Caution sign Caveats about Countermeasures for
Treatment of Internal Radiation Contamination

Information Sources

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General Caveats

  • This table is intended as a guide to the selection of medical therapy, and does not represent official policy of HHS.
  • Most of the medical countermeasures listed in this table have not been approved by the US Food and Drug Administration (FDA) for the listed use.
  • For FDA-approved drugs, consult the official package insert for detailed prescribing information.
  • For details concerning the use of non-FDA approved drugs, consult the NCRP 161 reference cited above. This table presents summary data included in that monograph.
  • Off-label use of medical countermeasures or use of non-FDA approved drugs to treat internal contamination carries an unknown risk-benefit ratio and warrants extreme caution.
  • Except as indicated in the official package insert, there is very little information about using these medical countermeasures in infants and children.
  • Decisions to use medical countermeasures to treat internal contamination should be made in conjunction with medical radiation or medical toxicology experts.

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Clinical Issues

  • Treatment of internal contamination
    • Is based on the radionuclide(s) involved (see tables)
    • Should occur in consultation with a professional who is knowledgeable about treating radiological injuries such as a hospital Radiation Safety Officer, nuclear medicine physician, radiation oncologist, and/or a toxicologist
  • Therapeutic objectives
    • Decrease radiation absorbed dose
    • Reduce the risk of future biological effects.
  • Many of the countermeasures listed in the table on REMM have an unfavorable risk-to-benefit ratio when used to treat persons having low levels of internal contamination.
  • Most authorities do not recommend treatment of internal contamination when the body burden is less than one annual limit of intake (ALI)8.
  • Treatment is strongly recommended when the body burden exceeds 10 ALI.
  • For internal contamination levels greater than 1 ALI and less than 10 ALI, clinical judgment dictates treatment of internal contamination.

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Conceptual Issues

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  1. 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.
  2. Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008.
  3. Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases (NCRP Report No. 161, Vol. II), National Council on Radiation Protection and Measurements, Bethesda, MD, 2010.
  4. Management of Terrorist Events Involving Radioactive Material (NCRP Report No. 138), National Council on Radiation Protection and Measurements, Bethesda, MD, 2001.
  5. Management of Persons Accidentally Contaminated with Radionuclides (NCRP Report No. 65), National Council on Radiation Protection and Measurements, Bethesda, MD, 1980.


  1. Protecting people against radiation exposure in the event of a radiological attack. (ICRP Publication 96), International Commission on Radiological Protection, 2005.
  2. Limits for Intakes of Radionuclides by Workers (ICRP Publication 30), International Commission on Radiological Protection. (Note: ICRP Publication 30 includes 10 separate documents published between 1979 and 1988. All are listed on ICRP Publications, but online access may be limited to libraries with electronic subscriptions.)


  1. Dose assessment of inhaled radionuclides in emergency situations (Public Health England [PHE], formerly Health Protection Agency [HPA]/United Kingdom and Treatment Initiatives After Radiological Accidents (TIARA) project/European Commission, August 2007)

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