RADIOLOGICAL

INCIDENTS AND
EMERGENCIES
GROUP 3 Presentation
NCM 122: Intensive Nursing
Practicum
Content
Types of radiation

Health Effects of radiation exposure (acute and chronic exposure) including clinical
signs of radiation exposure

Examples of radiological incidents and emergencies

Caring for Patients exposed to high levels of radiation

Summary of the guidelines for radiologically exposed patients at General Hospitals

(exposure type, possible effects and initial treatment)

Roles of Nursing
Introduction

Radiation usually refers to ionizing radiation with enough energy to create ion pairs in matter.
It is released as electromagnetic waves or moving subatomic particles. This ionizing radiation
can damage our DNA, causing health effects in sufficiently high doses. Natural radiation is
produced by a variety of radioactive materials found in soil, water, air, and the body.
Types of Radiation
Alpha Radiation
Alpha Radiation is emitted by heavy atoms such as uranium, radium, radon, polonium, and plutonium (to name a few),
alpha particles are helium nuclei, making them the most massive kind of radiation.

Beta Radiation
Beta particles are electrons or positrons, which are both lighter than alpha particles and have a lower electric charge.
This means they are not nearly as damaging, despite the fact that they can penetrate tissue up to a centimeter deep.
Beta particles will give a radiation dose to the skin, unless they are ingested, inhaled or entered the body via open cuts
or wounds.

Gamma Radiation
Gamma rays are energetic photons, similar to x-rays. Gamma radiation is much less damaging than alpha radiation and is
about as damaging as beta radiation.
 HEALTH EFFECTS OF RADIOACTIVE
EXPOSURE ACUTE EXPOSURE TO HIGH DOSES OF RADIATION

Figure 34.1, Figure 34.2, Figure 34.3, Figure 34.4, Figure 34.5, Figure 34.6,

Figure 34.7, Figure 34.8, Figure 34.9, Figure 34.10, Figure 34.11,
 Threshold Model
Under threshold models, there is a certain level of exposure that
is completely safe
One variation on the threshold model is the suggestion that
exposure to low levels of radiation may produce beneficial
effects. This is called “hormesis".
Substances that exhibit hormetic effects, including water,
vitamin D, selenium, and aspirin.

CHRONIC EXPOSURE TO LOW LEVELS OF RADIATION Reproductive Effects of Radiation Exposure

Linear No-Threshold (LNT) Radiation has been used for medical purposes for about a century
The LNT model is the most conservative, meaning that it predicts This includes tens or hundreds of thousands of pregnant women
the highest level of risk for any given radiation exposure. exposed to diagnostic radiation, and many pregnant women were
The LNT model predicts five additional cancer deaths for every also exposed to radiation during the atomic bombings in Japan in
person-Sv (100 person-rem of exposure) 1945. (Among all of these women, prenatal radiation exposure of
Under this model, a single person less than 50 mSv (5 rem) to the fetus has not been shown to have
with a lifetime radiation exposure of 0.1 Sv (10 rem) will have five resulted in birth defects.
chances in 1,000 (about 0.5%) of getting cancer from this exposure Higher levels of fetal radiation exposure have been known to lead
to birth defects;
Mental retardation
Low birth weight
Low organ weight
Higher levels of fetal radiation exposure have been known to lead to The exact fetal radiation dose must be calculated for every case
birth defects; of exposure, based on information on file at each hospital. As a
Mental retardation rule of thumb, until accurate dose calculations can be
Low birth weight performed, one may make the following assumptions:
Low organ weight
1. One x-ray that images the uterus will give a fetal dose of about 1
Radiology and the Pregnant Patient
mSv (100 mrem).
Radiographic procedures (x-ray, CT, fluoroscopy) administered
2. One CT that images the uterus will give a fetal radiation dose of
above the diaphragm (e.g., head, chest) or below the knees will not
20 to 50 mSv (2 to 5 rem).
give a significant radiation dose to the fetus. It is also safe to say
3. Fetal dose from fluoroscopy in which the uterus is in the field of
that the fetal radiation dose from a single CT scan or from several
view is about 10 to 20 mSv (1 to 2 rem) for 1 minute of machine “on”
x-ray films is not high enough to cause birth defects or to call for a
time.
therapeutic abortion.
Finally, medically necessary radiation should be administered if it is
not possible to determine a patient’s pregnancy status. If delaying a
radiographic procedure may result in the patient’s death or in
serious complications, the procedure must be administered
promptly, and the reproductive implications discussed after the
patient is stable and awake.
TREATMENT FOR PATIENTS
EXPOSED TO HIGH LEVELS OF
WHOLE BODY RADIATION

Life-threatening injuries and medical conditions must take priority

over radiological injury and contamination.

Keeping patients alive in the short term must take precedence over

worrying about long-term dangers

The National Council on Radiation Protection and Measurements has

developed a flowchart to help medical practitioners sort out these

competing priorities.
Internal Contamination
Patients exposed to Patients exposed to high
moderately high levels of levels of radiation is Patient receiving a dose of
radiation (1 Sv = 100 rem or between 2 and 8 Sv (200 about 4 Sv (400 rem)
less) and 800 rem)

Will likely exhibit no

symptoms of radiation
sickness while at the
scene
Has a 50% chance of death
without medical
A depression in red and
intervention, primarily
white blood cells, but may Nausea
from radiation-induced
not appear for several Vomiting
immune system
days after the exposure. Fatigue
suppression and
Physical weakness
subsequent infectious
About 10% of patients Psychological distress.
disease
exposed to 1 Sv (100 rem)
radiation sickness
will exhibit mild radiation
sickness, but may not
attribute it to radiation
exposure
TREATMENT FOR PATIENTS EXPOSED TO
HIGH LEVELS OF WHOLE BODY RADIATION

Patients exhibiting signs of radiation sickness immediately after an

accident have likely received a fatal dose of radiation. Treating their
symptoms will help to make them comfortable until a physician specializing in
such cases can be contacted for the most recent medical advice. Such
advice is available from the REAC/TS center at the Oak Ridge National
Laboratory (orise.orau.gov/reacts/).

Patients receiving several sieverts (several hundred rem) of exposure will

exhibit reduced immune system function. Such patients require medical
support until their immune systems can recover.
 PATIENTS MANAGEMENT-Doses Greater
than 200 rad (Berger et.al.,2007)
1. Use selective blocking of serotonin 5-HT3 receptors or use 5- 8. Begin supportive care in clean environment (reverse isolation).
HT3 receptor antagonists to treat vomiting. 9. Prevent and/or treat infections.
2. Consider initiating viral prophylaxis. 10. Use growth factors (e.g., GCSF, GMCSF, interleukin) to stimulate
3. Consider tissue and blood typing in anticipation of possible hematopoiesis.
blood transfusions and/or bone marrow transplant. 11. Provide psychological support to patient and family.
4. Treat trauma as necessary and appropriate. 12. Consider transfusions of stem cells via umbilical cord blood,
5. Consider consultation with hematologist and radiation experts peripheral blood, or bone marrow.
to determine dosimetry, prognosis, use of colony-stimulating 13. Consider platelet transfusions if platelet count is low or in case of
factors, stem cell transfusion, and so forth. bleeding.
6. Draw blood for chromosome analysis (possible biodosimetry); 14. Observe for erythema, hair loss, skin injury, mucositis, parotitis,
use heparinized tube weight loss, fever.
7. Note and record areas of erythema on body chart; take
photographs if possible.
RADIOLOGICAL INCIDENTS AND
EMERGENCIES
Radiological incidents and emergencies are any such events involving exposure of patients and or
emergency workers to radiation or radioactivity.

Radiological incident
Radiological incident is any instance in which people or the environment are exposed to radiation or radioactivity through
accident or misuse. It may not necessarily pose an immediate threat to public or safety, but it requires assessment and
appropriate response to mitigate potential risks.

Radiological emergency
Radiological emergency is any radiological incident in which there is the risk of injury or death. It requires immediate and
coordinated response efforts to protect the public and mitigate the consequences.
Example of Radiological Example of Radiological
Incidents Emergencies
Traffic accident involving a truck carrying Terrorist attack with an RDD (or “dirty
research or medical radioactive isotopes. bomb”)

Fire in a hospital or university radioactive waste

Unplanned radioactive release from a commercial
storage facility.
nuclear power station.

.Radiation burns to the fingers from the beam Accidental overexposure to an angiography patient
of an x-ray diffractor in a soil science from excessive fluoroscopy, resulting in radiation burns
laboratory. to the skin.

Spill of radioactive liquids in a

Detonation of a nuclear weapon
research laboratory
 Summary of the guidelines for
radiologically exposed patients at
General Hospitals (exposure type,
possible effects and initial treatment)
External Whole-Body Exposure
Exposure Type Possible Effects Initial Treatment

Localized erythema; possible blistering, Clinical observation and treatment of

Localized exposure—usually to hands
ulceration, and necrosis. symptoms.

No clinical signs in 3 plus hours after Clinical observation and treatment of

Total or partial whole-body exposure,
exposure, not life-threatening. symptoms.
minimal or delayed clinical signs.
Minor blood changes. Sequential blood samples.

Treatment as noted earlier, possible

specialized care.
Total or partial whole-body exposure Acute radiation syndrome with severity
Full blood count and HLA typing prior to
with early prodromal syndrome. depending on dose.
transfer to specialized center.

Total or partial whole-body exposure

Treat life-threatening conditions. Treat as
with thermal, chemical, or radiation
Severe injuries, life-threatening. above and early transfer to specialized
burns.
facility.
External Contamination
Exposure Type Possible Effects Initial Treatment

Low-level contamination, intact skin, No likely consequences, possible mild Decontaminate skin, monitor medical
cleaning possible. radiation burns. condition.

Low-level contamination, skin intact, Possible radiation burns.

Consult with specialist if possible.
cleaning delayed. Possible percutaneous intake.

Low-level contamination with thermal,

chemical, radiation burns, and/or Internal contamination possible. Consult with specialist if possible.
trauma.

Extensive contamination and associated

Internal contamination probable. Consult with specialist if possible.
wounds.

Extensive contamination with thermal, Severe combined injuries and probable First aid and treatment of life-threatening
chemical, radiation burns, and/or internal contamination. injuries, early transfer to specialized
trauma. center.
Internal Contamination
Exposure Type Possible Effects Initial Treatment

Inhalation and ingestion of minor

No immediate effects. Consult with specialist if possible.
quantities of radionuclides.

Inhalation and ingestion of large Nasopharyngeal lavage. Early transfer to

No immediate effects.
quantities of radionuclides. specialized center to increase excretion.

Absorption through damaged skin. No immediate effects. Consult with specialist if possible.

Major incorporation, with/without

Treat life-threatening conditions and
external irradiation, serious wounds, Severe combined radiation injury.
transfer to specialized center.
and/or burns
 ROLE OF THE PHN IN A RADIOLOGICAL
EVENT
Planning and Response Recovery
Preparing
State and local planning and PHNs working in a receiving station
should assume that all victims have Unlike most types of disasters,
preparation of a possible
been exposed to or contaminated by contamination-related health and
radiological event is necessary
radiation and should notify the safety issues including
because such an unforeseen
HAZMAT team and don the decontamination associated with
incident could strain public
appropriate level of PPE in advance radiological events make recovery
health systems, disturbances to
of people arriving. Being available to potentially more complex and
the social and economic order
help others will not occur if you do difficult (CDC, 2005).
as well as to health care
systems and resources (Smith & not take steps to protect yourself

Spano, 2003). first.

Thank You
For Your Attention