Regulatory cooperation between the Norwegian Radiation Protection Authority and the Federal Medical Biological Agency (FMBA) of the Russian Federation has the overall goal of promoting improvements in radiation protection in Northwest Russia. One of the projects in this programme has the objectives to review and improve the existing medical emergency preparedness capabilities at the sites for temporary storage of spent nuclear fuel and radioactive waste. These are operated by SevRAO at Andreeva Bay and in Gremikha village on the Kola Peninsula. The work is also intended to provide a better basis for regulation of emergency response and medical emergency preparedness at similar facilities elsewhere in Russia. The purpose of this paper is to present the main results of that project, implemented by the Burnasyan Federal Medical Biophysical Centre. The first task was an analysis of the regulatory requirements and the current state of preparedness for medical emergency response at the SevRAO facilities. Although Russian regulatory documents are mostly consistent with international recommendations, some distinctions lead to numerical differences in operational intervention criteria under otherwise similar conditions. Radiological threats relating to possible accidents, and related gaps in the regulation of SevRAO facilities, were also identified. As part of the project, a special exercise on emergency medical response on-site at Andreeva Bay was prepared and carried out, and recommendations were proposed after the exercise. Following fruitful dialogue among regulators, designers and operators, special regulatory guidance has been issued by FMBA to account for the specific and unusual features of the SevRAO facilities. Detailed sections relate to the prevention of accidents, and emergency preparedness and response, supplementing the basic Russian regulatory requirements. Overall it is concluded that (a) the provision of medical and sanitary components of emergency response at SevRAO facilities is a priority task within the general system of emergency preparedness; (b) there is an effective and improving interaction between SevRAO and the local medical institutions of FMBA and other territorial medical units; (c) the infrastructure of emergency response at SevRAO facilities has been created and operates within the framework of Russian legal and normative requirements. Further proposals have been made aimed at increasing the effectiveness of the available system of emergency preparedness and response, and to promote interagency cooperation.

Purpose: Development of recommendations on the use in medical practice of institutions under FMBA of Russia of operational values of radioactive skin contamination in the event of radiological accidents. Material and methods: The easily measured radiation parameters were used as operational values: ambient dose equivalent rate (ADER) of γ-radiation, density of skin contamination with γ-, β- and α-emitting radionuclides. Operational values ​​of skin contamination were estimated on the basis of experimental data described in the literature and models on the kinetics of radioactive substances transport in the body, accepted values ​​of dose criteria for deterministic and stochastic effects. The estimation of radioactive material resorption through the skin was based on the results of experimental studies in laboratory animals (mainly piglets) for a limited set of chemical compounds of radionuclides. Results: The values of γ-ADER of the main dose-forming radionuclides measured at a distance of 10 cm from the skin surface in the range of 10–1000 μSv/h and the possible health effects due to the skin exposure and the intake of radioactive substances into the body were presented. In the IAEA recommendations, the level of skin contamination at 1 µSv/h is considered as a significant operational value according to the criterion of radioactive substances intake through the mouth from the contaminated surface of the hands. However, in our opinion, this estimate is excessively conservative; therefore it is not included in the recommended operational values. If the skin is contaminated with γ-β-emitting radionuclide solutions at a surface contamination higher than 106 Bq/cm2 (ADER ≥1000 µSv/h), the out of turn emergency decontamination should be carried out. Obligatory indications for the whole body counter examination after thorough decontamination and conducting biophysical analysis of bioassay are the following operational values: γ-ADER from the skin > 10 µSv/h; surface contamination of intact skin with β-active radionuclides > 20 000 β-part./(cm2·min); surface contamination of intact skin with α-active radionuclides > 200 α-part./ (cm2·min). Conclusion: The recommended operational values allow preliminarily and promptly to assess the health risk not only in the case of external (contact) exposure of the skin and underlying tissues, but also due to the intake of soluble radioactive substances into the body through intact and damaged (injured) skin. Taking into account the high degree of uncertainty of the estimates obtained, the operational values ​​should be considered as strictly conservative. They should be used only to determinate of urgency of decontamination carrying out for the provision of medical care during the prehospital and early hospital periods with the obligatory follow-up dosimetry examination for the final assessment of absorbed dose.

Ключевые слова: лечебная медицинская организация, многопрофильная больница, пациенты,приёмно-сортировочное отделение, Федеральное медико-биологическое агентство, чрезвычайная ситуация радиационного характера Конфликт интересов. Авторы статьи подтверждают отсутствие конфликта интересов Для цитирования: Фролов Г.П., Казакевич Е.В., Семёнов А.Е., Парабин П.В., Клименко Е.И. Особенности организации работы приёмно-cортировочного отделения многопрофильной больницы в условиях поступления пациентов из зоны чрезвычайной ситуации радиационного характера// Медицина катастроф. 2020. №3. С. 28-37.

Natural killers (NK) were first described as large granular lymphocytes capable of destroying tumor and virus-infected cells without prior sensitization. The article deals with NK biology and specific features of their maturation and “licensing”. Particular attention is given to NK mechanisms and their differences from other lymphocytes. The article focuses on the role of NK in antitumor immune development in oncohematological patients as well as healthy individuals, potential bone marrow donors.

The article discusses the historical experience of introducing into practice the clinic of the State Research Center Institute of Biophysics, Ministry of Health of the USSR, the method of irradiation of the whole patient's body on a device containing 137 Cs at a dose of 10–12 Gy before bone marrow transplantation. To ensure the safety of the total therapeutic irradiation method (TTI, total body irradiation – TBI in the world literature), as well as to maintain the specified irradiation parameters, a dose control system was used using thermoluminescent dosimeters (TLD) attached to the patient's body at each irradiation fraction to correct the total dose to the last fraction. In addition to the therapeutic procedure, the TTO model was used to study aspects of verification of emergency exposure and other issues of supporting cases of acute radiation disease. The practical part of the article illustrates the method of radiation dose control using TLD at 22 points when changing the TTI (TBI) technique to a linear accelerator for radiotherapy 6 MeV to perform the procedure with a more preferable dose rate and reduce the patient's exposure time for a fraction of radiation at a dose of 2 Gy for 40 to 20 minutes. The article presents the parameters of the irradiation according to the method and the data obtained on the basis of TLD during the irradiation of the patient according to the modified method. The correspondence of the radiation dose, as well as the irregularity of the irradiation to the specified parameters (less than 10 %), as well as the effectiveness of the use of lung protection with dose reduction from 12 to 8 Gy, is shown. The specified measurements using TLD should be carried out when changing the method at the first actual application, especially in the absence of preliminary phantom measurements. A clear understanding of the principles of radiation therapy in the case of TTI (TBI) is an invaluable experience of doctors, which is used in the treatment of rare cases of acute radiation sickness as a result of emergency (uncontrolled) exposure, both at radiation-hazardous enterprises and with known calculation errors in planning therapeutic radiation.