2. Radiologic Terrorism Thomas P. Foley, Jr. M.D. May 1, 2004

3. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

4. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

5. Exposure to Ionizing Radiation Definitions Unstable atoms emit energy in the form of ionizing radiation to achieve stability. High frequency particles and electromagnetic energy causes adverse biologic effects –Damage to DNA –Production of free radicles –Disruption of chemical bonds –Production of new macromolecules Radionuclides are elements that emit ionizing radiation. They occur naturally [uranium] or are created by man [plutonium].

6. Types of Ionizing Radiation Alpha ( α ) particles = Helium atom nucleus (2 protons + 2 neutrons); source: nuclear weapon detonation. Beta ( β ) particles = electrons (high speed particles) Source:nuclear reactors and radioisotopes of iodine Gamma ( γ ) rays = photons (visible light) High energy & penetrance, external radiation hazard Sources:nuclear reactors and weapon detonation. X-Rays = energy emitted from electrons Unlikely source of ionizing radiation from disasters Neutrons = powerful and very damaging to tissues Emitted only from a nuclear weapon detonation. Characteristics Extremely heavy with limited penetrability. Cellular injury when ingested or inhaled.

7. Sources of Ionizing Radiation Nuclear weapon detonations –α particles –γ rays –Neutrons Nuclear reactors –β particles –γ rays Medical therapy –X rays –β particles –γ rays

8. Radiation Exposure Units of Measure Energy Absorbed from γ-rays and X-rays Old SI Units Conversion Radiation absorbed dose Rad Gray (Gy) 1 Gy = 100 rad 1 cGy = 1 rad Roentgen equivalent mass Rem Sievert (Sv) 1 Sv = 100 rem Average Annual Exposure= 360 mRem or 0.0036 Sv Chest X-Ray = 5-10 mrem CT Scan = 5,000 mRem (0.05 Sv) Activity for Radiation Emission of Radionuclides Unit of DecayOldSI UnitDisintergrations/sec CurieCi-1 Ci= 3.7 X 10 10 dps 1 Ci= 37 MBq Becquerel-Bq1 Bq= 1 dps 1 MBq = 10 9 dps

9. Environmental (Natural) Radiation Exposure Average Annual Exposure 360 mRem or 0.0036 Sv Sources: –Cosmic radiation and radon –Cigarette smoke –Medical devices –Home appliances –Pharmaceutical agent Specific Exposures 5-10 mRem: Flight from New York to Los Angeles 5-10 mRem:Chest radiograph 5,000 mRem (0.05 Sv):CT Scan

10. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

11. Dirty Bombs Radiological dispersion device –Conventional explosives (dynamite) with radioactive chemicals in powder or pellet form Purposes –Expose buildings and people to radioactivity. –Instill fear in people and contaminate buildings. Sources of radioactivity –Nuclear facilities: high-level radioactive material (unlikely) –Hospitals, construction sites, and food irradiation plants: low-level radioactive materials. Dangers –The effect of the explosive blast –Low-level radiation exposure: not enough radiation to cause severe illness from exposure

12. Dirty Bombs Previous use of dirty bombs in a UN report: –Iraq tested a device in 1987: abandoned its use because radiation levels were too low to cause significant damage. Clinical management –Humans cannot see, smell, feel, or taste radiation –They likely will not know if radioactive materials are present. –If they are not severely injured, they should: Leave the area to the nearest building & remain inside. Remove clothes and place into sealed bags for testing. Shower or wash themselves as best they can. Maintain contact with emergency information. –These procedures reduce injury from chemicals & radiation.

13. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

14. Atomic Bomb Detonation in Nagasaki August 9, 1945 at 11:02 AM Distance from Hypocenter 500 m1000 m Radiation Gamma rays70-80 Gy9-10 Gy Neutrons7-8 Gy0.9-1 Gy Heat Energy111.5 Cal/cm 2 42.2 Cal/cm 2 Wind Pressure19.0 ton/m 2 8.7 ton/m 2 Wind Velocity280 m/sec160 m/sec Deaths before December 1945 73,884 Atomic Bomb Survivors110,716 in 1978 88,249 in 1995 Total Population in Nagasaki City210,000 in 1945

15. Late Effects from Atomic Bomb Exposure DiseasesIncreaseIncrease SuspectedConfirmed Thyroid adenoma 3 years 5 years Leukemia 3 years10 years Thyroid cancer 7 years10 years Breast cancer10 years20 years Lung cancer10 years20 years Gastric cancer15 years30 years Colon cancer15 years30 years Multiple myeloma23 years30 years Parathyroid adenoma30 years

16. Thyroid Disease and Atomic Bomb Radiation

18. Age at Radiation Exposure and Breast Cancer Land CE. JAMA 1995;274:402-407, Figure 4

19. Atomic Bomb Survivors: Breast Cancer 1950-1990 Land CE, et al. Radiat Res 2003;160:707-717. Figure 6

20. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

21. Hypothetical Atomic Bomb Detonation in New York City A 150 kiloton bomb constructed by terrorists is detonated in the heart of Manhattan, at the foot of the Empire State Building. The bomb goes off without warning at noon time. It's a clear spring day with a breeze to the east.

22. Hypothetical Atomic Bomb Detonation in New York City 1 second after detonation: Blast wave 0.4 mile, Fireball thermal effects 0.2 mi

23. Hypothetical Atomic Bomb Detonation in New York City 4 seconds after detonation: Blast wave for 1 mile, buildings destroyed

24. Hypothetical Atomic Bomb Detonation in New York City 6 seconds after detonation: Blast wave for 1.5 miles, thermal effects and fires

25. Hypothetical Atomic Bomb Detonation in New York City 10 seconds after detonation: Blast wave extends 4 miles, damage to buildings

26. Hypothetical Atomic Bomb Detonation in New York City Long-Term fallout pattern from a 150 kiloton surface burst, with a uniform 2 mph wind from the east.

27. Hypothetical Atomic Bomb Detonation in New York City Fallout Effects Rem Effects 5-20Possible late effect; Possible chromosomal damage. 20-100Temporary reduction in white blood cells. 100-200Mild radiation sickness within a few hours: vomiting, diarrhea, fatigue; reduction in resistance to infection. 200-300Serious radiation sickness effects (as above) and hemorrhage; Lethal dose to 10-35% of population after 30 days (LD 1-35/30). 300-400Serious radiation sickness; also bone marrow and intestinal destruction; LD 50-70/30). 400-1000Acute illness, early death; LD 60-95/30. 1000-5000Acute illness, early death in days; LD 100/10.