The influence of extracorporeal clearance techniques on elimination of radiocesium after internal contamination.

Radiocesium, an isotope released after nuclear accidents such as Chernobyl, causes damage to the health of humans after internal contamination. As a result of an internal deposit of radiocesium these persons are continuously irradiated and noxious effects may occur. Removal of this internal radiation source will reduce immediate (short-term) and future damage (long-term). In order to obtain data with respect to cesium kinetics in vivo, data obtained in dogs by Nold et al. were fitted by a computer program. On the basis of these data, simulations were carried out to evaluate the influences of extracorporeal clearance on cesium kinetics. The influence of various treatments on the committed effective dose [E(50)] as a measure of radiation harm was simulated. For this purpose an equivalence between the committed effective dose and the area under the curve, a kinetic parameter, was derived. This equivalence only holds when comparisons are made for different treatments of one subject contaminated with one isotope. Treatment with orally administered Prussian Blue salts reduces the committed effective dose by 29% (50 y). This can be insufficient to prevent deterministic effects as a result of a severe internal contamination with radiocesium. For this purpose other methods are evaluated. In simulations, extracorporeal clearance (e.g. hemoperfusion or hemodialysis) proved to be more effective in reducing E(50) (> 50%, 50 y). Extracorporeal clearance also seems to be effective in the early dose reduction and its consequent deterministic effects. Simulations revealed that effectiveness is improved when the treatment is started earlier and continued for a longer period. Effective extracorporeal clearance may be considered to be a promising method to treat victims of nuclear accidents internally contaminated with radiocesium.