核事故应急医学救援分类后送工作方法探讨

军队核事故医学救援组织力量是国家核应急组织体系的重要力量分支。本文结合解放军第401医院崂山分院核事故医学救援队在辐射伤员早期分类后送专业模块训练中获得的经验,介绍了辐射事故早期伤员分类的原则与方法、伤员后送,以及伴随着伤员分类后送过程中应该掌握的现场急救技术和心理救助,以期为军队核应急医学救援组织遂行实战任务提供借鉴和参考。     

中国核工业职业医学成果摘要选集题录

选择收集了中国核工业30年(1958～1988)职业医学方面的科学论文648篇,以题录形式列出题目、作者和作者工作单位。共分四个部分:第一部分为实验研究,含放射性核素内污染、放射生物学、放射毒理学、放射卫生学。第二部分为流行病学调查,含辐射流行病学调查、现场职业危害调查。第三部分为放射损伤临床医学,含放射性核素内污染、β射线皮肤损伤、小剂量照射危害、淋巴细胞染色体分析、辐射血液学、辐射事故医学应急处置、铀矿工矽肺、铀矿工肺癌。第四部分为非放射性工业毒物的职业危害。     

中国核工业职业医学成果摘要选集题录(英文)

选择收集了中国核工业30年(1958～1988)职业医学方面的科学论文648篇,以题录形式列出题目、作者和作者工作单位。共分四个部分:第一部分为实验研究,含放射性核素内污染、放射生物学、放射毒理学、放射卫生学。第二部分为流行病学调查,含辐射流行病学调查、现场职业危害调查。第三部分为放射损伤临床医学,含放射性核素内污染、β射线皮肤损伤、小剂量照射危害、淋巴细胞染色体分析、辐射血液学、辐射事故医学应急处置、铀矿工矽肺、铀矿工肺癌。第四部分为非放射性工业毒物的职业危害。     

多学科合作推进核应急医学发展

依据核应急医学救援的原则,包括体表污染、放射损伤、内污染和复合伤的诊断和处理原则,结合担任核应急医学现场救援队伍和专科医疗救治任务的相关科室,包括急救和重症医学、放射医学、核医学、放射治疗学及其它临床学科的能力建设,提出多学科沟通、多单位合作的理念,充分发挥各相关专科的技术长项并取长补短,协力做好核应急医学现场救援和院后救治工作。     

关于放射性核素体内污染的医学干预水平

在内照射防护的实践中,确定体内污染的医学干预水平和医学处理是辐射防护和有关医学部门工作的一个组成部分。本文简要回顾有关出版物中提出的医学干预水平的建议,讨论了体内污染医学处理的代价利益,供有关部门处理放射性核素体内污染时参考。     

核辐射突发事件医学应急的现场救援及组织指挥原则

根据核辐射突发事件医学应急现场救援的具体任务和需要的处置力量,将其分为小规模核辐射突发事件、中等规模核辐射突发事件和大规模核辐射突发事件,并具体分析了各自的特点、危害、现场医学救援的任务和技术力量。重点针对＂脏弹＂恐怖袭击,介绍了现场医学救援的主要任务,以及污染控制和伤员救治的技术流程。为更好地执行核辐射事故现场医学救援任务,总结并提出了组织指挥中应该注意的几个原则,包括快速反应原则、剂量限值原则、防护最优化原则、权衡利弊原则,以及辐射监测、去污控污、伤员救治等核心任务的全流程贯穿原则等。     

辐射事故的初期医学处理

本文在总结20年来较重大辐射事故初期医学处理实践的基础上,强调了外照射及放射性核素内或外污染事故的初期医学处理应遵循的原则和程序,并对辐射事故初期医学处理的重要性和建立职责分级明确的阶段性医疗体制问题进行了扼要的讨论。     

基于操作层面的核事故现场医学应急处置流程优化探讨北大核心CSCD

通过对比国内外核应急相关标准,结合国际重大核事故医学应急处置经验及国内核应急演练经验,分析我国核事故医学应急现场处置现状,并重点就严重核事故现场医学救援过程中“辐射防护、伤员分类、去污洗消、心理干预”等方面分析探讨可能存在的问题,提出操作层面的流程优化建议,以助于提升核应急专业救援队伍能力。     

基于基因表达水平和骨髓功能评估核辐射受照剂量的研究进展

在核事故中,超大剂量核辐射损伤的特点是瞬时发生和不可预测,在受辐射伤员的紧急救治过程中,其实际受照剂量往往是完全未知的,这给伤情的评估和针对性救治方案的制定带来了很大困难。针对这一现状,本文综合介绍了辐射敏感基因的应答性表达改变,可以用来评估伤员曾经接受到的辐射剂量;骨髓免疫显像可以动态评估伤员骨髓造血功能的建立情况;建立辐射致裸小鼠骨髓毁损后骨髓移植救治模型,可为伤员骨髓移植临床前研究奠定基础。     

放射性核素锶的吸附法研究进展

放射性核素⁹⁰Sr是核工业生产过程中最常见的污染核素,吸附法是处理放射性核素⁹⁰Sr污染的重要方法。本文介绍了常用的吸附⁹⁰Sr的方法,如离子交换法、络合/螯合吸附法、静电吸附法、表面与多孔吸附法等,并比较了各自的优劣,以期对采用吸附法处理放射性核素的工艺过程提供参考。     

核与辐射突发事件放射性体表污染的去污洗消流程及场所

去污洗消设施能否满足技术要求,洗消流程是否规范,对于防止污染扩散,减少放射性核素的吸收是非常关键和必要的。本文主要就核与辐射突发事件中放射性体表污染的去污洗消流程及场所环节做一介绍,旨在为今后核与辐射突发事件提供一定的参考。     

Release of patients after therapy with unsealed radionuclides

After some therapeutic nuclear medicine procedures with unsealed radionuclides, precautions may be needed to limit doses to other people, but this is rarely the case after diagnostic procedures. Iodine-131 results in the largest dose to medical staff, the public caregivers, and relatives. Other radionuclides used in therapy are usually simple beta emitters (e.g. phosphorus-32, strontium-89, and yttrium-90) that pose much less risk. Dose limits apply to exposure of the public and medical staff from patients. Previously, the ICRP has recommended that a source-related dose constraint for optimisation of a few mSv/episode applies to relatives, visitors, and caregivers at home, rather than a dose limit. The present report recommends that young children and infants, as well as visitors not engaged in direct care or comforting, should be treated a s members of the public (i.e. be subject to the public dose limit.) The modes of exposure to other people are: external exposure; internal exposure due to contamination; and environmental pathways. Dose to adults from patients is mainly due to external exposure. Contamination of infants and children with saliva from a patient could result in significant doses to the child's thyroid. It is important to avoid contamination of children and pregnant women. After radioiodine therapy, mothers must cease breastfeeding immediately. Many types of therapy with unsealed radionuclides are contraindicated in pregnant females. Women should not become pregnant for some time after radioisotope therapy. Technetium-99m dominates discharges to the environment from excreta of nuclear medicine patients, but its short half-life limits its importance. The second largest discharges, iodine-131, can be detected in the environment after medical uses but with no measurable environmental impact. Storing patient's urine after therapy appears to have minimal benefit. Radionuclides released into modern sewage systems are likely to result in doses to sewer workers and the public that are well below public dose limits. The decision to hospitalise or release a patient should be determined on an individual basis. In addition to residual activity in the patient, the decision should take many other factors into account. Hospitalisation often involves a significant psychological burden as well as monetary and other costs that should be analysed and justified. Patients travelling after radioiodine therapy rarely present a hazard to other passengers if travel times are limited to a few hours. Environmental or other radiation-detection devices are able to detect patients who have had radioiodine therapy for several weeks after treatment. Personnel operating such detectors should be specifically trained to identify and deal with nuclear medicine patients. Records of the specifics of therapy with unsealed radionuclides should be maintained at the hospital and given to the patient along with written precautionary instructions. In the case of death of a patient who has had radiotherapy with unsealed radionuclides in the last few months, special precautions may be required.     

中国核工业30年过量受照人员临床案例选编(英文)

选编了三十多年来,核工业生产中部分过量受照人员的剂量估算、实验室检查、诊断、治疗及医学随访观察的临床案例。介绍了核工业系统中在防治内照射辐射损伤、皮肤放射损伤及小剂量外照射辐射效应等方面的临床实践经验。     

Protecting people against radiation exposure in the event of a radiological attack. A report of The International Commission on Radiological Protection

This report responds to a widely perceived need for professional advice on radiological protection measures to be undertaken in the event of a radiological attack. The report, which is mainly concerned with possible attacks involving 'radioactive dispersion devices', re-affirms the applicability of existing ICRP recommendations to such situations, should they ever occur. Many aspects of the emergency scenarios expected to arise in the event of a radiological attack may be similar to those that experience has shown can arise from radiological accidents, but there may also be important differences. For instance, a radiological attack would probably be targeted at a public area, possibly in an urban environment, where the presence of radiation is not anticipated and the dispersion conditions commonly assumed for a nuclear or radiological emergency, such as at a nuclear installation, may not be applicable. First responders to a radiological attack and other rescuers need to be adequately trained and to have the proper equipment for identifying radiation and radioactive contamination, and specialists in radiological protection must be available to provide advice. It may be prudent to assume that radiological, chemical, and/or biological agents are involved in an attack until it is proven otherwise. This calls for an 'all-hazard' approach to the response. In the aftermath of an attack, the main aim of radiological protection must be to prevent the occurrence of acute health effects attributable to radiation exposure (termed 'deterministic' effects) and to restrict the likelihood of late health effects (termed 'stochastic' effects) such as cancers and some hereditable diseases. A supplementary aim is to minimise environmental contamination from radioactive residues and the subsequent general disruption of daily life. The report notes that action taken to avert exposures is a much more effective protective measure than protective measure the provision of medical treatment after exposure has occurred. Responders involved in recovery, remediation and eventual restoration should be subject to the usual international standards for occupational radiological protection, which are based on ICRP recommendations, including the relevant requirements for occupational dose limitation established in such standards. These restrictions may be relaxed for informed volunteers undertaking urgent rescue operations, and they are not applicable for voluntary life-saving actions. However, specific protection measures are recommended for female workers who may be pregnant or nursing an infant. The immediate countermeasures to protect the public in the rescue phase are primarily caring for people with traumatic injuries and controlling access. Subsequent actions include respiratory protection, personal decontamination, sheltering, iodine prophylaxis (if radio-iodines are involved), and temporary evacuation. In the recovery phase, the relocation and resettlement of people may be needed in extreme cases. This phase may require remedial action, including cleanup, management of the resulting radioactive waste, management of any human remains containing significant amounts of radioactive substances, and dealing with remaining radioactive residues. The guidance given in relation to public protection is based solely on radiological protection considerations and should be seen as a decision-aiding tool to prepare for the aftermath of a radiological attack. It is expected to serve as input to a final decision-making process that may include other societal concerns, consideration of lessons learned in the past (especially these involving the public perception of the risks posed by radioactive contamination) and the participation of interested parties. A radiological attack could also be the cause of radioactive contamination of water, food, and other widely consumed commodities. This possible outcome is considered unlikely to lead to significant internal contamination of a large number of people owing to the large amounts of radioactive material that would be required to cause high levels of contamination of water, food, and other commodities. Nonetheless, the report recommends radiological criteria for restricting the use of commodities under such circumstances. The report concludes by re-iterating that the response to radiological attacks should be planned beforehand following the customary processes for optimisation of radiological protection recommended by ICRP, and that optimised measures should be prepared in advance. Such plans should result in a systematic approach that can be modified if necessary to take into account the prevailing conditions and to invoke actions as warranted by the circumstances. Many potential scenarios clearly cannot induce immediate severe radiation injuries. Therefore, in order to prevent over-reaction, response measures prepared in advance should reflect the real expected gravity of the various possible scenarios.     

Recent advances in medical radionuclide production and future perspective of compact medical cyclotrons

In recent years, many radiopharmaceuticals bearing different kind of radionuclides have been largely used in diagnostic and therapeutic studies, especially of cancer. The basic principle of radiodiagnosis and raditherapy is ensuring as low as radiation dose absorption by patients. Sometimes, the radionuclides having very short half-lives, and very interesting decay characteristics are required for this purpose. The use of short-lived radionuclides necessitates their productions just at the application sites. This necessity has provoked the development of compact particle accelerators. Nowadays, the radionuclide applications in diagnostic and therapeutic nuclear medicine are continuously escalation, and future perspective of these applications will strongly be depended on two important factors as being 1) increasing the variety of cyclotron-produced radionuclides, 2) design of new radiopharmaceuticals having different and specific metabolic pathways in normal and cancer tissues. For improvement of the first factor, new nuclear reactions should eventually be examined using new target materials. In this context, the targeting chemistry will be an essential role in this field. As the second factor, improvement of new radiopharmaceuticals will strongly be dependent on the biofunctional researches of new chemical agents and development of their radiolabeling techniques. The radionuclide production has evidently become more and more easy by using the compact medical cyclotrons. For this reason, the application of different radionuclides will be able to have an important role in the future either for scientific and technical applications or medical diagnostic and therapeutic studies. As a consequence of this progress, the basic nuclear scientists, especially nuclear and radiopharmaceutical chemists will be seeking professionals in the next new century.     

辐射损伤防治药物发展历史与展望

辐射损伤防治药物主要包括含硫化合物、激素类、植物药和细胞因子类,以及基于辐射损伤机制研究的新型药物等,主要用于预防和治疗受到外照射的人员,以减轻放射反应和正常组织的辐射损伤。本文分类介绍了辐射损伤防治药物的研究进展,分析了存在的主要问题,并提出新型的辐射损伤防治药物主要是基于辐射损伤的机制而发现的,不同作用途径的药物组合进行辐射损伤防治是未来发展的主要趋势。     

关于水源中放射性核素浓度标准问题

本文讨论了内照射剂量限制标准的发展。指出将水中放射性核素浓度作为内照射剂量限制标准的局限性。但是,对于环境管理,把它作为环境污染水平的管理限值还是有意义的。本文还讨论了推导管理限值的方法,认为考虑到关键途径和关键居民组的浓度因子法是一种合适的方法。     

建设和完善全国辐射环境监测网络初探

本文从分析我国环保系统辐射环境监测的现状和存在的主要问题出发 ,建议在现有基础上建设和完善一个既覆盖全国各省 ,又层次分明、突出重点、相互合作 ,并常规和应急监测积极兼容的全国辐射监测网络。该监测网络将能对污染源排放的重要污染核素和对公众健康影响最大的核素进行监测。系统由三部分组成 :( 1 )二个中心 ,国家环保总局辐射环境监测技术中心 ,国家环保总局核与辐射事故应急技术中心 ;( 2 )若干个重点监测站 ;( 3 )若干个基础监测站。     

Monitoring the radiation conditions in reactors by semiconductor spectrometry methods

Conclusions 1. Semiconductor spectrometry of the radiation facilitates the analysis of the radiation conditions in nuclear reactors for power generation and research:identification of the radiation sources (radionuclides, nuclear reactions); andquantitative determination of the intensity of the radiation from the identified radionuclides and from nuclear reactions in units of H.2. The information makes it possible to determine the origin of the radioactive contamination by man-made radionuclides on industrial sites and the degree of radionuclide migration and allows a comparison of the radiation conditions on inspected objects.3. The total H values of the monoenergetic radiation do not exceed 25% of the maximum admissible amounts in the reactor halls inspected [4].Translated from Atomnaya Energiya, Vol. 68, No. 5, pp. 385–386, May, 1990.