Lia radiological accident
The Lia radiological accident began on December 2, 2001, with the discovery of two orphan radiation sources near the Enguri Dam in Tsalenjikha District in the country of Georgia. Three villagers from Lia were unknowingly exposed. All three men were injured, one of whom eventually died. The accident was a result of unlabeled radioisotope thermoelectric generator cores which had been improperly dismantled and left behind from the Soviet era. The International Atomic Energy Agency led recovery operations and organized medical care.
Accident
Three men from Lia had driven to a forest overlooking the Enguri Dam reservoir to gather firewood. They drove up a nearly impassable road in snowy winter weather, and discovered two canisters at around 6 pm. Around the canisters there was no snow for about a radius, and the ground was steaming. Patient 3-MB picked up one of the canisters and immediately dropped it, as it was very hot. Deciding that it was too late to drive back, and realizing the apparent utility of the devices as heat sources, the men decided to move the sources a short distance and make camp around them. Patient 3-MB used a stout wire to pick up one source and carried it to a rocky outcrop that would provide shelter. The other patients lit a fire, and then patients 3-MB and 2-MG worked together to move the other source under the outcrop. They ate dinner and had a small amount of vodka, while remaining close to the sources. Despite the small amount of alcohol, they all vomited soon after consuming it, the first sign of acute radiation syndrome, about three hours after first exposure. Vomiting was severe and lasted through the night, leading to little sleep. The men used the sources to keep them warm through the night, positioning them against their backs, and as close as. The next day, the sources may have been hung from the backs of Patient 1-DN and 2-MG as they loaded wood onto their truck. They felt very exhausted in the morning and only loaded half the wood they intended. They returned home that evening.Aftermath
Medical
Two days after exposure, on December 4, patient 2-MG visited a local doctor but did not mention the mysterious heating source, and the doctor assumed he was drunk. The resulting treatment, however, did clear up the symptoms. On December 15, patients 1-DN and 2-MG developed burning and itching on the small of their backs, where the radiation source had been closest. Patient 1-DN lost his voice as well but did not seek care at that time. The wife of patient 3-MB and the brother of patient 2-MG learned that all three men were ill with similar symptoms, including increasing desquamation, especially on their backs. The wife and brother reached out to the police, who suggested that all three men seek medical attention. All three patients were finally hospitalized on December 22, and it was determined they had ARS. Patient 3-MB was released on January 23, 2002, as his injury was mild. The other patients remained in serious condition, and the Government of Georgia petitioned the IAEA for help treating them. The IAEA intervened: patient 1-DN was sent to Burnasyan Federal Medical Biophysical Center in Moscow, and Patient 2-MG was sent to the Percy military hospital in Paris. Patient 2-MG was hospitalized for over a year, and required extensive skin grafts, but survived and was discharged on March 18, 2003. Patient 1-DN's injuries lingered. He had received the greatest exposure on his back, as well as damage to his heart and vital organs. A large radiation ulcer formed on much of his upper left back. Despite intensive care, repeated antibiotics, multiple surgeries, and an attempted skin graft, the wound did not heal. His condition was complicated by tuberculosis, which prevented effective treatment of lung injury. He developed sepsis, and died of heart failure on May 13, 2004, 893 days after first exposure.Doses
Radiation doses were estimated in several different ways, but it was clear that Patient 2-MG received the greatest dose. Below, doses are measured in grays. A whole-body dose of 10 Gy is 99% fatal, a dose of 6 Gy is 50% fatal with treatment, and a dose of 2 Gy is 5% fatal with treatment. Localized doses, especially where the patients suffered radiation ulcers, may have been much higher. Patient 1-DN, despite a survivable whole-body dose of between 2.8 and 5.4 Gy, received 21-37 Gy to his shoulder, which eventually killed him. In the chart below, there is some uncertainty in the measurements. The calibration curve method is from an assumed exposure time, distance, and rate. This is close to the doses determined by the measurements of chromosome aberrations taken from blood samples analyzed by the Georgia Cytogenetics Laboratory. Also included are doses calculated by the Dolphin method, which uses a slightly different detector. No other people in the area were found to have been exposed.Analysis
The IAEA's final report concluded that the proximate cause of the accident was that the sources were unmarked and unlabeled, and thus their danger could not be known. It also chastised the illegal abandonment of the sources to begin with. The report stressed the importance of basic knowledge of radiation injuries by clinicians and called for increased programs to make them aware of the signs of radiation overexposure. The initial clinician who treated patient 2-MG did not accurately assess the injury, thus delaying proper treatment for almost three weeks.Between the fall of the Soviet Union in 1991 and 2006, the IAEA had recovered some 300 orphan sources in Georgia, many lost from former industrial and military sites abandoned in the economic collapse after the Soviet breakup.