted medical practice that is complicated by potential long-term, adverse outcomes. By contrast, radiation protection regulators must make prudent judgments without complete knowledge of the scope and consequences of their actions. Only by combining the strengths of epidemiological and experimental laboratory approaches can accurate predictive modeling be achieved after exposure to a low/very low dose. © 2016 Lippincott Williams & Wilkins. Source

Eight of the most severe cases of acute radiation disease (ARS) known to have occurred in humans (as the result of criticality accidents) had survival times less than 120 h (herein defined as "early death"). These accidents were analyzed and are discussed with respect to the specific accident scenarios and the resulting accident-specific, mixed neutron-gamma radiation clinical dose distributions. This analysis concludes that the cardiovascular system appears to be the most critical organ system failure for causing "early death" following approximate total body, mixed gamma-neutron radiation doses greater than 40-50 Gy. The clinical data also suggest that there was definite chest dose dependence in the resulting survival times for these eight workers, who unfortunately suffered profound radiation injury and unusual clinical effects from such high dose radiation exposures. In addition, "toxemic syndrome" is correlated with the irradiation of large volumes of soft tissues. Doses to the hands or legs greater than 80-100 Gy or radiation lung injury also play significant but secondary roles in causing "early death" in accidents delivering chest doses greater than 50 Gy. Copyright © 2012 Health Physics Society. Source

Kazzi Z.,Centers for Disease Control and Prevention | Kazzi Z.,Emory University | Buzzell J.,Centers for Disease Control and Prevention | Bertelli L.,Los Alamos National Laboratory | Christensen D.,Radiation Emergency Assistance Center Training Site
Emergency Medicine Clinics of North America | Year: 2015

After a radiation emergency that involves the dispersal of radioactive material, patients can become externally and internally contaminated with 1 or more radionuclides. Internal contamination can lead to the delivery of harmful ionizing radiation doses to various organs and tissues or the whole body. The clinical consequences can range from acute radiation syndrome to the long-term development of cancer. Estimating the amount of radioactive material absorbed into the body can guide the management of patients. Treatment includes, in addition to supportive care and long term monitoring, certain medical countermeasures like Prussian blue, calcium diethylenetriamine pentaacetic acid (DTPA) and zinc DTPA. © 2015 Elsevier Inc. Source

Christensen D.M.,Radiation Emergency Assistance Center Training Site | Iddins C.J.,Radiation Emergency Assistance Center Training Site | Parrillo S.J.,Philadelphia University | Glassman E.S.,National Security and Emergency Management Programs | And 2 more authors.
Journal of the American Osteopathic Association | Year: 2014

To provide proper medical care for patients after a radiation incident, it is necessary to make the correct diagnosis in a timely manner and to ascertain the relative magnitude of the incident. The present article addresses the clinical diagnosis and management of high-dose radiation injuries and illnesses in the first 24 to 72 hours after a radiologic or nuclear incident. To evaluate the magnitude of a high-dose incident, it is important for the health physicist, physician, and radiobiologist to work together and to assess many variables, including medical history and physical examination results; the timing of prodromal signs and symptoms (eg, nausea, vomiting, diarrhea, transient incapacitation, hypotension, and other signs and symptoms suggestive of high-level exposure); and the incident history, including system geometry, source-patient distance, and the suspected radiation dose distribution. © 2014 American Osteopathic Association. Source

Sugarman S.L.,Radiation Emergency Assistance Center Training Site | Toohey R.,Oak Ridge Associated Universities | Goans R.,REAC TS and MJW Corporation | Christensen D.,Radiation Emergency Assistance Center Training Site | Wiley A.,Radiation Emergency Assistance Center Training Site
Health Physics | Year: 2010

It is crucial to integrate health physics into the medical management of radiation illness or injury. The key to early medical management is not necessarily radiation dose calculation and assignment, but radiation dose magnitude estimation. The magnitude of the dose can be used to predict potential biological consequences and the corresponding need for medical intervention. It is, therefore, imperative that physicians and health physicists have the necessary tools to help guide this decision making process. All internal radiation doses should be assigned using proper dosimetry techniques, but the formal internal dosimetry process often takes time that may delay treatment, thus reducing the efficacy of some medical countermeasures. Magnitudes of inhalation or ingestion intakes or intakes associated with contaminated wounds can be estimated by applying simple rules of thumb to sample results or direct measurements and comparing the outcome to known limits for a projection of dose magnitude. Although a United States regulatory unit, the annual limit on intake (ALI) is based on committed dose, and can therefore be used as a comparison point. For example, internal dose magnitudes associated with contaminated wounds can be estimated by comparing a direct wound measurement taken soon after the injury to the product of the ingestion ALI and the associated f1 value (the fractional uptake from the small intestine to the blood). International Commission on Radiation Protection Publication 96, as well as other resources, recommends treatment based on ALI determination. Often, treatment decisions have to be made with limited information. However, one can still perform dose magnitude estimations in order to help effectively guide the need for medical treatment by properly assessing the situation and appropriately applying basic rules of thumb. Copyright © 2010 Health Physics Society. Source

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