Home > Contamination: Diagnose/Manage > Managing Internal Radiation Contamination

Managing Internal Radiation Contamination

Isotopes of Interest: Properties, Treatment, and Fact Sheets
Radiation Countermeasures for Treatment of Internal Radiation Contamination

Isotopes of Interest: Properties, Treatment, and Fact Sheets

Information in this table adapted from:

Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008.

View/Print as PDF (PDF - 74 KB)

Isotope	Ionizing radiation decay mode	Radioactive half-life	Major exposure pathways	Focal accumulation	Treatment: References for use	Fact sheets (CDC, ATSDR, EPA, Argonne Natl. Lab, Wikipedia)
Americium (Am-241)	α	458 years	Inhalation Skin	Lungs Liver Bone Bone marrow	DTPA† *	CDC ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia
Californium (Cf-252)	α, γ	2.6 years	Inhalation Ingestion	Bone Liver	DTPA*	Argonne (PDF - 2.34 MB) Wikipedia
Cesium (Cs-137)	β, γ	30 years	Inhalation Ingestion	Follows potassium; renal excretion	Prussian blue, insoluble† *	CDC ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia
Cobalt (Co-60)	β, γ	5.26 years	Inhalation	Liver	Succimer (DMSA)§ (DailyMed) DTPA* EDTA§ N-Acetyl-L-cysteine§	CDC ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia
Curium (Cm-244)	α, γ, neutron	18 years	Inhalation Ingestion	Liver Bone	DTPA† *	Argonne (PDF - 2.34 MB) Wikipedia
Iodine (I-131)	β, γ	8.1 days	Inhalation Ingestion Skin	Thyroid	Potassium iodide† * Saturated solution of potassium iodide§ Propylthiouracil§ Methimazole§ Potassium iodate§	CDC ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia
Iridium (Ir-192)	β, γ	74 days	N/A	Spleen	Consider DTPA* Consider EDTA§	CDC Argonne (PDF - 2.34 MB) Wikipedia
Isotope	Ionizing radiation decay mode	Radioactive half-life	Major exposure pathways	Focal accumulation	Treatment: References for use	Fact sheets (CDC, ATSDR, EPA, Argonne Natl. Lab, Wikipedia)
Phosphorus (P-32)	β	14.3 days	Inhalation Ingestion Skin	Bone Bone marrow Rapidly replicating cells	Hydration + Phosphate drugs Sodium glycerophosphate§ Sodium phosphate§ Potassium phosphate§ Calcium carbonate§ Aluminum hydroxide§ Aluminum carbonate§ Sevelamer§ (DailyMed)	Wikipedia
Plutonium (Pu-239)	α	24,100 years	Inhalation (limited absorption)	Lung Bone Bone marrow Liver Gonads	DTPA§ DFOA§ EDTA§ DTPA + DFOA§	CDC ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia IEER
Polonium (Po-210)	α	138.4 days	Inhalation Ingestion Skin	Spleen Kidneys Lymph nodes Bone marrow Liver Lung mucosa	Gastric Lavage Dimercaprol (BAL)* Succimer (DMSA)§ (DailyMed) D-Penicillamine§ (DailyMed)	CDC Argonne (PDF - 2.34 MB) HPS (PDF - 492 KB) NRC Wikipedia More references
Radium (Ra-226)	α, β, γ	1,602 years	Ingestion	Bone	Aluminum hydroxide* Barium sulfate* Sodium alginate§ Calcium phosphate§	ATSDR EPA Argonne (PDF - 2.43 MB) Wikipedia
Strontium (Sr-90)	β	28 years	Inhalation Ingestion	Bone	Inhalation: Calcium gluconate§ Barium sulfate§ Ingestion: Rx is the same as for radium (see above). Additional Rx may include stable strontium compounds: Strontium lactate§ Strontium gluconate§	CDC ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia
Isotope	Ionizing radiation decay mode	Radioactive half-life	Major exposure pathways	Focal accumulation	Treatment: References for use	Fact sheets (CDC, ATSDR, EPA, Argonne Natl. Lab, Wikipedia)
Thorium (Th-232)	α	1.41 x 10¹⁰ years	Inhalation Ingestion	Bone	Consider DTPA*	ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia
Tritium (H-3)	β	12.5 years	Inhalation Ingestion Skin	Whole body	Water diuresis*	EPA Public Health England (PHE), formerly Health Protection Agency (HPA), (UK) Wikipedia
Uranium (U-235)	α	7.1 x 10⁸ years	Inhalation Ingestion	Kidneys Bone	Sodium bicarbonate* For high level intake consider off-label diuretics and/or dialysis§	CDC ATSDR EPA Argonne (PDF - 2.34 MB) Wikipedia
Yttrium (Y-90)¶	β	64 hours	Inhalation Ingestion	Bone	DTPA* EDTA§	Argonne ¶ (PDF - 2.34 MB) Wikipedia

References for use
† FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA).

* NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).

§ NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).

See also:

Summary of Radioactive Properties for Selected Radionuclides (PDF - 2.34 MB) (Human Health Fact Sheet, Argonne National Laboratories, 2005)
Radiological and Chemical Fact Sheets to Support Health Risk Analyses for Contaminated Areas (PDF - 2.34 MB) (Argonne National Laboratories, 2007)
The Regulation and Use of Radioisotopes in Today’s World (PDF - 1.1 MB) (NRC, April 2020)
Radiological Sources of Potential Exposure and/or Contamination (PDF - 3.1 MB) (US Army Public Health Center, TG-238, January 2020)
- This document provides details about radioisotopes of potential concern and where they are used. It updates the TG-238 document from 1999.

More Polonium-210 references

Nathwani AC, Down JF, Goldstone J, Yassin J, Dargan PI, Virchis A, Gent N, Lloyd D, Harrison JD. Polonium-210 poisoning: a first-hand account. Lancet. 2016 Sep 10;388(10049):1075-80. [PubMed Citation]
Factsheets: Polonium-210 (IAEA)
Understanding Radiation - Topics: Polonium 210 (Public Health England [PHE], formerly Health Protection Agency [HPA])
Individual Monitoring Conducted by the Health Protection Agency in the London Polonium-210 Incident (Public Health England [PHE], formerly Health Protection Agency [HPA])
Jefferson RD, Goans RE, Blain PG, Thomas SH. Diagnosis and treatment of polonium poisoning. Clin Toxicol (Phila.) 2009 May; 47(5):379-92. [PubMed Citation]
Harrison J, Leggett R, Lloyd D, Phipps A, Scott B. Polonium-210 as a Poison. J Radiol Prot. 2007 Mar;27(1):17-40. [PubMed Citation]
Scott BR. Health risk evaluations for ingestion exposure of humans to polonium-210. Dose Response. 2007 Apr 20;5(2):94-122. [PubMed Citation]

¶ For Yttrium-90 radioactive properties and health concerns, see Strontium-90 Human Health Fact Sheet

top of page

Radiation Countermeasures for Treatment of Internal Radiation Contamination

Medical countermeasure information in this table adapted from:

Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008.
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.
FDA drug information related to radiation emergencies

Caution sign Caveats about Radiation Countermeasures for Treatment of Internal Contamination

View/Print as PDF (PDF -270 KB)

References for use
FDA approved: Countermeasures so marked have been approved as treatment for internal contamination with the listed radioisotope by the US Food and Drug Administration (FDA).

NCRP preferred: Countermeasures so marked have been listed as preferred treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Except where noted, use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).

NCRP suggested: Countermeasures so marked have been listed as suggested treatments for internal contamination with the listed radioisotope by the National Council on Radiation Protection and Measurements [Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been approved by the US Food and Drug Administration (FDA).

NCRP suggested/preferred medical countermeasures	Administered for	Mechanism of action	Route of administration	Dosage	Duration of treatment	References for use
FDA approved medical countermeasure	Administered for	Mechanism of action	Route of administration	Dosage	Duration of treatment	References for use
REMM DTPA page has more details FDA drug labels: Ca-DTPA, Zn-DTPA Hameln Pharmaceuticals: Ca-DTPA package insert, Zn-DTPA package insert	Americium (Am-241) Curium (Cm-244) Plutonium (Pu-238 and Pu-239)	Chelating agent	IV (give once daily as a bolus or as a single infusion, i.e., do not fractionate the dose)	Adults and adolescents: 1 g in 5 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS) slow IV push over 3-4 minutes or 1 g in 100-250 cc D5W or NS as an infusion over 30 minutes Children < 12 years: 14 mg/kg/d slow IV push over 3-4 minutes (not to exceed 1 g/day)	Begin treatment with Ca-DTPA , then change to Zn-DTPA for maintenance, as indicated Duration of therapy depends on total body burden and response to treatment	DTPA is FDA-approved for intravenous Rx of known or suspected internal contamination with Am, Cm, and Pu only DTPA is FDA-approved for nebulized inhalation in adults only, and if the only route of contamination is through inhalation
		Chelating agent	Nebulized inhalation (for use in adults only)	1 g in 1:1 dilution with sterile water or NS over 15-20 minutes
Potassium iodide (KI)	Iodine (I-131)	Blocking agent	PO	Adults over 40 years: 130 mg/day (For projected thyroid dose ≥500 cGy) Adults over 18 through 40 years: 130 mg/day (For projected thyroid dose ≥10 cGy) Pregnant or lactating women : 130 mg/day (For projected thyroid dose ≥5 cGy) Adolescents ≥ 150 lbs: 130 mg/day (For projected thyroid dose ≥5 cGy) Adolescents, 12 through 18 years: 65 mg/day (For projected thyroid dose ≥5 cGy) Children over 3 years through 12 years: 65 mg/day (For projected thyroid dose ≥5 cGy) Children 1 month through 3 years: 32 mg/day (For projected thyroid dose ≥5 cGy) Infants birth through 1 month: 16 mg/day (For projected thyroid dose ≥5 cGy)	Some incidents will require only a single dose of KI. Incident managers may recommend additional daily doses if ongoing radioactive iodine ingestion or inhalation represents a continuing threat. See also: Potassium Iodide (KI): Duration of Therapy.	FDA-approved
Prussian blue, insoluble	Cesium (Cs-137)	Ion exchange; inhibits enterohepatic recirculation in GI tract	PO	Adults, children >12 years: 1-3 g (2-6 capsules; 0.5 g insoluble Prussian blue per cap) TID; up to 10-12 g/day (based on Goiânia incident data) 3 g (6 capsules; 0.5 g insoluble Prussian blue per cap) TID (see: FDA Package Insert ) Children 2 - 12 years: 1 g (2 capsules; 0.5 g insoluble Prussian blue per cap) TID Capsules may be opened and contents mixed with food See: FDA Package Insert for pediatric prescribing information Children <2 years: Prussian blue is not FDA-approved for use (IND or EUA may be required)	Minimum 30 day course per FDA Obtain bioassay and whole body counting to assess treatment of efficacy Duration of therapy depends on total body burden and response to treatment	Prussian blue, insoluble, is FDA-approved for Rx of known or suspected internal contamination with radioactive Cs and/or radioactive or non-radioactive thallium; FDA-approved for ages > 2 years old only
Aluminum carbonate	Phosphorus (P-32)	Phosphate binder	PO	600 mg tablet TID or 400mg/5 cc TID		NCRP-suggested
Aluminum hydroxide	Radium (Ra-226) Strontium (Sr-90)	Blocks intestinal absorption	PO	Adults: 60-100 mL (1200 mg) Children: 50 mg/kg, not to exceed the adult dose	Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs	NCRP-preferred
Aluminum hydroxide	Phosphorus (P-32)	Phosphate binder	PO	600 mg tablet TID or 320 mg/5cc TID		NCRP-suggested
Barium sulfate	Radium (Ra-226) Strontium (Sr-90)	Blocks intestinal absorption	PO	100-300 g (as a single dose in 250 cc water)	Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs	NCRP-suggested
Calcium carbonate	Radium (Ra-226) Strontium (Sr-90)	Competes for bone binding sites	PO	Use as directed on label	Begin therapy within 12 hr of radionuclide intake if possible	NCRP-suggested
Calcium gluconate	Radium (Ra-226) Strontium (Sr-90)	Competes for bone binding sites; phosphate binder	IV	5 ampoules (500 mg Ca/amp) in 500 cc 5% dextrose in water (D5W); infuse over 4-6 hours	6 days; begin therapy within 12 hr of radionuclide intake if possible	NCRP-suggested
Calcium phosphate	Radium (Ra-226) Strontium (Sr-90)	Increases excretion	PO	1200 mg	Give one dose within 24 hr of radionuclide intake to block intestinal absorption; administer before absorption occurs	NCRP-suggested
Deferoxamine (DFOA) – AKA Desferrioxamine or Desferal	Plutonium (Pu-239)	Chelating agent	IM (preferred route)	2 ampoules (500 mg DFOA/amp)	Give a single dose, then obtain bioassay to assess residual body burden of Pu-239 Repeat as indicated: 500 mg IM (preferred) or IV q4 hr x2 doses, then 500 mg IVq12 hr for 3 days	NCRP-suggested DFOA is FDA-approved for Rx of acute and chronic iron poisoning only
Deferoxamine (DFOA) – AKA Desferrioxamine or Desferal	Plutonium (Pu-239)	Chelating agent	IV (slow infusion)	2 ampoules (500 mg DFOA/amp) at 15 mg/kg/hr
NCRP suggested/preferred Medical countermeasures	Administered for	Mechanism of action	Route of administration	Dosage	Duration of treatment	References for use
REMM DTPA page has more details FDA drug labels: Ca-DTPA, Zn-DTPA Hameln Pharmaceuticals: Ca-DTPA package insert, Zn-DTPA package insert	Americium (Am-241) Curium (Cm-244) Plutonium (Pu-238 and Pu-239)	Chelating agent	Wound irrigation fluid	1 g Ca- or Zn-DTPA and 10 cc 2% lidocaine in 100 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS)	Irrigation can be accompanied by IV DTPA Amount of DTPA absorbed by wound tissues cannot be measured Avoid overdosing with DTPA and/or 2% lidocaine	DTPA is NCRP-preferred as Rx of the other isotopes listed and NCRP-suggested as a wound irrigation fluid
Dimercaprol (REMM site) (AKA British anti-Lewisite - BAL)	Polonium (Po-210)	Chelating agent	IM (300 mg/vial for deep IM injection only)	2.5 mg/kg QID x2 days (days 1 & 2), then BID x1 day (day 3), then QD (days 4-10)	10 days	NCRP-preferred Dimercaprol (BAL) is FDA-approved for Rx of arsenic, gold and mercury poisoning and when used together with EDTA for Rx of acute lead poisoning only
NCRP suggested/preferred Medical countermeasures	Administered for	Mechanism of action	Route of administration	Dosage	Duration of treatment	References for use
EDTA	Cobalt (Co-60)	Chelating agent	IV	1000 mg/m²/day in 500 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS); infuse over 8-12 hours	Given as a single dose	NCRP-suggested EDTA is FDA-approved for Rx of lead poisoning only
EDTA	Cobalt (Co-60)	Chelating agent	IM	Divide IV dose equally into two doses and administer 8-12 hours apart	Given as a divided dose
D-Penicillamine (DailyMed) AKA Cuprimine®	Polonium (Po-210)	Chelating agent	PO	Adults: 0.75-1.5 g (250 mg/capsule) QD Children: 30 mg/kg/day (250 mg/capsule) divided into 4 doses	Obtain bioassay to assess Continue only if clinically indicated D-Penicillamine has a narrow therapeutic index; use is associated with high risk of toxicity	NCRP-suggested D-Penicillamine is FDA-approved for Rx of copper poisoning only
NCRP suggested/preferred medical countermeasure	Administered for	Mechanism of action	Route of administration	Dosage	Duration of treatment	References for use
Potassium phosphate	Phosphorus (P-32)	Phosphate binder	PO	600-1200 mg, given in divided doses		NCRP-suggested
Potassium phosphate, dibasic	Phosphorus (P-32)	Phosphate binder	PO (take with full glass of water with meals and at bedtime)	Adults: 1-2 tablets (250 mg/tab) QID Children >4 years: 1 tablet (250 mg/tab) QID		NCRP-suggested
Propylthiouracil	Iodine (I-131)	Blocking agent	PO	Adults: 2 tablets (50 mg/tab) TID	8 days	NCRP-suggested
NCRP suggested/preferred Medical countermeasure	Administered for	Mechanism of action	Route of administration	Dosage	Duration of treatment	References for use
Sevelamer (DailyMed)	Phosphorus (P-32)	Phosphate binder	PO	2-4 tablets (400 mg - 800 mg/tab) TID Not to exceed 1600 mg TID	5 days if possible; first dose is the most important	NCRP-suggested
Sodium alginate	Radium (Ra-226) Strontium (Sr-90)	Blocks intestinal absorption	PO (take with a full glass of water)	5g BID x1 day, then 1 g QID		NCRP-suggested
Sodium bicarbonate	Uranium (U-235)	Facilitates increased renal excretion	IV	2 ampoules (44.3 mEq bicarbonate/ ampoule) in 1000 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS) 250 cc (1-2 mEq/kg) slow infusion	Administer therapy until urine pH is 8-9 ; continue Rx for 3 days	NCRP-preferred
Sodium bicarbonate	Uranium (U-235)	Facilitates increased renal excretion	PO	2 tablets Q4 hr		NCRP-preferred
Sodium glycerophosphate	Phosphorus (P-32)		PO	600-1200 mg, given in divided doses		NCRP-suggested
Sodium phosphate	Phosphorus (P-32)		PO	600-1200 mg, given in divided doses		NCRP-suggested
Succimer (DMSA) (DailyMed)	Polonium (Po-210)	Chelating agent	PO	100 mg capsules Administer 10 mg/kg or 350 mg/m² every 8 hr for 5 days, then reduce; safety and efficacy in children <12 years has not been established	Reduce frequency of administration to 10 mg/kg or 350 mg/m² every 12 hr for an additional 2 weeks of therapy; typical treatment course: 19 days	NCRP-suggested DMSA is FDA-approved for the treatment of lead poisoning only
Water	Tritium (H-3)	Facilitates excretion	PO	>3-4 liters/day	3 weeks	NCRP-preferred

top of page