Medical Radiology and Radiation Safety. 2024. Vol. 69. № 3

 

PROMISING ASPECTS OF MEDICAL-BIOLOGICAL SCIENCE AND PRACTICE –

TO THE 100TH ANNIVERSARY OF A.K. GUSKOVA: ADDRESS TO DOCTORS AND SCIENTISTS

 

 

Angelina Konstantinovna Guskova

Doctor of Medical Sciences, Professor, Corresponding Member. RAS

March 29, 1924 – April 7, 2015

 

Guskova Angelina Konstantinovna (1974-2015) – 41 years of scientific and creative leadership of the Clinical Department of Radiation Medicine: Head of the Clinical Department of Radiation Medicine (1974–1996), Chief Researcher (1996–2015). In one of the sections of the book she wrote, “The Nuclear Industry of the Country Through the Eyes of a Doctor” (2004), in the chapter Instead of a conclusion - “Hear the call of the future!”, Angelina Konstantinovna presented aspects of medical and biological science, which, taking into account the accumulated data, can become, in her opinion, , the most promising for the future and require priority development in our country, in the FMBC named after. A.I. Burnazyan and in the Clinical Department of Radiation Medicine, in particular, in connection with the radically changed “set” of the main operating factors in the normal operation of all nuclear enterprises, especially in terms of the specific importance of the radiation component. At the same time, there must be a constant readiness to take adequate action in the event of an emergency situation and, especially, a large-scale radiation accident.

What aspects of medical and biological science, taking into account the accumulated data, can become the most promising for the future and require priority development? Based on the type of work of RERF branches, which were created not in the capital of Japan, but in cities affected by an atomic explosion, systematic, multi-year work should be organized to improve and maximize the filling of the medical and dosimetric register of the industry on the basis of its main enterprises of the nuclear industry and energy industry of Rosenergoatom .

The role of the clinical department of radiation medicine at the central institute in Moscow will be different than before. It should be focused on:

1. Supplementation with dynamic observation data on industry-trained workers working for a long time in contact with ionizing radiation in the nuclear industry and energy sector and closed administrative towns.

2. Formation of periodically changing industry nosological registers (cardiocerebrovascular pathology, psychosomatic diseases, etc.) for targeted clinical study of issues that arise but are not resolved within the framework of dosimetric industry registers.

3. Introduction to the database of information about rarer forms of occupational pathology, which were naturally concentrated earlier in the IBP blade (diseases from exposure to plutonium, polonium, beryllium, dust and toxic bronchopulmonary diseases). It is justified to preserve the sectoral Chernobyl data archive, which operates quite successfully both independently and as a complex in the RSMDR in Obninsk.

Thus, completeness of materials on the long-term consequences of occupational exposure in a wide range of doses and exposure conditions will be ensured (together with the data of qualified hygienists and biophysicists presented in their section). Reasoned assessments of the clinical validity of accepted standards and risk values, especially for situations of long-term chronic exposure, will be given. The contribution of radiation exposure to the complex of long-term health risks for personnel and descendants will be determined.

Another area that requires development and modern technical and drug support is the improvement of clinical programs to provide assistance in case of radiation accidents of various sizes, which are always possible in the industry. The occurrence of chronic diseases can be prevented, but the potential for local and general acute effects in humans cannot be excluded.

An adequate clinical model of these conditions, which allows one to improve the professional level and develop new promising therapeutic agents, is primarily oncohematological diseases. In their intensive care programs, the same techniques and means are used as for radiation sickness: transplantation of hematopoietic cells, growth factors and other means of treating the main complications (infections, multiple organ failure).

This area includes problems of diagnostics and therapy, the most common local radiation injuries in real conditions, with its own scope of diagnostic and therapeutic techniques and the provision of the possibility of retrospective reconstruction of radiation doses.

It is advisable to preserve and develop the work of the experimental group for preclinical testing of drugs and testing ideas that arise during clinical observations.

For the clinic of severe occupational injuries and especially the assessment of subclinical forms of reaction to chronic exposure, methodological guidance on targeted modification of the scope of research during routine and unscheduled medical examinations is of particular relevance. At the same time, the range of techniques based on modern technologies is expanding, and the possibilities for quantitative assessment of a huge volume of information are increasing.

Transformation of directions will require a certain reorientation of medical personnel and a painful “cut-off” of some unpromising structures in institutions. But this should be done, and as soon as possible, including in our institute.

There is a huge, labor-intensive work ahead with the clinical archive, with the digitization of primary documentation. It is necessary to transfer into digital format the most significant part of the information from databases, from medical records and journals (dosimetric and biophysical indicators of specific patients). First of all, this applies to verified cases of radiation sickness and thoughtful expert opinions denying this diagnosis.

References to literature and texts of exam programs for the section of clinical and experimental radiobiology need to be revised and updated. At the same time, it is necessary, due to the growth in the volume of information and the improvement of information technology, to publish collections and books in various electronic formats, and also to use CDs, flash drives and computer hard drives to store information.

Create separate lists and annotations of thematic bibliographies for monographs and publications of a programmatic nature, completed in specialized scientific institutions at the proper methodological level.

The nuclear industry promptly collected and published the personalities of its leading specialists. In radiation medicine and radiobiology, there are only a few fragmentary attempts to fill this gap (S.P. Yarmonenko, partially L.D. Lindenbraten - mainly in the field of medical use of radiation).

There is another pressing issue - the selection and training system to ensure adequate activities of medical units and research institutes serving enterprises in the nuclear industry, energy and specialized scientific institutions based on research reactors and accelerators. The competence of those who currently train specialists in radiation medicine for civil defense services, military medicine and the Ministry of Emergency Situations is hardly adequate.

It should be borne in mind that the “set” of the main operating factors has radically changed under the conditions of normal operation of all nuclear enterprises, especially in terms of the specific significance of the radiation component. The Ministry of Health of the Russian Federation needs to introduce the qualification of a doctor in the specialty “Radiation Medicine”. At the same time, there must be a constant readiness to take adequate action in an emergency situation, and especially in a large-scale radiation accident.

Under these conditions, the training of specialists in the following main options is justified:

Doctors to work in emergency teams and in specialized beds at the nearest and main hospital, where assistance will be provided to victims from the first hours to days after exposure until complete recovery;

Doctors providing clinical examination of contingents working under normal operating conditions of an industry enterprise and (or) living in the region where they are located. This also applies to a routine outpatient medical appointment, as well as, to some extent, the first measures after an emergency situation occurs in the region or a signal about it is received.

Every modern doctor of any specialty working in a hospital or clinic needs a minimum of information on the usual situation in the region and the basic rules for emergency actions in the event of an accident.

The doctor must also be aware of the potential sources of radiation hazard where he works and lives, must know the main manifestations of radiation sickness and MLP, first aid measures, addresses of institutions where he can seek advice and refer victims for consultation with specialists.

Doctors preparing to work in emergency conditions must constantly work in the inpatient department of a large multidisciplinary hospital - as hematologists, infectious disease therapists, transfusiologists,

clinical laboratory assistants who are proficient in methods of taking material from bone marrow and peripheral blood and analyzing them. Surgeons must work permanently in burn departments or in traumatology and plastic surgery departments. However, additional training is also necessary for all of them in courses in occupational pathology and radiation medicine with confirmation of training by the corresponding periodically updated certificate documents. The emergency team also includes specialist hygienists and physicists, most often from municipal SES or specialized institutes located in the region. Since the work is carried out under the guidance of the chief doctors of the hospital and clinic, this dictates the need for special training and health care organizers.

These are the formal criteria by which doctors are selected and the basic minimum requirements for their training. However, in addition to professional culture, social and labor motivation to work in the specified profile, as well as the personal qualities of the doctor, become of great importance. After all, in essence, it will operate within the system of activities of the Ministry of Emergency Situations. The doctor must be inquisitive, active, active, decisive and at the same time possess a certain set of skills for orientation in a radiation environment, diagnostic techniques and methods of providing emergency care according to clinical indications under conditions of simultaneous exposure to radiation and other factors. Having orientated himself in the situation, he must be able to reassure patients and explain to the people involved in the accident the rules of their behavior, as well as provide transportation to the appropriate medical institution for those in need.

A targeted interview and examination of the patient (or group of people who had contact with the source), especially children, allows the necessary measures to be taken urgently to detect and isolate the source. It becomes possible to at least roughly assess the degree of danger, take urgent measures to minimize possible, sometimes very serious consequences, and hospitalize the victim in an institution where he will be provided with qualified assistance in full. Sometimes these people do not find adequate help for a long time, even in the presence of already obvious signs of radiation damage, and the investigation proceeds, as it were, in the reverse order: the disease is the source. Sometimes, on the contrary, information about contact with a source or its presence (in a school classroom, living room, museum) initiates a search for people who had contact with it, and helps to identify among a large group of participants in the situation the few people who are actually affected.

The only world-famous radiation medicine clinic in the country, capable, but very limited in its ability to provide assistance to victims of radiation, languishes a miserable existence. The significance of the medical and scientific potential of its specialists in the problem of ensuring the country's security is undeniable. But significant targeted reinforcement of its resources is required in terms of equipment, medicines, and payment for highly specialized personnel, whose activities may be urgently needed by the country in emergency circumstances such as the Chernobyl accident.

M. Montaigne also said that a fruitful and natural desire of society is the ability to listen to scientists. It is probably necessary for the country's leadership to find time for this and listen to the opinion of scientists - specialists in radiation medicine, taking into account the threat of nuclear terrorism and the expanding list of countries that own nuclear weapons in the modern world. The Ministry of Health of the Russian Federation needs to introduce the qualification of a doctor in the specialty “Radiation Medicine”.

 

Metlyaeva N.A.
Scientific Secretary of the Clinical Department
Radiation Medicine, Doctor of Medical Sciences, Associate Professor

 

 

 

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