Dose Assessment Following a 238Pu-contaminated Wound Case with Chelation and Excision.

The urinary excretion and wound retention data collected after a Pu-contaminated wound were analyzed using Markov Chain Monte Carlo (MCMC) to obtain the posterior distribution of the intakes and doses. An empirical approach was used to model the effects of medical treatments (chelation and excision) on the reduction of doses. It was calculated that DTPA enhanced the urinary excretion, on average, by a factor of 17. The empirical analysis also allowed calculation of the efficacies of the medical treatments-excision and chelation averted approximately 76% and 5.5%, respectively, of the doses that would have been if there were no medical treatment. All bioassay data are provided in the appendix for independent analysis and to facilitate the compartmental modeling approaches being developed by the health physics community.

Development of a New Chelation Model: Bioassay Data Interpretation and Dose Assessment after Plutonium Intake via Wound and Treatment with DTPA.

The administration of chelation therapy to treat significant intakes of actinides, such as plutonium, affects the actinide's normal biokinetics. In particular, it enhances the actinide's rate of excretion, such that the standard biokinetic models cannot be applied directly to the chelation-affected bioassay data in order to estimate the intake and assess the radiation dose. The present study proposes a new chelation model that can be applied to the chelation-affected bioassay data after plutonium intake via wound and treatment with DTPA. In the proposed model, chelation is assumed to occur in the blood, liver, and parts of the skeleton. Ten datasets, consisting of measurements of C-DTPA, Pu, and Pu involving humans given radiolabeled DTPA and humans occupationally exposed to plutonium via wound and treated with chelation therapy, were used for model development. The combined dataset consisted of daily and cumulative excretion (urine and feces), wound counts, measurements of excised tissue, blood, and post-mortem tissue analyses of liver and skeleton. The combined data were simultaneously fit using the chelation model linked with a plutonium systemic model, which was linked to an ad hoc wound model. The proposed chelation model was used for dose assessment of the wound cases used in this study.

Construction, Validation and Sensitivity Analyses of a Job Exposure Matrix for Early Plutonium Workers at the Sellafield Nuclear Site, United Kingdom.

Plutonium is a radiologically significant alpha-particle emitter. The potential for adverse health effects from internal exposures due to plutonium intakes has been recognized since the 1940s. The workforce of the Sellafield nuclear facility (Cumbria, UK), includes one of the world's most important groups of plutonium-exposed workers for studying the potential health risks of this internal exposure. However, for several hundred workers employed at the start of plutonium work at the facility (1952-1963), historical monitoring records based on measurements of urinary excretion of plutonium are not sufficiently reliable to provide the accurate and unbiased exposure assessments needed for epidemiological studies. Consequently, these early workers have had to be excluded from such studies, significantly reducing their power. We constructed a population-specific quantitative job exposure matrix (JEM) to estimate the average intakes of "typical plutonium workers" in this period, from 1952-1963, and assessed its validity and sensitivity to exposure assessment decisions. We conducted internal cross-validation using an a priori 10% extracted sample to evaluate reliability of estimates, explored JEM sensitivity to assumptions in the exposure assessment, and assessed the impact of uncertainty in urinalysis measurements on the precision of annual intake estimates using Markov Chain Monte Carlo (MCMC) methodology. Pairwise correlations ( RP) of estimated (JEM) and measured (10% sample) annual intakes were moderate to high ( RP > 0.4) for 10 out of 13 JEM groups, while absolute differences were <20% for 11 out of 13 JEM groups. There was little evidence of a temporal trend in correlations ( P = 0.13) or absolute differences ( P = 0.34). The median JEM-derived cumulative intake of 95.2 (IQR, 55.0-130.0) Bq was comparable to those based on alternative assumptions in the exposure assessment (median range, 95.2-100.0 Bq; 75th percentiles, 130.0-146.0 Bq). Measurement error simulation resulted in a 40-60% reduced median cumulative intake but higher maximum cumulative intakes. The JEM finds a balance between reliability and precision that makes it useful for epidemiological purposes and is relatively insensitive to specific choices in the exposure assessment. This JEM will allow the inclusion of workers with longest follow-up and who could not be included up until now in epidemiological studies without introducing significant bias.

Rapid Response, Dose Assessment, and Clinical Management of a Plutonium-contaminated Puncture Wound.

Internalization of radionuclides occurs not only by inhalation, ingestion, parenteral injection (i.e., administration of radioactive material for a medical purpose), and direct transdermal absorption, but also by contaminated wounds. In June 2010, a glove-box operator at the U.S. Department of Energy's Savannah River Site sustained a puncture wound while venting canisters containing legacy materials contaminated with Pu. To indicate the canisters had been vented, a flag was inserted into the vent hole. The shaft of the flag penetrated the protective gloves worn by the operator. Initial monitoring performed with a zinc-sulfide alpha detector indicated 300 dpm at the wound site. After being cleared by radiological controls personnel, the patient was taken to the site medical facility where decontamination was attempted and diethylenetriaminepentaacetic acid (DTPA) was administered intravenously within 1.5 h of the incident. The patient was then taken to the Savannah River Site In Vivo Counting Facility where the wound was counted with a Canberra GL 2820 high-purity germanium detector, capable of quantifying contamination by detecting low-energy x rays and gamma rays. In addition to the classic 13, 17, and 20 keV photons associated with Pu, the low-yield (0.04%) 43.5 keV peak was also detected. This indicated a level of wound contamination orders of magnitude above the initial estimate of 300 dpm detected with handheld instrumentation. Trace quantities of Am were also identified via the 59.5 keV peak. A 24 h urine sample collection was begun on day 1 and continued at varying intervals for over a year. The patient underwent a punch biopsy at 3 h postincident (14,000 dpm removed) and excisional biopsies on days 1 and 9 (removal of an additional 3,200 dpm and 3,800 dpm, respectively). The initial post-DTPA urine sample analysis report indicated excretion in excess of 24,000 dpm Pu. Wound mapping was performed in an effort to determine migration from the wound site and indicated minimum local migration. In vivo counts were performed on the liver, axillary lymph nodes, supratrochlear lymph nodes, and skeleton to assess uptake and did not indicate measurable activity. Seventy-one total doses of DTPA were administered at varying frequencies for 317 d post intake. After allowing 100 d for removal of DTPA from the body, five 24 h urine samples were collected and analyzed for dose assessment by using the wound model described in National Council on Radiation Protection and Measurements Report No. 156. The total effective dose averted via physical removal of the contaminant and DTPA administration exceeded 1 Sv, demonstrating that rapid recognition of incident magnitude and prompt medical intervention are critical for dose aversion.

[Assessment of the Status of Effector and Regulatory Components of Immune System in Chelyabinsk Region Residents Exposed to Radiation Due to Residence in the Area Contaminated as a Result of the Radiation Accident at Mayak PA and in Their Offspring].

Immune status was studied in the framework of the current work and the results of the analysis of concentration of 26 characteristic parameters of innate and acquired immunity in 140 individuals from 56 trios (fathers, mothers and their Ist generation offspring that were included in 2 groups) are presented. Fathers and mothers of the children under study in the main groip Were exposed due to a long-term residence (from childhood to maturity) in the areas of Chelyabinsk region contaminated as a result of the-accident at Mayak PA (contamination included long-lived isotopes - 9°Sr and, to a smaller extent, ¹³7Cs and ²³9Pu) and then migrated into Ozyorsk prior to the conception of their children (75 individuals, 33 family trios). Comparison group (control) included parents and their offspring who are Ozyorsk residents never residing in the areas contaminated by radionuclides (65 individuals, 23 family trios). All the investigated individuals from the compared groups were of the corresponding age and gender and had never worked at nuclear facilities. Blood samples were obtained in the periods that excluded oncological, acute infectious and inflammatory diseases of any acute stages of chronic processes. Concentration of immune cells was measured by flow cytometer (Beckman Coulter, USA) using special monoclonal antibodies of the same manufacturer in a licensed medical center "Familia" (Chelyabinsk). The objective of the work is to assess the immune status in parents who migrated from contaminated areas prior to the conception of children and in their 1st generation offspring not exposed to radiation. Alterations of the immune status in the form of increase or, to a smaller extent, decrease of concentration of lymphocytes with effector and/or regulatory functions (B-1, T-helpers, NK, T-NK, late precursors of T-1 and T-1 of late activation) in blood of exposed parents and their offspring were detected in comparison with the results in the control group; that could possibly be related to the stimulation effect of low doses that support activation, proliferation and development of compensatory imbalance in the immune system and immunodeficiency in parents of the main group and in their offspring. In order to reveal the mechanisms of the detected alterations the interrelation between immune damage and incidence, of diseases among the cohorts involved in the current work will be studied further.

CREATION OF FEMALE COMPUTATIONAL PHANTOMS FOR CALIBRATION OF LUNG COUNTERS.

Plutonium isotopes are of high concern because they lead to high doses. In case of contamination, the activity burden inside the lungs should be assessed accurately. Many studies showed that the presence of breasts has a substantial influence on lung counting efficiencies. Currently, the calibration of most lung counting systems is done by means of physical phantoms representing only male chests. A set of female computational phantoms has been developed in order to provide gender-specific efficiency calibrations for the (241)Am gamma emission (59.54 keV). The phantoms were created starting from a library of female chest phantoms provided by Institut de radioprotection et de sûreté nucléaire (IRSN) (Farah, J. Amélioration des mesures anthroporadiamétriques personnalisées assistées par calcul Monte Carlo: optimisation des temps de calculs et méthodologie de mesure pour l'établissement de la répartition d'activite. PhD Thesis, 2011). While the IRSN phantoms represent a supine measurement position, the SCK•CEN lung counter set-up requires the persons to be sitting in a chair. Using open-source software, the breast shapes of the original phantoms have been recreated to simulate the drooping of breasts in vertical sitting position. A Monte Carlo approach was chosen for calculating calibration coefficients for female lung counting. The results obtained with MCNPx 2.7 simulations showed a significant decrease in the detection efficiency. For bigger bust and breast sizes, the detection efficiency showed to be up to 10 times lower than the ones measured with the Livermore male torso phantom.

[The assessment of accumulated internal irradiation doses of the inhabitants of the populated areas in Republik Belarus after Chernobyl accident].

A new system of evaluation methods has been developed for the assessment of the accumulated internal irradiation doses in the inhabitants of the populated areas of the Republic of Belarus that were contaminated by the Chernobyl radionuclides. The system is based on the results of WBC measurements. The model is based on the WBC-results of the State Dosimetric Register for the period of 1987-2010. The dose assessment model is based on the classification of the populated areas, on the regional features of the soils through which 137Cs can enter into the locally grown and produced foods. The model is also based on building the regressive correlations of accumulated internal doses to the contamination density of the territory of a populated area. Such regressive correlations are made for each region. The influence of indirect factors of dose forming was taken into consideration in the dose assessment. Among these factors are the population of the area, and the amount of forested territory around it, which were taken as correction coefficients. The coefficients were determined from the regressive correlation of the correction coefficients to a specific area of forest for each region. So called "countermeasure factor" was used for specification of other model results.

Absorption of plutonium compounds in the respiratory tract.

In order to optimise the monitoring of potentially exposed workers, it is desirable to determine specific values of absorption for the compounds handled. This study derives specific values of absorption rates for different chemical forms of plutonium from in vitro and animal (monkeys, dogs, mice, rats) experiments, and from human contamination cases. Different published experimental data have been reinterpreted here to derive values for the absorption parameters, f(r), s(r) and s(s), used in the human respiratory tract model currently adopted by the International Commission on Radiological Protection (ICRP). The consequences of the use of these values were investigated by calculating related committed effective doses per unit intake. Average and median estimates were calculated for f(r), s(r), and s(s) for each plutonium compound, that can be used as default values for specific chemical forms instead of the current reference types. Nevertheless, it was shown that the use of the current ICRP reference absorption types provides reasonable approximations. Moreover, this work provides estimates of the variability in pulmonary absorption and, therefore, facilitates analyses of the uncertainties associated with assessments, either from bioassay measurements or from prospective calculations, of intake and dose.

IMPDOS (improved dosimetry and risk assessment for plutonium-induced diseases): internal dosimetry software tools developed for the Mayak worker study.

A collection of software tools developed for the Mayak worker study is described. IMPDOS is software for modelling, data analysis, and activity and dose calculations using the bioassay and postmortem data from Mayak workers provided by Southern Urals Biophysics Institute. The capabilities include: parameter fitting of data for individual cases, Bayesian dose calculations using the fit results for collections of cases with extensive data as a biokinetic prior, and database storage of results for retrieval, analysis and interpretation.

To recycle or not to recycle? An intergenerational approach to nuclear fuel cycles.

This paper approaches the choice between the open and closed nuclear fuel cycles as a matter of intergenerational justice, by revealing the value conflicts in the production of nuclear energy. The closed fuel cycle improve sustainability in terms of the supply certainty of uranium and involves less long-term radiological risks and proliferation concerns. However, it compromises short-term public health and safety and security, due to the separation of plutonium. The trade-offs in nuclear energy are reducible to a chief trade-off between the present and the future. To what extent should we take care of our produced nuclear waste and to what extent should we accept additional risks to the present generation, in order to diminish the exposure of future generation to those risks? The advocates of the open fuel cycle should explain why they are willing to transfer all the risks for a very long period of time (200,000 years) to future generations. In addition, supporters of the closed fuel cycle should underpin their acceptance of additional risks to the present generation and make the actual reduction of risk to the future plausible.

Assessment of plutonium exposures for an epidemiological study of US nuclear workers.

An ongoing case-control study evaluating the association between workplace external radiation exposures and leukaemia mortality required an assessment of internal plutonium exposures as a potential confounder. Of the study participants, 1,092 were employed at four Department of Energy sites where plutonium-bearing materials were processed or stored. Exposures were assessed by first categorising exposure potentials based on available bioassay data, then estimating doses for workers in the highest categories using recent recommendations of the International Commission on Radiological Protection. Given the aetiology of leukaemia, equivalent dose to active bone marrow was chosen as the exposure variable. There were 556 workers each with at least one plutonium bioassay result, assigned to one of three evaluation categories. Dose estimates were made for 115 workers resulting in a collective equivalent dose of 2.1 person-Sv for 2,822 exposure-years, compared with 29.8 person-Sv estimated from photon exposures. Modelling uncertainties were examined by comparison of results from independent analyses and by Monte Carlo simulation.

A model for a comprehensive assessment of exposure and lifetime cancer incidence risk from plutonium released from the Rocky Flats Plant, 1953-1989.

A model was developed to calculate ambient air concentrations, surface deposition, and lifetime carcinogenic risk with uncertainty from plutonium released to the air from the Rocky Flats Plant between the years 1953 and 1989. The model integrated airborne release estimates and atmospheric dispersion and deposition calculations from 37 years of routine plant operations and episodic releases. Episodic releases included two major fires in 1957 and 1969 that breached the building air filtration systems, and suspension of plutonium contaminated soil from the former 903 waste storage area during high winds. Predicted air concentrations included contributions from site releases and resuspension from contaminated soil. Inhalation was the only exposure pathway considered. Environmental measurements suitable for model validation were lacking for the period when major site releases occurred (1953 to 1970). However, environmental media, such as soil and lake sediment, are natural accumulators and provided evidence of past offsite releases. The geometric mean predicted-to-observed (P/O) ratio for soil was 0.93 with a geometric standard deviation of 1.6. The model systematically underpredicted concentrations near the 903 Area because large, nonrespirable particles that deposited close to the source were not included in release estimates. Plutonium soil inventories for the model domain had P/O ratios ranging from 0.22 to 4.2. The geometric mean P/O ratio for ambient air was 0.90 with a geometric standard deviation of 2.6. Age-dated sediment cores from Standley Lake had a geometric mean P/O ratio of 1.0 with a geometric standard deviation of 1.7. Predicted-to-observed ratios for plutonium inventories in Great Western Reservoir ranged from 0.36 to 1.7. Lifetime cancer incidence risks were calculated for a male laborer scenario who resided in the model domain for the entire assessment time. Maximum cancer risks ranged from 10-6 (5th percentile) to 10(-4) (95th percentile). Most of the exposure was incurred during the 1950's.

[Health effects of plutonium pollution--assessment after the Thule disaster in 1968]. / Helseeffekter av plutoniumforurensning--vurderinger etter Thule-ulykken i 1968.

On 21 January 1968 a B-52 airplane with four nuclear weapons crashed on the ice close to the Thule air base in northern Greenland. Approximately six kilograms of plutonium was dispersed in the surroundings. Since 1968, the possible health impacts among the Danish civilian workers who assisted at the clean-up have been discussed regularly. A Nordic expert group was appointed by the Danish government to examine the evidence. The group concluded in May 1995 that no conclusive evidence of damage to the health of the worker as a result of plutonium pollution had been reported. However, they recommended continued follow-up of record linkage studies on cancer and a closer investigation of the rare skin disease parapsoriasis en plaque.

The artificial heart's threat to others.

A member of the two federal advisory panels on artificial hearts reflects that the nuclear-powered artificial heart, had it been developed, would have posed a physical threat to others. Today's artificial heart poses a different threat. Because of the high costs, many people may be deprived of access to other forms of medical care and other social goods.

KIE: Jonsen, who has been a member of two federal advisory panels on the artificial heart, comments on the difference in the societal threats posed by the proposed nuclear-powered heart in the early 1970s and the present program to develop mechanical circulatory support devices. The nuclear-powered heart posed a radiation threat. The present program threatens to divert public monies to research and to a major commitment of funds similar to that of the End Stage Renal Disease Program, at the expense of less visible health programs with the potential for more widespread benefit. Nevertheless, Jonsen supports a current Working Group's endorsement of federal involvement in the development of artificial hearts in order to check the impetus of private development, to provide performance standards, to promote the development of partial and temporary devices, and to continue to monitor the effect of the inevitable development of the technnology on the quality of health care in the U.S.

Allocation of resources: the artificial heart. An NIH panel's early warnings.

KIE: Green describes the work of the Artificial Heart Assessment Panel, an advisory body constituted in 1972 by the National Heart and Lung Institute (NHLI) and charged with assessing the social, ethical, and medical implications of a plutonium-powered, totally implantable artificial heart. The panel based its deliberations on what Green now considers to have been NHLI's unrealistically optimistic assessment of the state of artificial heart technology, but eventually recommended against use of the heart in humans because of radiation risks. In retrospect, the author questions the government's role in allocating enormous sums of money to the development of a medical technology from which few persons would benefit.^ieng