Radiation accidents - Oak Ridge National Laboratory

188 Pages·2008·4.93 MB·English

MnRTIN MARiETTA ENERGY SYSYEMS LIBRARIES
II I II Ill 111 I 1I I
3 445b 0322530 5
0R NL -2 748
- Part B
UC-41 Health and Safety
RADIATION ACCIDENTS: MEDICAL ASPECTS
OF NEUTRON AND GAMMA-RAY EXPOSURES
N. WaId
G. E. Thoma, Jr.
,
OAK RIDGE NATIONAL LABORATORY
operated by
UNION CARBIDE CORPORATION
for the
U.S. ATOMIC ENERGY COMMISSION
e
$2.75
.
Printed in USA. Price Avoilable from the
Office of Technical Services
Department of Commerce
Washington 25, D.C.
LEGAL NOTICE
This report was prepared as on account of Government sponsored work. Neither the United States,
nor the Commission, ncr any person acting on behalf of the Commission:
A. Makes any worranty or representation, expressed or implied, with respect to the accuracy,
completeness, or usefulness of the informotion contained in this report, or that the use of
any information, apparatus, method, or process disclosed in this report may not infringe
privately owned rights; or
6. Assumes any liobilities with respect to the use of, or for damages resulting from the use of
mny information, opporatus, method, or process disclosed in this report.
As used in the above, "person acting on behalf of the Commission" includes any employee or
contractor of the Commission, or employee of such Contractor, to the extent that such employee
or contractor of the Commission, or employee of such contractor prepares, disseminates, or
provides access to, any informotion pursuant to his employment or contract with the Commission,
or his employment with such contractor.
FEB 23 1961
ORNL-2748
Part B
RADIATION ACCIDENTS: MEDICAL ASPECTS OF
NEUTRON AND GAMMA-RAY EXPOSURES
1 2
N. Wald and G. E. Thoma, Jr.
HEALTH PHYSICS DIVISION
Date Issued
fEB 2 1 1961
Contract No. W-7405-eng-26
.
Oak Ridge National Laboratory
Oak Ridge, Tennessee
Operated by
Union Carbide Corporation
for the
U. S. Atomic Energy Commission
'University of Pittsburgh (consultant to ORNL)
2
St. Louis University (consultant to ORNL)
3 4456 0322510 5
ii
PREFACE
The Oak Ridge National Laboratory was asked by the Division of
Biology and Medicine, U. S. Atomic Energy Commission, to study methods
for determining the radiation dose received by persons involved in
accidental criticality excursions. A system of dosimetry for this
purpose has been devised and partially implemented a t various AEC
contractor sites in the United States. One objective of Part A of
this report is to serve as an information manual for those persons
responsible for implementing this system. A review and re-evaluation
of the dosimetry of previous accidents is also included in the in-
troduction of Part A.
Part B of the report deals with a review and analysis of the
medical data obtained from previous criticality accidents. It in-
cludes a method of defining human radiation injury and gives recom-
mendations for clinical and laboratory observations for future cases.
Parts A and B together form a complete analysis of dosimetric and
medical information pertinent to acute exposures of humans to mixed
radiations, and thus provide a basis for the correlation of biological
effects on man with radiation dose.
iii
ACKNOWLEDGMENTS
Sincere app ec i a ti o is expressed to many individuals and groups
in many countries who freely supplied unpublished information, advice,
a id, recommenda t ions, and encouragement to the authors. Among these
are:
K. Z. Morgan, G. S . Hurst, and R. H. Ritchie
Health Physics Division, Oak Ridge National Laboratory
W. T. Ham, Jr.
Medical College of Virginia
.
M. Brucer and G Andrews
Oak Ridge Institute of Nuclear Studies
T. Shipman
Los Alamos Acientif ic Laboratory
E. L. Saenger
University of Cincinnati
R. Latarjet
lnstitut du Radium, Paris
G. Mathe
Hopi tal Herold
(Association Claude Bernard) et Hopital Curie, Paris
P. S. Henshaw
U. S . Atomic Energy Commission
C. G. Stewart
Atomic Energy of Canada, Ltd.
R. Wegria
St. Louis University
A. G. Kammer
University of Pittsburgh
IV
TABLE OF CONTENTS
Page
------------------
1. Review of Previous Accident Medical Data i
.........................................
1.1 Introduction 1
1.2 Clinical Manifestations of Radiation Injury ---------- 6
-------------------
1.2.1 Dose-Response Relationships 7
.......................
1.2.2 Radiation Injury Groups 8
1.2.3 Hypothetical Clinical Case Illustrations------- 10
...........................
1.3 Analysis of Accident Cases 24
-------------------
1.3.1 Clinical Signs and Symptoms 24
1.3.1.1 Initial Stage 30
---------------I--------
---------------
1.3.1.2 Manifest Illness Stage 31
------------------
1.3.2 Clinical Laboratory Findings 33
1.3.2.1 Method of Presentation and Analysis--- 34
...........................
1.3.2.2 Hematology 36
.........................
1.3.2.3 Biochemistry 49
-----------
1.3.2.4 Miscellaneous Observations 51
...........................
1.3.3 Clinical Management 51
1.4 Correlation of Clinical Injury with Radiation Dose---- 55
..............................................
1.5 Summary 64
............................
2. Recommended Medical Procedures 66
.........................................
2.1 jntroduction 66
................................
2.2 Diagnostic Procedures 67
----
2.2.1 Preliminary Evaluation of Radiation Injury 70
2.2.2 Diagnostic Use of the Profile Scoring Method--- 71
--------------
2.2.3 Subsequent Diagnostic Procedures 74
..................................
2.3 Clinical Management 75
-------------
2.3.1 Recommendations for Injury Groups 76
...........................................
2.4 Conclusion 81
-----------------
3. Outline and Synopsis of ORNL-2748, Part A 83
.........................
3.1 Outline of ORNL-2748, Part A 83
........................
3.2 Synopsis of ORNL-2748, Part A 84
.
V
LIST OF TABLES
Table No. -Page
.......................
1. Chronology of Radiation Accidents 3
................................
I I . Summary of Exposure Data 4
I l l . Patients Classified by Clinical Radiation Injury Groups-- 25
IV. Time of Onset and Duration of Clinical Signs and
- ................................
Symptoms Initial Stage 28
.
V. Time of Onset and Duration of Clinical Signs and
- .......................
Symptoms Manifest Illness Stage 29
VI. Profile Values Assigned for Various Ranges of
- - ------------
Abnormality Hematology Peripheral Counts 35
-
VII. Erythrocyte Sedimentation Rate Profile Scores
- ...........................
Group 1 1 Oak Ridge Patients 48
V I I I . Summary of Therapeutics Employed in Radiation Accident
...................................................
Cases 53
IX. Recommended D i agnos t i c Procedures for C 1 i n i ca 1
..........................
Management of Radiation Injury 69
-
X . Blood Counts and Profile Scoring Hypothetical Case 3--- 73
vi
LIST OF APPENDIX TABLES
Table No. -Page
A-I. Summary of Laboratory Procedures Performed on
- ................................
Patients Hematology
90
A-I I . Summary of Laboratory Procedures Performed on
- .......................
Patients Biochemistry-Blood
93
A-Ill. Summary of Laboratory Procedures Performed on
- .......................
Patients Biochemistry-Urine
95
.
A-IV. Summary of Laboratory Procedures Performed on
- ............................
Patients Miscellaneous
97
A-V. Profile Values Assigned for Various Ranges of
- ----------
Abnormal i ty Hematology-Coagulation Tests 99
.
A-VI Profile Values Assigned for Various Ranges of
- ....................
Abnormali ty Biochemistry-Blood 100
A-VI I . Profile Values Assigned for Various Ranges of
- ....................
Abnormality Biochemistry-Urine 10 1
-
A-VIII. Individual Profile Scores Hematology-Peripheral
..............................................
Counts 102
A-IX. Cumulative Total Profile Scores through 120
-
Postexposure Days Hematology-Total Blood Counts---- 13 1
-
A-X. Group Prof i l e Scores Hematology-Peripheral Counts-- 135
. -
A-XI Individual Integral Profile Scores
Hematology-Coagulation
------------_---c------------- 139
-
A-XI I . Individual Integral Profile Scores
Biochemistry-Blood 142
--------------------_________I____
-
A-XI 1 1 . Individual Integral Profile Scores
..................................
Biochemistry-Urine 145
A-XIV. Amino Acids and Acid Hydrolysates of Normal Urine---- 147
........................
A-XV , Urinary Amino Acid Excretion 148
.
A-XVI Urine Beta-Aminoisobutyric Acid (BAIBA) Excretion in
..................................
Oak Ridge Patients
149
.
vi i
LIST OF FIGURES
Figure No. Page
- -------------------
1. Blood Counts Hypothetical Patient 1 12
- -------------------
2. Blood Counts Hypothetical Patient 2 14
-
--------
3. Blood Counts Hypothet tal Patients 3, 4, and 5 20
-
4. Frequency of Clinical S gns and Symptoms I ni ti a1 Stage- 26
-
5. Frequency of C1 i ni cal S gns and Symptoms Manifest
.................................
---------
Illness Stage 27
6. Mean Test Prof l e Scores - Hematology - Total Blood
- .........................................
Count Group 38
- -
7. Mean Test Prof l e Scores Hematology Total Blood
- ........................................
Count Group 1 39
- -
8. Mean Test Profile Scores Hematology Total Blood
Count - Group I I I ....................................... 40
- -
9. Mean Test Profile Scores Hematology Total Blood
- ................................
Counts Groups IV and V 41
10. Individual Cumulative Profile Scores Through 120-Post-
- - ----------
exposure Days Hematology Total Blood Count 42
- -
11. Group Mean Cumulative Profile Scores Hematology Total
.............................................
Blood Count 43
12. Relationship of 120-Day Postexposure Cumulative Score
- - ----------------
to Dose Hematology Total Blood Count 57
13. Relationship of 120-Day Postexposure Cumulative Score
- - .......................
to Dose Hematology Leucocytes 58
14. Relationship of 120-Day Postexposure Cumulative Score
- - ......................
to Dose Hematology Lymphocytes 59
15. Relationship of 120-Day Postexposure Cumulative Score
- - ......................
to Dose Hematology Neutrophils 60
16. Relationship of 120-Day Postexposure Cumulative Score
- - .....................
to Dose Hematology Erythrocytes 61
17. Relationship of 120-Day Postexposure Cumulative Score
- - ........................
to Dose Hematology Platelets 62
--------------
18. P re1 i m i na ry Eva 1u a t i on of Rad i a ti on I nj u ry 72
v i i i
LIST OF APPENDIX FIGURES
Figure No. Page
A-1. Individual Test Profile Scores (Group I)
.........................
Hematology-Total Blood Count 150
A-2. Individual Test Profile Scores (Group I)
.........................
Hematology-Total Blood Count 151
A-3. Individual Test Profile Scores (Group I)
.........................
Hematology-Total Blood Count 152
A-4. Individual Test Profile Scores (Group II)
.........................
Hematology-Total Blood Count 153
A-5. Individual Test Profile Scores (Group I I)
.........................
Hematology-Total Blood Count 154
A-6. Individual Test Profile Scores (Group I I)
.........................
Hematology-Total Blood Count 155
A-7. Individual Test Profile Scores (Group II)
.........................
Hematology-Total Blood Count 156
A-8. Individual Test Profi le Scores (Group I I)
.........................
Hematology-Total Blood Count 157
A-9. Individual Test Profile Scores (Group I I I)
.........................
Hematology-Total Blood Count 158
A- 10. Individual Test Profile Scores (Group Ill)
.........................
Hematology-Total Blood Count 159
A-11. Individual Test Profile Scores (Group I I I)
.........................
Hematology-Total Blood Count 160
A-12. Individual Test Profile Scores (Group I I I)
.........................
Hematology-Total Blood Count 161
A- 13. Individual Test Profile Scores (Group I I I)
.........................
Hematology-Total Blood Count 162
A- 14. Individual Test Profile Scores (Group IV)
.........................
Hematology-Total Blood Count 163
A- 15. Individual Test Profile Scores (Group IV)
.........................
Hematology-Total Blood Count 164