Far more chilling than anything novelist Stephen King could conceive is the latest publication from the American College of Radiology (ACR): Disaster Preparedness for Radiology Professionals, Response to Radiological Terrorism. Published just prior to the headlines about the arrest of a US citizen and a fuzzy plot to detonate a bomb spiked with radioactive materials on US soil, the matter-of-fact, 38-page guide is intended? to provide a quick reference in the event of a radiation disaster. As stated in the preface: “A radiation disaster is a possibility for which we must be prepared. Radiologists, radiation oncologists, and medical physicists will play a vital role as responders and as sources of accurate information for patients, the public, and the medical community.”
In stepping up to publish this primer, the ACR has taken a proactive stance in preparing health care for a radiation disaster, and the College, along with the committee that produced this document, led by Arl Van Moore, MD, should be applauded for assuming responsibility on behalf of its specialty to collect the resources necessary for organizing and managing a response to this potential threat. Moore acknowledged Harvey L. Neiman, MD, who was just named the first physician executive director of the College, for his leadership in convening the task force. As custodians of diagnostic and therapeutic radiation, radiologists, radiation oncologists, and radiological physicists are the default experts on radiation exposureor will be perceived as such. This book should top the summer reading list for every radiologist, oncologist, radiology administrator, and radiological physicist in the country.
This primer is not meant to sit on a shelf.? It begins with a checklist of 10 basics of response, preceded with the caveat that only advance planning will ensure an appropriate response. It is divided into12 chapters under the heading Radiation Incidents, and also includes a section on radiological findings associated with biological and chemical terrorist agents. Many tables, several appendices, and additional resources are included. As the ACR notes on its Disaster Preparedness web page, the primer is a “living document” that will be updated as new information becomes available. It can be downloaded at www.acr.org, and is not yet available in print form.
What is also implied by this primer and recent events is the need to limit access to those areas in the hospital where radiation sources used in medical diagnosis and therapy can be found. Though it is unlikely that a bomb laced with the radioisotopes available in the average hospital would result in significant radiation-related mortality or morbidity, the fact that the manufacture of such a threat could be on the agenda of a criminal who converted to Islam in prison underscores the need for preparedness. According to an article in the Wall Street Journal,1 the threat of what the primer refers to as a radiation dispersal device (RDD) was not taken seriously in the past by nuclear and defense experts because the act of making and carrying them would eventually kill the perpetrators by exposing them to a suicidal dose of radiation. “One of the things that’s changed since September 11 is the thought that death for the terrorist is part of the plan,” Matthew Bunn, a nuclear expert and assistant director of the Science, Technology and Public Policy Program at Harvard University’s John F. Kennedy School of Government, told the Journal.
In the event of a terrorist attack on US soil involving ionizing radiation or even an RDD, radiology departments will be called on to treat both the victims of the fallout and the terror itself: that is, fear of radiation exposure. The information and resources to develop a clear plan to treat victims and limit exposure and panic are available in this publication.