Conferences and Lectures

Special Feature: JMA Symposium on Health Policy “Disaster Medicine and Medical Associations”

Fukushima Daiichi Nuclear Accident and

Radiation Exposure
JMAJ 55(5): 393–399, 2012

Makoto AKASHI*1

Key words Radiation, Accident, Fukushima, Contamination, Medical response

I would like to talk about the topic that phy­ could feel a prick of pain when a radiological
sicians should have correct knowledge about technologist says, “Take a breath and hold it”
radiation at the accident of the Fukushima Dai­ for the chest X-rays examination at the hospital.
ichi Nuclear Power Plant (NPP) and the effect of But, since there is no pain, we don’t know when
radiation on health. we are being exposed.
Another thing we often hear is that it takes a
Introduction time until symptoms/signs appear. One example
is carcinogenesis. It could take, at least 2 years
We consider that the Great East Japan Earthquake or longer after radiation exposure depending on
was a combined disaster involving earthquake type of cancer. With the overlap of these kinds
and tsunami as well as the release of radioactive of problems, it is no wonder that even medical
materials into the environment (Fig. 1). staff members become quite uneasy about radia­
Something I would like you to notice here is tion and its exposure.
that among various disasters, a radiation nuclear
disaster cannot be seen; it cannot be felt; in Unlike Viruses or Chemicals,
fact it cannot be detected without special devices. Techniques Such as Sterilization and
Because of that, the fact that you cannot under­ Neutralization Do Not Change
stand what is happening even on the disaster site Radioactive Materials
is a peculiarity of this kind of disaster. This is
an important point. There are so many technical terms regarding
radiation such as Becquerel (Bq), Sievert (Sv),
Unlike Clinical Medicine Based on Gray (Gy), effective dose, and others, that even
Experiences, Those With Accidental health personnel get tired of it. However, com­
Radiation Exposure Do Not Accumulate, pared to viruses/bacterias and chemicals, the
Since It Rarely Occurs measurement techniques for radiation have been
extremely developed. For instance, the rapid de-
Why is there a need for special knowledge about tection kits for influenza antigen sometimes give
radiation exposure? Clinical medicine is a field false positive or negative results. For radiation,
based on experience. But, radiation exposure on the other hand, the detection capabilities are
accidents extremely rarely occur, and we don’t quite high and most of g-rays can be measured
know if we are being exposed. For example, we in real time.
might feel that radiation is being emitted if we Nonetheless, it is not all good. Even if you

*1 Executive Director, National Institute of Radiological Sciences, Chiba, Japan ([email protected]).

This article is based on the presentation made at JMA Symposium on Health Policy “Disaster Medicine and Medical Associations” held on
March 11, 2012.

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Akashi M

Earthquake
High tide Tsunami

Flood Volcano eruption

Heavy snowfall Other natural

Disasters phenomenon
Heavy rain Fire or wildfire
Storm Explosion
Release of radioactive Others
materials (train, plane)
Ship
accident

Fig.  1 Disasters covered by the basic act on disaster

control measures

Fig.  2  Levels of radiation from nature in Japan

irradiation treatment as the only effective means

of preventing the adverse effects in patients given
a transfusion, which can happen because of the
strong action of lymphocytes in the transfusion
blood. Furthermore, a radionuclide americium
(Am) is still probably used in smoke detectors.
Thus, there are many radiation sources in daily
life. However, I think that it would be a big prob­
lem, if and when an accident occurs, for physi­
Fig.  3  Ambient radiation dose rate from nature cians to not understand radiation effects.

Differing Levels of Radiation From

try to neutralize cesium 134 and 137, which are the Natural World in Different Parts
radioactive materials that flew from Fukushima, of Japan
even if you disinfect and sterilize, even if you
could make antibodies, not matter what you do Figure 2 shows that we are being bathed in
we cannot change a radioactive material. That, radiation from nature. This figure presents the
I think, is another major difference. exposed dose of people from nature per year in
Another point is the fact that radiation/ areas of Japan.
nuclear accidents have an extremely big social I think that physicians should know that
effect. Tokyo, Chiba, and Kanagawa are places with low
levels of natural radiation but, depending on
Physicians Should Have Correct the area; when you go to Gifu or Ehime, western
Knowledge About Radiation Japan, the levels of radiation are higher than
in Chiba or Tokyo.
The reason why physicians should have correct Shown in Fig. 3 is the ambient dose rate of
knowledge about radiation is because radiation gamma-radiation from the nature. In Tokyo, for
is actually used in wide variety of fields. For example, if you stay outside for an hour, you
example, all tires for automobile are exposed will be exposed to about 0.03 mSv of radiation on
to radiation to increase their heat resistance, average. But, if you go to Gifu it would be two
water resistance, impact resistance, and hardness. to three times of that. And on the summit of Mt.
Additionally, blood for transfusions undergoes Fuji, the dose rate will be five times of that in

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 FUKUSHIMA  DAIICHI  NUCLEAR  ACCIDENT  AND  RADIATION  EXPOSURE

Fig.  4  Daily ambient dose rates in Fukushima

Tokyo. This higher dose rate of radiation is caused which is almost 60 km away from the NPP
by that from outer space. whereas Tokyo is about 230 km away, was higher
Something I would definitely like you to than usual around March 15. I think that how to
know is the dose rate of radiation exposure on explain the present dose rate in Tokyo to resi­
an airplane—from Tokyo to San Francisco; of dents is important.
course it would be almost the same from Tokyo
to Europe. Since the exposure rate is about 7 mSv Radiation Cannot Be Correctly Feared
per hour, if you fly round-trip for 20 hours
between Tokyo and San Francisco, that would be There were many misunderstandings about
140 mSv of exposure. If you did that 10 times it this accident. Residents and patients even in
would be more than 1 mSv of exposure. Remem­ Hokkaido and Osaka were very anxious on
ber, this is radiation from nature. It is even higher March 15 notwithstanding the fact that there
inside the International Space Station—24 mSv/h was hardly any effect on the dose rates of radia­
—and 67 mSv/h of radiation outside the Interna­ tion in those areas.
tional Space Station. This is the level of radiation That is, the present situation is such that peo­
in nature. ple cannot correctly fear radiation to such an
extent that they develop the idea that they do not
Can You Correctly Explain the Ambient want to take medical tests involving radiation
Dose Rate to Residents and Patients? exposure, such as chest X-rays and CT scans at
hospital.
Figure 4 shows the dose rates in Fukushima Pre­ Looking at the flow of the radiation plume
fecture after the accident. When, for example, (the condition of gaseous radioactive material
these data were released, it was reported on the flowing together with air like a cloud) for March
news that residents of Fukushima Prefecture 15 released by the Ministry of Education, Cul­
were exposed to a higher level of radiation than ture, Sports, Science and Technology (MEXT) of
usual. However, if physicians do not know the Japan, we see that it flowed in two directions
health effects of radiation that residents received, from the Fukushima Daiichi NPP. One flowed to
it becomes a big problem because they cannot the northern Kanto region and the other went
give a correct explanation to them. out to the ocean and flowed in through Chiba
Further, the dose rate in Fukushima City, and Ibaraki Prefectures.

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Akashi M

Table  1  Case I logical Emergency of the International Atomic

Energy Agency, a dose rate of 1 mSv/h at a dis­
x A man was injured and contaminated at the hydrogen
explosion on March 14 2011 tance of 10 cm is a standard for decontamination
in the case of surface contamination of the body
x He was decontaminated at a local hospital and then
transferred to NIRS by a Japan Self-Defense Forces for the general public (IAEA 2006). We calcu­
(JSDF) helicopter lated the dose rate at a distance of 10 cm from a
x The level of surface contamination was under 100 kcpm, surface contaminated area with 100,000 cpm of
whereas almost whole body was contaminated
131
I, assuming that the surface of the head/face is
x The wound showed 2,500 cpm on the right thigh approximately 2,300 cm2 and is uniformly con­
taminated. The contamination with 100,000 cpm
x Contamination of the abdominal part was the most
prominent (31 kcpm) was almost 1 mSv/h at 10 cm. Thus, a screening
level of 100,000 cpm could be applied for decon­
x I-131, Te-132, and I-132 were detected from the right
nasal swab tamination of the surface of the human body.

Patients Accepted at the National

Institute of Radiological Sciences
Contamination and Decontamination of
Fukushima Residents The National Institute of Radiological Sciences
(NIRS) accepted 4 workers who had been in­
A major problem we faced in Fukushima was the volved in emergency tasks at the Fukushima NPP.
decontamination of residents. Before the acci­ In Table 1, I would like to introduce a worker
dent, Fukushima Prefecture had their cut-off accepted by the NIRS. This patient was injured
criterion for screening of the public of 40 Bq/cm2 by the hydrogen explosion and transported to
for beta/gamma contamination. The level of this the NIRS. There was contamination over the
contamination corresponds to 10,000 to 130,000 entire body, as high as about 31,000 cpm. Most
counts per minute (cpm) when measured by a of the contamination was iodine-based.
Geiger-Müller survey meter as 131I, depending on If a patient is physically injured, the injury
the type of detector. On March 12, 2011, how­ must be treated first regardless contamination
ever, the levels of body surface contamination of or not. The NIRS has many staff members who
some evacuees in shelters exceeded the criterion. can measure radiation and experts who can man­
At a level higher than this, decontamination age radiation contamination; so these kinds of
would be performed; at a lower level, decontam­ patients can be accepted smoothly without any
ination would not be performed. When contami­ problems.
nation is found on residents, they should change On March 24, workers being involved in a
their clothing and/or remove the contamination cable work plunged their feet into contaminated
with wet towels as soon as possible. But tap water water and it was reported on the news that these
was shut down in most shelters so decontamina­ workers were diagnosed with possible b ray burns
tion was not possible. Only drinking water was on their skin before they were even transported
available. The outside temperature was low, and to the NIRS. However, since we knew that cases
heating was insufficient, so many residents could with b-ray burns are very few, we wondered
not stay in the shelters for long periods without whether b burns could occur in the Fukushima
warmer clothes and overcoats. Thus, the pre- accident. They certainly had a lot of contamina­
accident criteria had to be revised. Fukushima tion on their feet from contaminated water. How­
Prefecture changed the screening level required ever, we found a number of problems. One thing
for decontamination from 13,000 to 100,000 cpm, that became clear was that even though workers
with decontamination by wiping being performed were given personal dosimeters set to alarm
for over 13,000 cpm. when a certain dose was reached, they ignored
The concern regarding the revision of the or did not realize the alarming sound and contin­
screening level is whether or not this screening ued working, suggesting that they were working
level fits the intervention exemption from the under quite chaotic circumstances.
viewpoint of radiation protection. According to On the other hand, looking at the level of
the Manual for First Responders to a Radio­ contamination on their feet, there was contami­

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 FUKUSHIMA  DAIICHI  NUCLEAR  ACCIDENT  AND  RADIATION  EXPOSURE

nation exceeding 10 mSv per hour at 10 cm. How­

ever, if you have enough knowledge, you can
judge right away whether it is dangerous or not
for the medical staff. We accepted these patients,
but no physicians or nurses—no one—hesitated
to approach them. We had judged straight away
that there was no problem. In other words,
correct knowledge is extremely important.
Skin doses of these feet were about 500 mSv
in these workers. It is thought that erythema
appears with about 3,000 mSv. Compared to that,
there is no way erythema was going to appear.
However, we had a very unfortunate experience,
since this incident became worldwide news. Fig.  5 No radioactive material has been incorporated
We are cognizant that it would be unaccept­ into the body
able to not deal with these patients if they had
had serious injuries or a heart attack or hemor­
rhage. Thus, we think that it is essential for physi­ 2. Effects of radiation on genes
cians to have correct knowledge and to correctly 3. Interactions of radiation with cells
fear radiation. 4. Mechanisms for cell death from radiation
5. Radiation sensitivity in various tissues
Guidelines for Medical Education Core 6. Local and whole-body injuries
Curriculum 7. Effects of radiation on humans, including the
fetus (acute and late effects)
Lastly, I would like to talk about the core cur­ We physicians use radiation on a daily basis,
riculum in the education of medical students. and of course accidental exposure to radiation is
In March 2001, the Model Core Curriculum different from medical exposure. However, from
for Medical Education—Guideline for Medical the viewpoint of the radiation effects on the body,
Education was published by the MEXT of they are exactly the same. Accordingly, I think
Japan (MEXT 2011). The guideline presents it is an extremely important point for physicians
what should be taught in medical schools and to have correct knowledge about radiation and
is a reference for medical school curricula. At to use radiation correctly.
the time when students move from basic medical Additionally, the curriculum also includes the
courses into clinical education, they have to pass ability to explain injuries caused by radiation,
a standardized test based on the guideline that is and the ability to accurately describe side effects
conducted voluntarily in medical schools. Those of diagnosis and treatment as well as the ability
guidelines were revised on March 31, 2011, just to explain radiation protection for medical pro­
after the earthquake. The rationale for this revi­ fessions and patients. I think these are matters
sion was that physicians need that we physicians are expected to know.
x to know that humans are constantly being
exposed to natural radiation in nature; Whole Body Counter
x to understand the impact of the use of ionizing
radiation for medical purposes; and What should be performed when radioactive
x to understand that radioactive materials are material has been incorporated into the body?
ubiquitous, thus increasing chances for radia­ There is a machine that detects radioactive mate­
tion exposure. rial in the body—called a whole body counter
In this latest revision, the guidelines recom­ (WBC). However, basically it can detect only g
mended that the following be included in medical rays, suggesting that WBC is used for internal
school curricula: contamination with g-emitters. When there is no
1. Radiation, radioactivity, their characteristics, radioactive materials incorporated into the body
radiation measurement, and units of measure­ accidentally or medically, a spectrum for potas­
ment sium 40 (40K, naturally occurring radionuclide),

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Akashi M

Acute intake

in the body
Residue
Chronic intake
Measured
value

time
Measurement

Fig.  6 Radioactive material has been incorporated into Fig.  7  Mechanism for dose calculation from WBC
the body

Count (cpm)
Count (CPM)
Conversion • Radionuclides (energy)
factors • Detection efficiency
Current amount of
Radioactivity (Bq) radioactive materials
• When
Behavior • How long
survey • Route into the body
Amount of radioactive
Biokinetics model materials incorporated
into the body
Effective dose coefficient
Equivalent coefficient
Dose
Radiation dose (mSv) estimation

Fig.  8  From measurement to internal exposure dose

which everyone has, will show up as marked by has been incorporated is different. For example,
the arrow in Fig. 5. This means accumulation of the exposure dose is completely different in the
40
K in the body. case where a large amount of radioactive mate­
If the body has been internally contaminated rial entered the body all at once on March 12,
with cesium Cs, Cs accumulation in the body will 2011 and then gradually fell to the measured
show up as shown by the arrow in Fig. 6. value versus the case in which radioactive mate­
rial slowly entered the body from food and the
Whole Body Count Is Not Omnipotent environment contamination up to the same mea­
sured value. That is, if the radionuclide was
The problem is that what WBC can measure is inhaled only on March 12 and then the level was
how much radioactive material is accumulated decreased to the measured value, the amount
in the body when the measurement has been of radionuclide that would have gone through
taken; the separate calculation is required for the body would be the integrated value shown by
dose assessment as Sv. The dose will be changed the bold line (Fig. 7).
even if the amount of accumulated radionuclide On the other hand, if one eats and inhales
is the same but if how or when the radionuclide radioactive material every day, it would be the

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 FUKUSHIMA  DAIICHI  NUCLEAR  ACCIDENT  AND  RADIATION  EXPOSURE

integrated value shown by the dotted line. The edge as well. I think that a big role given to our
radioactive material that had entered the body medical professions is to be able, when consulted,
would only be the amount shown by the diagonal to carefully explain correct knowledge and scien­
lines. Thus, dose assessment of internal exposure tifically right dose assessment in clear and simple
depends on the scenario used. Therefore, the words.
radiation dose could be 10 times or even 20
times different depending on the scenario. Under- Conclusion
standing WBC correctly will lead to a scientifi­
cally right dose assessment. If you think that the What a WBC tells us is only the current amount
internal radiation dose will all be shown by mea­ of radioactive material in the body (Fig. 8). From
suring with WBC—like having someone step on these results, we calculate the internal exposure
a scale and showing his weight immediately— dose based on the assumption or scenario. If
it is wrong. A whole body counter is not that kind you can see that there are a number of steps and
of machine. assumptions to go through until the dose calcula­
I would like you to have this kind of knowl­ tion can be made, then I am very much pleased.

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