Radiology Physicians Respond to “Dirty Bomb” Threats

 Radiology Physicians Respond to “Dirty Bomb” Threats

By Ellen Cannon

         The threat of a “dirty bomb” incident is real and dangerous.  The US remains far from where it needs to be regarding response, recovery, and preparedness for citizens and first responders.

     US radiologists are however, taking positive steps to fill the gap in their education specialization helping to prepare their field for expert diagnosis, response, and recovery should a dirty bomb incident occur.

     Dr. Charles Kitley, of the Madigan Army Medical Center in Tacoma, Washington notes that “when we think of disasters we normally acknowledge the role of the emergency physician as first responders. The new reality however suggests that this is a very dangerous world with in which a radiological attack or incident can occur.  This new reality has catapulted radiology physicians to play an ever increasing role as first responders.” (Andrew Grotto, “Defusing the Threat of Radiological Weapons” Center for American Progress, July 2008)

     According to a study by Israeli medical experts “the radiologists has become a crucial part of the first-line team of doctors treating victims of terrorism.”(Jacob Sosna, M.D. “Facing the New Threats OF Terrorism: Radiologists’ Perspectives Based on Experience in Israel”, http://radiology.rsna.org/content/237/1/28/.full)

     Similarly, authors of a recent study published in Emergency Medicine, concur writing “radiologists stand at the crossroads of screening, decontamination, diagnosis, and treatment planning.”(Emergency Medicine, 2010)

     Radiologists are not new to performing major roles in terrorism disasters.

     One such incident involving a prominent role for radiologists was the Oklahoma City bombing on April 19, 1995.

     The explosion caused enormous damage completely destroying a third of the seven story building, including a day care center on the first floor and damaged more than 300 buildings in the immediate neighborhood.

     The bomb killed 168 people, including 19 children and one rescue worker.  It injured over 800 people, blocks away as the explosion turned over street signs, smashed glass and caused debris to turn into missiles blowing pedestrians off their feet.

     Radiologists played a key role in assisting the patients as well as FBI bomb specialists.

     When a body was discovered an average of 15-20 x-rays of the deceased were taken.  These x-rays were used by pathologists and bomb experts to identify the victims, treat patients, as well as uncover crime scene evidence.

     The Radiological Society of North America (RSNA) is funding a new radiological project aimed at educating radiologists regarding the proper responses to a dirty bomb that can explode in any country. The project, “Training the Trainers: How to Answer Radiation Biology Questions, Before, During, and After and Event,” is headed by Michael Robbins, Ph.D.

     A primary Goal of “Training the Trainers” is to attract leaders in the field of radiation biology to share their knowledge and develop course material that can be distributed and used in hospitals and Continuing Medical Education (CME) courses.

     According to Dr. Douglas Coldwell, M.D., a leading biotech and counterterrorism consultant, the project is essential for national security and health reasons as it aims at re-educating radiologists in radiology biology.  Coldwell notes that most radiology personnel have not reviewed radiation biology since taking radiology board exams.  It is a knowledge base which will enable radiologists to actively assist in detecting a danger, diagnose a situation and assist in the response, recovery and resiliency of a community following an incident. (“Radiologists Prepare for Radiation Terrorism,” www.rsna.org/publications/january2009/terrorism)

     In addition, to their role in the diagnoses of trauma, radiation oncologists and nuclear medicine physicians use therapeutic doses of radiation and are comfortable in caring for these patients.

     Both Robbins and Coldwell agree that the “Training the Trainers” project can limit the effects from a radiation conventional attack a dirty bomb or both.

     Congressional leaders strongly underscore the growing threat of a potential dirty bombs going off in a major city as well as the need to fund programs which will protect and rebuild cities following an incident.

     Congressman Jane Harmon (D-CA) and Senator Susan Collins (R-ME) stated in a recent essay to the Wall Street Journal,”

“We know that terror groups remain highly interested in such devices as a dirty bomb.  Al Qaeda’s senior leadership has publicly expressed a desire to acquire weapons of mass destruction including radiological weapons with which to attack the US.  US officials have received many documents detailing Al Qaeda’s pursuit of these weapons.”  Furthermore,” in 2006 the leader of Al Qaeda in Iraq called for support from the nuclear science community to assist him in obtaining both nuclear and radiological weapons.” In addition, “in 2006 British citizen Dhirin Barot admitted to considering detonating a dirty bomb and specifically targeted underground garages in both the UK and US as well as the International Monetary Fund, The world Bank, the New York Stock Exchange, and business offices of Citigroup and Prudential Financial.” Also, Harmon and Collins point to the recent threat by Adman el Shukrijuman, an American citizen on the FBI’s most wanted list, who was named an accomplice in the New York subway bomb blast. He is a trained nuclear technician allegedly tasked by Al Qaeda to carrying off an “American Hiroshima”. (Representative Jane Harmon and Senator Susan Collins,”Al Qaeda Still Wants a Dirty Bomb” Wall Street Journal, July 22, 2010)

     Information from our European allies confirms this growing threat. Further increasing the potentiality of the dirty bomb threat being realized is the insufficiently protected vast amounts of explosives and radioactive materials from waste, hospitals, manufacturers, and test sources. It is not difficult for this radioactive material to fall into dangerous hands.

     Throughout the US used radioactive material is piling up in closets and basements of hospitals and research facilities.  For many years low level nuclear waste and radioactive materials were taken to a landfill in rural South Caroling by truck.  There, objects such as radioactive seeds for treating cancer and tubes used in industrial gauges were sealed in concrete and buried.(“Nuclear waste piling up at US hospitals,” msnbc.com, September 25, 2008)

     Recent laws in South Carolina terminated disposal of radioactive material at the landfill; consequently, 36 states do not have a disposal sites.

     Universities, hospitals, manufacturers and labs store more and more radioactive material on their own property. Some institutions do store their radioactive materials in

  lead lined safes, behind doors filled with alarms. 

      The former head of the Texas agency dealing with this issue, Rick Jacobi, notes that “instead of safely securing radioactive materials in one place, it is stored in thousands of places in urban locations all over the United stated. The vulnerability this creates to the country is obvious.”(Charles D. Ferguson, “Combating and Preparing for Radiological Terrorism,” Paper presented at 42nd Session of the UN Advisory Board on Disarmament Matters, Feb 5, 2007)

     Yearly, thousands of radioactive sources are lost, stolen and abandoned.  There is potential for these groups to get into the hands of homegrown terrorist groups, transnational terrorist groups, or for an accident to occur.

     According to the Council on Foreign Relations, in 1995 Chechen rebels planned but failed to detonate a dirty bomb consisting of dynamite and cesium 137 in Moscow’s Izmailovsky Park.  In 2002 the US arrested an alleged Al Qaeda operative, Jose Padilla, for plotting to build and detonate a dirty bomb. In 2003, British intelligence and weapons experts found documents and diagrams in Afghanistan suggesting that Al Qaeda might have succeeded in building a dirty bomb.  As of now no dirty bomb has been found. The important point is , acquiring the material for a dirty bomb and building it is not a difficult task. (Scott Stewart, “Dirty Bombs Revisited, www.stratfor.com,April 22, 2010)

     Adding to the risk is the fact that the American public has little information as to what dirty bomb is and what if any are its health and societal consequences should there be an incident. The lack of knowledge moat often results in public panic, fear, and incorrect responses.

     A “dirty bomb”, also known as a radiological dispersal device (RDD) is a conventional explosive packaged with radioactive materials.  A dirty bomb kills or injures through the initial blast of the convention explosive, and by airborne radiation and contamination hence the name “dirty bomb.”

     Most dirty bombs and other RDDs will have localized effects, ranging from less than a city block to several square miles.  The area over which radioactive materials would be dispersed depends on variables such as: the amount and type of radioactive material dispersed; means of dispersal (fire, spraying explosion); physical and chemical form of the radioactive chemical i.e. fine particles can be carried by wind over a large area, local topography, location of buildings; and local weather conditions.

     If the radioactive material is released as fine particles, the particles would spread with the speed and direction of the wind. As the radioactive particles spreads over a larger topography, the radioactivity becomes less concentrated. The more distant you are from the site the better off you will be for some period of time, depending on the activity and quality of the radioactive material you are using. ( Dr. Graham Allison, “Dirty Bomb: Preparing for Terrorism.” PBS TV,www.pbs.org./wgbh/nova/dirtybomb/Allison.html

     A dirty bomb combines available radioactive materials such as Cesium-137, Strontium 90, Cobalt-60, Americium-241, and Plutonium-210 with a conventional explosive such as TNT. The explosion of hot expanding gas jettisons the radioactive material over an area where the explosion has had an immediate impact. (“Dirty Bombs-question and answers”, www.bbc.co.uk/science/horizon/2006/dirtybombqa.shtml)

     According to Bill Nichols, Mimi Hall, and Peter Eisler the immediate lethal power of the bomb lays in the impact of the explosive itself and the civilian panic it causes.  Most dirty bombs do not contain radioactive material to cause death or illness. (“Feds work to secure Potential ‘Dirty Bomb” source, USA Today, Sept 24, 2008)

     Long term concerns include contamination of city buildings and the economic and social consequences of residents fleeing the city.  Depending on its size, a dirty bomb could contaminate large sections of an entire city, wreaking havoc by making neighborhoods uninhabitable until cleanup is feasible. Cleanup can involve demolition of whole blocks and can incur costs of tens of billions of dollars.

     Some residents located near to the explosion may have internal contamination through inhaling the radioactive material as well as primary/secondary ingestions which will require medical treatment.

     RDDs into the water or food system of large cities can result in increased lifetime cancer risk proportionate to dose.

     Dirty bombs are not nuclear weapons which can cause extensive death and destruction but are often described as “weapons of mass disruption.” They give terrorists just what they want – a cheap bang for their buck that instills fear, reduces faith in government, and promotes extensive economic instability.