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A New Century of International Telemedicine for Radiation-Exposed Victims in the World

Department of International Health and Radiation Research (N.T., S.Y.), Tissue and Histopathology Section (M.N.), Department of Molecular Pathology (M.I.), and Department of Radiation Epidemiology (Y.S.), Atomic Bomb Disease Institute, and First Department of Internal Medicine (K.A.) Nagasaki University School of Medicine Nagasaki 852-8523 Japan \

Address correspondence to: Noboru Takamura, M.D., Assistant Professor, Department of International Health and Radiation Research, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan. E-mail: takamura{at}net.nagasaki-u.ac.jp

To the editor:

Fifteen years have passed since the Chernobyl accident on April 26, 1986, but various efforts should still be made to alleviate medical consequences of this disaster (1). Medical examinations of about 210,000 children, performed within the framework of International Programme on the Health Effects of the Chernobyl Accident (IPEHCA) and Chernobyl Sasakawa Project, demonstrated a significant increase in the incidence of childhood thyroid diseases (2, 3). Especially in Gomel region, Belarus, incidence of thyroid cancer has increased by 100 times as compared with that before the accident. One of the important tasks in the continuation of humanitarian assistance to countries affected by the Chernobyl accident is the strengthening of medical infrastructure, mainly in the areas most radio-contaminated and with the largest number of childhood thyroid cancer patients. From this viewpoint, we introduced telemedicine system between Gomel and Nagasaki, Japan, in 1999 to improve diagnosis, treatment, and follow-up of patients with thyroid cancer (4).

Since the establishment of telemedicine system between Gomel and Nagasaki in February 1999, ultrasound and cytological images of 448 cases, who were suspected to have thyroid abnormalities, have been sent via Inmarsat B satellite communication system. Although most cases screened by two mobile diagnostic teams using ultrasound equipment were diagnosed as benign thyroid diseases, 18 of them (4.0%) were diagnosed as childhood thyroid cancer in the early stage.

Furthermore, another telemedicine system was introduced between Nagasaki and Semipalatinsk University Hospital, Kazakhstan where hundreds of nuclear tests had been carried out in the era of the former USSR (5), for the diagnostic support of thyroid diseases. Images of 492 adult cases have been sent from Semipalatinsk to Nagasaki since September 1999; 8 (1.6%) have been identified as thyroid cancer.

Based on our results of image analysis, special attention should be paid on the vulnerable population of radiation-associated thyroid cancer in both areas, whose age was restricted between 0 and 5 at the time of radiation exposure. In this point of view, the World Health Organization has just started to set up the special project of medical relief for children affected by the Chernobyl accident through the development and implementation of health telematics (http://www.who.int/peh/Radiation/healthtelepres.htm). Furthermore, the Japanese International Cooperation Agency, besides the official programs of United Nations Development Programme, has also started 3-year medical assistance project for Semipalatinsk, to establish an early diagnostic system for radiation-exposed victims in this area.

Although the cost-effectiveness and technical improvement should remain to be solved, introduction of telemedicine system in radio- contaminated remote areas definitely contributes to the improvement of the accuracy of thyroid disease diagnosis. The international collaboration project on thyroid screening, based on the transmission of our long-term experience and knowledge on Atomic Bomb Survivors in Nagasaki and Hiroshima, is beneficial for radiation-exposed victims as well as local medical staff. We should take an initiative and leading responsibility to introduce and operate International Telemedicine Projects for radiation-exposed victims in various countries.

Received May 11, 2001.

References

1. United Nations Scientific Committee 2000 Sources and effects of ionizing radiation, United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCARE2000) Report, volume II: Effects, Annex J. Exposures and effects of the Chernobyl accident; 451–566
2. Souchkevitch GN, Tsyb AF 1996 Health consequences of the Chernobyl accident. WHO Scientific Report
3. Yamashita S, Shibata Y 1997 Chernobyl: a decade. Amsterdam: Excerpta Medica
4. Yamashita S, Shibata Y, Takamura N, Ashizawa K, Sera N, Eguchi K 1999 Satellite communication and medical assistance for thyroid disease diagnosis from Nagasaki to Chernobyl. Thyroid 9:969[Medline]
5. Yamamoto M, Tsukatani T, Katayama Y 1996 Residual radioactivity in the soil of the Semipalatinsk nuclear test site in the former USSR. Health Phys 71: 142–148

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