Radiologists Prepare for Radiation Terrorism

It is a worst-case scenario played out in movies, on television and in popular novels: An unfriendly nation or terrorist sect obtains radioactive material and attempts to use the chemicals or substances in a so-called "dirty" bomb planned to detonate somewhere in the U.S. While the situation has been explored sensationally in fiction, a group of scientific experts is striving to prepare the medical community for a more sobering reality.

Michael Robbins, Ph.D., led a team of scientific experts in developing a radiation biology primer for radiologists. The Sept. 11, 2001, attacks and recent incidents involving radioactive materials have created a sense of urgency among healthcare providers to increase their knowledge about radiation terrorism, Dr. Robbins said. Image courtesy of Wake Forest University.

The team is led by Michael E. Robbins, Ph.D., who received a Radiology Education Research Development Grant from the RSNA Research & Education (R&E) Foundation to develop a course called "Training the Trainers: How to Answer Radiation Biology Questions, Before, During and Following a Radiation Terrorism Event." The grant was also sponsored by the Association of University Radiologists, Association of Program Directors in Radiology and Society of Chairs of Academic Radiology Departments.

The course brings together a series of lectures featuring the work of world-renowned radiation biologists, physicists and oncologists. Radiation biology leaders divided material into eight sections, then provided narration for the resulting presentations.

The program aims to provide a primer in radiation biology for those employed in radiology, with the idea that those personnel could then more successfully serve as subject-matter experts if such a need arose.

Sept. 11 Increased Training Urgency

Until several years ago, this type of training was not a top national medical priority, but the political climate changed following the Sept. 11, 2001, attacks, said Dr. Robbins, a professor in the Department of Radiation Oncology at Wake Forest University Health Sciences in Winston-Salem, N.C. The creation of the Department of Homeland Security, and its funding of projects to deal with mass casualty events, created a sense of urgency among healthcare providers to bring themselves up to speed in the area of radiation biology, he said.

Dr. Robbins noted that even before the Sept. 11 attacks, however, there were incidents in which threats involving radioactive materials became headline news. "The fact is, it's very simple to cause a lot of problems to a country with relatively little effort," he said. "If someone gets hold of a radioactive device, they can leave it anywhere."

For example, in 1998, about 30 miles from Dr. Robbins' research center at Wake Forest, 19 small tubes of cesium were removed from a locked safe at a hospital in Greensboro, N.C. Local, state and federal police scoured the area using radiation-sensing equipment. Authorities said they believe the thief was trained to handle radioactive materials, because unprotected contact would cause serious injury or death. The cesium was never recovered.

Incidents like the cesium theft, in conjunction with lingering fears from Sept. 11, make the "Training the Trainers" project more relevant than ever, said Dr. Robbins. "It's pretty clear we now have individuals out there willing to use various resources and a more modern approach to deliver either weapons of mass destruction or weapons that will cause mass panic and mass disruption," he said.

Public Perception of Radiation Misguided

All radiologists—from those working at Level 1 trauma centers to those employed at 100-bed hospitals in rural areas—must re-educate themselves in radiation biology, said Douglas Coldwell, M.D., Ph.D., a biotech and counterterrorism consultant who presented an RSNA 2008 Associated Sciences session, "Radiology's Role: When Disaster Strikes!"

By creating a more educated radiology community, said Dr. Robbins, the larger communities served by those radiologists will benefit. "The public's perception of radiation is negative," he said. "They believe radiation kills people, radiation makes people very sick, radiation is a slow death sentence." Having fast, accurate information disseminated immediately in times of a crisis is key to avoiding a larger catastrophe, he said.

"If there was an incident we'd have to worry about potentially hundreds of thousands of scared people, who might not be in direct danger but are trying to evacuate as soon as possible," said Dr. Robbins. "They could overwhelm our ability to cope rationally with the situation."

One of the primary goals of developing the "Training the Trainers" program was to attract the leaders in the field of radiation biology to share their knowledge and develop course materials. Members of RSNA's R&E Foundation Grant Program committee praised the detail and commitment to the material each team member provided, while leaders in the radiation biology field praised Dr. Robbins' ability to bring the prestigious group and their expertise under one umbrella.

Dr. Robbins pulled together the "crème de la crème," said Douglas Coldwell, M.D., Ph.D., presenter of an RSNA 2008 Associated Sciences session, "Radiology's Role: When Disaster Strikes!"

"They're believable," said Dr. Coldwell of the contributors to Dr. Robbins' project. "These people really know the subject backwards and forwards. This panel is made up of the top dogs in radiation biology and physics in the world. I'm very impressed."

Dr. Coldwell, formerly a professor of radiology with The University of Texas and now working as a biotech and counterterrorism consultant, added that he was thrilled to see the way the course developed. It's vital for all members of the radiology community to re-educate themselves on some of the basic biology they haven't reviewed since taking the radiology board exams, he said. "It doesn't make any difference if you're working at a Level 1 trauma center or at a 100-bed hospital in the middle of the boondocks," he said. "You could be faced with this problem. Everybody needs to look at this."

Training Could be Offered as CME

Dr. Coldwell said he supports developing coursework similar to the "Training the Trainers" program that would provide CME credits for physicians. "We should consider using this as a basis for some CME," he said. "That would get radiologists involved with it even more.

"There's no question we learn from each mass casualty event," Dr. Coldwell continued. "As an institution though, we forget it. We're still combating the last disaster. Hopefully training like this will turn things around. All radiologists need to have a basic knowledge of radiation biology; it's part of their diagnostic radiology board exams. There are a tremendous number of possibilities."

Dr. Robbins agreed, saying there is a sense of urgency about getting the information out into the medical community. "From an educational perspective, there's an ever-decreasing pool of individuals who have the expertise and knowledge to explain the consequences of radiation exposure," he said. "We have essentially lost a generation of people like myself. The radiation oncology community, the radiology community and the medical community are in dire need of educational resources that will give people up-to-date information."