Managing Internal Radiation Contamination
- Isotopes of Interest: Properties, Treatment, and Fact Sheets
- Radiation Countermeasures for Treatment of Internal Radiation Contamination
Isotopes of Interest: Properties, Treatment, and Fact Sheets
Information in this table adapted from:
- Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008.
![Print as PDF](RemmMockup_files/printer.gif)
Isotope |
Ionizing radiation |
Major exposure pathways |
Focal accumulation |
Treatment: |
Fact sheets |
|||
---|---|---|---|---|---|---|---|---|
Americium |
α |
458 years |
Inhalation |
Lungs |
DTPA† * |
|||
Californium |
α, γ |
2.6 years |
Inhalation |
Bone |
DTPA* |
|||
Cesium |
β, γ |
30 years |
Inhalation |
Follows potassium; renal excretion |
||||
Cobalt |
β, γ |
5.26 years |
Inhalation |
Liver |
Succimer (DMSA)§ (DailyMed) |
|||
Curium |
α, γ, neutron |
18 years |
Inhalation |
Liver |
DTPA† * |
|||
Iodine |
β, γ |
8.1 days |
Inhalation |
Thyroid |
Potassium iodide† * |
|||
Iridium |
β, γ |
74 days |
N/A |
Spleen |
||||
Isotope |
Ionizing radiation |
Major exposure pathways |
Focal accumulation |
Treatment: |
Fact sheets |
|||
β |
14.3 days |
Inhalation |
Bone |
Hydration + Phosphate drugs |
||||
Plutonium |
α |
24,100 years |
Inhalation (limited absorption) |
Lung |
||||
Polonium |
α |
138.4 days |
Inhalation |
Spleen |
Gastric Lavage |
CDC |
||
Radium |
α, β, γ |
1,602 years |
Ingestion |
Bone |
Aluminum hydroxide* |
|||
Strontium |
β |
28 years |
Inhalation |
Bone |
Inhalation: |
|||
Isotope |
Ionizing radiation |
Major exposure pathways |
Focal accumulation |
Treatment: |
Fact sheets |
|||
Thorium |
α |
1.41 x 1010 years |
Inhalation |
Bone |
Consider DTPA* |
|||
Tritium |
β |
12.5 years |
Inhalation |
Whole body |
EPA |
|||
Uranium |
α |
7.1 x 108 years |
Inhalation |
Kidneys |
Sodium bicarbonate* |
|||
Yttrium |
β |
64 hours |
Inhalation |
Bone |
||||
![]() |
References for use
† FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA).
* NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).
§ NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).
See also:
- Summary of Radioactive Properties for Selected Radionuclides (PDF - 2.34 MB) (Human Health Fact Sheet, Argonne National Laboratories, 2005)
- Radiological and Chemical Fact Sheets to Support Health Risk Analyses for Contaminated Areas (PDF - 2.34 MB) (Argonne National Laboratories, 2007)
- The Regulation and Use of Radioisotopes in Today’s World (PDF - 1.1 MB) (NRC, April 2020)
- Radiological Sources of Potential Exposure and/or Contamination (PDF - 3.1 MB) (US Army Public Health Center, TG-238, January 2020)
- This document provides details about radioisotopes of potential concern and where they are used. It updates the TG-238 document from 1999.
- Nathwani AC, Down JF, Goldstone J, Yassin J, Dargan PI, Virchis A, Gent N, Lloyd D, Harrison JD. Polonium-210 poisoning: a first-hand account. Lancet. 2016 Sep 10;388(10049):1075-80. [PubMed Citation]
- Factsheets: Polonium-210 (IAEA)
- Understanding Radiation - Topics: Polonium 210 (Public Health England [PHE], formerly Health Protection Agency [HPA])
- Individual Monitoring Conducted by the Health Protection Agency in the London Polonium-210 Incident (Public Health England [PHE], formerly Health Protection Agency [HPA])
- Jefferson RD, Goans RE, Blain PG, Thomas SH. Diagnosis and treatment of polonium poisoning. Clin Toxicol (Phila.) 2009 May; 47(5):379-92. [PubMed Citation]
- Harrison J, Leggett R, Lloyd D, Phipps A, Scott B. Polonium-210 as a Poison. J Radiol Prot. 2007 Mar;27(1):17-40. [PubMed Citation]
- Scott BR. Health risk evaluations for ingestion exposure of humans to polonium-210. Dose Response. 2007 Apr 20;5(2):94-122. [PubMed Citation]
Radiation Countermeasures for Treatment of Internal Radiation Contamination
Medical countermeasure information in this table adapted from:
- Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008.
- Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166), National Council on Radiation Protection and Measurements, Bethesda, MD, 2011.
- FDA drug information related to radiation emergencies
Caveats about Radiation Countermeasures for Treatment of Internal Contamination
![Print as PDF](RemmMockup_files/printer.gif)
Medical countermeasure |
Administered for |
Mechanism of action |
Route of administration |
Dosage |
Duration of treatment |
References for use |
Aluminum carbonate |
Phosphorus (P-32) |
Phosphate binder |
PO |
600 mg tablet TID or 400mg/5 cc TID |
||
Aluminum hydroxide |
Radium (Ra-226) Strontium (Sr-90) |
Blocks intestinal absorption |
PO |
Adults: 60-100 mL (1200 mg) Children: 50 mg/kg, not to exceed the adult dose |
Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs |
|
Phosphorus (P-32) |
Phosphate binder |
PO |
600 mg tablet TID or 320 mg/5cc TID |
|||
Barium sulfate |
Radium (Ra-226) Strontium (Sr-90) |
Blocks intestinal absorption |
PO |
100-300 g (as a single dose in 250 cc water) |
Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs |
|
Radium (Ra-226) Strontium (Sr-90) |
Competes for bone binding sites |
PO |
Use as directed on label |
Begin therapy within 12 hr of radionuclide intake if possible |
||
Radium (Ra-226) Strontium (Sr-90) |
Competes for bone binding sites; phosphate binder |
IV |
5 ampoules (500 mg Ca/amp) in 500 cc 5% dextrose in water (D5W); infuse over 4-6 hours |
6 days; begin therapy within 12 hr of radionuclide intake if possible |
||
Radium (Ra-226) Strontium (Sr-90) |
Increases excretion |
PO |
1200 mg |
Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs |
||
Deferoxamine (DFOA) |
Plutonium (Pu-239) |
Chelating agent |
IM (preferred route) |
2 ampoules (500 mg DFOA/amp) |
|
DFOA is FDA-approved for Rx of acute and chronic iron poisoning only |
IV (slow infusion) |
2 ampoules (500 mg DFOA/amp) at 15 mg/kg/hr |
|||||
Medical countermeasure |
Administered for |
Mechanism of action |
Route of administration |
Dosage |
Duration of treatment |
References for use |
REMM DTPA page has more details FDA drug labels: Ca-DTPA, Hameln Pharmaceuticals: Ca-DTPA package insert, Zn-DTPA package insert |
Americium (Am-241) Curium (Cm-244) Plutonium (Pu-238 and Pu-239) |
Chelating agent |
IV (give once daily as a bolus or as a single infusion, i.e., do not fractionate the dose) |
Adults: 1 g in 5 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS) slow IV push over 3-4 minutes or 1 g in 100-250 cc D5W or NS as an infusion over 30 minutes Children < 12 years: 14 mg/kg/d slow IV push over 3-4 minutes (not to exceed 1 g/day) |
|
DTPA is FDA-approved for nebulized inhalation in adults only, and if the only route of contamination is through inhalation DTPA is NCRP-preferred as Rx of the other isotopes listed and NCRP-suggested as a wound irrigation fluid |
Nebulized inhalation (for use in adults only) |
1 g in 1:1 dilution with sterile water or NS over 15-20 minutes |
|||||
Wound irrigation fluid |
1 g Ca- or Zn-DTPA and 10 cc 2% lidocaine in 100 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS) |
|
||||
Dimercaprol (BAL) |
Polonium (Po-210) |
Chelating agent |
IM (300 mg/vial for deep IM injection only) |
2.5 mg/kg QID x2 days (days 1 & 2), then BID x1 day (day 3), then QD (days 4-10) |
10 days |
Dimercaprol (BAL) is FDA-approved for Rx of arsenic, gold and mercury poisoning and when used together with EDTA for Rx of acute lead poisoning only |
Medical countermeasure |
Administered for |
Mechanism of action |
Route of administration |
Dosage |
Duration of treatment |
References for use |
EDTA |
Cobalt (Co-60) |
Chelating agent |
IV |
1000 mg/m2/day in 500 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS); infuse over 8-12 hours |
Given as a single dose |
EDTA is FDA-approved for Rx of lead poisoning only |
IM |
Divide IV dose equally into two doses and administer 8-12 hours apart |
Given as a divided dose |
||||
D-Penicillamine (DailyMed) |
Polonium (Po-210) |
Chelating agent |
PO |
Adults: 0.75-1.5 g (250 mg/capsule) QD Children: 30 mg/kg/day (250 mg/capsule) divided into 4 doses |
|
D-Penicillamine is FDA-approved for Rx of copper poisoning only |
Iodine (I-131) |
Blocking agent |
PO |
Adults over 40 years: 130 mg/day (For projected thyroid dose ≥500 cGy) Adults over 18 through 40 years: 130 mg/day (For projected thyroid dose ≥10 cGy) Pregnant or lactating women : 130 mg/day (For projected thyroid dose ≥5 cGy) Adolescents ≥ 150 lbs: 130 mg/day (For projected thyroid dose ≥5 cGy) Adolescents, 12 through 18 years: 65 mg/day (For projected thyroid dose ≥5 cGy) Children over 3 years through 12 years: 65 mg/day (For projected thyroid dose ≥5 cGy) Children 1 month through 3 years: 32 mg/day (For projected thyroid dose ≥5 cGy) Infants birth through 1 month: 16 mg/day (For projected thyroid dose ≥5 cGy) |
|
||
Medical countermeasure |
Administered for |
Mechanism of action |
Route of administration |
Dosage |
Duration of treatment |
References for use |
Potassium phosphate |
Phosphorus (P-32) |
Phosphate binder |
PO |
600-1200 mg, given in divided doses |
||
Phosphorus (P-32) |
Phosphate binder |
PO (take with full glass of water with meals and at bedtime) |
Adults: 1-2 tablets (250 mg/tab) QID Children >4 years: 1 tablet (250 mg/tab) QID |
|||
Iodine (I-131) |
Blocking agent |
PO |
Adults: 2 tablets (50 mg/tab) TID |
8 days |
||
Cesium (Cs-137) |
Ion exchange; inhibits enterohepatic recirculation in GI tract |
PO |
Adults, children >12 years:
Children 2 - 12 years:
Children <2 years: Prussian blue is not FDA-approved for use (IND or EUA may be required) |
|
Prussian blue, insoluble, is FDA-approved and NCRP-preferred for Rx of known or suspected internal contamination with radioactive Cs and/or radioactive or non-radioactive thallium; FDA-approved for ages > 2 years old only |
|
Medical countermeasure |
Administered for |
Mechanism of action |
Route of administration |
Dosage |
Duration of treatment |
References for use |
Sevelamer (DailyMed) |
Phosphorus (P-32) |
Phosphate binder |
PO |
|
5 days if possible; first dose is the most important |
|
Radium (Ra-226) Strontium (Sr-90) |
Blocks intestinal absorption |
PO (take with a full glass of water) |
5g BID x1 day, then 1 g QID |
|||
Uranium (U-235) |
Facilitates increased renal excretion |
IV |
|
Administer therapy until urine pH is 8-9 ; continue Rx for 3 days |
||
PO |
2 tablets Q4 hr |
|||||
Sodium glycerophosphate |
Phosphorus (P-32) |
PO |
600-1200 mg, given in divided doses |
|||
Sodium phosphate |
Phosphorus (P-32) |
PO |
600-1200 mg, given in divided doses |
|||
Succimer (DMSA) (DailyMed) |
Polonium (Po-210) |
Chelating agent |
PO |
|
Reduce frequency of administration to 10 mg/kg or 350 mg/m2 every 12 hr for an additional 2 weeks of therapy; typical treatment course: 19 days |
DMSA is FDA-approved for the treatment of lead poisoning only |
Water |
Tritium (H-3) |
Facilitates excretion |
PO |
>3-4 liters/day |
3 weeks |
References for use
FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA).
NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).
NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).