Short-Term and Long-Term Health Risks of Nuclear-Power-Plant Accidents

1
Short-Term and Long-Term Health Risks of
Nuclear-Power-Plant Accidents

• NEJM 2011 June 16364(24)2334-2341
• R1. ???

2
Mechanisms of Exposure

• Reactor accidents and the Release of radioactive
• materials

3
Mechanisms of Exposure

4
Mechanisms of Exposure
Three Mile Island Chernobyl
Radiation ??? ?? ?? ?? ?? health effect ??? ??? ??? ??? ???? ?? 28? ?? long-term effect? ??? ?? ?

• 1979, 3.28 Three Mile Island Nuclear generating
  station in
• Dauphin county, Pennsylvania
• ???? ??? loss ?? ???, non-nuclear secondary
  system
• failure
• ? 2.5?? curies? ??? ?? ??, ? 15 curies I131
  ??
• 40,000 gallon ??? waste water ????? ?? ??? ??
• ?? ? ?? ?? ?? ??.
• ?? ?? ?? The China syndrome ?? ??

? Fukushima ??? ??? ??? ?? ?? ??? ? ? ?? ??
??? ?? ???? ??
5
Type of Radiation Exposure

• ???? ???? ??? ?? ??
• 1. ??? ??? ?? ??
• 2. External contamination
• 3. Internal contamination
• ??? radiation type, energy? ?? ?? ??? Total or
• Partial body exposure ???.

ß - radiation
? - radiation
- ?? ??

• ??? ????? ????
• ?? ?? ??
• - ?? ??? significant source

6
Type of Radiation Exposure

• ?? ??
• - ?? ??? ????,
• ?? ? ??? plant ???, ?? ????? total or partial
  exposure
• - Total or partial exposure ???/
  contamination??? ????
• radioactive?? ?? caregiver?? ???? ????? ??.
• 2. External contamination
• - ?? ??? ??? ??? ? skin or ?? ?? ??.
• - ??? ?? ?? ?? ???? External contamination ???
  ??
• ???? ?? ??? ???? ??.

7
Type of Radiation Exposure

• 3. Internal contamination
• - ?? ?? ??, ??, ?? ?? ?? ?? ??? ?
• ? ??? ?? ?? ??? ???? radiation? ???? ??
• mechanism
• - ???? ?? ? ?? ?? 500??? internal contamination
  ??
• ??? ??? ???.
• ??? ??? ??? ??? ??? ???? ??

8
Type of Radiation Exposure

• Morbidity? ??? source
• Reactor discharge? ?? ?? ?? ?? ??? ??
• ?? or food chain(??, ??, ??, ???)?? ??
• ? thyroid gland? ??? ??
• ß radiation ???? source

??? ?? ??? ???? internal, external contamination
?? ??
9
Type of Radiation Exposure

• Radioactive water? Fukushima plant ??? ?? ???
• ? ??? ??? ?? food chain? ??? ?? ? ?? ???
• route.
• Plant ?? ????? radioactivity
• - ?? ?? ???? ????? ?????,
• ?? ??? ???? ?, ?? ?? ???? ?????
• ??? ??, ??? ?? ??? ??.

10
Clinical consequences of radiation

• Type of Radiation Dose Rates
• - ??? ???? ??? ??? ?? ?? DNA damage.
• - Damage? ??? ??, ?? ??? ????, carcinogenesis,
• cell death ??
• ??? ?? ? ??? ??? ??? ??? ??

11
Clinical consequences of radiation

• 1) Type of exposure
• (Total or partial body exposure VS. int./ext.
  contamination)
• 2) Type of tissue exposed
• (???? sensitive tissue VS. insensitive
  tissue)
• 3) Type of radiation (gamma VS. beta)
• 4) ?? ??? ?? ?? (low VS. high energy)
• 5) ? ???
• 6) ??? ?? ??? ?(dose rate)

12
Clinical consequences of radiation

• Radiation ??, dose rate? ?? ?? ??? ? ??? ??
• ?? ?? ???? ??? ??? ??? ??.
• Radiation dose
• - Gray(Gy) ???? ?? ?? ??
• - Sievert(Sv) ???? ?? ?? ??
• ? ??? ? radiation? whole body exposure?? 1Gy 1Sv

13
Clinical consequences of radiation
14
Clinical consequences of radiation

• International Atomic Energy Agency the world
  health organization
• - radiation exposure? ?? ???? comprehensive
  review
• Fukushima ??? ???? ???? ??? ?? ?? radiation
  exposure? ??? ??? ??? ??
• 1. Acute radiation sickness
• 2. Long-term cancer risk ?

15
Acute Radiation Sickness and its treatment

• 1Gy single dose? radiation ??? acute radiation
  sickness
• national international registries of radiation
  accident ???? 800? ?? ???? ??? ??? ??
• Nuclear-reactor ??? ??? ?? ???? ???? ??.
• - Chernobyl 134? ?? ?? plant worker or ??
  ???.
• - Three Mile Island ????, ?? ?? (-)

16
Acute Radiation Sickness and its treatment

• High total or near total body dose??? short- term
  morbidity, mortality ???? ????, ???, ?? ??? ??.
• Chernobyl ???? acute radiation sickness
• - 134? ?? BM depression
• - 19? ??? ?? radiation dermatitis
• - 15? severe GI complication

17
Acute Radiation Sickness and its treatment

• Hematological, GI ???
• ??, ? ???? ?? intrinsic replication rate
• ? radiosensitive ??? ??.
• Cutaneous toxic effect
• - external low-energy gamma radiation, beta
  radiation?
• ?? ???? ????? ??.
• - Chernobyl, ???? ???? ???? ???? 1030?
• ??? ???? ?? ???(gt20Gy)
• ?? acute neurovascular compromise? ??.
• Chernobyl ???? ?? ?? ??? ?? 16Gy.

18
Acute Radiation Sickness and its treatment

• ?? ??? ???? ??, ?? ?? ?? ??
• External, internal contamination ??
• ??? ? ???? ?? ??
• (?? ??? ??, lyphocyte depletion kinetics,
  cytogenetic analyses? ??? ??)

19
Acute Radiation Sickness and its treatment

• ??
• 315Gy mild erythema, pruritus
• 15gtGy blister, ulceration

• whole-body dose(2Gy) ???? ??
• - ???, ??????, ????
• - hematopoietic growth factor
• - ???? ?? ?? controversial
• ??? ?? ?? ?? poor
• - Chernobyl ?? ?? ?? ???? ??? 13 ? ? 2?
• ?? ?? 11??? 2? ?? ? ????
• ?? ?? ??
  

• Modest whole-body dose(lt2Gy)
• - nausea, vomiting? ?? ??? ??
• - ??? probiotics

• Cutaneous radiation injury
• - ???? ???.
• - 2?? ?? ??.
• - topical glucocorticoid? ??, ?? ??? ???.

20
Increased Long-Term cancer Risks

• Chernobyl
• - 500? ?? ???? ??? ???? ??
• - ?? I131, Cs? ?? contamination?
• - ??? ??? ??? ?? ??? ????? ???? long
• -term cancer risk??
• ?? ???? ???? ?? ??
• - ????? ?? ?????? ???? ???? ?? ?? ?
• ????? ??? ?? ??? ??? dose rate ??? ??? ??

21
Increased Long-Term cancer Risks

• Three Mile Island?? ??
• - ?? ?? ??? ? ??? ?? ?? ????? ??
• - ? ???? intensified cancer screening ??
• - Long-term F/U?? ? ??? ??? ??.
• I131 ??? ????? 2?? ???? ??? ??.
• Chernobyl ??? ?? ???? ?? ??
• ???? ??? thyroid dose 1Gy? 25 factor ??.

22
Increased Long-Term cancer Risks

• I131 ? carcinogenic?? ???? ??
• - ?? ??
• - ?? ?? ??? ??
• Endemic ??? ?? ??? ????
• - ???? ?? /1Gy thyroid dose 23?? gt ?????
  ???
• - Chernobyl?? ?? ????? ??? ???? ?? ???
• ???? ??? ?? ?? ???? ?? 1/3
• ?? ???, ???? Thyroid? radiation ?? ??? ?? ???
• ???? ??.

23
Increased Long-Term cancer Risks

• I131 ??? ?? ?? ?? ?????? ???? ??? ???,
• ??? ??? ???
• - I131 ??? 8?
• ??? ???? 23?? ?? ?? I131 ? ???? ??.
• Public health official
• - ?? ????? potassium iodide ??? ?? ??
• (????? I131 uptake? ?? ??)
• - I131?? ? ? ??? ? ??? potassium iodide ?? ??
  ???

24
Increased Long-Term cancer Risks

• Potassium iodide toxic effect ?
• - Chernobyl ?? ?? ????? ??? ??
• 1000? ???? ????? ??? potassium iodide?
  single dose
• ??? ?? ???? morbidity
• FDA?? ??? ???? radiation exposure? ?? potassium
  iodide
• ??? ?? guideline? ??.
• http//www.fda.gov/downloads/Drugs/GuidanceCom
  plianceRegulatoryInfomation/Guidances/ucm080542.pd
  f

25
FDA guideline for KI use in Radiation Emergency
26
Conclusions

• ??? ??? ?? ?? ??
• ? ???? ??? ???? ??, ???? public health response
  ??? ?? ??.
• ?? ??? ??? ?? ?? ????? ???? ??
• ????? ????? ????? ?.
• Acute radiation sickness, long term cancer risk?
  ??
• ??? ?? ?? ??? ??? ??
• ? ?? ??? ?? ??? ?? ?? ??? ????.

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• ?????.