Medical and health physics management of a plutonium wound

A puncture wound contaminated with plutonium and americium has provided an excellent case study for dealing with internal contamination. This case provides an opportunity to examine the effectiveness of diagnostic techniques, therapeutic techniques, dose assessment practices, and case management philosophy. The wound deposited 48kBq of transuranic alpha activity in the right index finger. Minor surgery reduced the long-term wound burden to about 5.4 kBq. Chelation therapy with DTPA lasted 17 months and resulted in urinary excretion of about 7 kBq of the initially deposited activity. Therapy appears to have been effective in limiting early uptake and internal doses from this wound. However, the possibility of slow future uptake from the wound exists. Thus, estimating long-term uptake and dose is difficult. In vivo measurements indicate that changes in residual wound contamination, if occurring, are quite small. However, there is indication of gradually increasing skeleton and axillary lymph nodes burdens. Also, within three weeks of the injury, an initially measurable liver burden was reduced by chelation therapy to below detectable limits, and no subsequent build-up has been observed. (author)