Lessons from the Goiania Radiation Accident

Nelson Valverde MD
JLVF Consultants for Hospital & Health Management, Rio de Janeiro, Brazil
Consultant for the Eletronuclear Medical Assistance
Foundation - FEAM, Angra dos Reis, Rio de Janeiro, Brazil

Abstract

On 13 September 1987, in Goiânia, the capital of State of Goiás in central Brazil, two scavengers removed the head of a radiotherapy device containing a 50.8 TBq 137Cs source, left in an abandoned clinic. As the result of the violation of the source integrity and being sold to a junkyard, many persons were externally irradiated, incurred external and internal contamination, and suffered associated radiological injuries and illnesses. Sixteen days elapsed from the source violation to the recognition of the accident's nature. A pivotal cause was that local physicians were not able to identify the clinical manifestations of the victims as radiation-induced. Twenty persons were hospitalized in Goiânia and Rio de Janeiro and four died of the Acute Radiation Syndrome (ARS). The Goiânia accident was the first opportunity for large-scale use of Prussian Blue for radiocesium decorporation and for the use of a bone-marrow growth factor, granulocyte macrophage – colony stimulating factor (GM-CSF), in patients with ARS. This experience opened way for the indication of this drug, on a much more rational basis, in other radiation accidents. The city clean-up resulted in 3,500 m3 of waste initially accommodated in a temporary disposal site and later on a permanent definitive site. Until today, victims of the accident are followed-up in Goiânia for long-term effects of radiation exposure, but so far no association has been established between exposures at the time of the accident and present medical conditions of the cohort. The Goiânia accident continues to be of relevance because of its magnitude, impacts and lessons. It also serves as a model for possible consequences of a malevolent act with radioactive materials.