Description Abstract-In the present report, ICRP provides information on radiation doses to the infant due to intakes of radionuclides in maternal
milk. As in Publication 88 (ICRP, 2001) on doses to the embryo and fetus following intakes of radionuclides by the mother, intakes
by female members of the public and female workers are addressed. Acute and chronic intakes are considered at various times before and
during pregnancy as well as during the period of breastfeeding. Dose coefficients per unit intake by the mother (Sv/Bq) are given for
the selected radionuclides of the same 31 elements for which age-specific biokinetic models were given in Publications 56, 67, 69,
and 71 (ICRP, 1989, 1993, 1995a,b). For these elements, doses were calculated for the most radiologically significant natural or
artificial radionuclides that might be released into the environment due to various human activities. Dose coefficients are also given
in this report for radionuclides of an additional four elements: sodium, magnesium, phosphorus, and potassium.
Relevant human and
animal data on elemental and radionuclide transfer to milk are reviewed. The biokinetic models for adults given in earlier ICRP publications
are adapted to include transfer to milk. Model predictions of fractional transfer of ingested or inhaled activity to milk are discussed
in the report, and the corresponding dose coefficients for the infant are compared with dose coefficients for in utero exposure, as given
in Publication 88 (ICRP, 2001). Illustrative information is also given on doses to the female breast from radionuclides in breast
milk, and external doses received by the child from radionuclides retained in the tissues of the mother. For the additional elements
considered in this report, but not in Publication 88 (ICRP, 2001), information is also given on doses to the embryo and fetus
following maternal intakes of radioisotopes during or before pregnancy.
A CD-ROM is to be issued giving data that will supplement
the information given in this report. In addition to the dose coefficients given here, committed equivalent doses to the various organs
and tissues of the offspring will be given. Dose coefficients will also be given for inhalation of a range of aerosol sizes for the selected
radionuclides of the elements covered by this report. Keywords: Dose coefficient; Maternal intake; Milk; Infant dose; Ingestion;
Inhalation
Contents ABSTRACT GUEST EDITORIAL PREFACE 5 EXECUTIVE SUMMARY 8 1. INTRODUCTION 17 BACKGROUND 17 Security of Radiation Sources
17 Radiation-Related Malevolence 18 AIM OF THE REPORT 19 INTENDED AUDIENCE 21 2. CHARACTERIZING THE SITUATION 22 POTENTIAL
SCENARIOS 22 Threat 22 Initiators 23 Common Features 24 SPECIAL FEATURES 25 Location 25 Public Perception 25 Source
Term Characterization 26 Covert Situations 26 Public Sentiment 27 Advance Warning 27 Criminal Investigation 28 Challenges
29 PLANNING 29 ?All-hazard? Planning 30 Disaster Management 31 Medical Preparedness 31 Psychological Issues 32 Exercises
33 EXPOSURE 34 Quantification 34 Pathways 36 INITIAL REACTION 38 Reacting to an Explosion 38 Reacting to an IND 38 RESPONSE
PHASES 39 Rescue and Early Actions 39 Recovery 40 Restoration 40 LINKS 40 3. POTENTIAL HEALTH EFFECTS ATTRIBUTABLE TO
RADIATION EXPOSURE 42 BIOLOGICAL HEALTH EFFECTS 42 Deterministic effects 42 Stochastic effects 43 Prenatal exposure effects
43 Other issues with pregnant women and children 45 Special considerations for INDs 45 Summary of Biological Health Consequences
46 PSYCHOLOGICAL HEALTH EFFECTS 46 Distress 47 Fear of Cancer and other Health Effects attributable to Radiation 47 4. PROTECTING
RESPONDERS 48 OCCUPATIONAL PROTECTION APPROACH 49 Occupational Dose Guidelines 50 OCCUPATIONAL PROTECTION TECHNIQUES 52 Managing
Field Exposures 52 Protective Clothing 53 Respiratory Protection 54 5. PROTECTING THE PUBLIC 54 RESCUE PHASE (IMMEDIATE ACTIONS)
54 Controlling access and spread of contamination 55 Immediate care of people with traumatic injuries 56 Triage Dose Assessment
58 Psychological triage and disposition 59 Respiratory protection 60 RESCUE PHASE (URGENT ACTIONS) 60 Personal Decontamination
60 Sheltering 61 Evacuation 64 Iodine Prophylaxis 66 RECOVERY PHASE 68 Refined Dose Assessment 68 Biological assays
68 Temporary Relocation and Resettlement 70 RESTORATION PHASE 71 Cleanup 71 Management of Radioactive Waste 73 Radioactive
Residues 74 Discontinuation of Protective Actions 75 Final dose assessment 76 SUMMARY OF DOSE CRITERIA FOR PROTECTING THE PUBLIC
77 Generic Optimized Protection Levels 77 Operational Levels 78 CONTROLLING CONTAMINATION OF CONSUMER GOODS 78 Basic Criteria
79 International consensus on radiological criteria for radionuclides in commodities 80 Radionuclides in Bulk Amounts of Materials
80 Radionuclides in Foods 81 Radionuclides in Water Supplies 82 Control in the Affected Area 84 Control Outside the Affected
Area 84 PARTICULAR SITUATIONS 84 Handling Situations with ?Hot Particles? 84 Handling Contaminated Corpses 85 6. MEDICAL
INTERVENTION 87 ESSENTIAL ELEMENTS OF MEDICAL TREATMENT 87 OTHER IMPORTANT MEDICAL ISSUES 89 Identification of radionuclides
89 Secondary treatment centers 89 Biodosimetry 90 Skilled personnel 90 Training Medical Personnel 91 Long term follow-up
91 7. COMMUNICATION 92 REFERENCES 94 ANNEX I: TERMINOLOGY 99 ANNEX II: POTENTIAL SCENARIOS 110 Malicious Intent 110 Unannounced
Events 110 Thefts 110 Radiation Exposure Devices 111 Radioactive Dispersion Devices 111 Site-Specific Radioactive Contamination
112 Radioactive Contamination of Food and Water Supplies 113 Attacking Nuclear Facilities 113 Improvised Nuclear Devices 114 ANNEX
III: MEDICAL ISSUES 115 PLANNING FOR PUBLIC HEALTH & MEDICAL INTERVENTION 115 Threats 115 Unannounced Events 115 Irradiation
115 Contamination of food and water supplies 116 RDDs 117 Attack upon a nuclear facility 117 RELEVANT INFORMATION FOR IMMEDIATE
MEDICAL PROGNOSIS AND INITIAL TREATMENT OF RADIATION EFFECTS ATTRIBUTABLE TO EXTERNAL RADIATION 117 Prodromal phase of acute radiation
syndrome 119 Change of lymphocyte counts in the initial days of acute radiation syndrome depending on the dose of acute whole body
exposure 121 Latent phase of acute radiation syndrome 121 Findings of critical phase of acute radiation syndrome following whole
body exposure 122 Principal therapeutic measures for acute radiation syndrome according to degree 123 Onset time of clinical signs
of skin injury depending on the dose received 123 THERAPIES FOR INTERNAL CONTAMINATION 124 Blocking, diluting and displacement
agents 124 Reduction of gastrointestinal absorption 126 Chelating agents 127 THERAPIES FOR EXTERNAL EXPOSURE 128 Prevention
and treatment of infections 129 Maintenance of fluid and electrolyte balance 129 Specific treatments of bone marrow depression
130 Radioprotective agents 133 ANNEX IV: PSYCHOLOGICAL ISSUES 134 COMMUNICATION BETWEEN CARE PROVIDERS AND PATIENTS 136 DEBRIEFING
138
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