L’objectif de ce document est de proposer aux médecins du travail des INB, des recommandations pour la rédaction de protocoles de traitement par le Ca-DTPA des contaminations internes par le plutonium et l’américium. Ces recommandations s’appuient sur le bilan des injections réalisées dans les centres CEA et AREVA en France. Elles ont été réalisées par un groupe de travail de médecins du CEA, d’AREVA et du Service de protection radiologique des Armées. Cet article concerne principalement le Ca-DTPA administré par voie intraveineuse (IV). Les autres formes galéniques, voies d’administration ainsi que les traitements adjuvants sont également évoqués. Pour les plaies contaminées et les inhalations, les indications du traitement par le Ca-DTPA sont précisés ; en particulier son initialisation, sa posologie, sa durée, sa fréquence d’administration, les critères d’arrêt, son efficacité et le gain dosimétrique. Une aide décisionnelle est proposée pour la prescription du suivi radiotoxicologique nécessaire à la conduite du traitement et à l’évaluation dosimétrique.

Ca-DTPA was used for the medical treatment of plutonium and americium contaminations in the CEA and AREVA plants from 1970 to 2003. This report is a survey of the administered injections of Ca-DTPA as a chelating molecule. This report will be part of the registration process for Ca-DTPA by intravenous administration, submitted by the Pharmacie Centrale des Armées. Out of 1158 injections administered to 469 persons, 548 events of possible or confirmed contaminations were reported. These employees were followed by occupational physicians according to the current regulations. The first part of the report is a summary of the most recent findings. Due to its short biological period and its limited action in the blood, Ca-DTPA does not chelate with plutonium and americium as soon as these elements are deposited in the target organs. This justifies an early treatment, even in cases of suspected contamination, followed by additional injections, if necessary. The second part presents data concerning these 1158 injections (contamination routes, posology, adverse effects, ...). These incidents took place at work, were most often minor, and did not require follow-up treatment. A study concerning the efficacy of the product was conducted on a group of people having received 5 or more injections. These results were compared with the efficacy theoretically estimated. Posologies and therapeutic recommendations were proposed based on these observations. Additional studies are needed to confirm these findings. This document is the first summary in this field. It is the result of the collaboration of the occupational medical departments, the laboratories of the CEA and the AREVA and a working group CEA-AREVA-SPRA.


Dismantling and decommissioning operation of three glove boxes contaminated by 241Am was conducted in summer 2001. During the first two terms of the decommissioning project no hesitation appeared about the adequacy of the protective regime. After measuring of filters from ventilation during the third term the volume activity was assessed as 1.5 Bq/m3 with the volume of filtered air of 69.2 m3 at a flow rate of 1 m3 per hour and all the working activities were stopped. On the basis of first results, six workers were treated with calcium trisodium diethylene-triamine-pentaacetate (Ca-DTPA) in infusions. The check of urine proved the increased excretion of contaminating radionuclide. The tolerance of the treatment was good. Final evaluation based on complex excretion data in the workers pointed to the committed effective dose of 35–185 mSv. This extraordinary event was caused first of all by the considerable underestimation of the hazard of the dismantling of dry glove boxes.


Emergency treatment of pulmonary contaminations by transuranium elements. A new galenic form of Na3CaDTPA.The emergency treatment of pulmonary contamination by plutonium and transuranium elements needs the early use of a chelator, the Na3CaDTPA under monocalcic trisodic form. The local administration ofthe active principle is carried out by an appliance, the Spinhaler$^{\circledR}$, which delivers theactive principle under micronised form without any propelled gas. The French Military Health Service isthe manufacturer which produces this treatment and has studied a modification of the galenic form ofNa3CaDTPA to improve the intrapulmonary distribution. This treatment, without any secondary effect, isproposed even for a presumed pulmonary contamination. Its easy use allows an early administration for alarge number of people supposed to be contaminated. However, it cannot take the place of the other formsof treatment, especially intraveinous, which needs a medical prescription in case of an establishedcontamination.