Health risk evaluations for ingestion exposure of humans to polonium-210

A sensitive method to determine 210Po and 210Pb in environmental samples by alpha spectrometry using CuS micro-precipitation

A new sensitive method to determine polonium-210 (210Po) and lead-210 (210Pb) in a diversity of environmental samples was developed. For fresh and marine waters, Po was pre-concentrated using a titanium (III) hydroxide (Ti(OH)3) co-precipitation. Solid environmental samples were digested with nitric acid (HNO3) and hydrogen peroxide (H2O2). The alpha thin layer source was prepared using CuS micro-precipitation and 210Po was measured by alpha spectrometry. Lead-210 was left to decay for up to a year and indirectly measured via its progeny, 210Po. The chemical recoveries for 210Po and 210Pb were high, 90% and 97%, respectively, for a large variety of samples and a very low minimum detectable activity (MDA) was obtained. The method was validated using standardized solutions and certified reference materials.

Radiogeochemistry, mineralogy, lithology, radiogenic heat production, and health implication using airborne radiometric data of Ilesha and its surroundings

The current study analyzed and interpreted airborne radiometric data from Ilesha's basement complex rock and its surroundings. At the surface, the concentrations of the most frequent primordial radionuclides notably K, elemental concentration of uranium eU, and elemental concentration of thorium eTh were measured. The weighted mean elemental and activity concentrations were 0.85%, 2.75 ppm, 10.22 ppm, and 267.54 Bq kg^-1, 34.41 Bq kg^-1, 41.51 Bq kg^-1 for ⁴⁰ K, ²³⁸U, and ²³²Th, respectively. The low concentration of ⁴⁰ K was certainly due to the effects of weathering, kaolinization of granites, and pedogenesis activities. The abundance of uranium was ascribed to the availability of uranium minerals such as allanite, apatite, and sphene with accessories minerals, while that of thorium was due to minerals such as cheralite, thorite, uranothorite, thorianite, and uranothorianite with accessories minerals. The RPHR weighted mean 1.48 µWm^-3 compared to the earth's crust mean between 0.8 and1.2 µWm^-3 was higher due to significant presence of gneiss rocks in all the studied profiles. Radiological hazard, in particular, dose rates, external hazard index, internal hazard index, radium equivalent, annual gonadal dose, effective dose dispensed to various organs of the body were computed to determine the deleterious effects of rocks in the area. The weighted means of annual gonadal dose of 363.98 µSv y^-1 and outdoor 0.91 × 10^×3 and indoor 1.65 × 10^-3 excessive life cancer risks were more than the global average 300 µSv y^-1, 0.29 × 10^-3 and 1.16 × 10^-3. As a result, proper surveillance is required in the area in order to prevent epidemics occurrence in future.

On 210Po and 210Pb in algae diet supplements - The assessed radiation hazard of aquatic superfoods

Algae are believed to give health benefits. However, the studies showed they contain toxic elements, including radionuclides, and may affect human health. The study presents the values of activity concentrations of ²¹⁰Po and ²¹⁰Pb in the algae supplements available worldwide for adults. The activity concentrations (Bq/kg dw) ranged from 0.07 to 14.5 (²¹⁰Po) and from 0.06 to 8.48 (²¹⁰Pb). Also, the effective radiation doses and the cancer risk from ²¹⁰Po and ²¹⁰Pb decay ingested with analyzed algal supplements have been assessed. The highest values of annual effective doses have been estimated for ²¹⁰Po in the recommended portion of Spirulina (Arthrospira platensis) from China (59.7 μSv/year) and Diatomaceous earth from the USA (50.4 μSv/year). The cancer morbidity and mortality risk ranged from 10^-4 to 10^-8. The study indicated the activity concentrations of ²¹⁰Po and ²¹⁰Pb were low, and algae supplements for human consumption could be considered safe food.

Removal of the Homolog Tellurium of Polonium by SiO2 Nanofiber Filter for Lead Alloy-Cooled Reactors

The lead–bismuth eutectic (LBE) can be easily activated by neutron radiation to produce the radionuclide ²¹⁰Po. It is therefore necessary to establish an effective method to remove vaporized polonium in the cover gas to prevent its release into the air in scenarios of reactor maintenance and coolant leakage accidents. This paper presents a SiO₂ nanofiber membrane prepared based on the electrostatic spinning and calcination process. The SiO₂ nanofiber membrane had the advantages of good flexibility, high-temperature resistance, and corrosion resistance. In the trapping experiments, the SiO₂ nanofiber membrane filters showed excellent filtration performance at 300~400 °C, and the filtration efficiencies for Te, Pb, and Bi could reach 99%, 99%, and 98%, respectively. Proper filtration temperature and gas flow rate are important to maintain high filtration efficiency. After five cycles, the SiO₂ nanofiber membrane filter still exhibited excellent cycle-use performance. In the density functional theory (DFT) calculations, PbPo and PbTe had strong interactions with amorphous SiO₂, having adhesion energies of −2.96 to −2.83 eV/molecule.

Rapid separation of Po-210 from Pb-210 based on the usage of a commercial Sr-Specific chromatographic resin

The efficient extraction of small quantities of ²¹⁰Po is necessary for preparing ²¹⁰Po standard reference materials. Herein, a commercially available strontrium-specific chromatographic resin (Sr spec resin) was used to rapidly and selectively extract ²¹⁰Po from a ²¹⁰Pb-²¹⁰Bi-²¹⁰Po mixture, and the distribution ratios of Pb, Bi, and ²¹⁰Po on Sr spec resin were probed using batch experiments. In contrast to ²¹⁰Pb and ²¹⁰Bi, ²¹⁰Po was retained on the Sr spec cartridge in 8 M HCl and was then effectively eluted by 0.1 M HNO₃. The contents of ²¹⁰Pb and ²¹⁰Bi in the thus obtained ²¹⁰Po solution were checked using a high purity germanium gamma-ray detector and the corresponding decay curve, respectively, and were found not to exceed 2%. Moreover, the ²¹⁰Pb and ²¹⁰Bi eluates could be used to regenerate ²¹⁰Po by the same method after a certain time period. Therefore, the extracted ²¹⁰Po solution was suitable for the preparation of the ²¹⁰Po standard area source and ²¹⁰Po standard reference materials.

Health Risk of Polonium 210 Ingestion via Drinking Water: An Experience of Malaysia

The presence of toxic polonium-210 (Po-210) in the environment is due to the decay of primordial uranium-238. Meanwhile, several studies have reported elevated Po-210 radioactivity in the rivers around the world due to both natural and anthropogenic factors. However, the primary source of Po-210 in Langat River, Malaysia might be the natural weathering of granite rock along with mining, agriculture and industrial activities. Hence, this is the first study to determine the Po-210 activity in the drinking water supply chain in the Langat River Basin to simultaneously predict the human health risks of Po-210 ingestion. Therefore, water samples were collected in 2015⁻2016 from the four stages of the water supply chain to analyze by Alpha Spectrometry. Determined Po-210 activity, along with the influence of environmental parameters such as time-series rainfall, flood incidents and water flow data (2005⁻2015), was well within the maximum limit for drinking water quality standard proposed by the Ministry of Health Malaysia and World Health Organization. Moreover, the annual effective dose of Po-210 ingestion via drinking water supply chain indicates an acceptable carcinogenic risk for the populations in the Langat Basin at 95% confidence level; however, the estimated annual effective dose at the basin is higher than in many countries. Although several studies assume the carcinogenic risk of Po-210 ingestion to humans for a long time even at low activity, however, there is no significant causal study which links Po-210 ingestion via drinking water and cancer risk of the human. Since the conventional coagulation method is unable to remove Po-210 entirely from the treated water, introducing a two-layer water filtration system at the basin can be useful to achieve SDG target 6.1 of achieving safe drinking water supplies well before 2030, which might also be significant for other countries.

An assessment of the (210)Po ingestion dose due to the consumption of agricultural, marine, fresh water and forest foodstuffs in Gudalore (India)

The activity concentration of (210)Po in cereals, pulses, food materials of animal origin, vegetables and spices collected from Gudalore (India) has been estimated by radiochemical method. The activity concentration of (210)Po in cereals is found to vary from 124 to 604 mBq kg(-1). Raw rice registered the highest mean activity 504 ± 61 mBq kg(-1). In pulses (210)Po activity concentration varies from 42 to 320 mBq kg(-1) and the highest activity is found in black lentil with the average value of 172 ± 38 mBq kg(-1). Leafy vegetables registered the highest (210)Po activity concentration (662-7336 mBq kg(-1)) and are followed by tuber vegetables (390-1269 mBq kg(-1)) and then by other vegetables (75-595 mBq kg(-1)). The higher concentration of (210)Po observed in leafy vegetables may be attributed to the dry deposition of (210)Po and other daughter products of (222)Rn on large leaf surfaces from the air. Among animal products fish of marine origin registered the highest (210)Po activity concentration 36,850-48,964 mBq kg(-1). The mean (210)Po activity concentration in coffee has been estimated as 7500 mBq kg(-1). The activity concentration of (210)Po in leaf and bark of tree Cinnamom zeylanicum, a popular spice, is found to vary from 3500 to 11,100 mBq kg(-1) and 1600-3400 mBq kg(-1). The consumption of marine and fresh water fish contribute 60.7% (506.1 μSv y(-1)) to the total ingestion dose received. Cereals being consumed in a large scale, contribute 23.4% (194.9 μSv y(-1)) of the total ingestion dose received. The contribution from spices and leafy vegetables consumed is 5.8% (48.1 μSv y(-1)) and 6.5% (54.3 μSv y(-1)), respectively. The remaining 3.6% (30.0 μSv y(-1)) contribution to the total ingestion dose comes from other food materials and vegetables.

Preliminary production of 211At at the Texas A&M University Cyclotron Institute

A feasibility study for the production of the alpha particle-emitting radionuclide At was performed at the Texas A&M University Cyclotron Institute as part of the Interdisciplinary Radioisotope Production and Radiochemistry Program. The mission of this program centers upon the production of radionuclides for use in diagnostic and therapeutic nuclear medicine with the primary focus on development of novel therapeutic strategies. As a first step in establishing this program, two goals were outlined: (i) verify production of At and compare results to published data, and (ii) evaluate shielding and radiological safety issues for large-scale implementation using an external target. The radionuclide At was produced via the Bi (α, 2n) At reaction using the K500 cyclotron. Two experiments were conducted, using beam energies of 27.8 MeV and 25.3 MeV, respectively. The resulting yields for At were found to be 36.0 MBq μA h and 12.4 MBq μA h, respectively, which fall within the range of published yield data. Strategies for increasing absolute yield and production efficiency were also evaluated, which focused chiefly on using a new target designed for use with the K150 cyclotron, which will enable the use of a higher beam current. Finally, neutron and gamma dose rates during production were evaluated by using the Monte Carlo code MCNPX. It was determined that a simple structure consisting of 4-in thick borated polyethylene will reduce the neutron dose rate within the cyclotron production vault by approximately a factor of 2, thereby decreasing activation of equipment.

Prenatal Radiation Exposure: Background Material for Counseling Pregnant Patients Following Exposure to Radiation

Fetal sensitivity to radiation-induced health effects is related to gestational age, and it is highly dependent on fetal dose. Typical fetal doses from diagnostic radiology are usually below any level of concern. Although rare, significant fetal radiation doses can result from interventional medical exposures (fluoroscopically guided techniques), radiation therapy, or radiological or nuclear incidents, including terrorism. The potential health effects from these large radiation doses (possibly large enough to result in acute radiation syndrome in the expectant mother) include growth retardation, malformations, impaired brain function, and neoplasia. If exposure occurs during blastogenesis (and the embryo survives), there is a low risk for congenital abnormalities. (In all stages of gestation, radiation-induced noncancer health effects have not been reported for fetal doses below about 0.05 Gy [5 rad].) The additional risk for childhood cancer from prenatal radiation exposure is about 12% per Gy (0.12%/rad) above the background incidence.

(Disaster Med Public Health Preparedness. 2011;5:62-68)

Occurrence of ²¹⁰Po and biological effects of low-level exposure: the need for research

BACKGROUND

Polonium-210 (²¹⁰Po) concentrations that exceed 1 Bq/L in drinking-water supplies have been reported from four widely separated U.S. states where exposure to it went unnoticed for decades. The radionuclide grandparents of ²¹⁰Po are common in sediments, and segments of the public may be chronically exposed to low levels of ²¹⁰Po in drinking water or in food products from animals raised in contaminated areas.

OBJECTIVES

We summarized information on the environmental behavior, biokinetics, and toxicology of ²¹⁰Po and identified the need for future research.

METHODS

Potential linkages between environmental exposure to ²¹⁰Po and human health effects were identified in a literature review.

DISCUSSION

²¹⁰Po accumulates in the ovaries where it kills primary oocytes at low doses. Because of its radiosensitivity and tendency to concentrate ²¹⁰Po, the ovary may be the critical organ in determining the lowest injurious dose for ²¹⁰Po. ²¹⁰Po also accumulates in the yolk sac of the embryo and in the fetal and placental tissues. Low-level exposure to ²¹⁰Po may have subtle, long-term biological effects because of its tropism towards reproductive and embryonic and fetal tissues where exposure to a single alpha particle may kill or damage critical cells. ²¹⁰Po is present in cigarettes and maternal smoking has several effects that appear consistent with the toxicology of ²¹⁰Po.

CONCLUSIONS

Much of the important biological and toxicological research on ²¹⁰Po is more than four decades old. New research is needed to evaluate environmental exposure to ²¹⁰Po and the biological effects of low-dose exposure to it so that public health officials can develop appropriate mitigation measures where necessary.

Direct and indirect tasks on assessment of dose and time distributions and thresholds of acute radiation exposure

Mathematical methods were developed to construct dose and time distributions and their associated risks and threshold values for lethal and non-lethal effects of acute radiation exposure to include mortality and incidence, prodromal vomiting, and agranulocytosis. A new distribution (T-model) was obtained to describe time parameters of acute radiation syndrome such as the latency period, time to onset of vomiting, and time to initiation of agranulocytosis. Based on the dose and time distributions, the parameter translation method was defined using an orthogonal regression, which allows one to solve for these distributions in the case of acute radiation exposure. The assessment of threshold doses was performed for some effects of acute radiation syndrome: for the latency period, ∼6-8 Gy absorbed dose and ∼0.7-0.9 h time to onset of vomiting; and for incidence (agranulocytosis), ∼2-3 Gy absorbed dose and ∼2-3 h time to onset of vomiting. The obtained new formula for assessment of radiation risk is applicable to the time parameters of acute radiation syndrome.

210Po in nevada groundwater and its relation to gross alpha radioactivity

Polonium-210 ((210) Po) is a highly toxic alpha emitter that is rarely found in groundwater at activities exceeding 1 pCi/L. (210) Po activities in 63 domestic and public-supply wells in Lahontan Valley in Churchill County in northern Nevada, United States, ranged from 0.01 ± 0.005 to 178 ± 16 pCi/L with a median activity of 2.88 pCi/L. Wells with high (210) Po activities had low dissolved oxygen concentrations (less than 0.1 mg/L) and commonly had pH greater than 9. Lead-210 activities are low and aqueous (210) Po is unsupported by (210) Pb, indicating that the (210) Po is mobilized from aquifer sediments. The only significant contributors to alpha particle activity in Lahontan Valley groundwater are (234/238) U, (222) Rn, and (210) Po. Radon-222 activities were below 1000 pCi/L and were uncorrelated with (210) Po activity. The only applicable drinking water standard for (210) Po in the United States is the adjusted gross alpha radioactivity (GAR) standard of 15 pCi/L. (210) Po was not volatile in a Nevada well, but volatile (210) Po has been reported in a Florida well. Additional information on the volatility of (210) Po is needed because GAR is an inappropriate method to screen for volatile radionuclides. About 25% of the samples had (210) Po activities that exceed the level associated with a lifetime total cancer risk of 1× 10(-4) (1.1 pCi/L) without exceeding the GAR standard. In cases where the 72-h GAR exceeds the uranium activity by more than 5 to 10 pCi/L, an analysis to rule out the presence of (210) Po may be justified to protect human health even though the maximum contaminant level for adjusted GAR is not exceeded.

Assessment of risks and dose thresholds for some effects of acute exposure

Findings from the analyses of the dose-response relationship are reviewed with regard to different effects of acute radiation exposure. The analyses have been performed based on the dosimetry and clinical data for the nuclear workers acutely exposed to gamma rays or gamma rays and neutrons as a result of radiation accidents at the Mayak Production Association (Russia). The statistically significant risk curves for morbidity and mortality from acute radiation syndrome (ARS), as well as risks of the onset of vomiting at the prodromal phase and agranulocytosis, have been obtained. The Weibull model appropriately describes the corresponding risk curves. Estimates of the dose thresholds have been obtained for ARS morbidity (∼0.7 Gy) and mortality (∼6-7 Gy), vomiting at the prodromal phase (∼1.5 Gy), and agranulocytosis (∼3.5 Gy). The statistically significant power dependence between the onset of vomiting at the prodromal phase and the onset of agranulocytosis, as well as the dose dependence for the onset of agranulocytosis, has been revealed.

Calculating pulmonary-mode-lethality risk avoidance associated with radionuclide decorporation countermeasures related to a radiological terrorism incident

Planning for and managing radiological terrorism incidents that involve the release of radionuclides from a dirty bomb requires considering the potential lifesaving impact of protective radionuclide decorporation countermeasures (e.g., lung lavage). Lung lavage therapy could prevent deaths via the pulmonary mode (which involves radiation pneumonitis and fibrosis) by reducing the radiation dose to the lung from inhaled radionuclides. The risk avoidance (RAV) assessment framework introduced in a related paper is used to evaluate the pulmonary-lethality-mode RAV due to lung lavage and the associated risk avoidance proportion (RAP) for hypothetical inhalation-exposure scenarios. The lethality RAV is a measure (on a scale from 0 to 1) of the actual risk reduction associated with the applied protective countermeasures. The lethality RAP is the lethality RAV divided by the lethality risk when no protective countermeasures are employed and is a useful measure of the efficacy of the countermeasures applied. Examples of pulmonary-mode lethality RAV and RAP calculations are presented for hypothetical scenarios involving lung lavage to remove beta and/or gamma-emitting radionuclides that are inhaled in highly insoluble forms. The approach presented could be used to develop optimal schemes for applying lung lavage therapy following a terrorist incident involving a dirty bomb.

Internal exposure to (210)Po and (40)K from ingestion of cooked daily foodstuffs for adults in Japanese cities

The isotope (210)Po was suspected of being involved in the death of a former Russian intelligence agent in 2006 in the UK. Although human exposure to this natural radionuclide in foods is estimated to be high, few studies are available. UNSCEAR Report 2000 does not contain data on (210)Po concentrations of foodstuffs in Japan. We analyzed samples of the everyday Japanese diet cooked with foodstuffs purchased at supermarkets in 7 major domestic cities in 2007-2008. (210)Po was quantified by alpha spectrometry and natural radionuclides such as (40)K by gamma spectrometry. The daily intake and committed effective dose of (210)Po, (40)K, and other natural radionuclides for Japanese adults were calculated. Daily intake was 0.34-1.84 (mean +/- sigma : 0.66 +/- 0.53) and 68.5-94.2 (81.5 +/- 8.5) Bq/d and the committed effective dose was 0.15-0.81 (0.29 +/- 0.24) and 0.16-0.21 (0.18 +/- 0.02) mSv for (210)Po and (40)K, respectively, comprising a high percentage of the total exposure. The total of the mean committed effective dose for the two nuclides (0.47 mSv) was higher than the annual effective dose from ingestion of foods reported by UNSCEAR 2000 (0.29 mSv). The mean committed effective dose of (40)K in the 7 major Japanese cities was comparable to the global average (0.17 mSv). The dietary exposure of Japanese adults can be characterized by a higher (210)Po contribution than in other countries. Of the total daily dietary (210)Po exposure (13 food categories excluding water) for adults in Yokohama, about 70% was from fish/shellfish and 20% from vegetables/mushrooms/seaweeds, reflecting preferences of Japanese to eat a considerable amount of fish/shellfish containing high (210)Po concentrations.

Calculating hematopoietic-mode-lethality risk avoidance associated with radionuclide decorporation countermeasures related to a radiological terrorism incident

This paper provides theoretical health-risk-assessment tools that are designed to facilitate planning for and managing radiological terrorism incidents that involve ingestion exposure to bone-seeking radionuclides (e.g., radiostrontium nuclides). The focus is on evaluating lethality risk avoidance (RAV; i.e., the decrease in risk) that is associated with radionuclide decorporation countermeasures employed to remove ingested bone-seeking beta and/or gamma-emitting radionuclides from the body. To illustrate the application of tools presented, hypothetical radiostrontium decorporation scenarios were considered that involved evaluating the hematopoietic-mode-lethality RAV. For evaluating the efficacy of specific decorporation countermeasures, the lethality risk avoidance proportion (RAP; which is the RAV divided by the total lethality risk in the absence of protective countermeasures) is introduced. The lethality RAP is expected to be a useful tool for designing optimal radionuclide decorporation schemes and for identifying green, yellow and red dose-rate zones. For the green zone, essentially all of the lethality risk is expected to be avoided (RAP = 1) as a consequence of the radionuclide decorporation scheme used. For the yellow zone, some but not all of the lethality risk is expected to be avoided. For the red zone, none of the lethality risk (which equals 1) is expected to be avoided.

Diagnosis and treatment of polonium poisoning

OBJECTIVES

Interest in the clinical toxicology of (210)polonium ((210)Po) has been stimulated by the poisoning of Alexander Litvinenko in 2006. This article reviews the clinical features, diagnosis, and treatment of acute radiation syndrome (ARS) resulting from the ingestion of (210)Po. PHYSICAL CHARACTERISTICS: (210)Po is a high-energy alpha-emitter (radioactive half-life 138 days) that presents a radiation hazard only if taken into the body, for example, by ingestion, because of the low range of alpha particles in biological tissues. As a result, external contamination does not cause radiation sickness.

TOXICOKINETICS

Ingested (210)Po is concentrated initially in red blood cells and then the liver, kidneys, spleen, bone marrow, gastrointestinal (GI) tract, and gonads. (210)Po is excreted in urine, bile, sweat, and (possibly) breath and is also deposited in hair. After ingestion, unabsorbed (210)Po is present in the faeces. The elimination half-life in man is approximately 30-50 days. In the absence of medical treatment, the fatal oral amount is probably in the order of 10-30 microg.

CLINICAL PRESENTATION

If the absorbed dose is sufficiently large (e.g., >0.7 Gy), (210)Po can cause ARS. This is characterized by a prodromal phase, in which nausea, vomiting, anorexia, lymphopenia, and sometimes diarrhea develop after exposure. Higher radiation doses cause a more rapid onset of symptoms and a more rapid reduction in lymphocyte count. The prodromal phase may be followed by a latent phase during which there is some clinical improvement. Subsequently, the characteristic bone marrow (0.7-10 Gy), GI (8-10 Gy), or cardiovascular/central nervous system syndromes (>20 Gy) develop, with the timing and pattern of features dependent on the systemic dose. The triad of early emesis followed by hair loss and bone marrow failure is typical of ARS. Those patients who do not recover die within weeks to months, whereas in those who survive, full recovery can take many months.

INVESTIGATION AND DIAGNOSIS

Serial blood counts are important for assessing the rate of reduction in lymphocyte counts. Chromosome analysis, especially the dicentric count, may establish radiation effects and provides an estimation of dose. The diagnosis of (210)Po poisoning is established by the presence of (210)Po in urine and faeces and the exclusion of other possible causes. In the absence of a history of exposure, diagnosis is very difficult as clinical features are similar to those of much more common conditions, such as GI infections and bone marrow failure caused, for example, by drugs, other toxins, or infections.

MANAGEMENT

Good supportive care is essential and should be directed at controlling symptoms, preventing infections but treating those that do arise, and transfusion of blood and platelets as appropriate. Gastric aspiration or lavage may be useful if performed soon after ingestion. Chelation therapy is also likely to be beneficial, with research in animals suggesting reduced retention in the body and improvements in survival, although increased activity in some radiosensitive organs has also been reported with some chelating agents. Dimercaprol (British Anti-Lewisite) (with penicillamine as an alternative) is currently recommended for (210)Po poisoning, but animal models also indicate efficacy for 2,3,-dimercapto-1-propanesulfonic acid, meso-dimercaptosuccinic acid, or N,N -dihydroxyethylethelene-diamine-N,N -bis-dithiocarbamate.

CONCLUSIONS

Internal contamination with (210)Po can cause ARS, which should be considered in patients presenting initially with unexplained emesis, followed later by bone marrow failure and hair loss.

Death by polonium-210: lessons learned from the murder of former Soviet spy Alexander Litvinenko

The medical response to radiation--whether the result of radiological warfare, terrorist deployment of improvised radiation dispersal weapons, political assassination, occupational or industrial accidents or the medically radiated patient remains one of the least taught among all disciplines within medical education. In the aftermath of 9/11 among medical vulnerabilities to toxicant threats, of all the categories of weapons of mass destruction (WMD)--whether using the CBRNE (chemical, biological, radiological, nuclear, explosive) or NBC (nuclear, biological, chemical) acronym--radiation is the least taught in professional schools, responder cultures or civil preparedness organizations. To date, few health care professionals (HCP) possess the fundamental knowledge or skills to identify and diagnose, let alone treat a radiation victim; this vulnerability made even more obvious in the aftermath of the high profile assassination of former Russian agent Alexander Litvinenko. He was poisoned with Polonium210. Radioactive substances are ubiquitous with radiation sources being in or transported through virtually every region nationwide. It is essential to increase preparedness among community and rural health care facilities as well as urban and university hospitals. Managing radiation injuries effectively requires access to specialized equipment and expertise. Radiation sickness is progressive and may require acute, critical and long-term care throughout the course of illness. Regardless of the source, preparedness rests upon acknowledging a threat exists and dedicating the resources to address the risks including the enhancement of training and equipment. Mass or individual exposures to radiation present unique challenges to the entire response continuum from law enforcement, first responders and emergency medical care. Increased education about and practice in responding to radiological threats is essential to enhance preparedness.

New human data versus estimates of effects of inhaling fission product mixtures

Recently, data on exposures of humans as well as animals to fission products in plumes emitted by underground Soviet tests have been declassified by the Khazakhstan government and published in English. Similar human intakes of gross fission product mixtures that caused acute prodromal symptoms have not been previously reported. Animal experiments with such complex mixtures have not received sufficient support to provide data that could be reliably extrapolated with dose-response models to humans for use in triage of internally exposed persons. This commentary compares some of the acute prodromal effects on humans from the recently released Soviet data with the estimates of Cowan and Kuper, and later estimates by Brodsky and colleagues. The latter estimates are concluded to be safer, and more easily adaptable, for use in triage of persons exposed to internal deposition of fission products of various mixtures.