Development of a Biokinetic Model for Radionuclide-Contaminated Wounds and Procedures for Their Assessment, Dosimetry and Treatment

Front Matter......Page 1
Preface......Page 3
Table of Contents......Page 7
1.1 Background......Page 17
1.2 Purpose and Scope......Page 19
2.1.1 The Epidermis......Page 21
2.1.3 The Subcutis......Page 22
2.2.2.1 Extracellular Water......Page 23
2.2.2.3 Organic Acids......Page 24
2.2.2.4 Transferrin......Page 25
2.2.3 Connective Tissue Macrophages......Page 27
2.2.4 Particle Transport by Macrophages......Page 28
2.3 Wound Healing......Page 29
2.3.4 Burns......Page 30
2.3.5 Foreign-Body Reactions......Page 31
3.1 Industrial Experience......Page 32
3.2.2 Persian Gulf War Experience......Page 34
3.2.3.1 Medical Surveillance and Results......Page 37
3.2.3.2 Summary of Urine Bioassay and Whole-Body Counting Results......Page 38
3.2.4 Embedded Radioactive Particles and Fragments......Page 39
3.3 Medical Cases......Page 42
4. Generic Biokinetic Model for Radionuclides in Wounds......Page 45
4.1 Implementation of the Wound Biokinetic Model......Page 48
4.2 Modeling Results......Page 50
4.2.1.2 Actinium-227......Page 51
4.2.2.1 Basic Data Set......Page 54
4.2.2.2 Radionuclide Retention Categories......Page 55
4.2.2.3 Conditions That Alter Retention of Soluble Radionuclides in Wounds......Page 67
4.2.2.4 Summary for Soluble Radionuclides......Page 68
4.3 Retention of Soluble Radionuclides in Other Types of Wounds: Quantitative Comparison with Intramuscular Data......Page 70
4.3.2 Lacerated Skin......Page 71
4.3.4 Intact Skin......Page 73
4.3.6 Acid-Burned Skin......Page 74
4.4 Modeling of Radioactive Colloids and Particles......Page 75
4.4.1 Wound Retention of ^239Pu^4+ Hydroxide Colloids and Polymers Injected Intramuscularly in Rats and Rabbits and Subcutaneously in Dogs......Page 77
4.4.1.1 Modeling Colloidal Plutonium Nitrate Injected Subcutaneously in Dogs......Page 85
4.4.1.2 Modeling Colloidal Plutonium Hydroxide Injected Intramuscularly in Rats......Page 88
4.4.1.3 Modeling Colloidal Plutonium Hydroxide Injected Intramuscularly in Rabbits......Page 89
4.4.1.4 Summary of Modeling Colloidal Plutonium......Page 90
4.4.2.1 Air-Oxidized ^239PuO_2 Particles Injected Subcutaneously in Dogs......Page 92
4.4.2.2 High-Fired ^239PuO_2 Particles Injected Subcutaneously in Dogs......Page 97
4.4.2.3 Summary for ^239PuO_2 Particles Injected Subcutaneously in Dogs......Page 99
4.4.3.2 ^ 235UO_2 Particles Deposited Intramuscularly in Rats and Rabbits......Page 100
4.4.4 Summary for Insoluble Radionuclides......Page 101
4.4.5.1 Particles of ^239PuO_2 Injected Subcutaneously in Dog Paws......Page 105
4.4.5.2 Particles of ^235UO_2......Page 107
4.5.1 Depleted Uranium Metal Fragments Implanted Intramuscularly in Rats......Page 108
4.5.2 Plutonium Metal Wire Implanted Subcutaneously in Rabbits and Rats......Page 112
4.5.3 Minispheres of Nuclear Weapons Test Fallout Contaminated with Plutonium and Americium Implanted Subcutaneously in Rats......Page 116
4.5.4 Summary for Solid Radioactive Materials......Page 117
4.5.5.1 Depleted Uranium Metal Wafers Implanted Intramuscularly in Rats......Page 120
4.5.5.2 Plutonium Metal Wire Implanted Subcutaneously in Rabbits......Page 122
4.5.5.3 Minispheres of Nuclear Weapons Test Fallout Contaminated with Plutonium and Americium Implanted Subcutaneously in Rats......Page 123
4.6 Default Biokinetic Parameters for Radionuclides in Wounds......Page 124
5.1 Wound Assessment......Page 128
5.1.2 Survey Meters......Page 129
5.1.3 Sequential Measurements......Page 130
5.2.1 Skin Shallow Dosimetry Models......Page 131
5.2.2 Dosimetry of Penetrating Wounds......Page 134
5.2.2.1 Line Sources......Page 135
5.3.1 Indirect Bioassay Measurements......Page 136
5.3.3 Intake Retention Fractions......Page 137
5.3.4 Excretion Fractions......Page 138
5.3.6 Systemic Dose Coefficients......Page 139
5.3.7 Systemic Dose Coefficients for Uranium Derived from the Wound Model......Page 140
5.3.8 Lymph-Node Dosimetry......Page 143
6.1 Evaluation and Treatment of Radionuclide-Contaminated Wounds......Page 144
6.2 General Principles in the Initial Evaluation and Care of a Wound Incident......Page 145
6.4 Wound Decontamination with Irrigation and Removal of Visible Foreign Materials......Page 146
6.5 Wound Dressing and Follow-up......Page 148
6.7 Obtaining Emergency Information and Expert Advice......Page 149
6.8 Use of DTPA in the Management of Actinide-Contaminated Wounds......Page 150
6.8.1 Dosage and Administration......Page 151
6.8.2 Combined Calcium- and Zinc-DTPA Therapy Guidelines......Page 152
7.1 Human Experience......Page 155
7.3 Management of Contaminated Wounds......Page 156
7.4 Animal Data......Page 157
A.1.1 Radionuclide Biokinetics Studies at the University of California Radiation Laboratory......Page 159
A.1.2 Studies in Other Laboratories......Page 174
A.1.3 Data Used in Model Development......Page 175
A.1.4 Supporting Studies of Intramuscularly Injected Radionuclide Solutions......Page 180
A.2.1 Subcutaneous Injections in Rats......Page 188
A.2.3 Intradermal Injection of ^239PuNO_3 _4 in Swine......Page 189
A.3 Lacerations Skin-Muscle Wounds......Page 192
A.4 Application to the Skin......Page 194
A.4.1 Penetration of Intact Skin......Page 195
A.4.3 Thermally-Burned Skin......Page 198
A.4.4 Acid-Burned Skin......Page 200
A.5.1 Increased Local Concentrations of Deposited Radionuclides......Page 202
A.5.3 Special Case of the Oxidation States and Isotopes of Plutonium......Page 206
B.1.1 Colloidal Plutonium in Puncture Wounds......Page 213
B.1.2 Very Small Particles of ^239PuO_2 Injected Intramuscularly in Rats......Page 232
B.1.3 Air-Oxidized ^239,240PuO_2 Particles Implanted Subcutaneously in Dog Paws......Page 233
B.1.4 High-Fired ^239,240PuO_2 Particles Implanted Subcutaneously in Dog Paws......Page 242
B.1.5 Plutonium Metal Discs Implanted Subcutaneously in Rats and Rabbits......Page 249
B.2 Small Particles of Insoluble Radiolabeled Compounds Injected Intramuscularly in Rats......Page 252
B.3.1 Suspensions of Uranium Oxides Injected Intramuscularly in Rats and Rabbits......Page 253
B.3.2 Dry UO_2 Particles Implanted Subcutaneously in Rats......Page 255
B.3.4 Depleted Uranium Metal Fragments Implanted Intramuscularly in Rats......Page 256
B.4.1 Mixed Oxide Particles Injected Intramuscularly in Rats......Page 265
B.4.2 Minispheres Contaminated with Plutonium and Amercium Implanted Subcutaneously in Rats......Page 266
B.5 Colloidal ^232ThO_2 "Thorotrast"®......Page 270
B.6.1 Air-Oxidized ^239PuO_2 Particles Implanted Subcutaneously in Dog Paws......Page 272
B.6.3 Plutonium Metal Wire Implanted Subcutaneously in Rats and Rabbits......Page 273
B.6.5 ^239Pu and ^241Am in Subcutaneous Tissue after Implantation of Contaminated Minispheres......Page 275
B.6.6 Deposited ^232ThO_2 Particles Thorotrast®......Page 276
C.1.1 Chemical Studies......Page 278
C.1.2 Autoradiographic Studies......Page 281
C.2.1 Initial Observations......Page 283
C.2.2 Long-Term Observations......Page 286
C.3.1 Dispersion of Subcutaneously Deposited Particles into Tissue Fluid......Page 287
C.3.2 Very Small Particles of PuO_2 Implanted Intramuscularly in Rats......Page 288
C.3.3 Transport of Small High-Fired PuO_2 Particles in Lymph......Page 289
C.3.4 ^239PuO_2 and ^232ThO_2 Particles Injected Intramuscularly in Rats......Page 290
C.3.5 ^239PuO_2 Particles Implanted Subcutaneously in Dog Paws......Page 291
C.3.8 Depleted Uranium Metal Fragments Implanted Intramuscularly in Rats......Page 298
Appendix D: Worked Examples of the Application of the NCRP Wound Model to Bioassay and Dose Assessment for Uranium......Page 300
E.1.1 Germanium Diodes......Page 314
E.1.3 Cadmium Telluride Detectors......Page 315
E.2.2 Dual-Crystal Scintillators......Page 316
E.3 Proportional Counters......Page 317
E.5 Detector Calibration......Page 318
F.1 Inflammation......Page 320
F.2 Reepithelialization......Page 321
F.3.1 Fibroplasia......Page 322
F.3.2 Neovascularization......Page 323
F.4 Wound Contraction and Extracellular Matrix Reorganization......Page 324
F.5.2 Healing of Burn Wounds......Page 325
F.6 Foreign-Body Reactions......Page 327
F.6.2 Foreign-Body Carcinogenesis in Animals......Page 328
F.7 Radiation Effects......Page 330
F.7.1 Soft-Tissue Responses in Humans......Page 331
F.7.2 Soft-Tissue Responses in Animals......Page 336
F.8 Summary......Page 338
Acronyms and Symbols......Page 340
Executive Summary......Page 342
Glossary......Page 348
A......Page 362
B......Page 363
C......Page 364
D......Page 365
E......Page 367
F......Page 370
H......Page 371
I......Page 372
L......Page 374
M......Page 375
O......Page 376
P......Page 377
R......Page 379
S......Page 383
T......Page 385
U......Page 388
W......Page 389
Z......Page 394
The NCRP......Page 395
NCRP Publications......Page 404
References......Page 415