WASHINGTON — They were developed as life-saving devices, ensuring that blood is properly treated before patients receive a transfusion. Massachusetts, because of its concentration of medical facilities, has one of the nation’s highest number of the machines.
But now federal officials worry the material that makes these devices dubbed blood irradiator machines so effective — a highly radioactive powder known as cesium chloride — could threaten public safety. Some fear that people could be exposed in an accident or, in a worst-case scenario, that the material could be stolen by terrorists to make a “dirty bomb” spewing radiation.
That has set the stage for an unlikely fight between the government and some in the medical industry who are reluctant to give up the relatively low-cost machines and replace them with more expensive devices that are safer but might break down more frequently.
“If we could make headway on this — if you could get all the cesium chloride off the market — it would be permanent risk reduction,” said Charles Ferguson, president of the Federation of American Scientists, a nonprofit dedicated to finding solutions to international security problems.
As the debate unfolds, Massachusetts hospitals and clinics, which have received more money for upgrading security of radioactive medical supplies than any other state, are considered central to the outcome.
‘There are going to be winners and losers. The people who only make cesium chloride aren’t going to like it.’
Treating donated blood through these machines is a crucial step to making sure that transfusions do not kill people with weak immune systems, including the elderly and the very young.
An internal panel convened by the Department of Energy recently concluded that the United States is trailing many other industrialized nations in eliminating the blood irradiators. Officials are prodding Boston hospitals and blood banks to phase these irradiators out and are considering the use of federal grants and other incentives to speed the process, according to officials and specialists who participated in the deliberations. They said they could not speak publicly because they signed nondisclosure agreements with the government.
But some health providers and suppliers, which have a history of resisting such a change, say they are not convinced it is feasible to invest in newer X-ray irradiators, which costs up to $2 million, not including maintenance costs. They also said the technology is less reliable than the current machines, which can last up to 30 years, require little upkeep, and can handle larger quantities.
“X-ray irradiators break with regular abandon, so of course you have to buy two,” said Dr. Jed Gorlin, vice president of medical and quality affairs at Innovative Blood Resources in St. Paul, Minn., and an adviser to the industry group AABB, formerly known as the American Association of Blood Banks.
Gorlin said that in his experience X-ray irradiators are also hard to find. One of the blood bank’s facilities expected to get delivery of an X-ray irradiator in November, he said. “Do we have it yet? No. To say there are myriad available alternatives . . . is not quite accurate.”
Those concerns have raised fears that a transition would harm patients.
In a recent paper, the AABB asserted that “inadequate availability of irradiation capability in hospitals and blood centers would have a dramatic impact on the standard of care that is provided to the most seriously ill patients.”
The same paper raised concerns that making the transition could hurt medical research.
Others contend that some of the resistance stems from the radioisotopes industry, for which cesium irradiation machines have been a lucrative slice of the market.
‘There are going to be winners and losers,” said Miles Pomper, a senior research associate at the Center for Nonproliferation Studies at the Monterey Institute of International Studies and an expert on radiological materials. “The people who only make cesium chloride aren’t going to like it.”
According to a recent study, Massachusetts is among the four states — along with Pennsylvania, Texas, and California — with the largest quantities of radiological medical materials that are considered highly dangerous and vulnerable to theft.
At the same time, the largest amount of federal dollars spent on upgrading security for such material has been directed to Massachusetts: more than $11 million at 25 facilities, according to the Government Accountability Office.
Among the area hospitals and universities that have participated in the security upgrades are Tufts University Medical Center, Brigham and Women’s Hospital, and the Massachusetts Institute of Technology, according to officials. Those institutions declined to discuss their role or their position on Department of Energy policy. Julie Jette, a spokeswoman for Tufts, said that “for security reasons, the medical center doesn’t publicly discuss our policies and practices.”
Cesium chloride is derived from cesium-137, a by-product of nuclear fission. In blood irradiators, it is compressed into stainless steel capsules.
If humans come in contact with cesium chloride, it can cause radiation sickness, burns, and death. An accidental exposure in Brazil in 1985 killed four people, contaminated 249 others, and required 112,000 to be monitored for adverse health effects.
Cesium chloride is considered among the most pressing challenges in preventing the use of a dirty bomb. It has similar properties as sodium chloride, or table salt, such as being dissolvable in water. Such properties, along with its high radioactivity, make it better suited to a terrorist weapon than other medical radiological materials, such as cobalt-60, which comes in the form of a small pellet or wire.
As early as 2008, the National Research Council, a private nonprofit that advises the government on policy, recommended getting rid of the material, saying that “cesium chloride is a greater concern than other radiation sources based on its dispersibility and its presence in population centers across the country.”
Those concerns have only grown in recent years.
GAO investigators detailed a series of security lapses around the country, including a hospital in an unnamed city where the combination to a lock on a room that housed a blood irradiator was written on the door frame. The room was near a loading dock.
At another unnamed hospital, research irradiators were kept in a basement open to the public. One of the irradiators was on a wheeled pallet, investigators found.
Officials also assert that the American medical community is far behind in finding a replacement. Other countries have already widely adopted such alternatives as X-ray technology, including Japan, France, Canada, Germany, Italy, Norway, Sweden, and the United Kingdom, according to a survey.
Still, others say that determining what to do with unused blood irradiators is a major challenge.
“There is no practical way of disposing of the cesium irradiator,” said Dr. Gorlin. “And Congress shows no ability to have radiological medical disposal sites. I think government incentives would be fantastic.”
The Department of Energy does have on board one powerful voice for phasing in X-ray technology: the American Red Cross.
“It is FDA-cleared and it has been for a long time and they have been in use in blood banks,” said Stephen Wagner, a biophysicist and director of the blood component department at the organization’s Jerome H. Holland Laboratory in Rockville, Md. “I think that they are equivalent. But there are still some concerns about significant downtime [with X-ray irradiators] that companies will have to address.”