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The Japanese Tsunami and Resulting Nuclear Emergency at the Fukushima Daiichi
Power Facility: Technical, Radiologic, and Response Perspectives
Lawrence T. Dauer, Pat Zanzonico, R. Michael Tuttle, Dennis M. Quinn and H. William Strauss

J Nucl Med. 2011;52:1423-1432.
Published online: July 28, 2011.
Doi: 10.2967/jnumed.111.091413

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the highest level on the and the long-term environmental and health impact will likely International Nuclear Event Scale (2). New York.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. Japan. R. the risk of additional fuel damage island of Honshu. William Strauss2 1Department of Medical Physics. Michael Tuttle3. monitoring of food from a magnitude 9. Department of Medical Physics. 28.snm. 2011. releases persists. 2011. ities have declared to be at level 7. (2) the sources and types of radioactive material available and released to the environment during the early weeks of the Fukushima nuclear reactor accident and why specific public protective actions were necessary. and (3) the appropriate use of potassium iodide as a countermeasure after nuclear reactor accidents. and H. revision accepted Jun. 2011 (1). making any radiologic health impact. NY 10065. Fukushima.7 gigawatts electrical power. and long-term cated on a 3.2. on March 11.. However. 3Department of Endocrinology. When operational. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. emergency responses. ronmental releases of radioactivity required mandatory evacuations and other protective actions. For personal use only.2967/jnumed.000 inhabitants from the vicinity in the world. Memorial Sloan-Kettering Cancer Center. The facility suffered major structural damage of the site and areas early in the emergency. events triggered a major nuclear event that Japanese author- uation at the Fukushima Daiichi nuclear facility remains fluid. Quinn4. New York. cooling water had not yet been achieved. and 4DAQ. Inc. this facility one of the 15 largest nuclear power installations nized evacuation of over 200. The resulting structural damage to the plant disabled the reac- tor’s cooling systems and led to significant. Memorial Sloan-Kettering Cancer Center. 1275 of its radioactive inventory and the associated contaminated York Ave. erated by the Tokyo Electric Power Co. Received May 2. These actions include an orga. ra. in the Futaba accident response. it the Japanese authorities during the event that should mitigate provided a total of 4. New York. SNM designates each JNM continuing education article for a maximum of 1. participants can access this activity through the SNM Web site (http://www. TEPCO COPYRIGHT ª 2011 by the Society of Nuclear Medicine. CONTINUING EDUCATION The Japanese Tsunami and Resulting Nuclear Emergency at the Fukushima Daiichi Power Facility: Technical. the facility con- it largely appears that appropriate key actions were taken by sists of 6 boiling water reactors. and systematic scan- ning of evacuees. ture in Japan. tial releases of radioactivity remain a possibility.0 earthquake (the Tohoku earthquake) and water and placement of radiation limits on such foodstuffs. Physicians should claim only credit commensurate with the extent of their participation in the activity. The sit. New York. The status of the facility continues to change. Significant envi- take years to fully delineate. These and of further. and permanent control of its radioactive inventory has not yet been achieved. Dauer. 1423 . New York Learning Objectives: On successful completion of this activity. 22. 52:1423–1432 damaged by the earthquake and ensuing tsunami that struck off DOI: 10. and as of the writing of this article. New York. The status of the Fukushima Daiichi nuclear facility continues to change. permanent containment For correspondence or reprints contact: Lawrence T. Japan. 2014. and ensuing tsunami that struck off the northern coast of the distribution of stable potassium iodide. ongoing environ- mental releases of radioactivity.Downloaded from jnm. 2011. Dauer1.5-km2 (860-acre) site in the towns of Okuma challenges associated with this event.111.snmjournals. was severely J Nucl Med 2011.org Published online Jul. New York. Box 84. Memorial Sloan-Kettering Cancer Center. nuclear The Fukushima Daiichi nuclear power facility. participants should be able to describe (1) the Fukushima nuclear reactor design and the multiple failures resulting from the earthquake and tsunami natural disasters. perhaps substantial. has developed a plan to bring all reactors under control and FUKUSHIMA ACCIDENT RESPONSE PERSPECTIVES • Dauer et al. is lo- diologic consequences. and Response Perspectives Lawrence T. 2011. 2Department of Radiology. Although there is on- and Futaba in the Futaba District of the Fukushima Prefec- going debate on preparedness before the event and the candor of responsible entities in recognizing and disclosing its severity. For CE credit. Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. New York. New York. The purpose of this edu- T he Fukushima Daiichi (meaning “Fukushima 1” or “Fukushima the First”) power facility. Key Words: radiation safety. First commissioned in 1971. triggering a mandatory evacuation of a large area surrounding the plant.0 AMA PRA Category 1 Credit. Radiologic.091413 the northern coast of the island of Honshu on March 11.org/ce_online) through September 2012. (TEPCO). Dennis M. Inc. Further substan- E-mail: dauerl@mskcc. constructed and op- cational article is to summarize the short-term chronology. Memorial Sloan-Kettering Cancer Center. radiation District of the Fukushima Prefecture in Japan. Pat Zanzonico1.

snmjournals. and professional societies have already to the reactor core to maintain core cooling and resume the begun to evaluate the preparation and response of TEPCO cycle (Fig. approximately 6% of that of the reactor immediately after and researchers. primary containment vessel (D). radiochemists. so-called Mark I containments (Fig. and cooling loop design: reac. preparations. radiologic consequences. shutdown. the liquid phase. and a venting network connecting the specific public protective actions were necessary.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. turbine and is cooled in a condenser. various regulatory and advisory bodies. and unit 6 management. several years of additional cooling are then reactor design and identify the multiple failures resulting required before transfer to dry storage casks (12).4). The wet well is situated beneath the The Fukushima Daiichi nuclear power facility consists of dry well and is connected to it by a system of vent piping. 1). The reactor cores at Fukushima with guidance and background information that can be useful Daiichi are designed to hold several hundred fuel assemblies. the wet well. electrical generator (K). radiopharmacists. this time and will likely take years to delineate. Typical boiling water reactor. 3. an under. concrete that surrounds the cylindric steel reactor pressure vessel containing the fuel assemblies in the reactor core and FUKUSHIMA DAIICHI NUCLEAR REACTORS the coolant loop piping. 9 • September 2011 .Downloaded from jnm. residents. including nuclear medicine physicians. water both removes heat from the and the Japanese authorities (4–9). These fuel pellet–containing tubes are tsunami and resulting nuclear emergency at the Fukushima bundled to form a fuel assembly. This article is aimed at describing the Japanese zirconium alloy. reactor coolant pump (M). As such. power grid (L). two.5 m Daiichi power facility and providing the nuclear professional (14. dry well (C). wet well torus (E). steel-lined pres- sider the appropriate use of potassium iodide (KI) as a sure vessel backed over most of its surface with reinforced countermeasure after nuclear reactor accidents. from the earthquake and tsunami natural disasters. and Pacific Ocean (P). The nuclear components of a boiling water reactor begin Nuclear medicine professionals are expected to assist in with the fuel pellets. These consist of solid ceramic pellets the response to nuclear emergencies. converting it back to Governments.400 MWt. facility—and the specific lessons associated with safety units 2.285C) to produce steam. RGB tor pressure vessel and core (A).75 atm at a temperature of . water. The thermal heat production of the spent-fuel rods is nurses. which is about 4. These pellets emergency response actions associated with such events is are stacked in long. 6 boiling water reactors (Fig. cooling water (I). 52 • No.5 ft) in length (11). Therefore. rods. For personal use only. 4. with electric pumps continually circulating directed at all nuclear medicine professionals and associated water to dissipate heat from the still highly radioactive fuel staff. and 5 are rated at about 2. and con. reactor and refueling building (G). to reduce the possibility of release of radioactive materials The resulting steam directly drives an electric generator within 6–9 mo (October–December 2011) (3. FIGURE 1. The major compo- leased to the environment during the early weeks of the nents of the primary containment structure include the dry Fukushima nuclear reactor accident and recognize why well. technologists. which is then subsequently pumped back the news media. The article specifically addresses the follow. 1). thin tubes made of corrosion-resistant essential. explain the Most of the Fukushima Daiichi units are equipped with sources and types of radioactive material available and re. for mitigating adverse public health outcomes during such a Spent-fuel assemblies are temporarily stored in a 14-m-deep large-scale nuclear event.400 MWt (10). steam turbine (J).380 megawatts thermal (MWt) heat generation. This continuing education article is pool of water. However. 2014. In addition. the the electrical generators. Such reactors use the heat The wet well is a steel or concrete toroidal (or donut-shaped) produced by nuclear fission to boil water (pressurized to pressure vessel normally filled to about half its height with . decreasing over several days to cold-shutdown ing learning objectives: describe the Fukushima nuclear temperatures. and response—are unclear at is rated at about 3. Fukushima Daiichi unit 1 is rated ultimate health and economic impact of the damage to this at about 1. it is natural core (maintaining fuel temperatures within operational that comparisons of the Fukushima Daiichi event to Three range) and flashes to steam used to propel the turbines for Mile Island and Chernobyl have emerged. 1). spent-fuel pool (F). containment. physicists.3%–5%) uranium dioxide or of a mixed standing of the chronology. of 235U-enriched (. 1424 THE JOURNAL OF NUCLEAR MEDICINE • Vol. steam piping (H). The dry well is a light-bulb–shaped. secondary cooling loop (O). condenser (N). and oxide of both uranium and plutonium isotopes.

molybdenum. together with the heat generated they are trapped in the fuel rods and are released in signifi- by decay of the fission product daughters. Longer-lived 134Cs (half-life. cerium. can be initiated. lanthanum. a simple steel of each fission product released from the core is estimated building encloses the top of the reactor floor to protect the to be higher in fuel-melt than in fuel-overheat conditions refueling bay and spent-fuel pool and forms a minimal out. The fuel-rod cladding and reactor pressure vessel and Table 1 presents estimates of the available total radio- its piping form the reactor coolant-pressure boundary and active releases for these respective scenarios based on a the primary containment. 235U nucleus. the fuel experiences a serious earthquake occurred in the Pacific Ocean (the largest in overheat condition.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. especially longer-lived 131I “can” of the fuel rods. 1425 .400-MWt Reactor at 7 Days After Shutdown Temperature required for Core condition Activity (EBq) condition (C) Total inventory in normal 4.700 tion of 235U fission products. neptunium. In the third and most of Sendai on the eastern coast of the island of Honshu. There are several barriers limiting release of radioactive causing the oxide fuel pellets themselves to melt. strontium. releasing fission products from the nuclear fuel into the environment an additional 2. quake. causing it to split (fission) into 2 smaller frag. with the latter occurring via the recently burned fuel elements) undergoes severe and pro. as well as other In the 235U fission process. which may have lasted as long as 3 min. xenon. .500 Fuel-overheat inventory 2. in a nuclear reactor fission is about 200 MeV. Although radioactive products ments as well as 2–3 neutrons. Iodine fission products. or filtration.2E10 .3E21 . The energy released per 235U were immediately available for release). centered 130 km east of the city 20-fold more of the fission products. several escalating release mechanisms ilarly. are damaged by mechanical means or undergo cracking during a slight overheat condition.2E10 . and molybdenum. For personal use only. a magnitude 9. (Table 2) (14).1E11 315 operating core Fuel-melt inventory 5. lanthanum.400-MWt reactor (14) and identifies the fuel temperatures tainment surrounds the primary containment and houses needed for each such condition. if the fuel-rod walls especially for food deposition pathways. fission product releases can undergo other removal vary as a function of their atomic numbers. (half-life. (13). including ruthenium. FUKUSHIMA ACCIDENT RESPONSE PERSPECTIVES • Dauer et al.2 y) and 137Cs (half- ceramic fuel pellets and be captured in the space (fuel gap) life. a neutron is captured by the radioactive elements. damaged fuel rods can lose integrity.8 d) can also be of concern for both external If an operating reactor core or a spent-fuel pool (with and internal exposures.) Released noble gas fission products have relatively short (Fig. this is the primary cant quantities only when the fuel melts. 2011. cesium. the secondary con. The fission product yields accidents. following a mechanisms such as deposition in the reactor pressure vessel.30 y) can result in both external and internal expo- between the fuel pellets and the wall of the zirconium alloy sures. the volatilized fission CHRONOLOGY OF THE FUKUSHIMA DAIICHI NUCLEAR products can be released to the reactor coolant water. The specific percentage emergency core cooling systems. March 11. The specific pathway of 80–110 (krypton. .to 3-fold more of the fission products.1. 2. pasture deposition–cow milk–human thyroid pathway.) and 120– to the environment will determine such reductions.0 absence of core cooling. barium. yttrium. 2). which may be captured by such as these were seen in weapons testing fallout (because and split up to 3 additional fissionable nuclei and thus sustain they were created in a near-instantaneous large fission and the nuclear chain reaction. Also in reactor contributor to heat production. Although both conditions likely result in a ermost barrier. In fuel melt. In the first type of event. released strontium fission products can be of concern.2.to Japan’s recorded history). the noble gases and half-lives and are typically a concern only as an external some volatilized forms of radioactive iodine will escape the source.2. 90Sr). During the reactor fission cycle. there is a significant amount of RELEASE MECHANISMS barium (140Ba) and strontium (89Sr. Sim- longed loss of coolant. if the fuel temperature continues to rise in the At 2:46 PM on Friday. iodine. etc. 2014. there are differences among these conditions for the other fission ISOTOPIC SOURCE TERMS AND POSSIBLE products. The severe type of event. which can release approximately 10. 155 (iodine.Downloaded from jnm. Bimodal distribu- Fuel-gap inventory 1.650 FIGURE 2.snmjournals. and cesium. etc. significant release of noble gases. . bimodal distribution with atomic mass numbers in the range the primary containment. In the FACILITY ACCIDENTS second type. In addition. set off a massive tsunami with devastating floods inundating an area TABLE 1 Sources for Release of Radioactivity Assuming . Typically.

the pressures within the primary containment Antimony 2 2 vessels rose beyond design limits and plant personnel Barium 1 20 initiated primary containment venting to prevent extensive Strontium 0.17). 1). The operating reactor cores in units 1–3 required on. unit 2 experienced an explosion. and external power was returned to of unit 4 had also been completely defueled in December units 5 and 6. For personal use only. shutdown procedures were able to achieve and (Fig. As the fuel temperature continued on an expected maximum tsunami height of 3. it was impossible to Noble gas (xenon. including all 6 external power supply sources (4) and quantities of hydrogen gas and a subsequent hydrogen on-site backup power emergency diesel generators (with explosion. Although the upper portion of its building and injuring 11 people each of the nuclear facilities along the northeast coast of (20).7 vironmental release of radioactive material. significant ra- cept for those at Fukushima Daiichi. dioactivity was released to the environment. with all of its spent fuel moved to the unit 4 spent-fuel units 5 and 6. Then. To mitigate further hydrogen to about 6% of that when the reactor is operating (18). one electrical generator at unit 6 was for inspection and planned maintenance. The reactor vessel restored to operation. although some believe the hydrogen blast at unit some diesel fuel tanks perhaps even being swept out to 4 may have originated from hydrogen generated in unit 3 sea). These hydro- Fukushima Daiichi units 1–3 were operating at the time of gen explosions further impeded emergency work (21) and the earthquake and tsunami. severely damaging the roof and walls of the such as cadmium) into the reactor core to absorb fission top floor and injuring 4 workers. Plant During the first several days and weeks after the tsunami. the plant staff removed panels from the roofs of The loss of electrical power resulted in loss of coolant to units 5 and 6 to allow any hydrogen gas to escape (16). but these in Fuel-Overheat or Fuel-Melt Conditions remained operational for a maximum of approximately Fission product type Fuel overheat Fuel melt only 8 h (19).23).1 m). However. The likely continued reduction eration during the quake triggered automatic shutdowns of the water levels in the core to levels below the top of the of several nuclear power facilities (including Onagawa. also experienced a large hydrogen explosion. Because of extensive damage to the infra- structure in the surrounding areas.30. the explosion at unit 4 going cooling to dissipate the significant heat they were caused significant damage to the upper floors of the reactor producing because of decay of the fission products created building and the likely environmental release of additional before the shutdown. thereby stopping the nuclear chain reaction. In the case of the unit 4 fuel pool. this thermal heat production amounts radioactive fission products. to rise above the boiling point. Regardless of the source. In each of these events. On March 14. which are normally main- designed to withstand a tsunami with a height of 5. 2014. Units 4–6 were in an outage attempts to provide active cooling. that the facility was unable to maintain adequate cooling of The plants had been modified in 2002 with a seawall spent-fuel pools in units 1–4.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. radio- Lanthanum Low 0. status during the event. unit 3 neutrons and thus bring the fission reaction below critical. pressure-relieving steam-venting operations. and Fukushima Daini) along cladding damage and some melting of the fuel cladding or the northeast coast of Honshu. Honshu experienced some damage and perhaps pressure likely in the wet well torus under the primary containment spikes.1 7 damage to the reactor vessel and a possible large-scale en- Ruthenium 0. personnel tried to maintain reactor-core and spent-fuel pool attempts were made to pump seawater supplemented with 1426 THE JOURNAL OF NUCLEAR MEDICINE • Vol. explosions. The ground accel. gen explosion occurred at the top of the unit 1 reactor ture of materials with a high–neutron-capture cross-section. TABLE 2 cooling and to perform shutdown activities with steam Percentage of Core Fission Products by Element Released turbine–driven emergency core cooling systems. the the seawall with massive flooding that disabled critical equip.01 active gases (including 131I).01 0. damaging ity. each of the reactors and associated spent-fuel pools. allowing cooling equipment to be restarted at 2010. a hydro- include automatic insertion of control rods (comprising a mix. 52 • No.snmjournals. possibly all) of the water in the pools evaporated and per- quake was estimated to have an unprecedented maximum haps was also lost through leaks caused directly by the wave height of 14–15 m (4. building. the least damaged at the facility. the containment structures. cold-shutdown condition in all plants ex. The shutdown procedures of some fuel pellets. (4. The tsunami overwhelmed earthquake (22). fuel rods resulted in significant additional overheating and Takai. overheating may also have caused the generation of large ment. krypton) 50 100 deliver additional resources to the site quickly. and hydrogen (primarily produced by the oxidizing reaction of the hot zirconium fuel cladding with the boiling water and possibly some radiolysis of water) as large as 561 km2 (4) and extreme damage and loss of were therefore released into the refueling bay building above life (.Downloaded from jnm. on March 15.000 or more fatalities) (15). It appears pool on the upper floor of the reactor building (16). as well as during required maintain a safe. it is likely that much (and the March 2011 tsunami arriving 41–60 min after the earth. Iodine 50 100 As the facility experienced a significant loss of cooling Cesium 50 100 Tellurium 10 30 capabilities. Steam.7 m (based tained at or below 50C. having been previously taken off line On March 17. Fukushima Daiichi. In the afternoon of March 12. 9 • September 2011 .

28).8E15 2.Downloaded from jnm. there were an estimated 50. Chernobyl. As of mid-April 2011.000 form and to the sea in liquid (and possibly some particulate) tons of highly radioactive water present on site. which was estimated at approximately 5. with cerns that the sea salt may have been building up in the clear indications of some fuel melting as well. to the atmosphere in gaseous (and possibly some particulate) cern. appears to identify a predominantly fuel-overheat event.31).” water heat and much lower than that expected for fuel melt. the diffi. 9. a method to provide fresh water to the site was to 55%–70% of the nuclear fuel. lated areas depending on the meteorologic conditions at the To assess the possible types of early fuel events experi. As of mid-April. currents.30. 3 (and others not yet identified) was therefore likely released culties managing this highly radioactive water are of con. 2014. equivalent to need to be repaired or modified in order to continue to about 10% of that released as a result of the accident at remove heat and to manage the large amounts of radio. As of early June. causing a pressure buildup in the containment.25. the total operators were able to restore some external power to the amount of radioactive material estimated to have been re- site. releases and ground deposition would be expected to dis- ment integrity. The 131I 4. the containment system was vented to prepared. It appears that there is GUIDANCE ON EVACUATIONS AND EARLY more iodine and less cesium than expected for either event SHORT-TERM PROTECTIVE ACTION Protective-action guidelines and limits are typically im- TABLE 3 plemented to reduce both deterministic and stochastic Assessing Type of Fuel Damage at Fukushima Daiichi health effect risks (32).4 2 17 and internal (inhalation or ingestion) pathways. children are generally at Radionuclide (Bq/mL) nuclide overheat melt higher risk than adults from radiation exposure events. initially officially estimated that unit 1 had sustained damage cient cooling. Several damaged systems will was raised to about 770 PBq (.4 MCi) of 131I and about 12 PBq In heroic efforts to stabilize the reactors. As indicated in Figure 3. results of turbine releases would be highly diluted and would follow sea hall water sample assays on March 25 and 26 were com. Japanese government to have been as high as about 150 PBq ing mechanism must be implemented. For personal use only.26) and later acknowledged that flash to steam or that was later condensed were collected most of the fuel rods likely melted and fell to the bottom of within the containment and turbine hall structures and appar.4E16 19 18 14 Several public exposure pathways. Overall. other units. must be considered when responding to nuclear reactor accidents FUKUSHIMA ACCIDENT RESPONSE PERSPECTIVES • Dauer et al. TEPCO had central components of the core and thereby preventing effi. Figure 3 summarizes some of the Nuclear Facility most important stochastic risks based on susceptible tissues and organs (such as the thyroid and hematopoietic stem Expected release cells) and age at exposure (33). To were not available or reported by the time this article was reduce this pressure. with particulates deposited more locally and solu- pared with expected release fractions.0. the lifetime- Average of turbine by event attributable cancer risks in Figure 3 are normalized to an hall water samples (% of total nuclide) absorbed dose of 1 Gy.5E15 11 31 23 136Cs pathways and the populations potentially exposed.2 EBq actively contaminated water at the site.8E16 65 40 30 specific public protective actions depend on the exposure 134Cs 8. the quantity of radioactive iodine and water being pumped into the reactors at the rate of 6–7 m3/h cesium released to the environment was estimated by the (24). Although seawater releases are not as immediate A mix of the radionuclides similar to those listed in Table a significant health hazard as are airborne releases.21. In an operation known as “feed and bleed. Some of this water boiled of pure b-emitters requires a separate assay and these data to steam. and an alternate cool.3 MCi) of 137Cs (4. including external 140Ba 1. Importantly. (petabecquerel [1015 Bq]) (. This is not sustainable long-term. with fresh form. Any waterborne enced at the Fukushima Daiichi facility.27. Unresolved issues (exabecquerel [1018 Bq]) (. but there is no evidence to suggest Activity % of that off-site population doses have even remotely approached concentration total Fuel Fuel 1 Gy. The barium activity is consistent with fuel over- vessels. After con. Airborne complicating the situation at the site include primary contain. releasing further radioactivity. was pumped into the reactor vessel and circulated within the Strontium would also be expected. Large quantities of the cooling water that did not unit 3 to 25%–30% (10. time of and immediately after the release. enabling the start of electrically driven pumps to inject leased into the atmosphere during the first week of the crisis cooling water into the core.7E14 1.3 4 3 137Cs 1. 1427 . the reactor pressure vessel within the first 4 d of the earth- ently leaked to the sea from unit 2 and possibly from the quake (4. loss of perse from the site in a gaussian plume pattern and would fuel assembly integrity. the facility (.29).org by Indonesia: J of Nuclear Medicine Sponsored on June 17.140 MCi) (16. and devised.snmjournals. and a series of aftershocks of up to 7 be transported out to the Pacific Ocean or inland over popu- or more in magnitude. possible fuel overheating and melting. Table 3 lists the only ble products dispersed more widely. boron (as a neutron absorber) into the reactor pressure specified. but the measurement damaged fuel rods and fuel pellets. unit 2 to 30%–35%. the analysis of turbine water samples the atmosphere. nuclides consistently identified and the expected release fractions for different fuel events.21 MCi).

with external dose rates of approximately 20–120 mSv/h (2–12 mrem/h). Namie. it has been conservatively and confirmed to date include particulate forms of iodine estimated that people who did not evacuate before the and cesium. the Japanese Prime mSv (100 mrem) or less if they were to remain in that area Minister declared a state of nuclear emergency (4) and. the National Nuclear Security Agency. the FIGURE 3.and g-irradiation emitted by would be expected to receive doses in excess of about 20 radionuclides in the environment (i. with dose rates of approxi- mately 2–12 mSv/h (0.. Within the higher-dose plume areas shown in Figure 4. thyroid cancers (dotted ranged from 3 to 30 MBq/m2 within the plume areas and lines). 2014. 2011. northwest deposition pathway had been noted. within about 80 km and having lower levels of radionuclide iodine. suming contaminated food for 1 y. and 137Cs was fairly widespread within the 0. the To control ingestion exposures.S. structures. it has been conservatively estimated that people who did not and ensuing environmental releases of radioactivity. 9 • September 2011 . Off-site environmental contamina- tion with 131I. Katsuo. it is difficult to accu- public from the area most likely to be affected by a major rately estimate at this time the total potential number of release of radioactive material (21). the evacuation radius was expanded to 10 km. km and a shelter-in-place (with evacuation suggested) zone These protective-action limits are lower than those recom- of 30 km (35). for most areas have resulted primarily from radioactive xenon. On of 30 km (35). This centers. deposition is clearly seen to the north- west. the between 3 and 10 km from the stricken facility. Exter. age at exposure. on the evening of March 11. in the radioactive mSv (2 rem) if they were to remain in that area for 1 y after plume or deposited on the ground. Although the prevailing wind in Japan was from the west and should have carried most of any airborne releases from the plant east out over the Pacific Ocean. Depart- ment of Energy. most distant areas are currently reporting even lower exposure rates. On March 13. an additional and it was subsequently expanded further to 20 km after the designation of a “planned evacuation zone” was created: initial hydrogen explosions and releases. Japanese authorities also distributed stable mended by the International Atomic Energy Agency (41). and the Japanese authorities (37. on April 11. evacuate before the releases occurred (before March 16) nal doses can result from x.e. 134Cs. In addition. Kawa- ordered for those in the 20. Japanese government instituted an evacuation zone of 20 uation zone was expanded as the event unfolded and the km and a shelter-in-place (with evacuation suggested) zone risk of a release of radioactive materials increased.2 mrem/h). In fact. and Iitate villages (15). evacuated an area people exposed in the contaminated areas. Estimates of lifetime-attributable radiation risks of can- longer-lived 134Cs and 137Cs deposited concentrations cer incidence for all cancers (solid lines). sheltering inside buildings was zone included parts of Minamisoma City. residents of areas with projected annual doses in excess decontamination screening was started at the evacuation of 20 mSv were directed to evacuate within 1 mo (15). within a 2-km radius and sheltered (in-house) residents To control external and inhalation doses to the public. In addition. and on March 15. krypton. and an additional smaller pathway RGB is indicated to the southwest. iodine (KI) tablets (or syrup for children) to the evacuation which are based on a 10-mSv (1-rem) annual dose limit to centers and instructed evacuees younger than 40 y to take the most restrictive individual (generally. an infant) if con- the KI on March 16 (21. Figure 4 shows the results of aerial measurements of total cesium deposition after the Fukushima Daiichi nuclear facility event based on data compiled by the U.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. Deposited fission products measured deposition during the releases. red 5 female data. and leukemia (dashed lines) from single exposure based on below 300 kBq/m2 outside the plume areas (38). and cesium. Japanese officials insti- Japanese government instituted an evacuation zone of 20 tuted water and foodstuff countermeasures (Table 4) (40). in the latter days 1428 THE JOURNAL OF NUCLEAR MEDICINE • Vol. to control external and inhalation doses to the public.to 30-km zone (34). Based on the release would be expected to receive an approximate dose type of events at Fukushima Daiichi. Blue 5 male data. The evac. Although some areas beyond 80 km have reported dose rates on the order of 10- fold higher than background exposure rates. early irradiation may of less than 20 mSv (2 rem). in for 1 y after the release (39).000 accordance with preexisting emergency plans to remove the people were likely evacuated (36). and other the release (39). as well as in a northwestern plume extending to about 50 km. releases occurred would be expected to receive about 1 Initially.snmjournals. after the significant March 12. Downloaded from jnm. As of April 29. For personal use only.36). Although at least 200.to 20-km radius. 52 • No. that is. at background levels.2–1.38). Those who did evacuate before plant locations) and b-particles deposited on skin. In an effort mata Town.

0. of March. were also found to be contaminated with 131I. Plans have been announced for a large-scale study of the environmental and health effects of radioactive contami- nation from the nuclear plant (44). with a concomitant change in management from strategies driven mainly by urgency (i.6–1 MBq/m2. cultural. particularly on the part of TEPCO. there will be a transition from the current emergency-response situation to a chronic-exposure sce- nario. the foodstuff and water protective-action (47). onstrating that a suitable value in long-term postaccident Later. several towns and villages did detect 131I in From the radiologic health perspective.000 3. resulted. especially to the thyroid. and political issues (45). long-term radiation levels around Fukushima has proven 134Cs.snmjournals.000 137Cs 200 500 500 2.000 134Cs 200 500 500 1. For personal use only. additional food sources were measured and other situations is 1 mSv/y (45).3–0. the International drinking water (e.000 Bq/L recorded in the Commission on Radiological Protection suggests that a village of Iitate just beyond 30 km northwest of Fukushima) reference level for the optimum protection of people living (42). limits were likely appropriately conservative. social.000 2. Nonetheless.3 MBq/m2.g. selection of levels foods. early protective actions taken by Japanese authorities likely miti- gated exposures of the public to released radioactive iodine and cesium.1. hatched line 5 no aerial data. ethical. of permissible exposures and public dose limits for the like fish). darker blue 5 . yellow 5 1–3 MBq/m2.000 FUKUSHIMA ACCIDENT RESPONSE PERSPECTIVES • Dauer et al. LONGER-TERM PROTECTIVE ACTIONS RGB Over time. lighter agement strategies will need to address all relevant health. onto facilities.. the relocation of individuals. Despite some initial confusion and miscal- culation. psycho- logic. Also. 1429 . with past experience dem- with 131I at levels exceeding the protective-action limits.e. Longer-term protective- action guidance around the Fukushima Daiichi nuclear FIGURE 4. within several days after the initial releases. However. in particular mushrooms and sand lances (small eel. remediation of soils and vegeta- TABLE 4 Protective-Action Activity Concentration Limits (in Bq/L or Bq/kg) on Food and Drinking Water Imposed by Japanese Officials After Fukushima Daiichi Nuclear Facility Event Nuclide Water and milk Vegetables Meat and fish International Atomic Energy Agency limits for all food 131I 300 2. aerial monitoring. based on contamination from deposition onto soils. in contaminated areas should be selected in the lower part milk and leafy vegetables were apparently contaminated of the 1–20 mSv/y range (46). Downloaded from jnm.. Longer-term man- 3–30 MBq/m2. Geographic distribution of radioactive cesium fission facility will likely be needed to deal with 134Cs and 137Cs products after Fukushima Daiichi nuclear facility accident. blue-green 5 0. and 137Cs at levels exceeding their respective limits to be difficult and has met with considerable criticism (15). X 5 Fukushima.6 MBq/m2. This result is in marked contrast to the Cher- nobyl nuclear reactor accident. particularly in the area of childhood protection (21). Dose reduction strategies in such a situation may include The International Commission on Radiological Protec. for which protective actions were not implemented in a timely fashion and large public exposures. environmental. emergency exposure situations should be set in the range of 20–100 mSv to the public and that projected doses approaching 100 mSv will almost always justify protective measures (43). decontamination of buildings tion has stated that the initial dose action levels for and other infrastructure. red 5 and in water (especially on-site water). economic. up to .org by Indonesia: J of Nuclear Medicine Sponsored on June 17. mental health. 2014. to avoid poten- tially high levels of exposure) and predominantly central- ized decision making to more decentralized strategies directed toward reducing exposures to as low as reasonably achievable given the circumstances. green 5 0. of the initial severity of the environmental releases of radioactivity.

(49). with the and the effects of modifying factors such as the amount of former including low-dose effects such as induction of dietary iodine remain uncertain. In marked contrast. Of course. Since these early reports. only 6 y cial effect on decreasing the total radiation dose to the thy- after the Chernobyl accident (49). effective than external radiation in causing thyroid cancer. and other deterministic effects. In Belarus. there was widespread contamination from other low overall effectiveness if KI is taken 6 h or longer after an radionuclides. respectively. dietary levels in low environmental releases of radioactivity (. 3) (48). compared with 4. will approach those associated with the Chernobyl nuclear that radioiodines (in particular 131I) are perhaps 2. for radioassay). its sequelae otherwise.006 adult and 508 the order of 1 Gy [100 rad] or more.snmjournals. In any case. however ous radiation protection measures at an early stage.g. Epidemiologic studies have shown a Fukushima Daiichi nuclear facility and resulting health statistically significant dose–response relationship between effects are uncertain. taken in malities are likely not stochastic. environmental releases of radioactivity from the stricken est risk (Fig. Among other considerations. In the scenario of a nuclear power plant that releases nonthreshold dose–response model. radioiodine (48. acute exposure. for example. and in con- less effective (on a per-rad basis) in inducing thyroid cancer trast to Chernobyl. for individuals on an iodine-deficient diet through the pasture–cow milk–human pathway and in the (. (several hundred rads) (49). However. the infrastructure and radiation exposure. 3). oral KI. but risk estimates be classified as either stochastic or deterministic. 2014.342 adult and 7 childhood thyroid cancers and occupational range on the order of 100 mSv [10 rad] or were reported in the 10-y period before the Chernobyl nu- less whereas the former are in the therapeutic dose range on clear reactor accident. there have been com- health surveillance. roid (52). if the exposure to radioiodine is The first reports of increases in thyroid cancer risk in protracted. management of waste. Japanese officials instituted fairly rigor- than external radiation. KI taken up to 48 h before 131I surrounding general population (49).1. birth cohort thyroid cancer and the latter including high-dose effects studies. This was the case ation countermeasure only for internal contamination with even in a worst-case radioiodine-release scenario such as radioactive iodine. such as the induction of hypothyroidism them efficiently. tion. to the general public) of a breach-of-containment priate time. guidance. thyroidal effects adequate quantities (65–135 mg in adults) and at the appro- offsite (i. even delayed administration may have a benefi- children thus exposed were published in 1992.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. with addition. It appears. For personal use only. The protective effect of KI blockade The Three Mile Island nuclear reactor accident resulted is affected by at least 2 highly variable factors.) Factors that affect the childhood thyroid cancers reported during the 9-y period response of the thyroid to radiation include sex and age at the after the accident (49). 9 • September 2011 .1 TBq of iodine (expected to be relatively high in the case of the [. Although the ultimate magnitude of time of exposure (Fig. doses. greatly reduce the thyroid absorbed dose. the former typically include doses in the diagnostic for example. KI taken large amounts of radioactivity. Functional effects of radi. since functional abnor. this remains controversial. with an surrounding general population as high as several grays iodine-sufficient diet ($150 mg/d) and by 95% and 85%. In an event with a significant radioactive iodine 1430 THE JOURNAL OF NUCLEAR MEDICINE • Vol.to 3-fold reactor accident. 30 Ci] of 131I). and no demonstrable health effects among the to radioiodine internalization. of an association between radioactive iodine exposure after iodine) effects on the thyroid is extensive. provision of information. with young children being at great. low radiation exposures (well under 1 Japanese population) and the time of administration relative cGy [1 rad]). instruction and equipment (e. KI is effective as a radi- tion of benign or malignant neoplasms. radioactive material to the environment. There is also a risk of benign thyroid nodules after despite the rigor of recommendations. KI taken 96 h or more before 131I exposure will absence of appropriate protective measures such as early have no protective effect.. have revealed a large increase in thy- such as induction of hypothyroidism. with thyroidal doses among children in the uptake by approximately 90% and 75%. These reports were ini.50–52). can almost completely block thyroidal uptake of nuclear reactor event are likely restricted to possible induc.50 mg/d). it has no effect on radiation exposure or the Chernobyl nuclear reactor accident. however. provision of noncontaminated period and the prevailing opinion that 131I was much less foodstuffs. (Although there is no roid cancer incidence after the accident in young Ukrainian rigorous distinction between “low” and “high” radiation children exposed to the fallout from Chernobyl.85 EBq (50 24 and 48 h before 131I exposure reduces the 24-h thyroid MCi) of 131I. changes in animal husbandry. the protective effect embargoing of contaminated milk and other foodstuffs.e. but the magnitude and dose dependence transportation issues that immediately followed the tsunami of that risk are less well known.Downloaded from jnm. 52 • No. Nonetheless. likely do not follow a linear. the Chernobyl nuclear reactor accident in Ukraine released therefore. however. it currently appears unlikely that they radiation exposure and thyroid cancer. Further. exposure can almost completely block thyroid uptake and. In decreases rapidly with time after radioiodine exposure. principally 137Cs.. 1. However. and education (45). disaster may have made it difficult to actually implement ation on the thyroid. These occurred primarily respectively. prehensive ongoing efforts to improve thyroid dosimetry and to follow the exposed population to determine the THYROID RISKS AND KI effects of the exposure. Such effects can childhood exposures and thyroid cancer. monitoring of the en. There is now compelling evidence The scientific literature on radiation (including radio. tially received with skepticism because of the short latency vironment and produce. including over 1.

Available at: http://in. Avail- able at: http://www. Fukushima Dai-ni NPP and Tokai NPP. fore.de/ international/world/0. therefore. every piece of wisdom we can get. Saoshiro S. release.55) will similarly take years to fully delineate. Department of Nuclear Engineering KI or with products containing iodide as a precaution against University of Berkeley Web site.S. the American Thyroid Prime Minister of Japan and His Cabinet. 2011.de/international/ tions.000 persons (4. and permanent a survey of the thyroids of 1. DC: U. 1431 . sionally cause side effects such as inflammation of the sali. JAIF Web site. Information update on Fukushima nuclear power station. KI administrations should be recommen. McKenna T. and addi. IAEA.jp/ foreign/kan/topics/201106/iaea_houkokusho_e. Available at: http://www.channelnewsasia. in excess of 0. Association. 2011. and potassium-sparing diuretics. Published March 17. For personal use only.who. The number and timing of KI doses actually the infusion of corrosive sea water into the reactor core. A hapless Fukushima clean-up effort: “we need or hypothyroidism. Krolicki K. TEPCO finalizes plan to cool down reactors. 1988.com/stories/afp_asiapacific/ view/1117111/1/. 2011. Health Organization cautioned against self-medicating with 3.N. 10. Fukushima Dai-ichi II receptor blockers.or. urges Japan nuclear safety overhaul after Fukushima. 2008. 2011. Importantly. Hackenbroch V. Nuclear power plant fuel. 2011. Japan: protective measures continue.com/article/2011/06/01/idINIndia- damage to the thyroid exceeds the risk of side effects. Japan (east coast of Honshu) tsunami.spiegel. health impact. nuclear radiation (56). and potentially affected areas early in the emergency. and long-term environmental and health thyroid doses (4. 2011. INES.080 children living in areas radiologic control of units 1–4 will likely take years. 2011. Chernobyl accident—and exposure rates in excess of 10 15. especially certain types of cardiovascular medications world/0. U. debate on preparedness before the event.000 inhabitants from the vicinity of the site block uptake of radioiodine by the fetal as well as the mater. With sponders.int/hac/crises/jpn/en/index. 2011. Washington. However.nuc. World Health Organization Web site. 2011. Three Mile Island accident but less than those from the Nuclear Regulatory Commission. it appears that ded for the duration of the release of radioactivity. 2005. as KI can occa.000 doses of KI to Japanese officials (54). Available at: http://www. Published April 4. Published March 15. Source Term Estimation During Incident Response to Severe Nuclear Power Plant Accidents: NUREG-1228.00.org/newscenter/news/tsunamiupdate01. 57416220110601. 2011. NOAA the United States) who took KI in response to the radiation Center for Tsunami Research Web site. Available at: http:// the facility. Vienna. 2.com vary glands. 6. Avail- mSv (1 mrem)/h generally extending to about 30 km from able at: http://www. 7751109. 8. possible severe allergic reactions or hyperthyroidism 7. Available at: http://nctr. Fukushima nuclear accident update log. Several professional societies. 2011.html. 2011. Accessed July 6.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. although Web site.edu/ node/3110. Accessed July 6. MCNP: A General Monte Carlo N-Particle Transport Code. Accessed (57). the American Associ. radioactivity—apparently far greater than those from the 14. Available at: http://www. Even in the best-case scenario.” Available at: http://www. REFERENCES gency protection zones in Japan and elsewhere (including 1. a region where some of the highest situation at the Fukushima Daiichi nuclear facility thus levels of terrestrial fallout have been seen. 2011. Fukushima Daiichi nuclear facility in Japan has resulted in 13. Austria: International Atomic Energy Agency. tion exposure situations in which the risk of radiation-induced Reuters Web site.spiegel. Although there is ongoing Updated July 5. Report of Japanese Government to the IAEA ministerial conference on nuclear ing the Society of Nuclear Medicine. Accessed July 6. on such foodstuffs.nei. KI administration should be reserved for specific radia. the risk of addi- 230. Appropriate use of KI is important. July 6. 16. a complete Fukushima Daiichi nuclear facility and to emergency re. Published June 2. safety: the accident at TEPCO’s Fukushima nuclear power stations. NEI Web site. Accessed July 14. with appropriate key actions were taken by the Japanese author- repeated doses given at 24-h intervals until the population ities during the event to effectively mitigate the radiologic is evacuated from the area or the releases cease. KI should not be taken in the absence of a clear risk of 5. Mark I Containment Report: March 19. Available at: http://www.kantei.noaa.html. 2011. There. Version 5.reuters. 2011.html. Meyer C.00. 2011. channelnewsasia.36). and the Endocrine Society. show minimal remains fluid. Accessed July 6. 2011—Whitepaper. FUKUSHIMA ACCIDENT RESPONSE PERSPECTIVES • Dauer et al. KI can also interact with other medica. rare. 2011. 2011: main event page. angiotensin ing the Great East Japan Earthquake and Tsunami: Tokyo. The damage to the earthquake. NM: Los Alamos National Laboratory. Accessed July 6. Thielke T.gov/ leaks from the Fukushima Daiichi nuclear facility although honshu20110311/. Web site of ation of Clinical Endocrinologists. rashes. IAEA International Fact Finding Expert Mission of the Nuclear Accident Follow- such as angiotensin-converting enzyme inhibitors.55).berkeley. and scanning The International Atomic Energy Agency made available of over 190.html.07 mSv h21. the taken by the Japanese population remain unclear. includ. not specifically directed to do so by authorities. 2011.and tsunami-stricken 12. tional KI was distributed to individuals in the vicinity of the releases persists. tional fuel damage and of further. mon- nal thyroid and effectively reduce the potentially high doses itoring of food and water and placement of radiation limits to the fetal thyroid (53). 2011. However. and. Japan—24 May–1 June 2011. Published June 1. Austria: International Atomic Energy Agency.Downloaded from jnm. distribution of stable KI. DC: fuel damage and substantial environmental releases of Nuclear Energy Institute.jp/english. Updated June 18. China urges Japan’s openness amid panic buying of salt. Giitter J. intestinal upset. rates extending beyond 30 km.org Web site. March 11. Accessed July 6. 1518. 9.pmel. NPP. There were several reports of people outside the emer. perhaps substantial.org/howitworks/ CONCLUDING REMARKS nuclearpowerplantfuel/. cold shut-down will likely require 6 or more months. facility is no doubt permanently disabled. nausea. Wagner W. 2011. 11. suggesting that large intakes of 131I had not occurred in this group (21). KI readily crosses the placenta and will tion of over 200. Accessed July 6.snmjournals.go. Available at: http://www.jaif. the International Nuclear and Radiological Event Scale User’s Manual. emphasized that Accessed July 6. Problematic public relations: Japanese leaders leave people in the exposure to a potentially dangerous level of radioiodine dark. Los Alamos. 754868. Accessed July 6. with some specific areas of higher exposure www. Spiegel Online International Web site. These actions include an organized evacua- in pregnant women. 2014.html. The northwest of the plant. Measurements revealed no dose rates impacts (8. 4.html.iaea. Washington. 1518. The World Vienna.

2011. Grier P. tion Web site. World Health Organiza- as of March 20th.neimagazine. Accessed July 6.com/all/dow-jones/asia-pacific/201106060452/ 51. Ann ICRP.int/NR/rdonlyres/ 25. 2008. Published April 30. Accessed July 6.html. 9 • September 2011 . radiation/ki.com/2011/05/01/world/asia/ lished March 26. 2011. 2011. 2011. Published April 8. Department of Energy. ENGNEWS01_1303901476P. TEPCO Web site. Japan races to restart reactors’ cooling system. For personal use only.pdf.morningstar.snmjournals.html. Rockville. 53. Asahi.jp/english/. 18. April 16. 2011. Criteria for Use in Preparedness and Response for a Nuclear or Radiological 24. Times Web site. fukushima-may-13-2011/.org/RS_No_significant_damage_to_fuel_at_unit_4_3004111. Washington.html. 2011. Published March 18. 2011.pdf. Focus on food safety and water quality. Advance Copy. Accessed July 6. Accessed July 6. Fukushima faced 14-metre tsunami. Nuclear meltdown at Fukushima plant. 17. living in long-term contaminated areas after a nuclear accident or a radiation 28. 2011. 2011. 2011. National Research Council of the National Academies. CDC Web site.or.html.S. April 27.nisa. 2011. Organization Web site.meti. Published April Forum. 2011.who.jp/japan.nei.meti.37:1–332. Food and radiologic and nuclear terrorism as public health threats: preparedness and re.org Web Ionizing Radiation.S.org by Indonesia: J of Nuclear Medicine Sponsored on June 17. Academy of Sciences. GSG-2.telegraph. Accessed July 6. Links JM. 2011. 40.nisa. Boice JD. Understanding cies. Earthquake report—JAIF.html. 2011. Na- 101-What-is-a-nuclear-reactor-meltdown. Blodgett DW. Published May 13. Published 27. Guidance: Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergen- 32. Japan’s prime minister defends handling of crisis. Vienna.co. 2011. Accessed July 6. asahi. com/story. Tokyo doubles estimate for total radiation release in 1st week after quake. Scholars eye extensive study on nuclear crisis. 01japan. Accessed July 6. Available at: http://www. 2011. 19/world/asia/19japan. 39. International Atomic Energy Agency.asp. Accessed July 6. 2001. Accessed July 6. No. 159. Barnett DJ. and the Society of Nuclear Medicine—March 18. Nature.co. 2011. Available at: http://www.S. United State House of Representatives Committee on Science. Accessed July 6. 41. Application of the Commission’s recommendations for the protection of people in 26. 2011. CNN. 55. Space Clinical Endocrinologists. National Council on Radiation Protection and Measurements. 2007. Phase 2—Committee to Assess Health Risks from Exposure to Low Levels of 54.nytimes. CDC Web site. 2003.cdc. WNN Web site. Accessed July 6.wpro. Handling of Food Contaminated by Radioactivity: March 17 Press Release. Austria: Nuclear Engineering International Web site. Fukushima health risks scrutinized. Available at: http://www. News release: INES (the International Nuclear and Radiological Event Scale) 48.org/newscenter/news/2011/tsunamiupdate01.39:1–73. The Telegraph Web site. World Health 2011.tepco. Available 17. Nuclear and Industrial Safety Agency Seismic Damage Information: The 74th ima Area: May 13 Update. Available at: http://www. 2011. Available at: emergency exposure situations: ICRP publication 109. 2014. Research Division on Earth and site.go. Radiation and potassium iodide (KI).or. Updated March 17. Guidelines for Iodine Prophylaxis Following Nuclear Accidents.com/USA/2011/0314/Meltdown. Accessed July 6. Tokyo.jp/en/press/corp-com/release/ 45.gov/radiation/japan/ki. 2011. Wakeford R. Reston. 2011:84. Countermeasures for the great east Japan earthquake. MD: www. 2011. Published April 30. 2011. Swit- 33. Accessed July 6. Ann ICRP.S. Fukushima. Japan confirms. 2011.jp/cgi-bin/nn20110416a4. Geneva. 52 • No. Application of the Commission’s recommendations to the protection of people betu11_e/images/110524e14. cdc.gov/ 000065/tokyo-doubles-estimate-for-total-radiation-release-in-1st-week-after-quake. Subcommittees on Energy and Environment and Investigations Society.co. 2011. Available at: http://www. 2011. congressionaltestimony/testimony-on-nuclear-energy-risk-management-after- Published March 23. Fukushima Daiichi plant is running out of wastewater storage space (updated). Available at: http://emergency. Accessed July 6. Published April 12. 19. 65:20:00. Available at: http://news. 57. Accessed July 6. 23. http://www. Ground Based and Aerial Monitoring Results: Data from March 30–April 03— Monitor Web site. DC: National Academies Press. 2011. 44. No significant damage to fuel at unit 4. Available at: http://search. Nuclear and Industrial Safety Agency Seismic Damage Information: The 36th Release 56. Web site. of Nuclear Medicine. Belson K. May 13. 29.pdf. NISA Web site.6. Ann ICRP. 2011. Radia- rating on the events in Fukushima Dai-ichi nuclear power station by the Tohoku tion disasters and children. Ryall J.html. Potassium iodide (KI). Bradsher K. 2011. Washington. NISA Web site.iaea.uk/news/worldnews/asia/japan/8509502/Nuclear-meltdown. zerland: World Health Organization. Available at: http://www. Available at: http://emergency. Radiological Assessment of Effects from Fukushima Daiichi Nuclear Power 22. Updated April 13.47:1653–1661. 2008.asp?storyCode52059351. 46. And now. 38. Published June 6. The 2007 recommendations of the International Commission on Radiological nuclear. Japan. CNN World emergency: ICRP publication 111. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII. Labour and Welfare. Center for Drug Evaluation and Research (CDER).org/publicpolicy/ world-nuclear-news. 2011. Available at: http:// 49. NEI Web site. 52.asahi.html. tional Nuclear Security Administration. 2006. Available at: http://www. DC: United States Department of En- Release as of April 5th. 2011. The Japan Times Online Web site. Life Studies. sion. Emergency: General Safety Guide No. Available at: http://www. 2009. 30. Pediatrics. Tokyo. 2011. 50. 2011. Fackler M. J Radiol Prot. Butler D. IAEA update on Japan earthquake: iodine distribution. Nuclear Safety Commis- world-nuclear-news.go. Fukushima Daiichi. Available at: http://www. Department of Health and Human Services.com/2011/WORLD/asiapcf/06/06/japan.39:1–69. 2011. J Nucl Med. Protection: ICRP publication 103. Japan: Ministry of Health. U. Plant: April 18. Available at: http://www. WHO warns against self-medicating against radiation. March 14. Published May 12. Wierzba RK.asp.jaif. 2011. 2006. American Academy of Pediatrics Committee on Environmental Health. 34.com Web 47. National html.pdf.com/english/TKY201103250204. 1999. Accessed July 6. IAEA. VA: Society and Oversight. WNN Web site. Inc. Pub. DC: U.aspx. WHO/SDE/PHE/99. April 17. 2011. Available at: http://www. Accessed July 6. Radiation Risks to Health: A Joint Statement from the American Association of 36. Washington. Published March 14. Published May 23.31:167–176.html. the Endocrine and Technology. Accessed July 13. WHO SITREP no 24. 2011. Published March 35. 43. Accessed July 6. Available at: http://www. Parker CL. 31. Testimony on nuclear energy risk management after Fukushima. DC: U. Radiation from Fukushima exceeds Three Mile Island.nytimes. 2011. Meltdown 101: what is a nuclear reactor meltdown? The Christian Science 37. 2011.472:13–14.jp/english/news_images/pdf/ 4. Department of Energy.Downloaded from jnm.meltdown/index. Risk to the thyroid from ionizing radiation: NCRP report no. 2011. 2011. 2011. Special report: Fukushima Daiichi. Board of Radiation Effects. Japan: Nuclear and Industrial Safety Agency. Department of Energy Releases Radiation Monitoring Data from Fukush- 20. 2011. Tabuchi H.jp/english/files/en20110412-4. Accessed July 14. ergy. district—off the Pacific Ocean earthquake. 1432 THE JOURNAL OF NUCLEAR MEDICINE • Vol. MD: U. Updated March 18. Obe M. at-Fukushimaplant. sponse perspectives. at: http://www.japantimes.com/2011/03/ Security Administration. Accessed July 6.html. 2011. Available at: http://www. 2011. 2011.cnn. Available at: http://www.who. 3 nuclear reactors melted down after quake.org/RS_Fukushima_faced_14-metre_tsunami_2303113. Japan Atomic Industrial C8F59957-A7B5-4008-B903-79A8BCC6F8DD/0/Sitrep24. Published June 7. Washington. National Nuclear The New York Times Web site. 2011. Bethesda. 2011. Status of cores at units 2 and 2 in Fukushima Daiichi nuclear power station. The New York site. Drug Administration.csmonitor. 42. 2011. 2011. the American Thyroid Association. Tokyo. Japan: Nuclear and Industrial Safety Agency. 21.111:1455–1466. Nuclear News. Web site. 2011. 2011.