1. Polonium!!!

2. The London Po-210 Poisoning Case: What we know and what we don’t know May 15, 2008 CAPT Michael A. Noska, USPHS Senior Health Physicist U.S. Department of Health and Human Services Food and Drug Administration Center for Devices and Radiological Health CAPT Michael A. Noska, USPHS Senior Health Physicist U.S. Department of Health and Human Services Food and Drug Administration Center for Devices and Radiological Health

3. Outline Basic chronology of the events Internal Radiation Dosimetry 101 Specifics of Polonium-210 Dosimetry for Mr. Litvinenko Health physics, public health and criminal F/U

4. Chronology 11/1/2006 Litvinenko meets Russians at London hotel. Several hours later, becomes sick with vomiting. 11/4/2006 Litvinenko admitted to hospital 11/11/2006 Condition very bad. Placed under armed guard. 11/19/2006 Report of thallium poisoning. 11/21/2006 Litvinenko critical, suffers heart attack. Russians deny involvement. 11/23/2006 Litvinenko dies. 11/24/2006 Litvinenko’s statement read. Health authorities identify Po-210 as probable cause of death.

5. Basic Radiation Physics and Dosimetry Types of radiation: α, β+/β-, γ/x, n Radioactivity: (units: Ci, Bq) Half-life Absorbed dose: energy imparted per unit mass of tissue Units: rad/rem, Gy/Sv 1 Gy=100 rad; 1 Sv=100 rem

6. Dose Parameters Type of radiation Amount of radioactivity Half-life Chemical form BiodistributionBiokinetics Body/organ mass Time of administration Route of administration

7. Absorbed Dose

8. Polonium-210 (Po-210) Solid metal at room temperature Dissolves readily in dilute acids Decays by alpha particle emission “Pure alpha” Becomes easily airborne and “creeps” due to alpha recoil energy

9. Po-210 continued Uranium series decay product Physical half-life: 138.38 days Biological half-life: 50 days Effective half-life: 36.7 days Specific activity: 4490 Ci/g

10. 210 Po Decay Scheme

11. Sources of Po-210 Naturally occurring in plants and foods (tobacco) Grazing animals concentrate in body tissues Nuclear weapons (not currently) RTGs for space program (not currently) Anti-static devices (sealed sources) Nuclear reactors Russia makes ~100 grams per year and exports ~1 gram per year to the US

12. Radiation Hazard No external hazard due to very low yield gamma emission Internal hazard due to α-particle High LET Distributes in soft tissue → whole body dose Concentrates in liver, kidney, RBM, spleen and skin Excreted via urine, feces, skin

13. Mr. Litvinenko

14. What do we know? Type of radiation Amount of radioactivity Half-life Chemical form BiodistributionBiokinetics Body/organ mass Time of administration Route of administration

15. What do we know? Type of radiationYES Amount of radioactivity Half-life Chemical form BiodistributionBiokinetics Body/organ mass Time of administration Route of administration

16. What do we know? Type of radiationYES Amount of radioactivityNO Half-life Chemical form BiodistributionBiokinetics Body/organ mass Time of administration Route of administration

17. What do we know? Type of radiationYES Amount of radioactivityNO Half-lifeYES Chemical form BiodistributionBiokinetics Body/organ mass Time of administration Route of administration

18. What do we know? Type of radiationYES Amount of radioactivityNO Half-lifeYES Chemical formNO BiodistributionBiokinetics Body/organ mass Time of administration Route of administration

19. What do we know? Type of radiationYES Amount of radioactivityNO Half-lifeYES Chemical formNO BiodistributionMAYBE Biokinetics Body/organ mass Time of administration Route of administration

20. What do we know? Type of radiationYES Amount of radioactivityNO Half-lifeYES Chemical formNO BiodistributionMAYBE BiokineticsMAYBE Body/organ mass Time of administration Route of administration

21. What do we know? Type of radiationYES Amount of radioactivityNO Half-lifeYES Chemical formNO BiodistributionMAYBE BiokineticsMAYBE Body/organ massYES Time of administration Route of administration

22. What do we know? Type of radiationYES Amount of radioactivityNO Half-lifeYES Chemical formNO BiodistributionMAYBE BiokineticsMAYBE Body/organ massYES Time of administrationNO Route of administration

23. What do we know? Type of radiationYES Amount of radioactivityNO Half-lifeYES Chemical formNO BiodistributionMAYBE BiokineticsMAYBE Body/organ massYES Time of administrationNO Route of administrationNO

24. Retrospective Dose Assessment Incomplete information Assumptions (time, route of administration) Biological samples Biokinetic models: ICRP 30, ICRP 68, ICRP 72 Animal data Lethal dose (LD 50/60 ) Acute versus chronic dose

25. ICRP GI Tract Model Stomach SI ULI LLI Feces Blood 1 hour 4 hours 13 hours 24 hours f 1 = 10% for polonium

26. Mr. Litvinenko’s Dose He got a snootfull (Sf)! 1-3 GBq (~25-80 mCi) 50 mCi? ~6 micrograms Dose to RBM ≈ 9 Gy in three weeks Other organs: liver (25 Gy/GBq), kidneys (40 Gy/GBq), spleen (15 Gy/GBq)* * J. Harrison et al, Polonium-210 as a poison, J. Radiol. Prot. 27 (2007), pp. 17-40.

27. Health Physics Response HPA aka NRPB Surveys Laboratory analysis Clean-up/remediation Total government response (NRC, DOE, EPA equivalents)

28. Other Contaminated Locations OfficesRestaurants Coffee bars Nightclubs Football (soccer) stadium AirplanesCars Hotels (3 primarily)

29. Public Health Response (UK) Health Protection Agency Tracked plane passengers and anyone else who had contact with Litvinenko Comm. plan (Website, media, call center) Developed protocols for lab analysis and dose assessment based on urinalysis, ICRP models Follow-up criteria: <1mSv,1 ≥EDE<6, ≥6 738 samples (686/35/17)

30. Public Health Response (US) CDC worked closely with UK State Department, CDC Quarantine program Public Health message (HAN, Epi-X) Identified labs and developed analytical plans (similar to UK) ~100 self-reported, 24 samples analyzed All results <1mSv

31. The CDC Team Radiation Studies Branch Charles W. Miller, PhD Robert C. Whitcomb, PhD, CHP Armin Ansari, PhD, CHP CDR Jeffrey B. Nemhauser, MD, USPHS Carol McCurley, MS Communications Bernadette Burden, Office of the Director Dagney Olivares, National Center for Environmental Health/Agency for Toxic Substances & Disease Registry Division of Laboratory Sciences Robert Jones, PhD Division of Global Migration and Quarantine Gary W. Brunette, MD Special Thanks: John Croft, PhD, Head of Emergency Response, United Kingdom Health Protection Agency

32. Criminal Investigation Poisoning suspected early, type unknown Discovery of rad contamination (11/21) Millenium hotel bar and sushi bar closed (crime scene and public health concern) Easy to follow trail Suspect identified May 2007

33. Conclusion Almost the perfect crime! Major impact both in UK and internationally Media frenzy View to the future? Could it happen here? It did!

34. June 29, 1995 NIH P-32 Incident 27 people (including pregnant worker) internally contaminated with ~1-500 μCi Laboratories and researcher’s home contaminated Massive survey, bioassay and decontamination effort Local event

35. Acknowledgement Dr. Charles Miller CDC, Radiation Studies Branch