MEDICAL ASPECTS OF RADIOLOGICAL ACCIDENT IN GILAN IRAN

MEDICAL ASPECTS OF RADIOLOGICAL ACCIDENT IN GILAN, IRAN Module XIX

Summary Morning of 24 July 1996 a worker (KZ) at Gilan Combined Cycle Fossil Power Plant, while carrying insulation material for lagging pipes, noticed a shiny pencil sized metal object beside of trench l He put it into his loose overall pocket on right side above chest l Module Medical XIX-(16) 2

Summary-2 The metal object - “pigtail” of radiograph with iridium-192 source, led to severe haemopoetic syndrome (bone marrow depression) and unusually extended local radiation injury of chest requiring plastic surgery l Surgery successfully performed a month later in Curie Institute, Paris l Module Medical XIX-(16) 3

Source Module Medical XIX-(16) 4

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Development of symptoms, recognition of accident At 9. 30 am, 1. 5 hrs after start of exposure, he experienced dizziness, nausea, lethargy and burning feeling in chest l Believing object cause of symptoms, he put it back into trench l 13: 00, KZ told colleagues about strange shiny object and weak, lethargic feeling l 13: 30 he was sent for blood sampling l Module Medical XIX-(16) 6

Investigation of accident Team of AEOI inspectors investigated accident on site next day l Recommended blood checks for all 600 personnel l All samples normal except for KZ’s l Module Medical XIX-(16) 7

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Course of lymphocytes Module Medical XIX-(16) 11

Course of leukocytes Module Medical XIX-(16) 12

Treatment in Iran Prophylactic antibiotics l Analgesia l Topical silver sulphadiazine (on chest lesion) l Platelet transfusion (7 units on Day 20) l Cytokine (G-CSF) — Leucomax 400 g 2 x/d (subcutaneously) l Module Medical XIX-(16) 13

Bone marrow sampling Module Medical XIX-(16) 14

Transfer to Paris l l l Need for bone marrow transplantation ? Transfer to Radiopathology Unit of the Institut Curie in Paris on Day 24 (16 Aug 96). Findings on examination n n Total loss of epidermis on right anterior chest/ upper abdominal wall — 30 x 15 cm — with necrotic epidermis around the edge Area of moist desquamation on medial side of right antecubital fossa — 6 x 7 cm Large hard bulla on palm of left hand — 5 x 5 cm Small area of increased pigmentation and erythema on anterior middle surface of right thigh — 2 x 2 cm Module Medical XIX-(16) 15

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Status in June 2001 Status November 97 (as examined by IAEA medical staff, confirmed June 2001): 1. Chest lesion showed no necrosis but graft was firmly fixed to the chest wall • Fibrosis leading to some retraction, adversely affecting posture Module Medical XIX-(16) 18

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Status in June 2001 2. Elbow lesion completely healed, but movements restricted in both flexion and extension - from 45 o to 135 o 3. Some thickening of left palmar observed, but with full function and strong grip Module Medical XIX-(16) 20

Status in June 2001 4. Right thigh lesion: hard and fibrotic, but completely healed and non-painful 5. Complete recovery of all lymphocyte subpopulations in 18 months Module Medical XIX-(16) 21

Lessons – medical l For non-homogeneous whole body irradiation (as in most accidents), initiate cytokine treatment at earliest opportunity when bone marrow recovery not detected l G-CSF may be drug of choice, but then direct particular attention to monitoring platelet counts Module Medical XIX-(16) 22

Lessons - medical l Use thermography, where available, to assess viability of radiation induced skin injuries for potential spontaneous recovery or suitability for grafting l Where dermal tissues are viable after radiation induced skin injury, and spontaneous reepithelialisztion is likely to be prolonged, consider early skin grafting to reduce physical and psychological morbidity Module Medical XIX-(16) 23

Lessons - radiation protection l Teach radiographers safety culture by organizing more training courses for them l Computerize and regularly update records of existing radiation sources, systems, equipment, projects and personnel l Provide psychological support to workers and public affected by any radiological accident Module Medical XIX-(16) 24