RADIOLOGICAL ACCIDENT IN GOI

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RADIOLOGICAL ACCIDENT IN GOIÂNIA

Module XIX
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137Cs-accident, Goiânia, Brazil September 13, 1987
Goiânia
Rio de Janeiro
Angra NPP
Sao Paulo
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Accident description
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Source
137CsCl (caesium chloride) 50.9 TBq (1375 Ci)
main gamma 0.66 MeV main beta 1.17 MeV T
1/230 years
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Radiological triage
112 000 persons monitored 249 identified
contaminated 120 only clothing and shoe
contamination 129 internal contamination 50
subjected to direct medical surveillance
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Technical management of accident
85 residences (houses) had significant level of
contamination, 41 evacuated, 4 demolished
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Environmental aspects of 137Cs accident in
Goiania

• Initial surveys conducted in suspect homes and
  work areas
• 67 km2 urban area of Goiania city monitored using
  helicopter to identify all hotspots (few mGy/hr
  to gt2 Gy/hr)
• 2000 m2 contaminated
• Several household pets (cats and dogs) and some
  livestock (pigs) slaughtered
• Air and water samples negative
• 3000 m3 contaminated (radioactive) material
  collected, 50.6 TBq 137Cs recovered lt0.37 TBq
  remained

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Internal dose assessment
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Dose assessment by cytogenetic dosimetry
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Medical aspects
250 persons exposed
50 persons WB exposure or local radiation injury
28 local radiation injury
14 bone marrow depression
8 ARS
4 died
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Therapeutic measures during critical period

• Managing critical period of ARS, bone marrow
  suppression
• Therapy for local radiation injury
• Decorporation of caesium-137
• General support and psychotherapy

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Treatment of haematological syndrome

• 8 ARS patients with estimated doses
• 1 ? 2-4 Gy
• 5 ? 4-6 Gy
• 2 ? gt6 Gy received GM-CSF therapy
• Four patients died two of hemorrhage and two of
  t sepsis from Klebsiella infection
• Two patients who received high doses (7.0 and 5.5
  Gy) and exhibited bone marrow depression but were
  not treated with GM-CSF spontaneously recovered
  and survived

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Radiation skin injuries

• Radiation induced skin injuries caused by gamma
  and beta radiations observed in 28 who had
  handled source housing or fragments of source
• 12 of the 28 victims had multiple injuries
  affecting predominantly upper limbs
• Injuries did not heal completely and relapsed in
  8 patients, who then required surgical
  debridement, amputation of digital extremities
  and plastic skin grafts
• In 1997 one severely irradiated patient developed
  a malignant skin lesion on lower limbs which was
  surgically excised

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Therapeutic management of localized radiation
injuriesGoiânia experience-i

• Pain management
• Opioid analgesia, extradural opioid analgesia
• Reduction of inflammatory reaction
• Systemic and local NSAID
• Extract of aloe vera
• Cleaning of wounds and use of antiseptics -
  prevention of infection
• Hands and fingers immersed in boric acid solution
  reducing skin dryness, pain and itching
• non-adherent dressing coated with neomycin

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Therapeutic management of localized radiation
injuriesGoiânia experience-ii

• Improvement of local microcirculation
• Pentoxifylline, which decreases blood
  viscosityused in two patients, reducing risk of
  early formation of microthrombi, thus improving
  blood flow in injured tissues
• Hyperbaric oxygen therapy (HOT) hastened
  granulation at wound edges, reduced ulcerated
  area considerably increasing local pO2, thus
  facilitating integration of graft with damaged
  area
•   Surgical treatment
• Complete excision of damaged tissue
• Skin graft abdominal flaps
• Amputation

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Prussian blue therapy for caesium decorporation
Figure 5.1 - Schematic representation of the PB
action in the body.
PB
Schematic representation of PB action in body
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Prussian blue administration in Goiania 137Cs
Accident

• 46 persons received prussian blue
• Dosage related to internal body burden
• Initial 3 g/day then
• 3-6 g/day in adults exceeding 5 x ALI
• For children initial dose 1-1.5 g/day then
• 3 g/day for those exceeding 5 x ALI
• Five adults with very high burdens received 10
  g/day

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Patient follow-up in Goiania

• Medical
• Cytogenetic
• Psychological
• Social
• Economic

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Medical follow-up of Goiania accident victims

• Status of skin injuries after initial healing
• 8/28 patients required surgery in 1989, and 6/28
  in 1990
• One patient required repeated surgery in 1991,
  92, 93
• Skin lesions tended to be affected by stress
• Sperm count in males now normal - 2 exposed in
  teenage males have fathered healthy children
• Follow-up of children
• - 7 exposed in utero have no abnormalities
• 10 conceived post-accident born with no
  abnormalities

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Cytogenetic follow-up (6 years)
Tdic110 d at gt 1 Gy
Tdic 160 d at 0.3-1 Gy
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Half-life of dicentric chromosomes and centric
rings in nine 13-57 year old people overexposed
in Goiania accident T1/2 90-230 days (Follow-up
7.5 years)
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Psychological and social follow-up of Goiania
accident victims

• Psychological alterations
• increase in psychosomatic disorders
• fear of leukaemia and early death
• increased use of alcohol and drugs
• lack of self-confidence
• Discrimination
• by others due to fear
• self-discrimination from social contact
• Stigmatization
• victims blamed for accident by many citizens

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137Cs retention curves of woman contaminated in
fourth month of pregnancy and her baby
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• Summary of therapeutic measures
• 8 patients with severe BM syndrome treated with
  GM-CSF 4 died due to haemorrhage and sepsis
• None received BMT
• All surviving patients - normal blood counts
  since 1988 (quarterly check ups and CBC)
• 3-10 g/day prussian blue to adults, 1-3 g/day to
  children
• 28 patients treated surgically for radiation
  skin injuries relapse in 8 patients leading to
  fibrosis in 4