Removal of Inhaled Radioactive Particles by Lung Lavage - A Review

Ba, Muggenburg; Sa, Felicetti; Sa, Silbaugh

doi:10.1097/00004032-197709000-00006

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…For lung intakes of insoluble particles with a high activity radionuclide ( 192 Ir, 90 Sr, 210 Po), one should consider physical removal by bronchioalveolar lavage (BAL). In addition to being used as a diagnostic procedure for radiation pneumonitis and other lung diseases, BAL is used therapeutically to remove unwanted material, including insoluble radionuclides, from the lungs of adults and children [14][15][16][17]. It should be performed by only an experienced health care provider, typically a pulmonologist or thoracic surgeon.…”

Section: Physical Removal Of Radionuclidesmentioning

confidence: 99%

Assessment and clinical management of internal contamination

Dainiak

Albanese²

2022

J. Radiol. Prot.

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Internal contamination by radionuclides may occur through inhalation, ingestion and absorption through the skin or subcutaneous tissue. The clinical management of internalized radionuclides requires integration of clinical signs and symptoms with dose estimates in biological tissues obtained from the face, nose, sputum, urine, feces and/or skin. Assessment of ingested radionuclides includes bioassays of urine and feces, and if available, whole body counting for radionuclides that emit penetrating x-rays or gamma-rays. An estimate of intake dose may be made at the time of initial patient evaluation by measuring radioactivity, converting counts/minute to depositions/minute with a specific gamma-ray constant, and comparing the amount to its annual limit on intake, clinical decision guide or derived reference level. Since no one dies from internal contamination per se, medically unstable patients should be stabilized before addressing internal contamination. Whenever possible, internal contaminants should be physically removed as soon as possible after exposure. For inhaled internal contaminants, radionuclide-specific therapy may include administration of an ion exchange resin (i.e., Prussian blue, PB) or chelating agent (i.e., diethylenetriamine pentaacetate, DTPA, that binds to radioactive plutonium, americium, and curium), or physical removal of insoluble particles having a high activity radionuclide (192Ir, 90Sr, 210Po) by bronchioalveolar lavage. Decorporation with PB, DTPA and other agents is used to enhance excretion. Treatment of wounds contaminated with an actinide includes gentle irrigation, surgical excision of contaminated tissue and DTPA. The averted dose (i.e., the total effective dose averted by therapy) may be calculated for each exposure route.

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Section: Physical Removal Of Radionuclidesmentioning

confidence: 99%

Assessment and clinical management of internal contamination

Dainiak

Albanese²

2022

J. Radiol. Prot.

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“…The only other approach to eliminate high activity MOX particles would be to use bronchopulmonary lavage. The use of this technique as a countermeasure for lung contamination with insoluble actinides has been addressed over the years in experimental models (see Muggenburg et al, 1977;Nolibé et al, 1989;National Council on Radiological Protection and Measurements. (NCRP), 2009).…”

Section: Data Availability Statementmentioning

confidence: 99%

Comparison of Local and Systemic DTPA Treatment Efficacy According to Actinide Physicochemical Properties Following Lung or Wound Contamination in the Rat

2021

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Purpose: In cases of occupational accidents in nuclear facilities or subsequent to terrorist activities, the most likely routes of internal contamination with alpha-particle emitting actinides, such as plutonium (Pu) and americium (Am), are by inhalation or following wounding. Following contamination, actinide transfer to the circulation and subsequent deposition in skeleton and liver depends primarily on the physicochemical nature of the compound. The treatment remit following internal contamination is to decrease actinide retention and in consequence potential health risks, both at the contamination site and in systemic retention organs as well as to promote elimination. The only approved drug for decorporation of Pu and Am is the metal chelator diethylenetriaminepentaacetic acid (DTPA). However, a limited efficacy of DTPA has been reported following contamination with insoluble actinides, irrespective of the contamination route. The objectives of this work are to evaluate the efficacy of prompt local and/or systemic DTPA treatment regimens following lung or wound contamination by actinides with differing solubility. The conclusions are drawn from retrospective analysis of experimental studies carried out over 10 years.Materials and Methods: Rat lungs or wounds were contaminated either with poorly soluble Mixed OXide (U, Pu O2) or more soluble forms of Pu (nitrate or citrate). DTPA treatment was administered promptly after contamination, locally to lungs by insufflation of a powder or inhalation of aerosolized solution or by injection directly into the wound site. Intravenous injections of DTPA were given either once or repeated in combination with the local treatment. Doses ranged from 1 to 30 µmol/kg. Animals were euthanized from day 7–21 and alpha activity levels were measured in urine, lungs, wound, bone and liver for determination of decorporation efficacy.Results: Different experiments confirmed that whatever the route of contamination, most of the activity is retained at the entry site after insoluble MOX contamination as compared with contamination with more soluble forms which results in very low activities reaching the systemic compartment and subsequent retention in bone and liver. Several DTPA treatment regimens were evaluated that had no significant effect on either lung or wound levels compared with untreated animals. In contrast, in all cases systemic retention (skeleton and liver) was reduced and urinary excretion were enhanced irrespective of the contamination route or DTPA treatment regimen.Conclusion: The present study demonstrates that despite limitation of retention in systemic organs, different DTPA protocols were ineffective in removing insoluble actinides deposited in lungs or wound site. For moderately soluble actinides, local or intravenous DTPA treatment reduced activity levels both at contamination and at systemic sites.

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“…As early as 1963, RAMIREZ et al [3) reported on whole lung lavage (WLL) using a large volume of fluid in patients with pulmonary alveolar proteinosis. Since then, this technique has been proposed for removal of any alveolar filling material, in conditions such as alveolar protein os is [ 4,5], alveolar microlithiasis (6], acute silicosis [7], or accidental inhalation of radioactive particles (8,9). Its use has also been proposed in obstructive lung diseases [10], to remove the mucous secretions accumulated in the bronchial tree, as in asthma [11,12], or cystic fibrosis (13,14).…”

Section: Therapeutic Applications Of Bronchoalveolar Lavagementioning

confidence: 99%

“…The benefit of WLL in human contamination is not yet clearly defined [8,9]. Experimental studies on dogs and baboons have been carried out over the last 20 yrs to determine the efficacy of WLL in the removal of such particles.…”

Section: Inhalation Of Radioactive Particlesmentioning

confidence: 99%