Rapid Response, Dose Assessment, and Clinical Management of a Plutonium-contaminated Puncture Wound

Abstract

Internalization of radionuclides occurs not only by inhalation, ingestion, parenteral injection (i.e., administration of radioactive material for a medical purpose), and direct transdermal absorption, but also by contaminated wounds. In June 2010, a glove-box operator at the U.S. Department of Energy's Savannah River Site sustained a puncture wound while venting canisters containing legacy materials contaminated with Pu. To indicate the canisters had been vented, a flag was inserted into the vent hole. The shaft of the flag penetrated the protective gloves worn by the operator. Initial monitoring performed with a zinc-sulfide alpha detector indicated 300 dpm at the wound site. After being cleared by radiological controls personnel, the patient was taken to the site medical facility where decontamination was attempted and diethylenetriaminepentaacetic acid (DTPA) was administered intravenously within 1.5 h of the incident. The patient was then taken to the Savannah River Site In Vivo Counting Facility where the wound was counted with a Canberra GL 2820 high-purity germanium detector, capable of quantifying contamination by detecting low-energy x rays and gamma rays. In addition to the classic 13, 17, and 20 keV photons associated with Pu, the low-yield (0.04%) 43.5 keV peak was also detected. This indicated a level of wound contamination orders of magnitude above the initial estimate of 300 dpm detected with handheld instrumentation. Trace quantities of Am were also identified via the 59.5 keV peak. A 24 h urine sample collection was begun on day 1 and continued at varying intervals for over a year. The patient underwent a punch biopsy at 3 h postincident (14,000 dpm removed) and excisional biopsies on days 1 and 9 (removal of an additional 3,200 dpm and 3,800 dpm, respectively). The initial post-DTPA urine sample analysis report indicated excretion in excess of 24,000 dpm Pu. Wound mapping was performed in an effort to determine migration from the wound site and indicated minimum local migration. In vivo counts were performed on the liver, axillary lymph nodes, supratrochlear lymph nodes, and skeleton to assess uptake and did not indicate measurable activity. Seventy-one total doses of DTPA were administered at varying frequencies for 317 d post intake. After allowing 100 d for removal of DTPA from the body, five 24 h urine samples were collected and analyzed for dose assessment by using the wound model described in National Council on Radiation Protection and Measurements Report No. 156. The total effective dose averted via physical removal of the contaminant and DTPA administration exceeded 1 Sv, demonstrating that rapid recognition of incident magnitude and prompt medical intervention are critical for dose aversion.

The crucial contribution of X-ray fluorescence spectroscopy in medicine

“…Also noteworthy is the recent development of portable XRF devices that allow assessing the presence of Pu in biological fluids [68][69][70]. As underlined by Izumoto et al [68], fast on-site detection of Pu is usually performed by analysis of α-particles emitted from the adhesive tape peeled off the wound.…”

Cutaneous Radiation Injuries: Models, Assessment and Treatments

“…The second was a nuclear worker who experienced skin contamination with 238 Pu from an industrial procedure. In that case study, contaminated tissue was excised to remove the isotope (132). These human exposures highlight the fact that skin complications arising from radiation are not limited to highdose, external X-ray or gamma exposures.…”

Comparison of Local and Systemic DTPA Treatment Efficacy According to Actinide Physicochemical Properties Following Lung or Wound Contamination in the Rat

“…With regard to wound contamination, excision of the wound site is often practiced and has indeed been employed in several cases of accidental contamination in man (Bailey et al, 2003;Laroche et al, 2010;Schadilov et al, 2010;Sugarman et al, 2018;Klumpp et al, 2020). In general surgical removal of the contaminated site is combined with both local (washing of the wound) and intravenous DTPA.…”

“…Cases of actinide contamination by inhalation have been reported since the initial use of compounds for either military devices or nuclear fuels (Carbaugh and La Bone, 2003;Okladnikova et al, 2005;Grappin et al, 2007). Similarly, accidental entry of actinides following wounding has also been reported (Ilyin, 2001;Falk et al, 2006;James et al, 2007;Sugarman et al, 2018;Klumpp et al, 2020). Indeed, case reports of incidents/accidents, biological assay data and tissues have been collated by registries in several countries (Loffredo et al, 2017;Kathren and Tolmachev, 2019) that provide a valuable source of information.…”