Dr. Robert E. Reiman

"We want to determine people's current practice, and compare and contrast this to the generally accepted guidance for controlling surgical smoke," said Ben Edwards, MS, CLSO, a health physicist in the Radiation Safety division at Duke University Medical Center who designed the survey with his colleague Robert Reiman, MSPH, MD, assistant clinical professor in the department of radiology at Duke University Medical Center.
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This work led Edwards and Reiman to the realization that no U.S. regulatory agencies, including the Labor Department's Occupational Safety and Health Administration (OSHA), explicitly mandates LEV use to control surgical smoke.

By Dr. Robert E. Reiman of Duke University Medical Center.

Robert Reiman, MSPH, MDDuke University Medical Center

But Robert Reiman, a public health physician in the radiation safety division of Duke University Medical Center, noted that thyroid cancer in children is very rare -- less than one case per year per million children.

That risk factor increased to between 30 and 100 cases per million children per year in the Ukraine and Belorussia among children exposed to the 1986 Chernobyl nuclear power plant meltdown, Reiman noted.The event exposed some 17 million people to radioactive fallout, but only a few died as a result.

"Even after an accident, relatively few children would be affected.However, almost all those cases could be prevented with potassium iodide," he said.

The KI tablets are most effective if taken during the first few hours of a radiation release, Reiman said.The compound is effective only against the material known as iodine-131 and has no effect against other radioactive materials that might escape from sources such as a "dirty bomb," he said.

And some people should not take KI tablets at all, he noted.For example, people who have had allergic reactions to X-ray contrast agents may well have iodine allergies, and shouldn't take these tablets even if exposed to radiation.

"The risk of anaphylaxis, a potentially fatal allergic reaction, far outweighs the risk of adverse effects from radiation for allergic individuals," Reiman said.

Also, people with certain forms of thyroid disease should take KI only under a doctor's direct supervision, he said.And pregnant women and newborn infants shouldn't take more than one dose, because repeat doses have been shown to result in an under-active thyroid gland, a condition called hypothyroidism that can impair brain development.

The best way to deal with a radiation release, especially for people who can't take one KI tablet a day for several days, is to evacuate the area according to directions broadcast by public health and emergency officials, Reiman said.That information would be determined by wind direction, severity of the release and other factors that could produce different recommendations for different scenarios.

Though it may be depressing to think about preparing for a terrorist attack or an accident that would require fast access to KI tablets, excess fear also can be damaging, Reiman said.

A terrorist attack or an accidental release of radiation from a nuclear power plant or fuel-processing facility would not produce an atomic bomb-like explosion, he said.Instead, it would be more likely to produce localized radioactive environmental contamination with decreasing intensity at greater distances from the plant.So-called radiation sickness generally would occur only in people on the plant site, within a few hundred yards of the reactor, he said.

Besides Shearon Harris, Carolina Power and Light owns the Brunswick nuclear plant.They and Duke Power Co.'s McGuire and Catawba power stations directly affect North Carolina residents.

"From the perspective of a terrorist," Reiman said, "radioactive materials do not make particularly good weapons, in terms of the number of casualties produced.Instead, the terrorist exploits the fear and disruption that such an attack would cause.The psychosocial and economic damages would far outweigh actual health concerns."

Informed sources

WHO: Robert Reiman, M.D.

EXPERTISE: Reiman, 54, a native of Valparaiso, Fla., is the associate director in the Radiation Safety Division of the Occupational and Environmental Safety Office at Duke University Medical Center and an assistant clinical professor in the Department of Radiology.He received a master's degree in public health in radiation protection from the UNC School of Public Health in 1974 and a medical degree from Case Western Reserve University School of Medicine in Cleveland in 1987.Certified by the American Board of Nuclear Medicine, he is the author or co-author of 21 articles on internal radiation dosimetry and the development of diagnostic radiopharmaceuticals for positron-emission tomography.Reiman lives in Durham with his wife Sandra.His hobbies include genealogical research.