INTRODUCTION
The worst radiation accident in South America occurred in the city of Goiânia in Goias, Brazil, on September 13th, 1987. An abandoned telegraph machine was dismantled by a junkyard owner unaware of its content (Green 2018). Inside the telegraph machine was an encased radioactive Cesium-137 (Cs-137) source, seen in Figure 1. 
Due to the appealing nature of Cs-137, he began to distribute it among his family, which quickly spread to other members of the community (Green 2018). The dispersion of Cs-137 resulted in external and internal exposure among the locals of Goiânia. The radioactive Cs-137 ended up taking four lives while contaminating 249 others (Roberts 1987). It also indirectly impacted over 100,000 residents. It is important to note that even though the city of Goiânia had a large population, the area where the incident occurred was underprivileged and had lower poverty (IAEA 1988). Once authorities were notified of the seriousness of the incident, clean-up and remediation began. The cleaning process occurred rapidly in a two thousand square meter area. During the clean-up, many were forced out of their homes while having personal belongings confiscated. Additionally, this event was often overlooked based on the amount of radioactive Cs-137, the number of fatalities/injuries, and the size of the affected area. Despite all of that, the physical, social, and economic consequences that the city endured can not be neglected.
Later, it was discovered that the physician who originally left the telegraph machine relocated two years before the incident. During relocation, the physician neglected to inform licensing authorities of the unsecured radioactive material (IAEA 1988). This incident is a reminder of what can occur when improper disposal and not improper accountability of radioactive waste. Ultimately, the incident resulted in the death of 4 individuals, hundreds of others injured via radiation, and radioactively contaminating parts of the city (IAEA 1988).
ABOUT CESIUM-137
The element of interest within the Goiânia tragedy primarily focuses on the radioactive isotope Cesium-137 (Cs-137). Originating from uranium-234 or plutonium-239, Cs-137 is an unintended byproduct of the material through nuclear fission. It is commonly found on smaller scales from medical machinery and infamously connected to nuclear weaponry activity, such as the Chernobyl incident in Kyiv. Different emission levels, such as alpha and beta particles and gamma rays, are expelled into the atmosphere through radioactive decay. Cs-137 undergoes a beta decay. As the neuron from Cs-137 is transformed into a proton, a beta particle and antineutrino are released. It becomes the stable isotope of Ba-137m (Fig. 3). 
Through the radioactive decay chain process, the parent-daughter isotope exposure is responsible for both the beta and gamma-ray emissions in radioactivity. When exposed to human life, the isotope is extremely hazardous regarding health and environmental factors. With an average half-life of thirty years and the isotope’s affinity to be absorbed by sediment (Venturi 2021), Cs-137 can be traced as far as several hundreds of years. In different degrees of exposure, the isotope can cause various health implications. Through external exposure, radiation sickness and burning may occur, whereas internal exposure, such as inhalation and ingestion, can have more severe effects. Cs-137 has been connected as a cancer risk factor and shortening and lowering quality of life (Venturi 2021).
In the Goiânia tragedy, the improper disposal of medical equipment from an abandoned radiotherapy unit, which was left unattended, led to numerous implications in the affected community. The dangers of Cs-137 and its exposure resulted in 4 deaths, 249 contaminated, and 112,000 people monitored (Green 2018). The devastating incident in the community was originally left in the hands of the people rather than the aid from their government. Despite the effects this incident had on hundreds of thousands of lives, Goiânia’s government did not understand the magnitude of the problem. Most of the aid was prompted by the Soviet Union and the United States, as this singular incident was labeled as one of the most serious radioactive incidents in the Western World (Gergi 2018).
EFFECTS IN THE COMMUNITY
The Goiânia tragedy resulted in various implications that affected the Brazilian population at the communal, familial, and individual levels. As a result of the Cs-137, the radiation exposure had many physiological alterations seen throughout the community. As Cs-137 is a non-naturally occurring element, the decay of the material is prolonged through the exposed environment if not disposed of properly. The radioactive isotope has a high affinity, which helps it stay within the sediment; various surrounding plants can absorb the radiocesium and spread it to high trophic levels within the environment. This was especially seen within Goiânia, as multitudes of health implications were observed.
Despite the effective and efficient clean-up efforts, the residents of Goiânia were still discriminated against in public facilities. Some residents even went out of their way to receive a certificate to show that they were not contaminated so that they were not discriminated against when flying on a plane, using an interstate bus, or staying in a hotel (IAEA 2003).
BREAST CANCER INCIDENT IN THE FEMALE POPULATION
One of the most prominent health implications seen within the population was the rise of breast cancer in the exposed female population. There was a significant increase in new cases of breast cancer patients in females, which manifested between 1988 to 2012. As radioactive exposure has been linked to an increase in cancer risk, the Goiânia population reflected similar trends. Data composed by Rahal et al. 2019 in Figure 4 showed that there was an almost doubled rate of breast cancer as the years went by. This suggests that the radiation exposure had a severe impact on women several years after rather than the initial incident. Connecting this back to Cs-137’s adverse health implications, radiation exposure in the population was observed to have certain genetic damage to the human body. These effects are prolonged and persist for an extended period after initial exposure.
COMMUNAL IMPLICATIONS WITHIN GOIANIA
From a communal perspective, there was an increase in chromosomal structure within the individuals exposed to Cs-137 (Natarajan 2019). This refers to changes in the chromosomes of individuals exposed to radiation and the structures within chromosomes. Some adverse effects displayed were chromosomes combining and repositioning themselves in ways that caused severe side effects in the human body. As the chromosomes carry all genetic makeup, mutations, and manipulation of DNA can lead to adverse outcomes within DNA replication and genetic makeup. Individuals suffering from this radiation exposure suffer from having an abnormally high amount of chromosomal DNA in their genetic makeup (Canoy et al., 2022). Furthermore, individuals from the Goiânia radiological accident had significantly higher gene-hprt (Hypoxanthine-guanine phosphoribosyltransferase) mutations. HPRT encodes an important gene in our bodies that regulates human stem cell signaling (Cruz and Glickman 1998).
GENERATIONAL EFFECTS TO THE COMMUNITY
On the familial level, these genetic adversities are likely to perpetuate in a multi-generational context. Cruz and Glickman (1998) and Costa et al. (2011) argue about the generational effects of radiation exposure. In a family dynamic context, children are more likely to obtain mutations. Specifically, Costa et al. (2011) mention that the risk of mutation in the children of people who were directly exposed to the Cs-137 radiation was three times as likely to obtain a mutation as a result.
The cases of exposed individuals were quite tragic and a stark reminder of the serious consequences of radiation exposure. In particular, according to the International Atomic Energy Agency, Vienna (1998), one of the most extreme cases seen was that of a six-year-old girl who died due to multiple hemorrhages in plaque and various hemorrhagic areas within her internal organs. It was also autopsied that there was an alteration in the lumina of her intestines and stomach. A similar fatality was seen from the same exposure, noting the death of a twenty-two-year-old man. This individual suffered from necrosis, localized inflammation, and lymph node hyperplasia and was noted to have an enlarged right ventricle of the heart. It was seen in individuals with overexposure to gamma radiation to have various degrees of effects, such as acute local radiation in their skin, which further penetrated the tissues of patients. Individuals in general exposed to the Cs-137 radiation had also delayed cell cycle progression in their lymphocytes (Natarajan 2019).
ENVIRONMENTAL INJUSTICE
Goiânia, Brazil, is a relatively impoverished zone with many Brazilians living in poor conditions. The affected individuals who sought hospital treatment were treated inappropriately, which resulted in unnecessary radiation exposure (IAEA 1988). During this time, Brazil had several developing public facilities and living complexes with unfavorable conditions, partially responsible for the Cs-137 along the Goiânia population (Fig 5). This initial radiation incident would have been preventable had Goiânia residents been educated on potential contaminants and toxicants within the waste. The improper waste disposal by the hospital and lack of radioactive regulations with the government led to the spread and indirect exposure of individuals that led over 100,000 Goiânia residents to be potentially exposed to the Caesium outbreak.
During the remediation phase, it was reported that part of the environment was contaminated with Cs-137, such as the soil and multiple homes. Some homes were demolished for safety while the soil was taken out and disposed of properly (IAEA 1988). Even though the clean-up was done effectively, the accident caused property sales to increase significantly, dropping for the underprivileged community. Although a small area of Goiânia was affected, the state of Goiâs felt the incident’s repercussions. The state was known for its cereal farming, textile products, and cattle, making up most of its economy. Due to the broadcasting of the incident, the entire state of Goiâs was left to suffer an economic downfall. The outcome of their wholesale value involving agriculture fell by 50%, while clothing and other textile products fell by about 40% (Petterson 1988). It is critical to note that many of these products were not produced in Goiânia, so there was no possibility that they could have been contaminated, but the consequence affected the entire state. Throughout this, other states in Brazil were also refusing to buy grain, milk, and other food supplies from Goiâna (Roberts 1987).
The events that led to this tragedy had numerous preventative options that were not taken. The Goiâna tragedy showed the importance of disposing of chemical waste properly. In addition, it shows the importance of educating the public and ensuring that the general public understands and is wary of the dangers of certain chemicals. This radioactive isotope was left disposed of in a trash bin unethically and, as a result, cost the lives of many and affected the lives of many more. The lack of accountability and seriousness in the initial response to this tragedy should be criticized.
If such an event were to happen again, it is important to understand that radioactive contaminants have long-lasting and devastating effects. Furthermore, radiation is almost an invisible contaminant with no initial visual feedback of exposure. This illustrates how contaminants often go unnoticed and unseen while still greatly interacting with the environment and its surroundings. This event also occurred in a developing nation without proper resources to educate, dispose of, and treat the exposed people. In such cases, it is crucial to have preventative measures and safety precautions for circumstances like this incident.
SOLUTIONS
LEGISLATIVE ACTION
The incident could have been prevented if proper measures were placed. Establishing who was responsible for the security of the radioactive source while also initiating good communication between the state and the person responsible (IAEA 2018) was the first big step. Implementing regulation and national laws will account for the entire lifespan of radioactive sources, preventing an incident such as the Goiâna one from reoccurring. It is important to note that it would be beneficial if the public population were also educated on radioactive sources (Green 2018). Ultimately, the physician who had relocated their clinic and left the telegraph machine behind was charged with criminal negligence, while the Brazil Nuclear Energy Commission denied any responsibility (Robert 1987). Moving forward, new regulations implemented by the Brazil Nuclear Energy Commission will help prevent future accidents while developing a system for accountability of radioactive material.
PROTECTION AND SAFETY FOR RADIOACTIVE MATERIAL
One of the initial responses for the disposal of the Cs-137 involved field workers being provided with film monitors and Thermoluminescent Dosimetry (TLD) rings (Instituto de Radioproteção e Dosimetria 2018). TLD rings were used to protect workers and as indicators of gamma and beta radiation within an area. This offered an understanding of where the sources of radiation were coming from. It also served as an indicator of the amount of radiation in particular areas that should be avoided. Heavy machinery to remove large amounts of soil was also used to remove any possible traces of Cs-137 left in the environment (IAEA 1988).
A specific compound called hexacyanoferrate, better known as Prussian blue, has also been claimed to help with Cs-137 exposure. It reduces radiocesium poisoning by reducing cesium’s half-life by 43% (Thompson et al. 2001). As Cs-137 is secreted in the gut, Prussian blue binds to the cesium in the lumen. An exchange between cesium and potassium stops the isotope’s reabsorption in the body. As one of the obstacles was the lack of treatment for the exposure, having accessible and affordable healthcare and medication for the whole population would contribute largely to safety in circumstances like this.
References
Barretto, P. M. C., & Fonseca, E. S. da. (2023). The Cs-137 radiological accident in Goiânia, Brazil: Conditions and results of the airborne radiometric survey. Brazilian Journal of Radiation Sciences, 11(2), 01–13. https://doi.org/10.15392/2319-0612.2023.2231
Canoy RJ, Shmakova A, Karpukhina A, Shepelev M, Germini D, Vassetzky Y. 2022. Factors That Affect the Formation of Chromosomal Translocations in Cells. Cancers. 14(20):5110. doi:https://doi.org/10.3390/cancers14205110.
Costa EOA, Silva D d. M e., Melo AV d., Godoy FR, Nunes HF, Pedrosa ER, Flores BC, Rodovalho RG, da Silva CC, da Cruz AD. 2011. The effect of low-dose exposure on germline microsatellite mutation rates in humans accidentally exposed to caesium-137 in Goiânia. Mutagenesis. 26(5):651–655. doi:https://doi.org/10.1093/mutage/ger028.
Da Cruz AD, Glickman BW. 1998 Dec 1. Monitoring the genetic health of persons in Goiânia accidentally exposed to ionizing radiation from caesium-137. www.osti.gov. [accessed 2023 Oct 30]. https://www.osti.gov/etdeweb/biblio/324483.
Green, C. 2018. The Evolution of CNEN Regulation on Radiological Materials with Medical Applications before and after the Goiânia Radiological Accident of 1987. Project on Nuclear Issues: A Collection of Papers from the 2017 Conference Series and Nuclear Scholars Initiative. 91-104.
International Atomic Energy Agency. 1988. The Radiological Accident in Goiânia.
International Atomic Energy Agency. 2003. Security of Radioactive Sources. March 10-13, 2003. Vienna, Austria. International Conference on Security of Radioactive Sources
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Mauricio, C.L.P. 2018. Analysis of the external doses received by workers involved in the mitigation of the Goiânia radiological accident. Instituto de Radioproteção e Dosimetria/Divisão deDosimetria,Rio de Janeiro-22783-127
Natarajan AT, Vyas RC, Wiegant J, Curado MP. 1991. A cytogenetic follow-up study of the victims of a radiation accident in Goiânia (Brazil). Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis. 247(1):103–111. doi:https://doi.org/10.1016/0027-5107(91)90038-p.
Petterson JS. 1988. From perception to reality: The Goiânia socioeconomic impact model. Impact Assessment, Inc. Waste Management ’88: Symposium on Waste Management.
Rahal RMS, Rocha ME, Freitas-Junior R, Correa R da S, Rodrigues D, Martins E, Soares LR, Oliveira JC. 2019. Trends in the Incidence of Breast Cancer Following the Radiological Accident in Goiânia: A 25-Year Analysis. Asian Pacific Journal of Cancer Prevention. 20(12):3811–3816. doi:https://doi.org/10.31557/apjcp.2019.20.12.3811.
Roberts, L. (1987). Radiation Accident Grips Goiânia. Science, 238(4830), 1028–1031. http://www.jstor.org/stable/1700832
Scrap yard in Goiânia.jpg – Wikimedia Commons. File:02010031 2007 Oct 6. Wikimediaorg. [accessed 2023 Nov 15]. https://commons.wikimedia.org/wiki/File:02010031_scrap_yard_in_Goi%C3%A2nia.jpg.
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Thompson DF, Church CO. 2001. Prussian blue for treatment of radiocesium poisoning. Pharmacotherapy. 21(11):1364–1367. doi:https://doi.org/10.1592/phco.21.17.1364.34426. https://pubmed.ncbi.nlm.nih.gov/11714209/#:~:text=Prussian%20blue%20is%20well%20tolerated%20at%20a%20dosage.
Venturi S. (2021). Cesium in Biology, Pancreatic Cancer, and Controversy in High and Low Radiation Exposure Damage-Scientific, Environmental, Geopolitical, and Economic Aspects. International journal of environmental research and public health, 18(17), 8934. https://doi.org/10.3390/ijerph18178934
Barretto, P. M. C., & Fonseca, E. S. da. (2023). The Cs-137 radiological accident in Goiânia, Brazil: Conditions and results of the airborne radiometric survey. Brazilian Journal of Radiation Sciences, 11(2), 01–13. https://doi.org/10.15392/2319-0612.2023.2231 Canoy RJ, Shmakova A, Karpukhina A, Shepelev M, Germini D, Vassetzky Y. 2022. Factors That Affect the Formation of Chromosomal Translocations in Cells. Cancers. 14(20):5110. doi:https://doi.org/10.3390/cancers14205110. Costa EOA, Silva D d. M e., Melo AV d., Godoy FR, Nunes HF, Pedrosa ER, Flores BC, Rodovalho RG, da Silva CC, da Cruz AD. 2011. The effect of low-dose exposure on germline microsatellite mutation rates in humans accidentally exposed to caesium-137 in Goiânia. Mutagenesis. 26(5):651–655. doi:https://doi.org/10.1093/mutage/ger028. Da Cruz AD, Glickman BW. 1998 Dec 1. Monitoring the genetic health of persons in Goiânia accidentally exposed to ionizing radiation from caesium-137. http://www.osti.gov. [accessed 2023 Oct 30]. https://www.osti.gov/etdeweb/biblio/324483. Green, C. 2018. The Evolution of CNEN Regulation on Radiological Materials with Medical Applications before and after the Goiânia Radiological Accident of 1987. Project on Nuclear Issues: A Collection of Papers from the 2017 Conference Series and Nuclear Scholars Initiative. 91-104. International Atomic Energy Agency. 1988. The Radiological Accident in Goiânia. International Atomic Energy Agency. 2003. Security of Radioactive Sources. March 10-13, 2003. Vienna, Austria. International Conference on Security of Radioactive Sources KDS444. 2012 Feb 26. Wikimedia Commons. [accessed 2023 Nov 15]. https://commons.wikimedia.org/wiki/File:Teletherapy_Capsule.jpg. Mauricio, C.L.P. 2018. Analysis of the external doses received by workers involved in the mitigation of the Goiânia radiological accident. Instituto de Radioproteção e Dosimetria/Divisão deDosimetria,Rio de Janeiro-22783-127 Natarajan AT, Vyas RC, Wiegant J, Curado MP. 1991. A cytogenetic follow-up study of the victims of a radiation accident in Goiânia (Brazil). Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis. 247(1):103–111. doi:https://doi.org/10.1016/0027-5107(91)90038-p. Petterson JS. 1988. From perception to reality: The Goiânia socioeconomic impact model. Impact Assessment, Inc. Waste Management '88: Symposium on Waste Management. Rahal RMS, Rocha ME, Freitas-Junior R, Correa R da S, Rodrigues D, Martins E, Soares LR, Oliveira JC. 2019. Trends in the Incidence of Breast Cancer Following the Radiological Accident in Goiânia: A 25-Year Analysis. Asian Pacific Journal of Cancer Prevention. 20(12):3811–3816. doi:https://doi.org/10.31557/apjcp.2019.20.12.3811. Roberts, L. (1987). Radiation Accident Grips Goiânia. Science, 238(4830), 1028–1031. http://www.jstor.org/stable/1700832 Scrap yard in Goiânia.jpg - Wikimedia Commons. File:02010031 2007 Oct 6. Wikimediaorg. [accessed 2023 Nov 15]. https://commons.wikimedia.org/wiki/File:02010031_scrap_yard_in_Goinia.jpg. Search media - Wikimedia Commons. commonswikimediaorg. [accessed 2023 Nov 15]. https://commons.wikimedia.org/w/index.php?search=Goinia+accident&title=Special:MediaSearch&go=Go&type=image. Thompson DF, Church CO. 2001. Prussian blue for treatment of radiocesium poisoning. Pharmacotherapy. 21(11):1364–1367. doi:https://doi.org/10.1592/phco.21.17.1364.34426. https://pubmed.ncbi.nlm.nih.gov/11714209/#:~:text=Prussianblueiswelltoleratedatadosage. Venturi S. (2021). Cesium in Biology, Pancreatic Cancer, and Controversy in High and Low Radiation Exposure Damage-Scientific, Environmental, Geopolitical, and Economic Aspects. International journal of environmental research and public health, 18(17), 8934. https://doi.org/10.3390/ijerph18178934
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