Clinical Pre Computer Proforma for the International Computer Database for Radiation Exposure Case Histories

This publication provides guidance on preparing data to be input into an international computerised database for clinical case histories of persons accidentally exposed to whole body irradiation. The publication has resulted from a close collaboration between the Institute of Biophysics including its Hospital Number 6 in Moscow, Russia, and the Institute of Occupational and Social Medicine at the University of Ulm. In both institutions, much experience has been accumulated during the last 20 years in dealing with basic and clinical research in the field of radiation accident management. In both institutions many case histories of radiation accident victims have been recorded. On this basis the scientists and clinicians from both institutions developed, over the last two years, a pre computer proforma to feed the International Computer Database for Radiation Exposure Case Histories, with standardised data from clinical case histories of radiation accident victims. This activity should be seen as part of WHO efforts to establish a network of institutions around the world, competent in Radiation Emergency Medical Preparedness and Assistance. This network has become known as REMPAN and it is prepared to provide medical advice and assistance when a radiation accident occurs in any country. The Institute of Occupational and Social Medicine, at the University of Ulm, is part of this global network.

1. General Data on the Irradiated Patient.- 1.1 Demographic Data.- 1.2 Occupation at the Time of the Accident.- 1.3 History at the Time of the Accident.- 1.4 Institutions Involved in Patient Care and Database Recording.- 1.4.1 Primary Care Institution Keeping the Patient’s Medical Records.- 1.4.2 Definitive Care Institution.- 1.4.3 Physician Submitting the Case to the Registry.- 1.4.4 Source of Compilation.- 2. Accident Information and Personal Exposure Conditions.- 2.1 Accident Description.- 2.1.1 Country.- 2.1.2 City.- 2.1.3 Location (Factory etc.) of the Accident.- 2.1.4 Begin and End of the Accident.- 2.1.5 Proprietor of the Radiation Source.- 2.1.6 General Description of the Accident.- 2.1.7 Number of Persons Involved.- 2.1.8 IAEA Nuclear Event Scale.- 2.2 Source of Irradiation.- 2.2.1 Critical Chain Reaction.- 2.2.2 Reactor Accident with Consecutive Emission.- 2.2.3 Nuclear Explosion.- 2.2.4 Sealed Source.- 2.2.5 Unsealed Source.- 2.2.6 X-ray Equipment.- 2.2.7 Accelerators.- 2.2.8 Other Sources than 2.2.1 – 2.2.7.- 2.3 Personal Exposure Conditions.- 2.3.1 Begin and End of Exposure.- 2.3.2 Individual Description of the Accident.- 2.3.3 External Irradiation.- 2.3.4 External Contamination.- 2.3.5 Internal Contamination.- 2.3.6 Evaluation of the Average Total Body Dose.- 2.3.7 Evaluation of Local Doses.- 2.3.8 Evaluation of Doses of Internal Exposure.- 3 Clinical Data After Exposure.- 3.1 Primary Reaction.- 3.1.1 Dyspeptic Symptoms and Enlargement of Parotid Glands.- 3.1.2 Primary Skin Erythema and Hyperaemia of Mucous Membranes.- 3.1.3 General Neurocirculatory Symptoms and Signs.- 3.2 Involvement of the Nervous System and the Eyes.- 3.2.1 Diagnostic Procedures for Central and Peripheral Nervous System.- 3.2.2 Impairment of Central and Peripheral Nervous System.- 3.2.3 Lesions of Eyes.- 3.3 Radiation Induced Lesions of Skin, its Appendices, and Underlying Tissues.- 3.3.1 Diagnostic Procedures.- 3.3.2 Radiation Induced Skin Lesions.- 3.3.3 Disturbances of Nails.- 3.3.4 Epilation.- 3.3.5 Amputation of Extremities.- 3.3.6 Debridement of Necrotic Tissue.- 3.3.7 Reconstructive Surgery due to Dermal Radiation Lesions.- 3.4 Bone Marrow Syndrome and Blood.- 3.4.1 Peripheral Blood Count.- 3.4.2 Peripheral Blood Smear.- 3.4.3 Bone Marrow Examination.- 3.4.4 Cytogenetic Data.- 3.4.5 Biochemical Data.- 3.4.6 Haemostatic Parameters.- 3.4.7 Immunological and Immunohaematological Tests.- 3.4.8 Microbiological Analysis.- 3.4.9 Lesions of Bone Marrow.- 3.5 Radiation Induced Lesions of Gastrointestinal Tract.- 3.5.1 Diagnostic Procedures.- 3.5.2 Faeces Analysis.- 3.5.3 Radiation Mucositis.- 3.5.4 Acute Gastrointestinal Syndrome.- 3.5.5 Stool Characteristics.- 3.6 Organs Especially Sensitive Under Certain Exposure Conditions.- 3.6.1 Lesions of Upper Respiratory Tract and Lung.- 3.6.2 Lesions of the Thyroid Gland.- 3.6.3 Pregnancy.- 3.7 Lesions of Other Organs.- 3.7.1 Lesions of the Kidneys.- 3.7.2 Lesions of the Liver.- 3.7.3 Evaluation of Male Reproductive Function.- 3.7.4 Evaluation of Female Reproductive Function.- 3.7.5 Lesions of Cardio-Vascular System.- 3.7.6 General Physiological Parameters.- 4. Treatment and Drugs.- 4.1 Individual Radiation Protection Measures.- 4.1.1 Application of Personal Radiation Protectants during the Accident.- 4.1.2 Methods (Drugs) of Early Pathogenetical Treatment.- 4.1.3 Decontamination Measures.- 4.1.4 Decorporation Measures.- 4.2 Physical Methods of Treatment.- 4.2.1 Hospitalisation and Protective Environment.- 4.2.2 Locally Reversed Isolation for Bum Treatment.- 4.3 Substituting Therapy by Blood and Blood Products.- 4.3.1 Irradiation of Blood and Blood Products.- 4.3.2 Blood Groups and Alloimmunisation.- 4.3.3 Whole Blood Transfusions.- 4.3.4 Red Blood Cell Transfusions.- 4.3.5 Platelet Transfusions and Thrombocytapheresis.- 4.3.6 White Blood Cell Transfusions.- 4.3.7 Plasma Transfusions and Plasmapheresis.- 4.3.8 Albumin Solution Infusions, Gamma Globulin Substitution and Other Blood Components.- 4.4 Drugs.- 4.5 Haemostimulators.- 4.5.1 Myelopoietic Growth Factors.- 4.5.2 Other Growth Factors.- 4.5.3 Drugs as Leucostimulators.- 4.6 Haemopoietic Stem Cell Transplantation.- 5. Clinical Status at the Time of Reporting.- 5.1 Survival Status.- 5.1.1 General Information on the Survival Status.- 5.1.2 Loss of Follow-Up.- 5.1.3 Death of Patient.- 5.1.4 Causes of Death.- 5.2 Clinical Status.- 5.2.1 Time of Evaluation.- 5.2.2 Radiation Related Persisting Haemopoietic Disorders.- 5.2.3 Other Persisting Haemopoietic Disorders.- 5.2.4 Radiation Related Persisting Lesions of Skin and Underlying Tissue.- 5.2.5 Other Persisting Lesions of Skin and Underlying Tissue.- 5.2.6 Radiation Related Persisting Lesions of Other Organs.- 5.2.7 Additional Persisting Lesions of Other Organs.- 5.3 Functional Status.- 5.3.1 Time of Evaluation.- 5.3.2 Karnofsky Performance Score.- 5.3.3 Rehabilitation.- 6. Skin Burns.- 6.1 Burn Score.- 6.2 Localisation Coding - Total Body, Head, Neck and Upper Trunk.- 6.3 Localisation Coding - Arms, Lower Trunk.- 6.4 Localisation Coding - Lower Trunk, Legs.- 6.5 Skin Burns.- 7. Haematopoietic Stem Cell Transplantation.- 7.1 Source of Stem Cells.- 7.2 Type of Transplantation.- 7.3 Histocompatibility Tests for Allogeneic Transplantation.- 7.3.1 Typing.- 7.3.2 Donor and Recipient Cells Were Tested for Matching.- 7.4 Donor Information.- 7.4.1 Donor’s Demographical Data.- 7.4.2 Donor Relationship and Alloimmunisation History.- 7.4.3 Donor had Serological Evidence of Previous Viral Exposure or Infection.- 7.5 Transplant Manoeuvre.- 7.5.1 Conditioning Therapy prior to Stem Cell Therapy.- 7.5.2 Cells Were Manipulated or Concentrated in vitro.- 7.6 Drugs to Prevent Acute Graft-versus-Host Disease (GvHD).- 7.7 In vitro and in vivo Removal of Donor T Cells to Prevent GvHD.- 7.8 Evidence for Haemopoietic Engraftment.- 7.9 Overall Evaluation of Engraftment.- 7.10 Graft-versus-Host Disease.- 7.11 Specific Therapy for GvHD.- 8. Annexes.- 8.1 IAEA International nuclear event scale.- 8.2 Conversion of Non-SI to SI Units.- 8.3 Orders of Magnitude.- 8.4 Karnofsky Scale for Rating Activity Status.- 8.5 References.- 8.6 Normal Values of Laboratory Parameters.- 8.7 Pages for copying.- 8.7.1 Symptoms and Signs.- 8.7.2 Laboratory Values (left & right).- 8.7.3 Normal Values.- 8.7.4 Antibiogramm (left).- 8.7.5 Antibiogramm (right).