EU Including: Development of Radiological and Nuclear Training Learning Objectives

Worldwide, about 20 million consignments of radioactive material are transported annually on public roads, railways, aircraft, and ships. About 95% of radioactive consignments are not related to nuclear power. In 2016, a total of 143 incidents of nuclear or other radioactive materials were found to be outside of regulatory control, which occurred in 19 countries. On an international level risk assessment has to account for the potential threats due to millions of radioactive sources in use worldwide and hundreds of tons of military grade U/Pu not under IAEA safeguards. The European Union (EU) has tasked the INCLUDING project consortium, connecting 15 partners from 10 EU Member States, to address this issue and create an innovative cluster for radiological and nuclear (RN) emergencies. The project is coordinated by the Italian Agency for the New Technologies, Energy and Sustainable Economic Development (ENEA). INCLUDING will provide comprehensive training in the RN security sector. Thereby, know-how is enhanced for practitioners in this sector. An important part in this endeavor is the development of radiological- and nuclear training learning objectives. INCLUDING partners involved in this task (Work Package 4) represent companies, organisations and government agencies from Austria, Greece, Italy, Lithuania, Hungary and Portugal. The task has four main objectives: 1) Harmonisation of RN education/training for EU first responders: 2) Identification of main problems in setting norms;3) Developing a training matrix using revised Bloom’s taxonomy;4) Use of the methodology developed for Joint Actions and its application at INCLUDING Cluster Facilities in different EU Member States. The INCLUDING Work Package 4 members have analyzed the EU EDEN Training Matrix and identified gaps in accordance with NATO CBRN training standards related to civil-military cooperation. Furthermore, they analyzed 5 EUHORIZON 2020- and 9 EUFP7-SECURITY projects, and 97 RN training courses offered to the international community by NATO, 6 EU organisations, Qatar, US military- and civilian organisations, and the International Atomic Energy Agency (IAEA). This paper will present these results, which are being used to develop the basic structure for the Learning Objective Catalogue (LOC), comprised of multiple RN-related Learning Objectives for different threat scenarios.

Preparing for a “dirty bomb” attack: The optimum mix of medical countermeasure resources

Background: In radiological emergencies with radionuclide incorporation, decorporation treatment is particularly effective if started early. Treating all people potentially contaminated("urgent treatment") may require large antidote stockpiles. An efficacious way to reduce antidote requirements is by using radioactivity screening equipment. We analyzed the suitability of such equipment for triage purposes and determined the most efficient mix of screening units and antidote daily doses.Methods: The committed effective doses corresponding to activities within the detection limits of monitoring portals and mobile whole-body counters were used to assess their usefulness as triage tools. To determine the optimal resource mix, we departed from a large-scale scenario(60,000 victims) and based on purchase prices of antidotes and screening equipment in Germany, we calculated efficiencies of different combinations of medical countermeasure resources by data envelopment analysis. Cost-effectiveness was expressed as the costs per life year saved and compared to risk reduction opportunities in other sectors of society as well as the values of a statistical life.Results: Monitoring portals are adequate instruments for a sensitive triage after cesium-137 exposure with a high screening throughput. For the detection of americium-241 whole-body counters with a lower daily screening capacity per unit are needed. Assuming that 1% of the potentially contaminated patients actually need decorporation treatment, an efficient resource mix includes 6 monitoring portals and 25 mobile whole-body counters. The optimum mix depends on price discounts and in particular the fraction of victims actually needing treatment. The costeffectiveness of preparedness for a "dirty bomb" attack is less than for common health care, but costs for a life year saved are less than for many risk-reduction interventions in the environmental sector.Conclusion: To achieve economic efficiency a high daily screening capacity is of major importance to substantially decrease the required amount of antidote doses. Among the determinants of the number of equipment units needed, the fraction of the potentially contaminated victims that actually needs treatment is the most difficult to assess. Judging cost-effectiveness of the preparedness for "dirty bomb" attacks is an issue of principle that must be dealt with by political leaders.

Estimation of radiation-induced health hazards from a“dirty bomb”attack with radiocesium under different assault and rescue conditions

In the case of a terrorist attack by a“dirty bomb”,blast injuries,external irradiation and the incorporation of radioactivity are to be expected.Departing from information about the radiological attack scenario with cesium-137 in the U.S.National Scenario Planning Guide,we estimated the radiological doses absorbed.Similar calculations were performed for a smaller plume size and a detonation in a subway.For conditions as described in the U.S.scenario,the committed effective dose amounted to a maximum of 848 mSv,even for very unfavorable conditions.Red bone marrow equivalent doses are insufcient to induce acute radiation sickness(ARS).In the case of a smaller plume size,the ARS threshold may be exceeded in some cases.In a subway bombing,doses are much higher and the occurrence of ARS should be expected.The health hazards from a dirty bomb attack will depend on the location and the explosive device.The derived Haddon matrix indicates that preparing for such an event includes education of all the medical staff about radiation effects,the time lines of radiation damages and the treatment priorities.Further determinants of the outcome include rapid evacuation even from difficult locations,the availability of a specific triage tool to rapidly identify victims at risk for ARS,the availability of an antidote stockpile and dedicated hospital beds to treat seriously irradiated victims.

Gastric blunt traumatic injuries: A computed tomography grading classification

AIM To produce a radiological grading of gastric traumatic injuries. METHODS In our study, we retrospectively analyzed 32 cases of blunt gastric traumatic injuries and compared computed tomography(CT) data with patients' surgical or medical development. In all cases, a basal phase was acquired, and an intravenous contrast material was administered via an antecubital venous catheter with acquisition in the venous phase(70-90 s). In addition, a further set of delayed scans was performed 4-5 min after the first scanning session, without supplementary intravenous contrast material, to identify or better define areas of active bleeding. All CT examinations were retrospectively reviewed by two radiologists, with more than 5 years of experience in emergency radiology, to detect signs of gastric injuries and/or associated abdominal lesions according to literature data. Specific CT findings for gastric rupture include luminal content extravasation and discontinuity of the gastric wall, while CT findings suggestive of injury consisted of free peritoneal fluid, extraluminal air, pneumatosis, and thickening and hematoma of gastric wall.RESULTS We found 32 gastric traumatic injuries. In 22 patients(68.8%), the diagnosis was based on the surgical findings; in the other 10 patients(31.2%), the diagnosis was based on the clinical and CT radiological data. We observed discontinuity of the gastric wall and luminal content extravasation in 1 patient(3.1%); in 10 patients(31.2%), there was extra-luminal air in the peritoneum. In 28 patients(87.5%), there was peritoneal fluid, which was blood in 14 patients(hematoma in 11 patients and contrast material extravasation from active bleeding in 3 patients). In 15 patients(46.9%), there was gastric wall thickening. In 3 patients, it was possible to identify a prevalent involvement of the external layer of the gastric wall, whereas, in 2 patients, the inner side of the gastric wall presented with major involvement. In 3 patients(9.4%), pneumatosis of the gastric wall was detected. In 19(59.4%) patients, the stomach was full. The fundus was the most frequently damaged part of the stomach because it was involved in 17 patients(53.1%). Based on the observed data, we identified four grades of gastric lesions.CONCLUSION A radiologic score is helpful for guiding the diagnosis and management(surgical or conservative) of gastric blunt traumatic injuries and stratify patients according to short-term outcomes.

Performance tests of a portable thyroid radioiodine meter

Objective:To evaluate the effectiveness of a portable thyroid radioiodine meter in on-site monitoring to enhance the monitoring precision of radioiodine inhaled by nuclear medicine staff and patients.Methods:A portable thyroid radioiodine meter was developed to measure the 131I activity in the thyroid.Performance tests of the portable thyroid radioiodine meter were conducted using calibration sources and testing methodologies adhering to national metrological standards.Results:The thyroid radioiodine meter exhibited integral non-linearity,8-h measurement stability,measurement linearity,and an energy resolution of 0.42%,1.05%,1.56%,and 7.11%,respectively for ^(137)Cs at 661.66 keV.Additionally,its minimum detectable activity for ^(131)I at 364.49 keV was approximately 22 Bq(10 min).Conclusion:The developed thyroid radioiodine meter features elevated performance and great potential for application in nuclear medicine and monitoring of responses to nuclear or radiological emergencies.