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Medical Diagnosis: Internal Radionuclide Contamination
Background
Worldwide, there have been hundreds of recorded accidents with significant radioactive
contamination, but only the accidents that occurred at Chernobyl, Ukraine, and Goiania,
Brazil, resulted in significant numbers of children who required internal and external
decontamination (see historical overview earlier in this chapter). Radionuclides are
widely used in research, medicine, nuclear power, and industry, so further incidents of
external and internal contamination will certainly occur. Exposure to radionuclides can
occur in peacetime and as a result of a terrorist event such as use of a radiological
dispersal device (RDD). Both military and civilian populations are potential targets.
Medical management requires knowledge of the physical and chemical characteristics of
radionuclides, as well as the indications and methods for their removal from the body.
Patient management must be a team effort that includes physicians, other health care
professionals, and health physicists. Patients can be contaminated by any one of the
hundreds of radioisotopes in common use, although only a limited number are medically
significant. The medical effects from these different exposures vary. Reference materials,
such as the National Council on Radiation Protection and Measurements (NCRP) Report
No. 65, health physics texts, and standard operating procedures, can be used to guide
patient management.
Internal Contamination
Internal contamination occurs when radioactive material enters the bodies of unprotected
people through inhalation, ingestion, or wound contamination. Health physicists have
defined internal contamination as “unwanted radioactive material present in the body.”
Contamination and exposure are not the same. Patients can have external exposure to
radiation, external contamination by radioactive material, internal contamination with
radionuclides, or any combination thereof (Figure 6.7).
Medical effects. ARS has occurred after contamination with high-energy isotopes (e.g.,
Cs-137). However, internal contamination is usually asymptomatic initially, with no
acute medical effects. The main medical concerns are chronic radiation injury of target
organs, such as lung or bone, and long-term stochastic effects, such as malignancy.
Causes. The greatest public concern currently centers around terrorism involving
radioactive materials. However, medical errors made during medical diagnosis and
treatment historically have been the most common cause of significant internal
contamination. Industrial accidents are the second most common cause. Institutional and
military use of a great number and variety of isotopes has also led to contamination
events.
The “dirty bomb.” The most likely terrorist use of radioactive materials would be an
RDD, variously referred to as a contaminated conventional explosive or “dirty bomb.”
Such a weapon can contain any liquid or particulate radioisotope. There is no nuclear
detonation. Rather, the radioactive material is actually most hazardous before the
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