Hospital Management of Mass Radiological Casualties: Reassessing Exposures From Contaminated Victims of an Exploded Radiological Dispersal Device

Smith, James M.; Ansari, Armin; Harper, F.T.

doi:10.1097/01.hp.0000175444.30788.75

Cited by 37 publications

(27 citation statements)

References 5 publications

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“…Furthermore, attempts to alter the time between fractions to increase the efficacy of treating the cancer have shown promise, but there are no data on how this might affect healthy tissue tolerance, especially for the tissue outside the targeted treatment field (14). Additionally, radiation response profiles are also now of national strategic interest with the growing concern for potential population exposure to low levels of radiation via terrorist acts involving radiation dispersal devices (as reviewed in [15][16][17]. Thus, for both individual cancer patient counseling and public policy development, information on the temporal response to low-dose radiation exposure in human tissue is needed.…”

Section: Introductionmentioning

confidence: 99%

Transient Genome-Wide Transcriptional Response to Low-Dose Ionizing Radiation In Vivo in Humans

Berglund

Rocke

Dai

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-The in vivo effects of low-dose low linear energy transfer ionizing radiation on healthy human skin are largely unknown. Using a patient-based tissue acquisition protocol, we have performed a series of genomic analyses on the temporal dynamics over a 24-hour period to determine the radiation response after a single exposure of 10 cGy.Methods and Materials-RNA from each patient tissue sample was hybridized to an Affymetrix Human Genome U133 Plus 2.0 array. Data analysis was performed on selected gene groups and pathways.Results-Nineteen gene groups and seven gene pathways that had been shown to be radiation responsive were analyzed. Of these, nine gene groups showed significant transient transcriptional changes in the human tissue samples, which returned to baseline by 24 hours postexposure.Conclusions-Low doses of ionizing radiation on full-thickness human skin produce a definable temporal response out to 24 hours postexposure. Genes involved in DNA and tissue remodeling, cell cycle transition, and inflammation show statistically significant changes in expression, despite variability between patients. These data serve as a reference for the temporal dynamics of ionizing radiation response following low-dose exposure in healthy full-thickness human skin.

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Section: Introductionmentioning

confidence: 99%

Transient Genome-Wide Transcriptional Response to Low-Dose Ionizing Radiation In Vivo in Humans

Berglund

Rocke

Dai

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…The general consensus in the radiological community appears to be that treatment of life-threatening injuries should always take precedence over measures to address radioactive contamination (Miller and Erdman 2004;IAEA 2005;NCRP 2005). A recent study suggests, however, that there may be rare situations where special precautions are necessary, even while managing life-threatening injuries of a contaminated victim (Smith et al 2005). The medical health physicist is in a unique position to assist the healthcare provider in evaluating the true extent and potential impact of any contamination present so that appropriate medical activities can take place in a timely manner consistent with the safety of hospital personnel.…”

Section: Receipt Of Victimsmentioning

confidence: 96%

The Roles of Medical Health Physicists in a Medical Radiation Emergency

Miller¹,

Whitcomb²,

Ansari³

et al. 2007

Health Physics

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Medical health physicists working in a clinical setting will have a number of key roles in the event of a nuclear or radiological emergency, such as a terrorist attack involving a radiological dispersal device or an improvised nuclear device. Their first responsibility, of course, is to assist hospital administrators and facility managers in developing radiological emergency response plans for their facilities and train staff prior to an emergency. During a hospital's response to a nuclear or radiological emergency, medical health physicists may be asked to (1) evaluate the level of radiological contamination in or on incoming victims; (2) help the medical staff evaluate and understand the significance to patient and staff of the levels of radioactivity with which they are dealing; (3) orient responding medical staff with principles of dealing with radioactive contaminants; (4) provide guidance to staff on decontamination of patients, facilities, and the vehicles in which patients were transported; and (5) assist local public health authorities in monitoring people who are not injured but who have been or are concerned that they may have been exposed to radioactive materials or radiation as a result of the incident. Medical health physicists may also be called upon to communicate with staff, patients, and the media on radiological issues related to the event. Materials are available from a number of sources to assist in these efforts. The Centers for Disease Control and Prevention (CDC) is developing guidance in the areas of radiological population monitoring, handling contaminated fatalities, and using hospital equipment for emergency monitoring. CDC is also developing training and information materials that may be useful to medical health physicists who are called upon to assist in developing facility response plans or respond to a nuclear or radiological incident. Comments on these materials are encouraged.

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“…Fission bomb dispersal of radioactive dust and dirty bomb effects (conventional explosive packaged with "subcritical mass quantities of Uranium 235, Plutonium 239, or other isotopes to produce radioactive clouds) are dependent upon particle size, elevation of the explosion, and prevailing wind patterns. Dispersal in either scenario leads to inhalation of radioactive materials by victims [12][13]. Management of pulmonary injury in both of these categories requires attention to ionizing irradiation effects on the lung.…”

Section: Introductionmentioning

confidence: 99%

Antioxidant Therapeutic Approaches Toward Amelioration of the Pulmonary Pathophysiological Damaging Effects of Ionizing Irradiation

Greenberger¹,

Epperly²

2007

CRMR

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There is increasing evidence that lung irradiation damage is mediated by oxidative stress responses of pulmonary vascular and parenchymal cells. The acute irradiation response involves strand breaks in nuclear DNA, then stress activated protein kinase (SAP-Kinase) transport to mitochondria where lipid peroxidation changes lead to cytochrome-c release and apoptosis. However, secondary cytokine elevations lead to a second wave of apoptosis both directly and indirectly mediated through inflammatory cell infiltrates. A recovery phase and latent period follows wherein little structural or physiological evidence of lung damage is detectable in animal models or in humans. The late effects of irradiation pulmonary fibrosis initiate by unknown triggering events thought to involve not only resident pulmonary endothelial cells, but also recruited bone marrow origin macrophages and progenitors of myofibroblasts, which contribute to the lesion of organizing alveolitis in the mouse model or pulmonary irradiation fibrosis in humans. Oxidative stress markers are elevated during formation of the late lesion in a pattern, which is reminiscent of the acute lesion. The amelioration of both the acute and late pulmonary pathophysiologic changes by administration of antioxidant therapies suggests that similar molecular mechanisms may be involved. This article reviews several bodies of evidence concerning the cause and possible therapeutic strategies, which may be of value in treating ionizing irradiation, induced lung damage.

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Hospital Management of Mass Radiological Casualties: Reassessing Exposures From Contaminated Victims of an Exploded Radiological Dispersal Device

Cited by 37 publications

References 5 publications

Transient Genome-Wide Transcriptional Response to Low-Dose Ionizing Radiation In Vivo in Humans

Transient Genome-Wide Transcriptional Response to Low-Dose Ionizing Radiation In Vivo in Humans

The Roles of Medical Health Physicists in a Medical Radiation Emergency

Antioxidant Therapeutic Approaches Toward Amelioration of the Pulmonary Pathophysiological Damaging Effects of Ionizing Irradiation

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