Radiation Accidents

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Radiation Accidents

Presented by John Pickering San Jose State Un
iversity
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Types of Accidents

• Reactor or Criticality
• Windscale, England (1957)
• Three Mile Island, USA (1979)
• Chernobyl, Ukraine (1986)
• Tokai-Mura, Japan (1999)
• Mishandled/Lost/Stolen Sources
• Mis-administration of Medical Radiation

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Criteria for Classification as an Accident

• One of
• Whole Body Dose
• 250 mSv (25 rem)
• Skin or Extremity Dose
• 6,000 mSv (600 rem)
• Other Tissue or Organ Dose (External)
• 750 mSv (75 rem)

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History of Accidents1944 - 2000

• US
  non-US
  
• Reported Accidents 245 169
• People involved 1,351 132,391
• Significant dose 792 2,206
• Fatalities 30
  97
  
• Mostly Chernobyl

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Fatal Criticality Accidents

• Weapons Program
• Los Alamos 1945 (1), 1946 (1), 1958 (1)
• Reactors
• Idaho Falls 1961 (3 - non-radiation)
• Chernobyl 1986 (28 3 explosion)
• Fuel Handling
• Rhode Island 1964 (1)
• Tokai-Mura, Japan1999 (2)

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Fatal Source Accidents

• 1981 Oklahoma (1 fatality)
• 1984 Morocco (16.3 Ci 192Ir 8 fatalities)
• 1987 Goiania, Brazil (1375 Ci 137Cs 4
  fatalities)
  
• 1993 Tallinn, Estonia (137Cs 1 fatality)
• 2000 Bangkok, Thailand (750 Ci 60Co 3
  fatalities)

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Fatal Medical Accidents

• 1968 Wisconsin (1 fatality)
• 1975 Ohio (10 fatalities)
• 1980 Texas (7 fatalities)
• 1986 Texas (2 fatalities)
• 1990 Spain (10 fatalities)
• 1992 Indiana, PA (1 fatality)
• 1996 Costa Rica (3-7 fatalities)

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Four Example Accidents

• Bangkok, Thailand Lost(stolen)
  Source
  
• Tokai-Mura, Japan Criticality
• Tammiku, Estonia Stolen Source
• Indiana, PA Medical

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Bangkok, ThailandFebruary 15, 2000

• Four Co-60 radiation therapy sources left in
  parking lot
  
• 750 Ci up to 10 Sv/hr (1000 rem/hr) at surface
• Person A sold source to scrapyard
• Claimed to have purchased it from others
• Three others also accused of stealing
• Person B purchased source
• Persons B and C disassembled source

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Bangkok, Thailand(Continued)

• Others who received a radiation dose
• Person D scrapyard owner
• Person E husband of owner
• Persons F G workers
• Person H brother of person A
• Source integrity apparently not breached

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Bangkok, ThailandMedical Consequences

• Three fatalities
• Person C March 9 (marrow erosion)
• Person B March 18 (marrow erosion)
• Persons E march 25 (organ failure)
• Two with burns
• Person A hands gangrene to hands
• Person H hands

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Bangkok, ThailandMedical Consequences

• Three with low blood counts
• Person D
• Person F
• Person G
• About 40 others had some low blood counts /or
  local tissue injury
  

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Tokai-Mura, JapanSeptember 30, 1999

• Criticality accident
• Person A holding the funnel
• Person B was pouring nitrate solution into vessel
  to dissolve uranium oxide (19 enriched)
  
• Person C was in office, 5 m away

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Tokai-Mura, JapanAccident Events

• Solution went prompt critical
• No explosion, but some fission products released
  criticality reaction continued for 17 hours
  
• All three evacuated to hospital

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Tokai-Mura, JapanDoses

• Different measurements gave different doses
• Radioactive sodium produced in blood
• Blood cell changes
• Person A 10-20 Sv (1000 - 2000 rem)
• Person B 6 - 10 Sv (600 - 1000 rem)
• Person C 1- 3 Sv (100 - 300 rem)

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Tokai-Mura Medical Consequences Person A

• Immediate loss of consciousness
• Severe vomiting, diarrhea within 1 hr
• Kidney failure in week 3
• Severe skin damage over more than 50 of body
• Death on day 82 from massive organ failure

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Tokai-Mura Medical Consequences Person B

• Nausea and vomiting within 1 hr
• Early decrease of lymphocyte counts
• Skin reddening, blisters after 3 weeks
• Pneumonia, kidney failure
• Death on day 210 from multiple organ failure

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Tokai-Mura Medical Consequences Person C

• Slight nausea at 4 hours
• Lung problems (also a 2 pack/day smoker)
• Full recovery after 1 month

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Tammiku, EstoniaOctober 21, 1994

• Persons A, B, and C broke into radioactive waste
  facility at night
  
• Stole large Cs-137 source
• Source placed in coat pocket, taken home, and
  hung on wall in entrance hall and then in
  kitchen
  
• Dose rates 0.14 Gy/hr (14 rem/hr) at 1 meter

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Tammiku, EstoniaOthers Exposed

• Person D Persons A stepson
• Person E Person Ds mother
• Person F Person Ds great-grandmother
• Dog (slept in kitchen)

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Tammiku, EstoniaDose Reconstruction

• Person A 1830 Gy (183,000 rem) to thigh
  4 Gy (400 rem) whole body
  
• Person B 12 - 20 Gy (1200-2000 rem) to hands
• Person C
• Person D 20 - 30 Gy (2000-3000 rem) to hands
• Person E 0.5 Gy (50 rem) whole body
• Person F 2 - 2.5 Gy (200-250 rem) whole body

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Tammiku, EstoniaMedical Consequences

• Person A
• Hospitalized with severe injury to leg
• Claimed injury while working in forest
• Treated for crush injury
• Death on day 12
• Renal failure, hemorrhaging
• Person B
• Ulcerative lesion on thumb

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Tammiku, EstoniaMedical Consequences

• Person C
• Mild radiation syndrome recovery
• Person D
• Bone marrow affected
• Tissue death of fingers on left hand
• Amputated

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Tammiku, EstoniaMedical Consequences

• Person F
• Moderate radiation syndrome
• Dog
• Death

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Indiana, PennsylvaniaNovember 16, 1992

• Elderly patient being treated for anal carcinoma
• Treatment brachytherapy
• Five catheters used
• Ir-192 gamma source used

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Indiana, Pennsylvania Treatment Problems

• Insertion of source in first four catheters
  successful
  
• Fifth unsuccessful
• Treatment terminated

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Indiana, PennsylvaniaSafety Violations

• Area radiation monitor alarmed after supposed
  retraction from fifth catheter
  
• Control console indicated successful retraction
• Source actually left in patient
• Nobody used radiation meter to check the patient

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Indiana, PennsylvaniaSource Movements

• Patient transported to nursing home
• Day 4 Catheter with source fell out
• Personnel put it in biohazard bag
• Stayed in storage room for 5 days
• Day 9 Biohazards picked up
• Driver had survey meter, but did not use it
• Source put in trailer

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Indiana, PennsylvaniaSource Movements

• Day 11 Trailer driven to Warren, Ohio, to
  disposal site
  
• Radiation monitor sounded
• Traced source to hospital
• Source sent back to hospital

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Indiana, PennsylvaniaRadiation Doses

• Patient
• 16,000 Sv (1,600,000 rem) at 1 cm from source
  (160 Sv (16,000 rem) at 10 cm) so internal organs
  received very large dose
  
• Patient died Acute Radiation Exposure and
  Consequences thereof
  

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Indiana, PennsylvaniaRadiation Doses

• Others exposed
• Hospital personnel, ambulance driver, nursing
  home personnel, visitors, other residents, waste
  driver
  
• Maximum dose
• Estimated 0.7 - 1.6 Sv (70 - 160 rem) to hands
  of one nursing assistant

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Indiana, PennsylvaniaRadiation Doses

• Whole body doses
• people dose range (mSv(rem))
• 1 150 - 200 (15 - 20)
• 7 100 - 150 (10 - 15)
• 13 50 - 100 (5 - 10)
• 20 10 - 50 (1 - 5)
• 11 5 - 10 (0.5 - 1)
• 42 0 - 5 (0 - 0.5)

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Credits

• This presentation was developed by the HPS
  Science Teachers Workshop Committee, 2000-2002
  
• Members
• Lisa Bosworth (chair), John Doroski,
• David Fogle, Ian Hamilton, Anne Harri,
• Karen Langley, John Leighliter,
• John Luetzelschwab, Margaret Marks, ,
• Bill Somers, Carl Tarantino, C.M. Wood
• Special Thanks to Richard Toohey for supplying
  much of the information