[Diagnosis and emergency management of radiological incidents]. / Diagnostic et prise en charge en urgence des incidents radiologiques.

Incidents involving ionizing radiation pose a risk of immediate and long-term clinical consequences for both victims and responders in the event of secondary contamination. Rapid identification of the problem and a coordinated response are crucial. This article summarizes the key challenges related to the emergency management of a single patient or multiple victims, addressing the importance of recognizing such a case, radioprotection measures, decontamination, and available treatments.

Les incidents impliquant des rayonnements ionisants représentent un risque aux conséquences cliniques immédiates et à long terme, tant pour les victimes que pour les intervenants en cas de contamination secondaire. L'identification rapide de la problématique et une réponse coordonnée sont cruciales. Cet article résume les principaux enjeux liés à la prise en charge en urgence d'un patient unique ou de plusieurs victimes, en abordant l'importance de la reconnaissance d'un tel cas, des mesures de radioprotection, de la décontamination et des traitements disponibles.

Expected role of photodynamic therapy to relieve skin damage in nuclear or radiological emergency: Review.

Nuclear and radiological accidents can occur due to poor management, in transportation, radiation therapy and nuclear wards in hospitals, leading to extreme radiation exposure and serious consequences for human health. Additionally, in many of previous radiological accidents, skin damage was observed in patients and survivors due to the high radiation exposure. However, as part of a medical countermeasures in a nuclear/radiological emergency, it is critical to plan for the treatment of radiation-induced skin damage. Hence, the new, non-invasive technology of photodynamic therapy (PDT) is projected to be more effectively used for treating skin damage caused by high-dose radiation. PDT plays an important role in treating, repairing skin damage and promoting wound healing as evidenced by research. This review, highlighted and recommended potential impacts of PDT to repair and decrease radiation-induced skin tissue damage. Moreover, we have suggested some photosensitizer (PS) agent as radio-mitigator drugs to decrease radiobiological effects.

Awareness and preparedness level of medical workers for radiation and nuclear emergency response.

Radiological science and nuclear technology have made great strides in the twenty-first century, with wide-ranging applications in various fields, including energy, medicine, and industry. However, those developments have been accompanied by the inherent risks of exposure to nuclear radiation, which is a source of concern owing to its potentially adverse effects on human health and safety and which is of particular relevance to medical personnel who may be exposed to certain cancers associated with low-dose radiation in their working environment. While medical radiation workers have seen a decrease in their occupational exposure since the 1950s thanks to improved measures for radiation protection, a concerning lack of understanding and awareness persists among medical professionals regarding these potential hazards and the required safety precautions. This issue is further compounded by insufficient capabilities in emergency response. This highlights the urgent need to strengthen radiation safety education and training to ensure the well-being of medical staff who play a critical role in radiological and nuclear emergencies. This review examines the health hazards of nuclear radiation to healthcare workers and the awareness and willingness and education of healthcare workers on radiation protection, calling for improved training programs and emergency response skills to mitigate the risks of radiation exposure in the occupational environment, providing a catalyst for future enhancement of radiation safety protocols and fostering of a culture of safety in the medical community.

Has Health Physics Contributed to an 80-y False Narrative about the Trinity Nuclear Test?

ABSTRACT: This paper discusses the various analyses of the Trinity Nuclear Test, including how they might apply to the issue of infant mortality. This paper was first drafted as a response to a letter by Rice, who commented on my earlier letter on that issue. My earlier letter commented on the National Cancer Institute's 2020 series of papers in the October Issue of Health Physics on the impact of the Trinity Nuclear Test that was conducted on unoccupied government lands on 16 July 1945. The Journal editors requested that my response to Rice be edited and submitted as a paper to ensure adequate technical review and suggested that the article also add material summarizing the series of exchanges that were published in the Journal. This article suggests that significant differences exist between various summaries of the offsite impact of the Trinity Nuclear Test and offers that Trinity might be the largest nuclear accident in terms of the impact on uninvolved civilians who were downwind following the test. It suggests areas for further study to resolve these significant differences. It also asserts that until the estimated exposures of downwind residents are resolved and an appropriate study is made of infant deaths following the Trinity Nuclear Test, the issue of infant mortality remains an unanswered, 80-y-old question.

The difficulty of nuclear emergency prevention measures during natural disasters: ongoing challenges in Japan.

It is crucial to anticipate nuclear emergency scenarios and implement effective measures. Japan's climate and topography make it vulnerable to natural disasters; thus, it is necessary to address compounding and cascading disaster scenarios involving the simultaneous occurrence of natural and nuclear disasters. On 1 January 2024, an earthquake hit the Noto region of Ishikawa Prefecture, resulting in damage to the area around the Shika Nuclear Power Plant, located 90 km from the epicenter. This earthquake revealed that, in the event of a complex disaster, it is possible that residents living within 30 km of the Shika Nuclear Power Plant will be completely unprepared for a nuclear disaster. In the event of a complex disaster, it is crucial to implement appropriate countermeasures while balancing responses to both nuclear and natural disasters and optimizing radiation disaster prevention measures.

Rethinking the Role of Biodosimetry to Assess Risks for Acute Radiation Syndrome in Very Large Radiation Events: Reconsidering Legacy Concepts.

The development of effective uses of biodosimetry in large-scale events has been hampered by residual, i.e., "legacy" thinking based on strategies that scale up from biodosimetry in small accidents. Consequently, there remain vestiges of unrealistic assumptions about the likely magnitude of victims in "large" radiation events and incomplete analyses of the logistics for making biodosimetry measurements/assessments in the field for primary triage. Elements remain from an unrealistic focus on developing methods to use biodosimetry in the initial stage of triage for a million or more victims. Based on recent events and concomitant increased awareness of the potential for large-scale events as well as increased sophistication in planning and experience in the development of biodosimetry, a more realistic assessment of the most effective roles of biodosimetry in large-scale events is urgently needed. We argue this leads to a conclusion that the most effective utilization of biodosimetry in very large events would occur in a second stage of triage, after initially winnowing the population by identifying those most in need of acute medical attention, based on calculations of geographic sites where significant exposures could have occurred. Understanding the potential roles and limitations of biodosimetry in large-scale events involving significant radiation exposure should lead to development of the most effective and useful biodosimetric techniques for each stage of triage for acute radiation syndrome injuries, i.e., based on more realistic assumptions about the underlying event and the logistics for carrying out biodosimetry for large populations.

Society and Nuclear Energy: What Is the Role for Radiological Protection?

ABSTRACT: The harm that society expects from ionizing radiation does not match experience. Evidently there is some basic error in this assumption. A reconsideration based on scientific principles shows how simple misunderstandings have exaggerated dangers. The consequences for society are far-reaching. The immediate impact of ionizing radiation on living tissue is destructive. However, this oxidative damage is similar to that produced during normal metabolic activity where the subsequent biological reaction is not only protective but also stimulates enhanced protection. This adaptation means that the response to oxidative damage depends on past experience. Similarly, social reaction to a radiological accident depends on the regulations and attitudes generated by the perception of previous instances. These shape whether nuclear technology and ionizing radiation are viewed as beneficial or as matters to avoid. Evidence of the spurious damage to society caused by such persistent fear in the second half of the 20 th century suggests that these laws and attitudes should be rebased on evidence. The three stages of radiological impact-the initial physical damage, the subsequent biological response, and the personal and social reaction-call on quite different logic and understanding. When these are confused, they lead to regulations and public policy decisions that are often inept, dangerous, and expensive. One example is when the mathematical rigor of physics, appropriate to the immediate impact, is misapplied to the adaptive behavior of biology. Another, the tortured historical reputation of nuclear technology, is misinterpreted as justifying a radiological protection policy of extreme caution.Specialized education and closed groups of experts tend to lock in interdisciplinary misperceptions. In the case of nuclear technology, the resulting lack of independent political confidence endangers the adoption of nuclear power as the replacement for fossil fuels. In the long term, nuclear energy is the only viable source of large-scale primary energy, but this requires a re-working of public understanding.

Evaluating Reception Center Models for Radiation Response Screening Capacity and Throughput Predictions.

ABSTRACT: Introduction: The current fleet of nuclear reactors in the United States is mandated to provide evidence that surrounding jurisdictions can screen their populations should an incident occur. Capacity can be measured as throughput in reception centers used for screening. Due to the significant staffing and resources required to exercise screening capacity, most jurisdictions typically perform smaller exercises and use models to estimate their overall throughput. Objective: To evaluate the applicability and realism of current throughput models and practices. Methods: Throughput capacity for radiation screening is estimated with a mathematical model derived by the Federal Emergency Management Agency (FEMA). The Centers for Disease Control and Prevention developed a discrete event simulation model as a tool, SimPLER, to evaluate capacity and make throughput predictions. Model estimates will be compared and evaluated using timing data collected at a large-scale exercise. Results: The FEMA model estimated a throughput 41.2% higher than the actual radiation screening throughput, while the SimPLER model provided identical values. The FEMA and SimPLER models' predicted throughputs were 50% and 3.8%, respectively, higher than total exercise throughput. Applying each model to the throughput projections for a 12-hour shift, the FEMA model estimates ranged from 665 to 6,646 people and the SimPLER model yielded an estimated throughput of 1,809 people with a standard deviation of 74.6. Conclusion: Discrete event simulation models, such as SimPLER, may provide more realistic and accurate predictions of radiation screening and throughput capacity of reception centers than mathematical models such as the FEMA model.

The convergence approach may be critical to improving early situational awareness in hostile radioactive environments.

This study explores the impact of a simulated radiological dispersal device (RDD) event in an urban area on young adults around 20 years old. The RDD releases radioactive Cs-137 (7.0E+3 Ci), a common industrial sterilization source. The study aims to demonstrate that combining computational codes and epidemiological models can produce valuable data to guide initial actions when confronting a hostile radioactive environment. The HotSpot Health Physics and RESRAD-RDD codes were used in the simulation to evaluate the event's initial phase. The codes were executed together, and the HotSpot output data was input into RESRAD-RDD. Based on simulated radiation dose levels, estimated doses were incorporated into radioepidemiological models proposed by the Committee on Biological Effects of Ionizing Radiation (BEIR V or VII report). Despite limitations, data transfer between the models revealed no discontinuities or antagonisms. Radiation doses were simulated under three exposure conditions and two atmospheric release modes (day or night), suggesting that atmospheric conditions, sex, and exposure routine can strongly influence the perception of radiation impacts. This combination of methods can increase situational awareness and help with decision-making and developing coping strategies.

Radiation and Chemical Program Research for Multi-Utility and Repurposed Countermeasures: A US Department of Health and Human Services Agencies Perspective.

Although chemical and radiological agents cause toxicity through different mechanisms, the multiorgan injuries caused by these threats share similarities that convene on the level of basic biological responses. This publication will discuss these areas of convergence and explore "multi-utility" approaches that could be leveraged to address common injury mechanisms underlying actions of chemical and radiological agents in a threat-agnostic manner. In addition, we will provide an overview of the current state of radiological and chemical threat research, discuss the US Government's efforts toward medical preparedness, and identify potential areas for collaboration geared toward enhancing preparedness and response against radiological and chemical threats. We also will discuss previous regulatory experience to provide insight on how to navigate regulatory paths for US Food and Drug Administration (FDA) approval/licensure/clearance for products addressing chemical or radiological/nuclear threats. This publication follows a 2022 trans-agency meeting titled, "Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures," sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), a part of the National Institutes of Health (NIH). Discussions from this meeting explored the overlapping nature of radiation and chemical injury and spurred increased interest in how preparedness for one threat leads to preparedness for the other. Herein, subject matter experts from the NIAID and the Biomedical Advanced Research and Development Authority (BARDA), a part of the Administration for Strategic Preparedness and Response (ASPR), summarize the knowledge gained from recently funded biomedical research, as well as insights from the 2022 meeting. These topics include identification of common areas for collaboration, potential use of biomarkers of injury to identify injuries caused by both hazards, and common and widely available treatments that could treat damage caused by radiological or chemical threats.

Radiation-Related Thyroid Cancer.

Radiation is an environmental factor that elevates the risk of developing thyroid cancer. Actual and possible scenarios of exposures to external and internal radiation are multiple and diverse. This article reviews radiation doses to the thyroid and corresponding cancer risks due to planned, existing, and emergency exposure situations, and medical, public, and occupational categories of exposures. Any exposure scenario may deliver a range of doses to the thyroid, and the risk for cancer is addressed along with modifying factors. The consequences of the Chornobyl and Fukushima nuclear power plant accidents are described, summarizing the information on thyroid cancer epidemiology, treatment, and prognosis, clinicopathological characteristics, and genetic alterations. The Chornobyl thyroid cancers have evolved in time: becoming less aggressive and driver shifting from fusions to point mutations. A comparison of thyroid cancers from the 2 areas reveals numerous differences that cumulatively suggest the low probability of the radiogenic nature of thyroid cancers in Fukushima. In view of continuing usage of different sources of radiation in various settings, the possible ways of reducing thyroid cancer risk from exposures are considered. For external exposures, reasonable measures are generally in line with the As Low As Reasonably Achievable principle, while for internal irradiation from radioactive iodine, thyroid blocking with stable iodine may be recommended in addition to other measures in case of anticipated exposures from a nuclear reactor accident. Finally, the perspectives of studies of radiation effects on the thyroid are discussed from the epidemiological, basic science, and clinical points of view.

LARCalc, a tool to estimate sex- and age-specific lifetime attributable risk in populations after nuclear power plant fallout.

A tool called LARCalc, for calculating the radiological consequences of accidental large scale nuclear power plant releases based on estimates of 137Cs ground deposition, is presented. LARCalc is based on a previously developed models that has been further developed and packaged into an easy-to-use decision support tool for training of decision makers. The software visualises the radiological impact of accidental nuclear power plant releases and the effects of various protective measures. It is thus intended as a rapid alternative for planning protective measures in emergency preparedness management. The tool predicts projected cumulative effective dose, projected lifetime attributable cancer risk, and residual dose for some default accidental release scenarios. Furthermore, it can predict the residual dose and avertable cumulative lifetime attributable risk (LAR) resulting from various protective measures such as evacuation and decontamination. It can also be used to predict the avertable collective dose and the increase in cancer incidence within the specified population. This study presents the theoretical models and updates to the previous models, and examples of different nuclear fallout scenarios and subsequent protective actions to illustrate the potential use of LARCalc.

STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE¼ - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2022. / РЕЗУЛЬТАТИ РОБОТИ ДУ «ÐÐÐ¦Ð†ÐžÐÐÐ›Ð¬ÐÐ˜Ð™ НАУКОВИЙ ЦЕНТРРАДІАЦІЙНОЇ МЕДИЦИНИ НАЦІОНАЛЬНОЇ АКАДЕМІЇ МЕДИЧНИХ НАУК УКРАЇНИ¼ У 2022 РОЦІ.

Research activities and scientific advance achieved in 2022 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident. The report also shows the results of scientificorganizational and health care work, staff training. The Scientific Council meeting of NAMS approved the NRCRM Annual Report.

STATUS OF THE CURRENT DOMESTIC REGULATORY BASE FOR ENSURING RADIATION SAFETY AND ANTI-RADIATION PROTECTION OF MILITARY PERSONNEL DURING THE PERIOD OF MARTIAL STATUS. / СТАН ЧИННОЇ ВІТЧИЗНЯНОЇ НОРМАТИВНОЇ БАЗИ ЩОДО ЗАБЕЗПЕЧЕННЯ РАДІАЦІЙНОЇ БЕЗПЕКИ ТА ПРОТИРАДІАЦІЙНОГО ЗАХИСТУ ВІЙСЬКОВОСЛУЖБОВЦІВ НА ПЕРІОД ВОЄННОГО СТАНУ.

Prerequisite. In the conditions of a full-scale invasion, the issue of radiation safety and anti-radiation protection in the Armed Forces of Ukraine (AFU) occupies a special place, since the aggressor country violated global geopolitical international decisions, occupied civilian nuclear facilities, in the process of their liberation servicemen mayhave to act in conditions of increased radiation risk, the possibility of using tactical nuclear weapons also is not excluded. OBJECTIVE: to investigate the state of the current national regulatory framework for ensuring radiation safety and anti-radiation protection of military personnel during the period of martial law. METHODS: bibliographic, analytical, historical, systematic approach. RESULTS: The main normative document on the organization of radiation safety and anti-radiation protection of both personnel and the population in Ukraine, as well as military personnel, currently in everyday conditions and in case of radiation accidents since 1998 and until now, are the State Hygienic Standards «Radiation Safety Standards of Ukraine (NRBU-97)¼. But neither in this document, nor in the transition to NRBU-2021-P, the issue of exposure to such a category as military personnel during the performance of combat (special) tasks is considered. The system of monitoring the radiation situation in Ukraine, documents on the organization of medical support for military personnel, including the Guidelines on the Medical Support of the Armed Forces of Ukraine for a Special Period (2019)and the Guidelines on the Organization of Radiation Safety in the Armed Forces of Ukraine (2020), were analyzed.modules of radiation safety principles in the Armed Forces of Ukraine were proposed. CONCLUSION: The unsolved problem of normalization of the radiation factor in the case of man-made and socio-political emergencies can create significant problems in the organization of anti-radiation protection of troops and the population in the case of the use of nuclear weapons or radiation accidents in a special period and requires anurgent solution. It is obvious that there is a need to develop regulatory documents regarding the response and planning of continuous activities to respond to potential nuclear and radiation threats during martial law, including relationships at all levels of the management vertical and methods of communication in the event of a threat.

COGNITIVE ASPECTS OF DEPRESSION IN VICTIMS OF RADIATION ACCIDENTS, THE COVID-19 PANDEMIC, AND WARS. / КОГНІТИВНІ АСПЕКТИ ДЕПРЕСІЇ У ПОСТРАЖДАЛИХ ПРИ РАДІАЦІЙНИХ АВАРІЯХ, ПАНДЕМІЇ COVID-19, ВІЙНАХ.

The relevance of the work is due to the significant increase in depression with cognitive disorders (CD) worldwide, and in Ukraine in particular, in victims of emergencies situations (ES), and the importance, but insufficient development of clinical and psychopathological aspects of medical and psychological-psychiatric care for this contingent of people. Despite the modern achievements of psychiatry in the study of depression in ES, an important problem is CD, which worsen the quality of life of patients, increase the risk of relapse, progressive course, and suicidal behavior. In order to improve the level of psychological and psychiatric care for depressed patients with CD in post-stress disorders by radiation accidents, the COVID-19 pandemic, and wars, the study of domestic and foreign literature on these disorders, which have both common features and certain differences, was conducted.Conclusions. The study confirms the significant prevalence of depression with CD in victims of radiation accidents, the COVID-19 pandemic, and wars, the insufficient development of clinical and psychopathological aspects and theneed for further study of this problem, as well as the creation of state measures of psychological and psychiatric care for these patients.

Resilience after a nuclear accident: readiness in using mobile phone applications to measure radiation and health indicators in various groups (SHAMISEN SINGS project).

An anonymous web-based survey was developed to check different aspects (SHAMISEN SINGS project): stakeholder awareness and perceptions of available mobile applications (apps) for measuring ionising radiation doses and health/well-being indicators; whether they would be ready to use them in the post-accidental recovery; and what are their preferred methodologies to acquire information etc. The results show that participation of the citizens would be most beneficial during post-accident recovery, providing individual measurements of external ionizing dose and health/well-being parameters, with possible follow-up. Also, participants indicated different preferences for sources to gain knowledge on ionising radiation and for the functions that an ideal app should have. The level of awareness and readiness to use apps to measure ionising radiation dose depended on two main aspects: individual differences (age & gender) and whether people were from countries affected by the previous major accidents. We concluded that stakeholders could have benefits from the data management plan: (1) it potentiates resilience at individual and community level; (2) citizens' measurements contribute to environmental monitoring and public health screening; (3) linkages between different types of data (environmental exposure, individual behavioural diaries, and measurements of health indicators) allow to perform more rigorous epidemiological studies.

The NIAID/RNCP Biodosimetry Program: An Overview.

Established in 2004, the Radiation and Nuclear Countermeasures Program (RNCP), within the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health has the central mission to advance medical countermeasure mitigators/therapeutics, and biomarkers and technologies to assess, triage, and inform medical management of patients experiencing acute radiation syndrome and/or the delayed effects of acute radiation exposure. The RNCP biodosimetry mission space encompasses: (1) basic research to elucidate novel approaches for rapid and accurate assessment of radiation exposure, (2) studies to support advanced development for US Food and Drug Administration (FDA) clearance of promising triage or treatment devices/approaches, (3) characterization of biomarkers and/or assays to determine degree of tissue or organ dose that can predict outcome of radiation injuries (i.e., organ failure, morbidity, and/or mortality), and (4) outreach efforts to facilitate interactions with researchers developing cutting edge biodosimetry approaches. Thus far, no biodosimetry device has been FDA cleared for use during a radiological/nuclear incident. At NIAID, advancement of radiation biomarkers and biodosimetry approaches is facilitated by a variety of funding mechanisms (grants, contracts, cooperative and interagency agreements, and Small Business Innovation Research awards), with the objective of advancing devices and assays toward clearance, as outlined in the FDA's Radiation Biodosimetry Medical Countermeasure Devices Guidance. The ultimate goal of the RNCP biodosimetry program is to develop and establish accurate and reliable biodosimetry tools that will improve radiation preparedness and ultimately save lives during a radiological or nuclear incident.

Radiation risks and information needs of pregnant and lactating women.

This a historical review and current information regarding risks and effects of ionizing radiation in the context of human pregnancy and in particular the information needed for pregnant women to understand the type and magnitude of risks placing them in a realistic context. Much of our understanding comes from early animal studies but has been supported by studies of human exposure to medical radiation, radiation accidents and nuclear weapons.

Radioactive contamination in feral dogs in the Chernobyl exclusion zone: Population body-burden survey and implications for human radiation exposure.

This report describes a two-year effort to survey the internal 137Cs and external ß-emitter contamination present in the feral dog population near the Chernobyl nuclear power plant (ChNPP) site, and to understand the potential for human radiation exposure from this contamination. This work was performed as an integral part of the radiation safety and control procedures of an animal welfare oriented trap-neuter-release (TNR) program. The measurement program focused on external contamination surveys using handheld ß-sensitive probes, and internal contamination studies using a simple whole-body counter. Internal 137Cs burden was measured non-invasively during post-surgical observation and recovery. External ß contamination surveys performed during intake showed that 21/288 animals had significant, removable external contamination, though not enough to pose a large hazard for incidental contact. Measurements with the whole-body counter indicated internal 137Cs body burdens ranging from undetectable (minimum detection level ∼100 Bq/kg in 2017, ∼30 Bq/kg in 2018) to approximately 30,000 Bq/kg. A total of 33 animals had 137Cs body-burdens above 1 kBq/kg, though none posed an external exposure hazard. The large variation in the 137Cs concentration in these animals is not well-understood, could be due to prey selection, access to human food scraps, or extended residence in highly contaminated areas. The small minority of animals with external contamination may pose a contamination risk allowing exposures in excess of regulatory standards.