Goiania radiation

1. RADIOLOGICAL ACCIDENT IN
GOIÂNİA
Module XIX

2. Module Medical XIX-(18) - 2
137Cs-accident, Goiânia, Brazil
September 13, 1987
Goiânia
Rio de Janeiro
Sao Paulo
Angra NPP

3. Module Medical XIX-(18) - 3
Accident description

4. Module Medical XIX-(18) - 4
Source
137CsCl
(caesium chloride)
50.9 TBq (1375 Ci)
main gamma: 0.66 MeV
main beta: 1.17 MeV
T 1/2=30 years

5. Module Medical XIX-(18) - 5
Radiological triage
112 000 persons monitored
249 identified contaminated
120 only clothing and shoe contamination
129 internal contamination
50 subjected to direct medical surveillance

6. Module Medical XIX-(18) - 6
Technical management of
accident
85 residences (houses) had significant level
of contamination, 41 evacuated, 4 demolished

7. Module Medical XIX-(18) - 7
Environmental aspects of 137Cs
accident in Goiania
 Initial surveys conducted in suspect homes and
work areas
 67 km2 urban area of Goiania city monitored using
helicopter to identify all hotspots (few mGy/hr to >2
Gy/hr)
 2000 m2 contaminated
 Several household pets (cats and dogs) and some
livestock (pigs) slaughtered
 Air and water samples negative
3000 m3 contaminated (radioactive) material
collected, 50.6 TBq 137Cs recovered; <0.37 TBq
remained

8. Module Medical XIX-(18) - 8
Internal dose assessment

9. Module Medical XIX-(18) - 9
Dose assessment by
cytogenetic dosimetry
Re-estimated dose through
cytogenetics (Gy)
Number of individuals
< 0.1 - 0.49 105
0.50 - 0.99 8
1.00 - 1.99 8
2.00 - 2.99 3
3.00 - 3.99 2
4.00 - 4.99 2
5.00 - 5.99 1
Total 129

10. Module Medical XIX-(18) - 10
Medical aspects
250 persons exposed
50 persons WB exposure or local radiation injury
14 bone marrow depression 28 local radiation injury
4 died
8 ARS

11. Module Medical XIX-(18) - 11
Therapeutic measures during
critical period
 Managing critical period of ARS,
bone marrow suppression
 Therapy for local radiation injury
 Decorporation of caesium-137
 General support and psychotherapy

12. Module Medical XIX-(18) - 12
Treatment of haematological
syndrome
 8 ARS patients with estimated doses
 1  2-4 Gy
 5  4-6 Gy
 2  >6 Gy received GM-CSF therapy
 Four patients died: two of hemorrhage and two of t
sepsis from Klebsiella infection
 Two patients who received high doses (7.0 and 5.5
Gy) and exhibited bone marrow depression but were
not treated with GM-CSF spontaneously recovered
and survived

13. Module Medical XIX-(18) - 13
Radiation skin injuries
 Radiation induced skin injuries caused by gamma and
beta radiations observed in 28 who had handled
source housing or fragments of source
 12 of the 28 victims had multiple injuries affecting
predominantly upper limbs
 Injuries did not heal completely and relapsed in 8
patients, who then required surgical debridement,
amputation of digital extremities and plastic skin
grafts
 In 1997 one severely irradiated patient developed a
malignant skin lesion on lower limbs which was
surgically excised

14. Module Medical XIX-(18) - 14

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19. Module Medical XIX-(18) - 19
Therapeutic management of localized
radiation injuries:
Goiânia experience-ı
 Pain management
 Opioid analgesia, extradural opioid analgesia
 Reduction of inflammatory reaction
 Systemic and local NSAID
 Extract of aloe vera
 Cleaning of wounds and use of antiseptics -
prevention of infection
 Hands and fingers immersed in boric acid solution
reducing skin dryness, pain and itching
 non-adherent dressing coated with neomycin

20. Module Medical XIX-(18) - 20
Therapeutic management of localized
radiation injuries:
Goiânia experience-ıı
 Improvement of local microcirculation
 Pentoxifylline, which decreases blood viscosityused
in two patients, reducing risk of early formation of
microthrombi, thus improving blood flow in injured
tissues
 Hyperbaric oxygen therapy (HOT) hastened
granulation at wound edges, reduced ulcerated area
considerably increasing local pO2, thus facilitating
integration of graft with damaged area
 Surgical treatment
 Complete excision of damaged tissue
 Skin graft abdominal flaps
 Amputation

21. Module Medical XIX-(18) - 21

22. Module Medical XIX-(18) - 22
Prussian blue therapy for caesium
decorporation
BLOOD
LIVER
GI TRACT
FECES
PB
PB
Schematic representation of PB action in body

23. Module Medical XIX-(18) - 23
Prussian blue administration
in Goiania 137Cs Accident
 46 persons received prussian blue
 Dosage related to internal body burden
 Initial 3 g/day then
3-6 g/day in adults exceeding 5 x ALI
 For children initial dose 1-1.5 g/day then
3 g/day for those exceeding 5 x ALI
 Five adults with very high burdens received 10
g/day

24. Module Medical XIX-(18) - 24
Patient follow-up in
Goiania
 Medical
 Cytogenetic
 Psychological
 Social
 Economic

25. Module Medical XIX-(18) - 25
Medical follow-up of Goiania accident
victims
• Status of skin injuries after initial healing
– 8/28 patients required surgery in 1989, and 6/28 in 1990
– One patient required repeated surgery in 1991, ‘92, ‘93
• Skin lesions tended to be affected by stress
• Sperm count in males now normal - 2 exposed in teenage males
have fathered healthy children
• Follow-up of children
- 7 exposed in utero have no abnormalities
– 10 conceived post-accident born with no abnormalities

26. Module Medical XIX-(18) - 26
Cytogenetic follow-up
(6 years)
Tdic=110 d at > 1 Gy Tdic =160 d at 0.3-1 Gy

27. Module Medical XIX-(18) - 27

28. Half-life of dicentric chromosomes
and centric rings in nine 13-57 year
old people overexposed in Goiania
accident
T1/2 = 90-230 days
(Follow-up 7.5 years)

29. Module Medical XIX-(18) - 29
Psychological and social follow-up
of Goiania accident victims
• Psychological alterations
– increase in psychosomatic disorders
– fear of leukaemia and early death
– increased use of alcohol and drugs
– lack of self-confidence
• Discrimination
– by others due to fear
– self-discrimination from social contact
• Stigmatization
– victims blamed for accident by many citizens

30. 137Cs retention curves of woman contaminated in fourth
month of pregnancy and her baby

31. Module Medical XIX-(18) - 31
Summary of therapeutic measures
8 patients with severe BM syndrome treated with GM-CSF
4 died due to haemorrhage and sepsis
• None received BMT
• All surviving patients - normal blood counts since 1988
(quarterly check ups and CBC)
• 3-10 g/day prussian blue to adults, 1-3 g/day to children
• 28 patients treated surgically for radiation skin injuries
relapse in 8 patients leading to fibrosis in 4