Radiologists should lead triage and training for nuclear terrorism

Because of their in-depth knowledge of the effects of radiation on the human body, radiologists have an important role in the response to a radiological mass casualty event. The profession has a responsibility to lead in triage, preparation and education, according to Donald Frush, MD, professor at Duke Radiology in Durham, North Carolina.

Frush is moderating a RSNA 2016 session on this very topic on Monday, Nov. 28, called, “Radiology and Nuclear Terrorism: Like It or Not, Radiology Professionals Will Be in the Hot Seat.”

Every hospital or health system has a mass casualty protocol, Frush explained, but it’s often a single umbrella plan that doesn’t distinguish between different types of events. Responding to a nuclear disaster is much different than responding to a toxic spill or an anthrax-type event, and radiologists must educate clinical staff on proper procedure.

“One of the principles of emergency management is the role of the response team, and with any event that involves loss of life or limb to the patient, you have to attend to those things first,” Frush said. “You may or may not know that they are irradiated, but you can’t have technologists saying ‘this patient’s radioactive, I’m not going near them.’”

However, the radiology department must keep track of patients who may be irradiated; Frush recommends departments appoint a radiation monitor.

“Are [patients] appropriately decontaminated and tagged? Or did they get through the system in their street clothes?” Frush said. “Who’s responsible for radiation detection? This has to be worked out ahead of time, so people aren’t running around blind.”

It’s also important to understand the difference between a nuclear bomb and a dirty bomb, Frush added. A nuclear bomb involves splitting atoms and a huge release of energy, while a dirty bomb is a conventional explosive that scatters radioactive material over an area. Communicating how the type of device changes obligations and duties of the response team is an important tenant of weathering a radiological event.

Even with this extra responsibility, radiologists are still expected to carry out diagnostic and interventional imaging, albeit with a few wrinkles. If radioactive shrapnel is removed from a patient, it must be disposed of carefully—simply dropping it in the bucket is not an option.

Radiologists should also serve as go-to spokespersons and experts. Radiologists and oncologists have had the most extensive radiobiology training and are the most qualified to answer questions from the media, the public and even their own hospital administration. It’s a natural fit for the specialty even if they aren’t experts on dirty bombs, according to Frush.

“If they don’t have the knowledge front and center, they will know where to get that info or who to call,” he said. “The expectation is that radiologists have the resources to be informed—saying ‘I don’t know’ is not what the public or patients want to hear when dealing with a radiological event.”

Designing response plans and participating in mock events are two ways for radiologists to ensure their department is ready for anything, including the unthinkable.

“The radiology community needs to understand the triage process, how patients are decontaminated, how to measure nuclear material, knowing the difference between nuclear material that emits radiation versus dispersion devices,” Frush said.

Another speaker Monday will be Nicholas Dainiak, MD, director of the Radiation Emergency Assistance Center/Training Site at the Oak Ridge Institute for Science and Education.