Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device

One of the key issues in the aftermath of an exploded radiological dispersal device from a terrorist event is that of the contaminated victim and the concern among healthcare providers for the harmful exposures they may receive in treating patients, especially if the patient has not been thoroughly decontaminated. This is critically important in the event of mass casualties from a nuclear or radiological incident because of the essential rapidity of acute medical decisions and that those who have life- or limb-threatening injuries may have treatment unduly delayed by a decontamination process that may be unnecessary for protecting the health and safety of the patient or the healthcare provider. To estimate potential contamination of those exposed in a radiological dispersal device event, results were used from explosive aerosolization tests of surrogate radionuclides detonated with high explosives at the Sandia National Laboratories. Computer modeling was also used to assess radiation dose rates to surgical personnel treating patients with blast injuries who are contaminated with any of a variety of common radionuclides. It is demonstrated that exceptional but plausible cases may require special precautions by the healthcare provider, even while managing life-threatening injuries of a contaminated victim from a radiological dispersal device event.     

Realistic radiological dispersal device hazard boundaries and ramifications for early consequence management decisions

If dispersal occurs from an explosive radiological dispersal device, first responders need to know what actions they need to take to protect life and property. Many of the decisions required to minimize exposure will be made during the first hour. To help the first responder decide what countermeasures to employ, Sandia National Laboratories has established realistic hazard boundaries for acute and sub-acute effects relevant to radiological dispersal devices. These boundaries were derived from dispersal calculations based on the aerosolization behavior of devices tested in the Sandia Aerosolization Program. For 20 years, the Sandia Aerosolization Program has performed explosive and non-explosive aerosolization tests relevant to radiological dispersal devices. This paper discusses (1) the method and technical bases used to establish hazard boundaries and the appropriate actions that apply within those areas and (2) whether large-scale evacuations or sheltering in place are appropriate responses to a radiological dispersal device event.     

Emergency response guidance for the first 48 hours after the outdoor detonation of an explosive radiological dispersal device

Strategies and decisions to protect emergency responders, the public, and critical infrastructure against the effects of a radiological dispersal device detonated outdoors must be made in the planning stage, not in the early period just after an attack. This contrasts with planning for small-scale types of radiological or nuclear emergencies, or for a large-scale nuclear-power-type accident that evolves over many hours or days before radioactivity is released to the environment, such that its effects can be prospectively modeled and analyzed. By the time it is known an attack has occurred, most likely there will have been casualties, all the radioactive material will have been released, plume growth will be progressing, and there will be no time left for evaluating possible countermeasures. This paper offers guidance to planners, first responders, and senior decision makers to assist them in developing strategies for protective actions and operational procedures for the first 48 hours after an explosive radiological dispersal device has been detonated.     

对放射医疗设备非通用辅助装置配置方法的探讨

目的：探讨放射医疗设备非通用辅助装置的配置方法。方法：总结具体运作的实践经验。结果：采取三方合作。共同研制出一套与DSA区配的介入防护装置。结论：这种配置方法对器材管理是有益的。     

Dose assessment for reentry or reoccupancy and recovery of urban areas contaminated by a radiological dispersal device: the need for a consensus approach

Should an attack occur in an urban area with a Radiological Dispersal Device (RDD), guidance is available on the acceptable total dose equivalent for reentering the contaminated zone, and there is an accepted methodology for plume projection in the model used by the Federal Radiological Monitoring and Assessment Center (FRMAC). After initial characterization of the impact of the plume caused by an RDD, there will be considerable pressure from the public to allow them to return and quickly collect their belongings, and, eventually, to reoccupy residences and to reopen businesses. The FRMAC procedures principally deal with early and intermediate phase dose assessment, but do include late phase assessment procedures. However, the late phase assessments do not include complex geometries, such as the internal structure of buildings. This paper identifies areas where more specificity is needed to rapidly provide assessments to health officials and senior decision-makers. In this regard, there is no national consensus method to calculate projected dose inside buildings after an RDD event that addresses selecting the exposure pathways, scenarios, key parameters, etc. Therefore, to demonstrate an approach that exemplifies some of the technical and policy issues, which are unresolved, four exposure scenarios (residential, industrial, public park, park worker) were evaluated to determine the level of contamination that would deliver a dose equivalent of 10 mSv in the first year, excluding exposure during the first 4 d (emergency phase). In addition, the retrieval of personal belongings was simulated by assessing a 1-h exposure for the residential and industrial scenarios. RESRAD-BUILD was used to calculate the surface concentration of 60Co, 90Sr, 137Cs, 192Ir, 226Ra, 238Pu, 241Am, and 252Cf that would lead to a 10 mSv reference dose for these exposure periods. These example studies are intended to provide insights and guidance on how a municipal health agency can begin to develop a response plan, and to understand how the assessment process will determine the dose impacts resulting from an RDD event. The model's predictions heavily depend on the choice of the model's parameters; for several key ones, there are large uncertainties about their appropriate values. To avoid having to make hasty decisions during an emergency after an RDD attack, this analysis demonstrates that a detailed protocol for calculating dose should be developed prospectively so that decision-makers already are fully familiar with the process and its ensuing products.     

Characterisation of radiological properties of a brachytherapy moulding material

The use of a non-water-equivalent personalised mould for gynaecological brachytherapy treatments can result in a substantial dose reduction at the treatment site, compared to calculated dose, in lieu of a dose calculation algorithm capable of modelling non-water-equivalent materials. This study describes the characterisation of the radiological properties of a brachytherapy applicator moulding material. Simple line source correction factors for an ¹⁹²Ir source are obtained through Monte Carlo simulations and verified by film measurements. The dwell position corrections are used to estimate aggregate correction factors for dose deliveries that involve multiple dwell positions, in terms of treatment length, applicator radii and depth of reference dose. For the Fricotan moulding material used locally, the dose reductions varied from 1% for an applicator radius of 0.5 cm to > 4% for radii exceeding 2 cm. The method described in this paper could be used to develop correction factors for other non-water-equivalent moulding materials, in a TG-43UI dose calculation environment.     

小型医疗仪器中嵌入式Linux设备驱动程序的开发

介绍了Linux驱动程序的实现机制,分析了嵌入式Linux驱动程序开发的特点,并结合小型医疗仪器硬件平台说明了嵌入式Linux系统下,设备驱动程序的设计、编译和测试方法.     

箱装物资快速搜寻装置的研制

箱装物资搜寻系统主要用于野战医疗箱组以及箱纽内所携带物品的快速搜寻、查找、定位。在医疗器材的运输、空投、机动展开时及时掌握医疗物资的位置和数量，提高伤员快速、机动救治保障能力。该系统也可用于物流行业．它采用无线模块，可以实现手持机和被搜寻箱子的双向通信，通信距离远，并且声光报警。主要由计算机管理系统、手持机、终端机3部分组成。     

New self-marking device for dispersal studies of black flies (Diptera: Simuliidae).

An effective and inexpensive device is described for marking newly emerged black flies with fluorescent dust. Survival of marked adults of Simulium venustum s.l. and Stegopterna mutata s.l. did not differ significantly from unmarked individuals over a 5-day period. Marked individuals were attracted to human hosts in landing biting tests, and the portions of the self-marking trap lying just above the water surface did not appear to significantly hamper black fly emergence success.     

Biokinetics and tolerance development of toxic metals in Daphnia magna

Daphnia magna is widespread in many freshwater systems of temperate regions and frequently is used to test metal toxicity. Recently, studies have been performed to determine metal biokinetics and development of tolerance in this important zooplankton species. In the present paper, we review the recent progress in these areas and suggest possible directions for future studies. Substantial differences exist in aqueous uptake, dietary assimilation, and elimination of several metals (Cd, Se, Zn, Ag, Hg, and MeHg) by D. magna. The routes of uptake are metal-specific, with Se and MeHg being accumulated predominantly through diet. All metals except Ag can be biomagnified from algae to D. magna, providing that metal concentrations in algae and algal food density are relatively low. Methylmercury is biomagnified in all situations. As a route for metal elimination in D. magna, maternal transfer is especially important for Se, Zn, and MeHg. On the other hand, the effect of single-generation exposure to metals on D. magna is very different from multigeneration exposure, which often results in a significantly higher metal tolerance. Moreover, D. magna easily loses metal tolerance developed through long-term exposure. Recovery from metal stress can temporarily increase the sensitivity of D. magna to metal toxicity. Finally, metallothionein-like protein is responsible for minimizing metal toxicity in D. magna. The results inferred from these studies can be extrapolated to other aquatic invertebrates as well as to other pollutants in the aquatic environment.     

An indicator device for monitoring of room illuminance level in the radiological image viewing environment

Illuminance level in the softcopy image viewing room is a very important factor to optimize productivity in radiological diagnosis. In today's radiological environment, the illuminance measurements are normally done during the quality control procedure and performed annually. Although the room is equipped with dimmer switches, radiologists are not able to decide the level of illuminance according to the standards. The aim of this study is to develop a simple real-time illuminance detector system to assist the radiologists in deciding an adequate illuminance level during radiological image viewing. The system indicates illuminance in a very simple visual form by using light emitting diodes. By employing the device in the viewing room, illuminance level can be monitored and adjusted effectively.     

The Management of a patient with a fragmented intrauterine device embedded within the cervical canal

A 28-year-old woman presented with a malpositioned intrauterine device (IUD) that was fragmented and significantly entrenched within the cervical canal and myometrium. IUD malposition with concomitant device fragmentation and embedded segments, albeit rare, should be a consideration given the device's prevalence.     

Biokinetics of nuclear fuel compounds and biological effects of nonuniform radiation.

Environmental releases of insoluble nuclear fuel compounds may occur at nuclear power plants during normal operation, after nuclear power plant accidents, and as a consequence of nuclear weapons testing. For example, the Chernobyl fallout contained extensive amounts of pulverized nuclear fuel composed of uranium and its nonvolatile fission products. The effects of these highly radioactive particles, also called hot particles, on humans are not well known due to lack of reliable data on the extent of the exposure. However, the biokinetics and biological effects of nuclear fuel compounds have been investigated in a number of experimental studies using various cellular systems and laboratory animals. In this article, we review the biokinetic properties and effects of insoluble nuclear fuel compounds, with special reference to UO2, PuO2, and nonvolatile, long-lived beta-emitters Zr, Nb, Ru, and Ce. First, the data on hot particles, including sources, dosimetry, and human exposure are discussed. Second, the biokinetics of insoluble nuclear fuel compounds in the gastrointestinal tract and respiratory tract are reviewed. Finally, short- and long-term biological effects of nonuniform alpha- and beta-irradiation on the gastrointestinal tract, lungs, and skin are discussed.     

新型便携式正电子放射性药物防护装置的设计与研究

目的：设计新型正电子放射性药物取用、转运及注射防护装置,降低核医学工作人员职业照射剂量。方法：选择钨合金作为防护材料,设计为便携式可分段拆卸的全封闭式注射器（2 ml）防护装置,并增加其他相关配套装置,测量对PET正电子放射性药物18F-氟脱氧葡萄糖（18F-FDG）444 MBq（0.5－2 ml）的防护效能。结果：全封闭注射防护装置针筒防护套正面有效屏蔽为35 mm Pb。配套转运铅提盒有效屏蔽为10 mm Pb。PET正电子放射性药物18F-FDG封闭注射防护装置注射器针筒防护套正面30 cm处剂量率为1.5μSv/h;在距离注射器针筒防护套后部位置30cm处剂量率为0.4μSv/h。设计参数和辐射防护数据达到预期的职业外照射控制目标。结论：新型便携式正电子放射性药物防护装置可以有效降低核医学工作者职业照射剂量,值得推广。     

Synthesis of radiological models and radiological invariants (constants). Part 2

The goal of this work was to synthesize a mathematical model (MM) on the basis of Klepper and Lyman MMs, which describe the probability of post-radiation complications (PRC) in tissue subjected to radiation therapy with given scheme of dose fractionating (DF), and the LQ-model, which describes equivalent DF schemes for a fixed PRC value. Construction of synthesized MMs (SMMs) becomes possible only on the basis of several assumptions requiring further clinical validation. Synthesized MMs can be used for determination of the optimal dynamic conditions of irradiation of malignant tumors. These conditions include the optimal physical plan of irradiation and the optimal time scheme of its implementation. Synthesis of MMs leads to determination of radiological invariants (constants), which can become a basis for a new branch of medical science, quantitative radiology.