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Abstract: Following a radiological accident on 11 March 2006 in an industrial irradiation facility involving one victim, a physical dosimetry was reconstructed using on site measurements and numerical simulations in order to estimate as accurately as possible and as quickly as possible the dose received and its distribution throughout the organism so that doctors may fine tune their diagnosis and prescribe the most suitable treatment. The data compiled from the experimental reconstruction resulted in a first estimation of the distribution of the dose in the victim''s organism. The numerical simulations indicated a dose gradient corresponding to a factor of 2 in anteroposterior and between the pelvis and the skull. [Copyright &y& Elsevier]

A European consensus concerning the medical management of mass radiation exposure was obtained in 2005 during a conference held by the European Group for Blood and Bone Marrow Transplantation, the Institute of Radioprotection and Nuclear Safety, and the University of Ulm. At the conference, a two-step triage strategy to deal with large masses of radiation-exposed patients was designed. The first step of this strategy concerns the first 48 h and involves scoring the patients exclusively on the basis of their clinical symptoms and biological data. This allows the non-irradiated bystanders and outpatient candidates to be identified. The remaining patients are hospitalized and diagnosis is confirmed after the first 48-h period according to the METREPOL (Medical Treatment Protocols for radiation accident victims) scale. This grades the patients according to the severity of their symptoms. It was also agreed that in the case of acute radiation syndrome (ARS), emergency hematopoietic stem cell (HSC) transplantation is not necessary. Instead, cytokines that promote hematological reconstruction should be administered as early as possible for 14-21 d. Crucial tests for determining whether the patient has residual hematopoiesis are physical dose reconstructions combined with daily blood count analyses. It was agreed that HSC transplantation should only be considered if severe aplasia persists after cytokine treatment. Two recent cases of accidental radiation exposure that were managed successfully by following the European consensus with modification are reviewed here. Thus, a European standard for the evaluation and treatment of ARS victims is now available. This standard may be suitable for application around the world.