Abstract
Background: In the case of a nuclear or radiological incident, there is a risk of external and
internal contamination with radionuclides in addition to external irradiation. There
is no consensus whether decorporation treatment should be initiated right away on
spec or pending the results of internal dosimetry to determine the indication.
Method: Based on biokinetic models for plutonium-239, americium-241 and cesium-137, the efficacy
of a decorporation treatment using DTPA or Prussian blue was simulated depending on
the initiation time and the duration of treatment for different invasion pathways
and physicochemical properties of the inhaled compounds.
Results: For the same level of radioactivity incorporated, the committed effective dose increases
with the speed of the invasion process. The impact of the initiation time of a decorporation
treatment is particularly important when the absorption of the radionuclide is fast.
Even if started early after incorporation, the therapeutic efficacy is less for americium-241
or cesium-137 compared to plutonium-239. Therapeutic efficacy increases with treatment
duration up to about 90 days for plutonium-239 and cesium-137, whereas a prolongation
of the treatment over this limit may further enhance efficacy in the case of americium-241.
Conclusion: In the case of a nuclear incident, several fractions with different but a priori
unknown physicochemical properties may be inhaled. Thus, decorporation therapy should
be started as soon as possible after the incorporation of the radionuclide(s), as
a loss of efficacy caused by a delay of treatment initiation possibly cannot be compensated
later on. Treatment should be pursued for several months.
Key words
dirty bomb - radionuclide incorporation - decorporation treatment - treatment initiation
time - duration of treatment
