The blessing and curse of blood irradiators

Life-saving blood transfusions happen every day in the United States and around the world. In order to make sure blood used in a transfusion is free from infections and bacteria, hospitals run it through a machine that uses radioactive material as a sterilizer. Blood irradiators can help save lives, but what makes them so effective can end lives. Therein lies the blessing and the curse.

The material that makes blood irradiators so effective is a highly radioactive substance — cesium-137. Cesium-137 poses a pressing security challenge in that it can be used to make a radiological dispersal device (RDD), commonly known as a dirty bomb. The material is like talcum powder: it is highly dispersible and soluble in water. Cesium-137’s properties, along with its high radioactivity, make a RDD incident likely.

{mosads}Human contact with cesium-137 can cause radiation sickness, burns, and death. Any type of RDD which includes cesium-137 could cause immediate casualties from the blast, as well as widespread panic, economic disruption, long-term evacuations, exorbitant decontamination costs, casualties from cancer, and overwhelming psychological damage. In 1985, an accidental exposure to cesium-137 in Goiâna, Brazil killed four people and required 112,000 others to be monitored for adverse health effects; 249 were contaminated.

Phasing out the use of cesium-137 in favor of non-radioactive alternatives would help keep the United States safe from a dirty bomb incident, especially in hospitals that allow unescorted access to their radiological sources. Anyone who has been to a hospital knows that most areas are, indeed, open to all. Escort access areas are the exception, rather than the rule. Many hospitals don’t even store their radiological medical materials in those limited restricted areas.

In 2012, the Government Accountability Office (GAO), a reliable government agency that investigates how the federal government spends taxpayer dollars, issued a report on what needed to be done to improve security of radioactive sources at U.S. medical facilities. The report detailed a number of security lapses around the country, including one at a hospital that kept research irradiators in a basement open to the public.

One of the irradiators was on a wheeled pallet in a room near an external loading dock. At another unnamed hospital, a blood irradiator was in a locked room, but the combination was written on the door frame. The door was in a heavily-trafficked hallway. At a third unnamed hospital, a blood irradiator was in a room secured by a conventional key lock, but it was located in the middle of a room, not secured to the floor. In the room were a bank of unalarmed and unsecured windows that looked out onto a publically accessible loading dock, making the irradiators highly vulnerable to theft or sabotage of the radioactive material. It is not hard to imagine what the devastating consequences would be if criminals were to access the unprotected radioactive material.

The good news is that hospitals don’t need to use cesium-137 anyway. Blood can be irradiated through the use of non-radioactive alternatives, such as x-ray technologies, linear accelerators (LINACs), and dedicated photochemical (“UV”) sterilizers.

Other countries have already widely adopted such alternatives, including Canada, Germany, Italy, Sweden, and the United Kingdom. France and Norway have replaced all their irradiators, and Japan — additionally cautious due to the Fukushima nuclear disaster — has reduced its supply of irradiators by up to 80 percent. Despite the clear dangers, U.S. efforts to phase out its cesium irradiators are still considerably behind the curve.

Since 2014, the Department of Energy’s National Nuclear Security Administration’s Office of Radiological Security (NNSA ORS) has committed to facilitating the replacement of 34 cesium-137 irradiators with non-radioactive alternatives by 2020. Moreover, the Food and Drug Administration has approved x-ray equipment as alternatives for blood irradiators. These devices cost around $250,000, half of which would be paid for by the NNSA’s ORS. In addition, NNSA’s ORS will remove and dispose hospitals’ cesium irradiators for free, saving institutions $100,000–$200,000 per irradiator in disposal costs.

Despite progress, much work remains. Four U.S. states host the largest quantities of radiological medical materials that are considered highly dangerous (i.e., radioactive) and vulnerable to theft: California, Massachusetts, Pennsylvania, and Texas. All four have cities that would be potentially attractive to terrorists to unleash a RDD, which would incur widespread panic, death, and disruption. Thus far, only California, through the efforts of Governor Brown, is making strides to work with hospitals around the state to replace their cesium-137 blood irradiators with alternative x-ray technologies.

Hospitals around New York City are expected to phase out their blood irradiators by 2020. In following the Big Apple and the Golden State’s lead, other large U.S. cities would also be making an effort to keep their citizens safe from a RDD attack. This isn’t a choice between health and national security — neither should ever be compromised. This is about keeping America safe and secure from terrorism.

Sara Z. Kutchesfahani, Ph.D., is a senior policy analyst at the Center for Arms Control and Non-Proliferation, focusing on nuclear terrorism, and author of the book, “Politics and the Bomb: The Role of Experts in the Creation of Cooperative Nuclear Non-Proliferation Agreements.”