Eurados review of retrospective dosimetry techniques for internal exposures to ionising radiation and their applications.

This work presents an overview of the applications of retrospective dosimetry techniques in case of incorporation of radionuclides. The fact that internal exposures are characterized by a spatially inhomogeneous irradiation of the body, which is potentially prolonged over large periods and variable over time, is particularly problematic for biological and electron paramagnetic resonance (EPR) dosimetry methods when compared with external exposures. The paper gives initially specific information about internal dosimetry methods, the most common cytogenetic techniques used in biological dosimetry and EPR dosimetry applied to tooth enamel. Based on real-case scenarios, dose estimates obtained from bioassay data as well as with biological and/or EPR dosimetry are compared and critically discussed. In most of the scenarios presented, concomitant external exposures were responsible for the greater portion of the received dose. As no assay is available which can discriminate between radiation of different types and different LETs on the basis of the type of damage induced, it is not possible to infer from these studies specific conclusions valid for incorporated radionuclides alone. The biological dosimetry assays and EPR techniques proved to be most applicable in cases when the radionuclides are almost homogeneously distributed in the body. No compelling evidence was obtained in other cases of extremely inhomogeneous distribution. Retrospective dosimetry needs to be optimized and further developed in order to be able to deal with real exposure cases, where a mixture of both external and internal exposures will be encountered most of the times.

ICRP Publication 141: Occupational Intakes of Radionuclides: Part 4.

The 2007 Recommendations (ICRP, 2007) introduced changes that affect the calculation of effective dose, and implied a revision of the dose coefficients for internal exposure, published previously in the Publication 30 series (ICRP, 1979a,b, 1980a, 1981, 1988) and Publication 68 (ICRP, 1994b). In addition, new data are now available that support an update of the radionuclide-specific information given in Publications 54 and 78 (ICRP, 1989a, 1997) for the design of monitoring programmes and retrospective assessment of occupational internal doses. Provision of new biokinetic models, dose coefficients, monitoring methods, and bioassay data was performed by Committee 2 and its task groups. A new series, the Occupational Intakes of Radionuclides (OIR) series, will replace the Publication 30 series and Publications 54, 68, and 78. OIR Part 1 (ICRP, 2015) describes the assessment of internal occupational exposure to radionuclides, biokinetic and dosimetric models, methods of individual and workplace monitoring, and general aspects of retrospective dose assessment. OIR Part 2 (ICRP, 2016), OIR Part 3 (ICRP, 2017), this current publication, and the final publication in the OIR series (OIR Part 5) provide data on individual elements and their radioisotopes, including information on chemical forms encountered in the workplace; a list of principal radioisotopes and their physical half-lives and decay modes; the parameter values of the reference biokinetic models; and data on monitoring techniques for the radioisotopes most commonly encountered in workplaces. Reviews of data on inhalation, ingestion, and systemic biokinetics are also provided for most of the elements. Dosimetric data provided in the printed publications of the OIR series include tables of committed effective dose per intake (Sv per Bq intake) for inhalation and ingestion, tables of committed effective dose per content (Sv per Bq measurement) for inhalation, and graphs of retention and excretion data per Bq intake for inhalation. These data are provided for all absorption types and for the most common isotope(s) of each element. The online electronic files that accompany the OIR series of publications contains a comprehensive set of committed effective and equivalent dose coefficients, committed effective dose per content functions, and reference bioassay functions. Data are provided for inhalation, ingestion, and direct input to blood. This fourth publication in the OIR series provides the above data for the following elements: lanthanum (La), cerium (Ce), praseodymium (Pr), neodymium (Nd), promethium (Pm), samarium (Sm), europium (Eu), gadolinium (Gd), terbium (Tb), dysprosium (Dy), holmium (Ho), erbium (Er), thulium (Tm), ytterbium (Yb), lutetium (Lu), actinium (Ac), protactinium (Pa), neptunium (Np), plutonium (Pu), americium (Am), curium (Cm), berkelium (Bk), californium (Cf), einsteinium (Es), and fermium (Fm).

EURADOS work on internal dosimetry.

European Radiation Dosimetry Group (EURADOS) Working Group 7 is a network on internal dosimetry that brings together researchers from more than 60 institutions in 21 countries. The work of the group is organised into task groups that focus on different aspects, such as development and implementation of biokinetic models (e.g. for diethylenetriamine penta-acetic acid decorporation therapy), individual monitoring and the dose assessment process, Monte Carlo simulations for internal dosimetry, uncertainties in internal dosimetry, and internal microdosimetry. Several intercomparison exercises and training courses have been organised. The IDEAS guidelines, which describe - based on the International Commission on Radiological Protection's (ICRP) biokinetic models and dose coefficients - a structured approach to the assessment of internal doses from monitoring data, are maintained and updated by the group. In addition, Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides have been elaborated on behalf of the European Commission, DG-ENER (TECHREC Project, 2014-2016, coordinated by EURADOS). Quality assurance of the ICRP biokinetic models by calculation of retention and excretion functions for different scenarios has been performed and feedback was provided to ICRP. An uncertainty study of the recent caesium biokinetic model quantified the overall uncertainties, and identified the sensitive parameters of the model. A report with guidance on the application of ICRP biokinetic models and dose coefficients is being drafted at present. These and other examples of the group's activities, which complement the work of ICRP, are presented.

The Mayak Worker Dosimetry System (MWDS-2013): A Bayesian Analysis to Quantify Pulmonary Binding of Plutonium in Lungs Using Historic Beagle Dog Data.

The revised human respiratory tract model, published in Part 1 of the International Commission on Radiological Protection's (ICRP) report on Occupational Intakes of Radionuclides (OIR), includes a bound fraction, fb, to represent radionuclides that have become chemically bound in the lungs following dissolution of particulates in lung fluid. Bound radionuclides are not subject to particle transport clearance but can be absorbed to blood at a rate, sb. The occurrence of long-term binding of plutonium can greatly increase lung doses, particularly if it occurs in the bronchial and bronchiolar regions. However, there has been little evidence that currently supports the existence of a long-term bound state for plutonium. The present work describes the analysis of measurements of lung data obtained from a life span study of Beagle dogs that were exposed by inhalation to different concentrations of plutonium-239 (239Pu) nitrate aerosol at Pacific Northwest Laboratories, USA. The data have been analysed to assess whether a bound state was required to explain the data. A Bayesian approach was adopted for the analysis that accounts for uncertainties in model parameter values, including uncertainties in the rates of particle transport clearance. Furthermore, it performs the analysis using two different modelling hypotheses: a model based on the current ICRP human respiratory tract model and its treatment of alveolar particle transport clearance; and a model of particle transport clearance that is based on the updated model developed by ICRP to calculate dose coefficients for the OIR. The current model better represents clearance in dogs at early times (up to 1 year following intake) and the latter better represents retention at greater times (>5 years following intake). The results indicate that a long-term bound fraction of between 0.16 and 1.1%, with a mean value of between 0.24 and 0.8% (depending on the model) is required to explain the data.

ICRP Publication 130: Occupational Intakes of Radionuclides: Part 1.

Abstract ­: This report is the first in a series of reports replacing Publications 30 and 68 to provide revised dose coefficients for occupational intakes of radionuclides by inhalation and ingestion. The revised dose coefficients have been calculated using the Human Alimentary Tract Model (Publication 100) and a revision of the Human Respiratory Tract Model (Publication 66) that takes account of more recent data. In addition, information is provided on absorption into blood following inhalation and ingestion of different chemical forms of elements and their radioisotopes. In selected cases, it is judged that the data are sufficient to make material-specific recommendations. Revisions have been made to many of the models that describe the systemic biokinetics of radionuclides absorbed into blood, making them more physiologically realistic representations of uptake and retention in organs and tissues, and excretion. The reports in this series provide data for the interpretation of bioassay measurements as well as dose coefficients, replacing Publications 54 and 78. In assessing bioassay data such as measurements of whole-body or organ content, or urinary excretion, assumptions have to be made about the exposure scenario, including the pattern and mode of radionuclide intake, physical and chemical characteristics of the material involved, and the elapsed time between the exposure(s) and measurement. This report provides some guidance on monitoring programmes and data interpretation.

Triage, monitoring and dose assessment for people exposed to ionising radiation following a malevolent act.

The part played by individual monitoring within the context of the overall response to incidents involving the malevolent use of radiation or radioactive material is discussed. The main objectives of an individual monitoring programme are outlined, and types of malevolent use scenario briefly described. Some major challenges facing those with responsibilities for planning the monitoring response to such an incident are identified and discussed. These include the need for rapid selection and prioritisation of people for individual monitoring by means of an effective triage system; the need for rapid initiation of individual monitoring; problems associated with monitoring large numbers of people; the particular difficulties associated with incidents involving pure-beta and alpha-emitting radionuclides; the need for techniques that can provide retrospective estimates of external radiation exposures rapidly and the need for rapid interpretation of contamination monitoring data. The paper concludes with a brief review of assistance networks and relevant international projects planned or currently underway.

Thoracolumbar spinal fixation for camptocormia in Parkinson's disease.

A man with early non-fluctuating Parkinson's disease developed disabling camptocormia. The patient was treated with posterior thoracolumbar fixation, which subsequently had to be augmented with anterior interbody fusion. Although the patient ultimately achieved excellent sagittal correction, his postoperative course was complicated and prolonged. Therefore, although this case demonstrates that spinal fixation surgery can be successful, it should probably only be offered after subthalamic nucleus deep brain stimulation has been unsuccessful, or for well motivated patients who express a strong wish for this major reconstructive surgery.

Internal dosimetry: towards harmonisation and coordination of research.

The CONRAD Project is a Coordinated Network for Radiation Dosimetry funded by the European Commission 6th Framework Programme. The activities developed within CONRAD Work Package 5 ('Coordination of Research on Internal Dosimetry') have contributed to improve the harmonisation and reliability in the assessment of internal doses. The tasks carried out included a study of uncertainties and the refinement of the IDEAS Guidelines associated with the evaluation of doses after intakes of radionuclides. The implementation and quality assurance of new biokinetic models for dose assessment and the first attempt to develop a generic dosimetric model for DTPA therapy are important WP5 achievements. Applications of voxel phantoms and Monte Carlo simulations for the assessment of intakes from in vivo measurements were also considered. A Nuclear Emergency Monitoring Network (EUREMON) has been established for the interpretation of monitoring data after accidental or deliberate releases of radionuclides. Finally, WP5 group has worked on the update of the existing IDEAS bibliographic, internal contamination and case evaluation databases. A summary of CONRAD WP5 objectives and results is presented here.

Uncertainties in doses from intakes of radionuclides assessed from monitoring measurements.

The evaluation of uncertainties in doses from intakes of radionuclides is one of the most difficult problems in internal dosimetry. In this paper, the process of assessing internal doses from monitoring measurements is reviewed and the major sources of uncertainty are discussed. Methods developed independently at HPA and at IRSN for the determination of uncertainties in internal doses assessed from monitoring measurements are described. Both use a Monte Carlo simulation approach. Results are described for three illustrative examples. An alternative method developed at the Los Alamos National Laboratory that uses Bayesian statistical methods is also described briefly.

Is there a role for surgery in the management of dropped head syndrome?

We present a 50-year-old chronic epileptic man with a long-standing head drop, who fell sustaining multilevel thoracic vertebral body fractures. The antiepileptic medication was thought to be responsible for his osteoporosis and dropped head. We review the aetiology of the dropped head and report on our experience of surgery for this rare and disabling condition.

Extensive spinal epidural abscess associated with an unremarkable recovery.

Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.

A review of measurements of radionuclides in members of the public in the UK.

This paper summarises a comprehensive review of radio-analytical data from autopsy, whole or partial body monitoring and the assay of teeth, foetuses and urine for non-occupationally exposed members of the public in the UK between 1957 and 2003. Most attention has been given to measurements of artificial radionuclides formed in the nuclear fuel cycle, uranium and thorium. The review concentrates on measurements on people in the UK who live or have lived in the vicinity of nuclear power sites. When UK data are unavailable, or for the purposes of comparison, information has been included from studies in other countries. Highlights of key findings of the document are listed: The concentrations of strontium-90 in bone and teeth have reflected changes in the amounts present in the environment due to fallout from nuclear testing. There are higher concentration levels of 239+240Pu in samples from West Cumbria compared with the rest of the UK. However, the levels are so low that any increase in risk of induced skeletal tumours (including leukaemia) would be very small compared with those arising from the intake of natural radionuclides. As expected there have been only a few published autopsy studies. Both tissue sample mass and radionuclide concentrations were low, leading to relatively large measurement uncertainties. Whole body measurements of 137Cs in residents in Berkshire and Oxfordshire clearly show the effect of atmospheric testing of nuclear weapons and of the Chernobyl accident. A survey of whole body 137Cs and 134Cs content following the Chernobyl accident showed that residents of Central Scotland, North-West England and North Wales had twice the radiocaesium content of residents in the rest of England and Wales. Measurements of 131I in the thyroid have been reported following the accidents at Windscale and Chernobyl for most regions of the UK. Few excretion studies have been reported although this does not diminish their importance. One study on the urinary excretion rate of 90Sr in adults and children living in the Dounreay area suggested that the results did not support this radionuclide as being the cause of increased childhood leukaemia. Similar conclusions were drawn from another study involving the assay of 239Pu. It is suggested that a national database of measurements made on members of the public should be initiated. The database would provide a means for identifying future trends.

Comparison of predicted with observed biokinetics of inhaled plutonium nitrate and gadolinium oxide in humans.

The absorption kinetics to blood of plutonium and gadolinium after inhalation as nitrate and oxide in humans and animals has been studied. For each material, values describing the time dependence of absorption were derived from the studies in animals and used with the ICRP human respiratory tract model to predict lung retention and cumulative amounts to blood for the volunteers inhaling the same materials. Comparison with the observed behaviour in the volunteers suggests that absorption of plutonium and gadolinium is reasonably species independent, and that data obtained from animal studies can be used to assess their biokinetic behaviour in humans.

Optimising monitoring regimens for inhaled uranium oxides.

This paper provides guidance on the most appropriate monitoring procedures and intervals, the likely uncertainties in the assessment of intake and recommendations on appropriate investigation levels for repeated exposures to uranium trioxide, octoxide and dioxide of natural composition.

Anomalously high excretion of Pu in urine following inhalation of plutonium nitrate?

A study of the biokinetics of inhaled plutonium nitrate in two volunteers has been carried out. Low doses (approximately 80 microSv) were achievable because tracers of high isotopic purity were used: 237Pu (measurable by X ray spectrometry) and 244Pu (measurable by accelerator mass spectrometry). Lung retention, amount in blood, uptake to the liver and skeleton, and urinary and faecal excretion were measured. The measured urinary excretion rates are about a factor of three higher than those predicted from urine excretion data measured following intravenous injection of plutonium to the same volunteers. If similar biokinetic behaviour occurs in workers exposed to plutonium nitrate, intakes by inhalation and corresponding committed doses assessed by urine bioassay could be consistently overestimated by a similar factor.

OMINEX: survey of internal dose monitoring programmes for radiation workers.

Monitoring of the workforce in the nuclear industries is carried out primarily in order to demonstrate compliance with European Union (EU) legislation and the Basic Safety Standards for the protection of the health of workers against the dangers arising from ionizing radiation recommended by the International Atomic Energy Agency (IAEA). There is, however, no common strategy for internal dose monitoring programmes currently in use in the EU countries. Surveys have been carried out in which organisations were asked to provide information on the design of their internal dose monitoring programmes and on the costs of these programmes. Information was requested from both EU countries and Associated States. Databases for storage and reporting of all gained information were constructed, and results from the surveys have been compiled. This work was carried out within the EC 5th Framework Programme project, OMINEX, which aims to provide advice and guidance on designing and implementing internal dose monitoring programmes in the workplace in such a way that best use is made of available resources, while minimising costs.

A feasibility study for transportable 241Am-in-lung and 241Am-in-nose-blow monitoring systems for use following a weapons accident.

In a nuclear weapon accident involving fire or conventional explosion, most of the radiation dose received by people in the immediate vicinity would result from inhalation of 239Pu. This is accompanied by the nuclide 241Am, which is much easier to determine by external counting because of the 60 keV gamma ray emission. In the event of an accident, a priority would be to identify any people who have had intakes of 239Pu which were so large that decorporation therapy should be considered. Direct measurement of lung content provides the most rapid and convenient method for assessing intakes by inhalation. A transportable system has been considered as this could be deployed close to the site of the accident and would allow rapid measurements to be made. The feasibility of a transportable 241Am-in-nose-blow and nasal swab measurement system has also been considered. This would be used to help select people for 241Am-in-lung measurements.