Daily Bulletin 2016

Preparedness is Key for Radiologists in Event of Radiological or Nuclear Terrorism Incident

Tuesday, Nov. 29, 2016

Radiologists play important medical and educational roles regarding a potential radiological or nuclear terrorism event in the United States. However, in order to maximize their effectiveness, they need to be prepared ahead of time.

That was the theme running throughout an educational session presented Monday, "Radiological and Nuclear Terrorism: Like it or Not, Radiology Professionals Will Be in the 'Hot' Seat."

"Whether or not you are prepared, radiologists will be integrated into the hospital's radiation response plan," said Nicholas Dainiak, MD, medical and technical director at the Radiation Emergency Assistance Center/Training Site (REAC/TS) in Oak Ridge, Tenn.

"Without preparation, we're going to fail," he added.

Moderator Donald P. Frush, MD, (far left) stands with presenters (left to right) Brooke R. Buddemeier, John J. Lanza, MD, PhD and Nicholas Dainiak, MD.

Disaster response plan practice is key

In general, radiologists can prepare by understanding overall local, state, regional and national responses to a radiological or nuclear attack. Closer to home, Dr. Dainiak said radiologists should also learn and participate in their hospital's disaster response plan practice exercises. And if necessary, lobby their hospital leaders to develop those exercises.

"Exercises are the best way to develop relationships with fellow physicians," Dr. Dainiak said.

Because of their background and training, Dr. Dainiak said radiologists understand basic radiation physics and radiobiology, are knowledgeable about selecting appropriate imaging exams and can help educate the general public about the dangers of radiation to lessen fear during the fallout.

Dr. Dainiak offered some questions for radiologists to proactively ask themselves in order to assess their level of preparedness. They include how would your routine day change, how would you advise primary caregivers about radiation exposure and how would you recommend allocation of scarce resources?

Radiologists can promote public education

Radiologists can also work proactively to educate the public about the nature of radiation and its health effects. Dr. Dainiak pointed to a 2005 study published in Health Physics that showed increased knowledge about radiation effects helps to eliminate the fear that exists for many people.

"So the more we can teach, the more knowledgeable our patient population is, the less fear there will be. That applies to physicians and nurses, too, by the way," said Dr. Dainiak, who is also a clinical professor of medicine in the Department of Therapeutic Radiology at the Yale University School of Medicine in New Haven, Conn.

Despite the plans and structures in place, the overall level of preparedness for large-scale radiological or nuclear terrorism attacks is less than it is for events such as natural disasters and biological incidents, according to presenter John J. Lanza, MD, PhD, director of the Florida Department of Health in Escambia County.

Dr. Lanza encouraged radiologists to seek volunteer opportunities now that will lead to better preparedness should a radiological or nuclear terrorism event occur.

He pointed to the 32 core capabilities that are part of the National Preparedness Goal, created by the Federal Emergency Management Agency (FEMA). The goal defines what it means for the whole community to be prepared for all types of disasters and emergencies.

"This is a marketing pitch to get you involved with that," Dr. Lanza said. "The world will not come to an end if nuclear detonation occurs. It won't be a good day for anybody, but we need to do what we can to help."

What to expect in a crisis

Presenter Brooke R. Buddemeier, a health physicist at the Lawrence Livermore National Laboratory, described in detail fallout scenarios from the hypothetical detonation of a radiological dispersal device in Brooklyn, N.Y., and an improvised nuclear device in Washington, D.C.

In addition, he disproved medical response myths circulating about radiation from a nuclear event. He explained that, contrary to belief, radioactive contamination is not immediately dangerous to life and health. It presents little hazard to medical staff and is easily managed and contained.

Buddemeier also pointed out that critical care takes precedence over monitoring for decontamination. He said removing outer clothing and wiping exposed skin is often sufficient for simple decontamination.

Knowing those facts and others aid in preparations for all medical and emergency personnel.

"If you know what to do to support the victims of an event like this, you can save a lot of lives. We can help mitigate the consequences," Buddemeier said.

Question of the Day:

I want to buy a new mammography unit, but it has a tungsten target. Don't I need the characteristic x-rays from Molybdenum to have the optimal energy range for breast imaging?

Tip of the day:

Dose alerts are set for equipment as a complete unit. This means it may help prevent overdosing a patient, but it also means that the alert may kick in during a high-dose procedure like CT-fluoroscopy and interrupt imaging. Always make sure someone in the room has the password to override when performing high dose procedures on dose alert enabled equipment.

The RSNA 2016 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.