Role of radoncs in a nuclear fallout

[Raygun77]

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As most/all of you will know, Japan is currently facing it's second biggest nuclear (and population) emergency in history with the catastrophic quake-'nami combo. Latest status on the no.2 reactor is that the seawater has failed to abate the crisis, so who knows what comes next.

For all rad oncs/resident rad oncs- I'm curious to hear your thoughts- what do you think your role, and indeed, duty is during a nuclear emergency such as this?

For example, the IAEA syllabus for rad oncs (endorsed by ASTRO and ESTRO) list a whole section on "principles of radiation protection" (pg 15) as one of the specific core competencies. Under this heading, rad oncs apparently should be versed in "public exposure and emergency planning" for nuclear events.

So what do you think you feel your capacity would be in a nuclear emergency? I imagine rad oncs would be experts at treating acute and preventing delayed radiation side effects, as well as estimating stochastic risks of cancer, effects on embryos, etc.

Would like to hear your thoughts.
Ray

 

[Gfunk6]

Zero, zip, nada.

The radiation safety officers at our institution are always trying to get us involved but seriously, our training is tangential at best. In fact, other than the fact that radiation oncology and radiation fallout have one word in common, there is not much else related. Oh sure the physical principles are the same but this is like arguing a geologist who studies plate tectonics should be administering the recovery efforts.

Emergency medicine physicians should be at the forefront of any such efforts and our role advisory at best.

 

[Werg]

I think this is actually an interesting question. mostly because no one at your local hospital, certainly not ED docs, is trained for radiation related injury/illness of this type (so you might be getting a call). At the same time, the feds are increasingly worried about this as a terrorist threat.

The only place I've heard of for training in "Radiation Emergency Medicine" is through Oak Ridge National Lab. They apparently coordinate the federal radiation emergency medical response effort.

As part of grad school in medical physics you usually need to take a course in internal dosimetry (it's really more geared towards health physicists, but also nuc med physicists). In our class the instructor would always say, "if you have determined that the person has had an exposure over the threshold limit, you then need to immediately put them under the care of the radiation physician". I remember asking the instructor what kind of doctor that would be, but he didn't really know, having never actually done that in his 20+ year career.

On a related note, I needed to get a health clearance to work in a radiation area at a European physics lab. So I went to my normal PCP at the student health clinic. As you might imagine, neither she nor I had any idea what might constitute a radiation worker physical, besides the recommended complete blood count.

Honestly, if someone showed up at your hospital with radiation injuries (especially from something like a nuclear reactor), the I would immediately get on the phone with NRC, etc. and tell them to get the real experts in. The feds have money and people for this. They'll be even more interested if someone shows up with a nice case of Po-210 poisoning (of course you probably won't suspect Po-210 for a while).

 

[Charles_Carmichael]

As an outsider, looking at the acute radiation syndromes (hematopoetic, GI, and cerebrovascular syndromes are the ones I know of) and the medical management behind them, I can't really see radoncs being primarily responsible for managing these patients. For the acute high dose exposures (that will pretty much be lethal), it's more palliative care. And for low dose exposures/non-lethal hematopoetic syndrome, it seems like bone marrow transplant and/or cytokine therapy and/or possible prophylactic antibiotics are the things that seem to pop up in the literature.

Like I said though, this is just the basic stuff I know and I could be wrong, but it doesn't seem like radoncs will be able to do a whole lot in case of nuclear fallout. 😳

 

[Brim]

Maybe my Osiris Therapeutics stock (OSIR) will finally go up! So far, however, it hasn't moved. I wonder if the disaster in Japan will accelerate FDA approval.

Prochymal facts
Prochymal - press release
Prochymal - Awarded $224.7M DOD contract

 

[Werg]

This article is from Radiology, March 2010. It mentions the role of radiologists, nuc med physicians, and rad oncs in responding to a "major radiologic emergency".

http://radiology.rsna.org/content/254/3/660.full

Choice quote: "Physicians familiar with the biologic effects of radiation exposure from such events, and with the medical treatment of irradiated and/or contaminated individuals, will play vital roles in emergency response."

 

[seper]

question: what is the minimal whole body dose able to cause acute laryngitis? skin tanning?

 

[seper]

clarification: single dose administered in a matter of few hours

 

[Joaquin]

radoncs responding to this situation?

I can see it now.........

 

[NIHNewInnovator]

It's funny watching the senior Rad Oncs on CNN comment on the unfolding disaster, each having no training in health physics, nuclear reactor design, or even unsealed sources. They say everything is okay one day and the next some new event occurs - like high-levels of radioactivity measured in sea water off Tokyo. Clearly, there are fission fragments in the water which only could come from breached fuel rods. They add to the confusion and not the clarity.

 

[MadamCurie]

It's funny watching the senior Rad Oncs on CNN comment on the unfolding disaster, each having no training in health physics, nuclear reactor design, or even unsealed sources. They say everything is okay one day and the next some new event occurs - like high-levels of radioactivity measured in sea water off Tokyo. Clearly, there are fission fragments in the water which only could come from breached fuel rods. They add to the confusion and not the clarity.

Except that, IMHO, the rad oncs did a better (albeit still not great) job discussing radiation's potential risks to human health – as opposed to issues of reactor design, fission processes and temperatures that fuel rods melt – than any of the physics types did. And in the final analysis, isn't that what the general public is really concerned about?

Nor did the rad oncs mess up their powers of ten when it came to units of dose/dose equivalent that can cause particular effects either. (Or go back and forth between rad/rem and Gray/Sievert, which only added to the confusion.)

Ironically though, very few media outlets have bothered to consult with actual radiation biologists...we merely being the peons who taught both the physicists and physicians most of what they know about the subject in the first place.

Not that I'm bitter or anything. 😉