A Dirty Bomb Explodes - APHL · National Center for Environmental Health. 2 The Boston Marathon...
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Robert L. Jones, PhD Inorganic and Radiation Analytical Toxicology Branch June 4, 2019 APHL 2019 Meeting A Dirty Bomb Explodes Division of Laboratory Sciences National Center for Environmental Health
Transcript of A Dirty Bomb Explodes - APHL · National Center for Environmental Health. 2 The Boston Marathon...
Robert L. Jones, PhD
Inorganic and Radiation Analytical Toxicology Branch
June 4, 2019
APHL 2019 Meeting
A Dirty Bomb Explodes
Division of Laboratory SciencesNational Center for Environmental Health
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The Boston Marathon 2013Example
What if,
It had been an Radiological
Dispersion Device (RDD)
(“Dirty Bomb”)?
Presenter
Presentation Notes
What we need is lab capicity to link EPI to lab to analyze the most critical first 100 samples form the exposed population (out of possible thousands) and do that on 10-50 mL of sample in 12-36 hours.
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Was it a Widespread Dispersal?
Reproduced with permission from Dr. Michael Brown, LANL
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Examples of Mass ScreeningRadiation Specific
• 1986 Chernobyl, Incident – >300,000 screened
• 1987 Goiania, Incident - ~112,000 screened
• 1999 Japan, Tokaimura Incident – >74,600 screened
• 2011 Japan, Fukushima incident – >244,000 screened
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• Radiation Exposure: A person is “exposed” to radioactive materials through – gamma irritation (external only e.g. IND blast) – “exposure” to alpha, beta or gamma radiation from
external or internal contamination (RDD or IND fallout).
• Radiation Contamination : A person is “contaminated” internally with radioactive materials via inhalation, ingestion or wound.
Both “exposure” and “contamination” results in an exposure dose.
Radiation Diagnostics
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Radiation DiagnosticsTool Effectiveness vs. Type of
IncidentType of Incident Exposure (Biodosimetry)
Contamination (Bioassay)
Improvised Nuclear Device (IND)
Effective (shine) Effective (fallout)
Nuclear Power Plant (NPP) Limited Effective (fallout)
Radiation DispersalDevice (RDD)
Limited Effective
Radiation ExposureDevice (RED)
Effective Not useful
Biodosimetry determines a “past” radiation dose from an “exposure” incident. (HHS/BARDA Diagnostic test Development)
Bioassay determines “past, current and future” radiation doses from a “contamination” incident. (CDC Diagnostic test Development)
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How is Public Health involved?
What State and Federal groups
will be involved and how does the
state public health organizations
work with them?
Presenter
Presentation Notes
What we need is lab capicity to link EPI to lab to analyze the most critical first 100 samples form the exposed population (out of possible thousands) and do that on 10-50 mL of sample in 12-36 hours.
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How is Public Health involved?
Today you will hear from the
FBI
CDC’s Center for Preparedness and Response
CDC’s Bioassay Laboratory
Presenter
Presentation Notes
What we need is lab capicity to link EPI to lab to analyze the most critical first 100 samples form the exposed population (out of possible thousands) and do that on 10-50 mL of sample in 12-36 hours.
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
For more information please contactCenters for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected]: http://www.cdc.gov
“The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy. Use of trade names is for
identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the U.S. Department of Health and Human Services.”
National Center for Environmental HealthDivision of Laboratory Science
Thank you
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Robert L. Jones, PhD
Inorganic and Radiation Analytical Toxicology Branch
June 4, 2019
APHL 2019 Meeting
Public Health and CDC’s Laboratory Response to a Radiological Incident
Division of Laboratory SciencesNational Center for Environmental Health
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Example of a Possible Rad Response
FBI notified and responds
State CRCPDnotified
and responds
DOEnotified
and responds
CDCnotified
and responds
State Public Health
notified and responds
State RadLaboratory
notified and responds
State Sets up CommunityReception
Centers (CRCs)
State ReceivesThousands of
People at CRCs
State CollectsThousands of
Clinical Samplesat CRCs
State SendsThousands ofSamples to
CDC
State EPI StaffDetermines
CaseDefinition
State EPIsReceive updated
Enviro. data
State EPI StaffRefines
CaseDefinition
State Prioritizes
Thousands ofSamples
EPAnotified
and responds
DHSnotified
CRCPD=Conference of Radiation Control Program Directors
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Rapid Response: Epidemiologic, Laboratory and Health Physics Coordination
EPIPrioritization
LabScreening
300,000 People100,000Samples
1,000Samples
ReturnResults forMedicalManagement
Flag/EvaluateHigh/Elevated
Results
DoseCalculation
Program
ID & Quantitative analysis
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Bioassay: Key Issue Detection of Internal Contamination
Radionuclides Urine bioassaydetection
Primary radiationdetection
Uranium ( 235U, 238U), Thorium yesStrontium, Plutonium ( 238Pu,239Pu) yes
Americium, Californium, Neptunium, yes
Phosphorus, Curium, Polonium yes
Cesium, Cobalt (57Co, 60Co), Radium yes
Iodine ( 125I, 131I),Technetium -99m yes
Selenium, Molybdenum, Iridium yes
alpha and beta
Gammarays
Internal radiation screening via hand held detectors or portals is only applicable for gamma emitting radionuclides.
Radionuclides of concern can be found at:www-pub.iaea.org/MTCD/publications/PDF/Pub1309_web.pdfwww.energy.gov/media/RDDRPTF14MAYa.pdfc
The “Grand Rounds” presentation and slides can be found at:www.cdc.gov/about/grand-rounds/archives/2010/03-March.htm
Presenter
Presentation Notes
Shown here is a listing of the radionuclides of concern from an emergency response point of view. Because ALL of these radionuclides can be detected by a urine bioassay methods versus a limited set of radionuclides via other methods, our laboratory efforts have focused on developing the rapid urine bioassays. They include both the traditional radiation counting technologies, alpha, beta and gamma spectroscopy and liquid scintillation counting, as well as, state-of-the-art mass spectrometry analytical methods. This allows for the most efficient and rapid detection based on the type of radioactive decay. Due to the sensitivity of these urine bioassays, exposure can be evaluated, in most cases, days or weeks after an initial exposure event.
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Examples of Contamination Triage Testing for Alpha Emitters
External Testing: Alpha /Beta/Gamma
EmittersPre-Decon
External(Alpha /Beta/Gamma)
Internal(Gamma only)
Testing: Post-Decon
External(Alpha /Beta/Gamma)
Testing
Internal(Gamma only)
Testing
The Clinical Decision Guide (CDG),
• Physicians can use for considering: • the need for medical treatment for internally-
deposited radionuclides • or as a screening level indicating the need for a
more detailed investigation
For radionuclides other than isotopes of iodine, the CDG is the maximum, once-in-a lifetime, intake of a radionuclide.
NCRP Report 161: Management of Persons Contaminated with Radionuclides: Handboo
CDC’s Urine Radionuclide Screen
Gamma SpectrometryQuantification
Urine “Spot” Sample
Alpha/Beta Radionuclide Screen/Quantification Alpha (Long Lived) ICP-MS Screen
Mass SpectroscopyQuantification
High Resolution Mass Spectroscopy Quantification
Alpha SpectrometryQuantification
Gamma Radionuclide Screen
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• Text
CDC’s Urine Radionuclide Screen
Gamma SpectrometryQuantification
Urine “Spot” Sample
Alpha/Beta Radionuclide Screen/Quantification Alpha (Long Lived) ICP-MS Screen
Mass SpectroscopyQuantification
High Resolution Mass Spectroscopy Quantification
Alpha SpectrometryQuantification
Gamma Radionuclide Screen
e.g. 1,000 to 10,000 Samples
e.g. 100,000 Samples
High Throughput Screening Methods
Identification and Quantification
Screen for any radionuclide and Prioritize
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Sample Collection
https://www.cdc.gov/nceh/radiation/emergencies/labinfo.htm
Presenter
Presentation Notes
Hospital planning needs to cover the range. Very varied response. Worried well, special concerns for pregnant women, breast-feeding women, people seeking reassurance, communication plan
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Sample Shipping
https://www.cdc.gov/nceh/radiation/emergencies/labinfo.htm
Presenter
Presentation Notes
Hospital planning needs to cover the range. Very varied response. Worried well, special concerns for pregnant women, breast-feeding women, people seeking reassurance, communication plan
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Next Steps: Radiological Dose Assessment
• Lab analytical results sent to the CDC Radiation Studies Section
• Rapid Dose estimates (Batch Mode)• Dose estimates reported back to the CRCs,
medical facilities, etc.• CRCs need to know how to contact people to
relay dose results• Medical countermeasures administered if
needed
Presenter
Presentation Notes
Hospital planning needs to cover the range. Very varied response. Worried well, special concerns for pregnant women, breast-feeding women, people seeking reassurance, communication plan
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Radiological Incident• A complex response across public health,
state environmental groups and radiation measurement specialists
• Loss of life• Acute radiation exposure• Potential future cancer risk• Psychosocial issues• Economic impact, including area denial (due
to contamination)• Increased anxiety among citizens• Preparation and planning is critical
Presenter
Presentation Notes
Hospital planning needs to cover the range. Very varied response. Worried well, special concerns for pregnant women, breast-feeding women, people seeking reassurance, communication plan
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AcknowledgementsCurrent: Olga Piraner, PhD Ge Xiao, PhD Jon Button, PhD Carl Verdon, PhD Youngzhong Liu, PhD Supriyadi Sadi, PhD
Past: Kathleen Caldwell, PhD Jennifer Buzzell, MS Shannon Sullivan, MS Rebecca Hunt, MS Kameswara Voleti, PhD David Saunders, PhD
Collaborators: Los Alamos National Labs Sandia National Labs Savannah River National Labs
Argonne National Labs Lawrence Livermore National Lab Pacific Northwest National Lab FDA, EPA, NIST, DOD, DOE, DHS
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Questions
and
Discussions
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
For more information please contactCenters for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected]: http://www.cdc.gov
“The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy. Use of trade names is for
identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the U.S. Department of Health and Human Services.”
National Center for Environmental HealthDivision of Laboratory Science
Thank you
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ContactRobert L. Jones, PhD
Centers for Disease Control and Prevention4770 Buford Hwy
Mailstop F-50Atlanta, GA 30341-3724
“The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not
be construed to represent any agency determination or policy.
Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the
U.S. Department of Health and Human Services.”
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Backup Slides
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Summary• Radiation Laboratory Methods (bioassay): rapidly identify and
quantify specific radionuclides in people potentially contaminated in a radiological or nuclear event.
• Provides timely and critical information for effective medical management and follow -up of individuals by assessing risk for contamination by radionuclides.
• Provides information for population monitoring (populations and population sub -groups ) by determining the level of internal contamination/exposure.
• Provides “negative ” results for people, who think that they may be contaminated but are not truly contaminated, thereby relieving the stress on the public health system and medical infrastructure.
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• Radiation Exposure: A person is “exposed” to radioactive materials through – gamma irritation (external only e.g. IND blast) – “exposure” to alpha, beta or gamma radiation from
external or internal contamination (RDD or IND fallout).
• Radiation Contamination : A person is “contaminated” internally with radioactive materials via inhalation, ingestion or wound.
Both “exposure” and “contamination” results in an exposure dose.
Radiation Diagnostics
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Radiation DiagnosticsTool Effectiveness vs. Type of
IncidentType of Incident Exposure (Biodosimetry)
Contamination (Bioassay)
Improvised Nuclear Device (IND)
Effective (shine) Effective (fallout)
Nuclear Power Plant (NPP) Limited Effective (fallout)
Radiation DispersalDevice (RDD)
Limited Effective
Radiation ExposureDevice (RED)
Effective Not useful
Biodosimetry determines a “past” radiation dose from an “exposure” incident. (HHS/BARDA Diagnostic test Development)
Bioassay determines “past, current and future” radiation doses from a “contamination” incident. (CDC Diagnostic test Development)
250 -3000 samples per day10-20 samples per daySample throughput
70 mL1 -2 LSample Size Requirement
yesminimalScalable for “Surge Capacity”
yesnoCLIA Certified Methods
22 + “fission products”(14 current)
Limited to contract with Bioassay lab
Number of radionuclides with validated clinical methods
“spot” collection24 hour collectionSample Requirements
Less than 24 hoursAbout 3-6 daysTime to first analytical results for 40 samples
New “Rapid” methods: CDC
“Traditional” Radionuclidemethods
Rapid Radionuclide Bioassay analytical methods: traditional versus new methods
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Examples of Mass Screening/Analysis
• 1987 Goiania – 137Cs - 112,000 tests in ~ 3 Months
• 1995-1996 U.S. Methyl parathion – 16,000 tests
• 2001-2002 U.S. Anthrax (clinical) - 250,000 tests
• 2001-2002 U.S. Anthrax (environmental) – 1,000,000
• 2005 NV Mercury exposure – 280 tested
• 2006 London - 210Po - 800 tested in ~ 6 weeks
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Concerned Citizen Multiplier• 1987 Goiania – 137Cs – 50 treated / 112,000 screened
= 2240 “concerned citizen multiplier” (CCM)
• 1995-1996 U.S. Methyl parathion – 16,000 CCM
• 2001-2002 U.S. Anthrax (clinical) – 30 casualties or
infected / 250,000 tests = 8,500 CCM
• 2005 NV Mercury exposure – 1 contaminated /280
tested = 280 CCM
• 2006 London - 210Po –1 casualty / 800 tested = 800
CCM
