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Radiation Exposure

Radiation exposure may cause gastrointestinal, pulmonary, hematologic and central nervous system symptoms and their severity, as well as the patient outcome, is directly correlated with the dose of radiation received. Diagnosis is made by clinical findings and patient history.


Presentation

The term acute radiation syndrome (ARS) is used to describe the onset and progression of symptoms after exposure to ionizing radiation, and the clinical course is divided into four phases [1] [2]:

  • Prodromal phase - Gastrointestinal complaints, such as nausea, vomiting, diarrhea, weakness and weight loss due to profound damage of the intestinal mucosa are main features. In doses of 1-2 grays (Gy), symptoms appear two or more hours after exposure, whereas very severe and lethal exposures (6-8 and > 8 Gy, respectively) produce symptoms in less than 30 minutes [3]. Headaches, altered consciousness, and fever may be observed as well [3]. Cutaneous radiation syndrome (CRS) is the term used to describe skin-related changes that range from mild erythema in this period to more severe lesions encountered later on [4].
  • Latent phase - Myelosuppression is the hallmark of latent phase, developing between 1 and 5 weeks after initial exposure, again depending on the severity of exposure [5]. Lymphopenia, granulocytopenia, and thrombocytopenia are most prominent findings, accompanied by anorexia and generalized fatigue [1]. Pneumonitis, pulmonary edema, and varying degrees of skin depilation are other notable symptoms [1] [3].
  • Illness manifestation phase - Considered as the "critical phase" of radiation exposure, it is characterized by the dose-dependent occurrence of impaired central nervous system activity (headaches, impaired cognitive function, disorientation, ataxia, and convulsions), the progression of vomiting and fever to life-threatening bloody diarrhea, cardiovascular collapse, and shock. Additionally, acute respiratory distress syndrome (ARDS), purpura, electrolyte disturbances and infection due to severe myelosuppression that may lead to sepsis are frequently reported [1] [2].
  • Final outcome - Patients either recover from the deleterious effects induced by radiation, or suffer from fatal organ damage, and the most significant predictors of outcome are the dosage received and heterogeneity of dosage, as either single or multiple organs may be affected [3].
Fatigue
  • They presented with run-down symptoms of neck strain associated with throbbing headache, irritability, loss of appetite, fatigue, memory difficulties, and numbness of extremities.[ncbi.nlm.nih.gov]
  • Lymphopenia, granulocytopenia, and thrombocytopenia are most prominent findings, accompanied by anorexia and generalized fatigue. Pneumonitis, pulmonary edema, and varying degrees of skin depilation are other notable symptoms.[symptoma.com]
  • Later symptoms, which may last hours or months, include loss of appetite, fatigue, fever, nausea, vomiting, diarrhea and possibly even seizures, coma and death. Radiation poisoning also usually causes skin damage.[healthland.time.com]
  • Exposure to small doses of radiation over time is associated with changes in blood chemistry, nausea, burns, fatigue, vomiting, hair loss, diarrhea and the development of cancer. 1 Exposure to high doses of radiation has also been associated with damage[itnonline.com]
  • Acute Radiation Syndrome occurs at 150-350 rem, presenting nausea, fatigue, hair loss, and skin reddening.[mirion.com]
Anemia
  • On July 4, 1934, Marie Curie died of aplastic anemia, a blood disease that often results from getting too much radiation.[web.archive.org]
Rigor
  • […] licensing Supervision of personnel Use of dosimetry badges Training or certification Dental office design and radiation shielding Record keeping Equipment Radiographic training requirements for dental office personnel frequently differ from and are less rigorous[ada.org]
Chills
  • CHILL. Refrigerate food promptly. For more information on food irradiation and other food safety issues, contact USDA's Meat and Poultry Hotline at 1-888-MPHotline (1-888-674-6854) or visit www.fsis.usda.gov. [ Top of Page ][web.archive.org]
Nausea
  • The term acute radiation syndrome (ARS) is used to describe the onset and progression of symptoms after exposure to ionizing radiation, and the clinical course is divided into four phases: Prodromal phase - Gastrointestinal complaints, such as nausea,[symptoma.com]
  • The first symptoms of ARS are typically nausea, vomiting and diarrhea. These symptoms, the CDC says, start within minutes to days after the exposure, and can last for minutes or days.[healthland.time.com]
  • Some examples of the symptoms seen in radiation sickness include nausea, skin burns, hair loss and reduced organ function. In severe cases, exposure to a large amount of radiation can even cause death.[news-medical.net]
  • Early gastrointestinal effects such as nausea or vomiting may occur after single exposures of 1000 mSv or more (100 rads or cGy), and hematopoietic marrow suppression will occur after single doses of 3000 mSv or more.[atlasofscience.org]
Vomiting
  • External contamination is performed by surveying the skin, while internal contamination requires sampling of the ears, the mouth, as well as urine, feces and vomit.[symptoma.com]
  • The first symptoms of ARS are typically nausea, vomiting and diarrhea. These symptoms, the CDC says, start within minutes to days after the exposure, and can last for minutes or days.[healthland.time.com]
  • Median doses cause initial anorexia, lethargy and vomiting then normality for several weeks followed by vomiting, nasal discharge, dysentery, recumbency, septicemia and a profound pancytopenia. Death is the most common outcome.[medical-dictionary.thefreedictionary.com]
  • Early gastrointestinal effects such as nausea or vomiting may occur after single exposures of 1000 mSv or more (100 rads or cGy), and hematopoietic marrow suppression will occur after single doses of 3000 mSv or more.[atlasofscience.org]
  • The most common symptoms are nausea and vomiting, diarrhea, and fever, and the illness often resolves within days. At higher doses, symptoms become more severe and can lead to long-term health consequences or death.[technologyreview.com]
Diarrhea
  • […] acute radiation syndrome (ARS) is used to describe the onset and progression of symptoms after exposure to ionizing radiation, and the clinical course is divided into four phases: Prodromal phase - Gastrointestinal complaints, such as nausea, vomiting, diarrhea[symptoma.com]
  • The first symptoms of ARS are typically nausea, vomiting and diarrhea. These symptoms, the CDC says, start within minutes to days after the exposure, and can last for minutes or days.[healthland.time.com]
  • High doses cause intense diarrhea and dehydration and extensive skin necrosis.[medical-dictionary.thefreedictionary.com]
  • The symptoms of ARS include headache and diarrhea. They usually start within hours. Those symptoms will go away and the person will seem healthy for a little while. But then they will get sick again.[nlm.nih.gov]
Leg Pain
  • The transforaminal lumbar interbody fusion (TLIF) is used for the treatment of back and leg pain secondary to spinal stenosis, degenerative disc disease, and spondylolisthesis.[ncbi.nlm.nih.gov]
Alopecia
  • They also presented with alopecia areata which is felt to be causally linked to the radiation exposure.[ncbi.nlm.nih.gov]
Blister
  • […] similar to a sunburn). 10,000 mSvor more can cause a breakdown of the intestinal lining, leading to internal bleeding, which can lead to illness and death when the dose is to the abdomen. 15,000 mSvor more locally to the skin can cause skin reddening and blistering[radiationanswers.org]

Workup

Physicians must be careful when interpreting symptoms, as gastrointestinal and central nervous system complaints are nonspecific and may arise in a myriad of conditions. For this reason, patient history is the vital component of the diagnostic workup. The detailed information regarding the onset of symptoms, potential exposure to radioactive substances at the workplace, as well as presence of similar findings in other coworkers is vital in making a presumptive diagnosis [6]. The use of a Geiger-Muller probe attached to a Geiger counter to inspect patients for contamination is pivotal for confirming radiation exposure, and the entire body should be examined [6]. External contamination is performed by surveying the skin, while internal contamination requires sampling of the ears, the mouth, as well as urine, feces and vomit [6]. Laboratory studies should include complete blood counts (CBC) performed on a daily basis after admission, with a particular emphasis on total lymphocyte count, which is considered to be one of the most valid indicators of the dose of radiation received [6]. If a total lymphocyte count is > 1500/mL, the radiation dose is expected to be around 0.4 Gy, and the chance of survival is very high, whereas counts of < 500/mL indicate exposure to > 4 Gy and carry a poorer prognosis [6]. A lymphocyte count of < 100/mL is universally fatal [6]. In addition to lymphocyte count, serum amylase, and C-reactive protein (CRP) levels should be evaluated, as they are elevated in proportion to the dose received [3] [6]. In the setting of profound skin changes, procedures such as bone scintigraphy, capillary microscopy and nuclear magnetic resonance imaging should be performed, if possible [4].

Treatment

  • Growth delay was observed in both cell lines during SAHA treatment; 2 μM SAHA treatment decreased clonogenicity and induced cell cycle block in G1 phase but 0.2 μM SAHA treatment did not show either of them.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: In endovascular treatment of lower limb PAD, use of an FC-arm system is associated with more radiation exposure to the patient than an MC-arm system.[ncbi.nlm.nih.gov]
  • Radiation leading to peripheral neuropathy is also related to radiotherapy in cancer treatment, as an undesirable side-effect. We present here a case report of short, intense UV radiation exposure at work, leading to delayed-onset ocular neuropathy.[ncbi.nlm.nih.gov]
  • Biologically important doses of ionizing radiation can be given as an incidental part of a variety of medical treatments.[ncbi.nlm.nih.gov]
  • Second Cancers Caused by Cancer Treatment Some cancer treatments such as chemotherapy and radiation therapy may increase a person's risk of developing a different type of cancer later in life.[cancer.org]

Prognosis

  • The absence of cellular atypia may account for a favorable prognosis and enables clear distinction from more serious diagnoses such as lentigo maligna melanoma.[ncbi.nlm.nih.gov]
  • If a total lymphocyte count is 1500/mL, the radiation dose is expected to be around 0.4 Gy, and the chance of survival is very high, whereas counts of 500/mL indicate exposure to 4 Gy and carry a poorer prognosis.[symptoma.com]
  • Prognosis is initially estimated by the time between exposure and symptom onset, the severity of those symptoms, and by the lymphocyte count during the initial 24 to 72 h.[merckmanuals.com]

Etiology

  • The role of radiation exposure in the etiology of pituitary adenoma is discussed, along with a literature review of radiation-induced tumors.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiologic studies on cancer risk in surgeons and interventional proceduralists and dosimetry studies on true radiation exposure during trauma and spine surgery recently have been conducted.[ncbi.nlm.nih.gov]
  • This case report supports experimental and epidemiological evidence implicating ultraviolet radiation as a risk factor for cataract formation.[ncbi.nlm.nih.gov]
  • This review summarizes all of the published human epidemiological data on ionizing radiation exposure to the lens of the eye in order to evaluate the proposed threshold.[ncbi.nlm.nih.gov]
  • Clinical and epidemiologic data were gathered from all patients.[ncbi.nlm.nih.gov]
  • Further epidemiologic studies should be conducted to evaluate health outcomes among interventional radiation medical workers. Copyright 2017 SIR. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Prevention

  • , Cheonan, South Korea. 4 Department of Preventive Medicine, Keimyung University College of Medicine, Daegu, South Korea. 5 National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, South Korea. 6 Department of Preventive Medicine[ncbi.nlm.nih.gov]
  • Thus, we not only recommend taking into account the risk of radiation exposure, when referring patients to undergo AVS, but also to establish improved standard operating procedures to prevent unnecessary radiation exposure. 2018 The authors[ncbi.nlm.nih.gov]
  • The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations, and a report will be submitted to the relevant public health authorities in the Korea Centers for Disease Control and Prevention to help[ncbi.nlm.nih.gov]
  • According to the Centers for Disease Control and Prevention (CDC), potassium iodide prevents the thyroid gland from quickly absorbing radioactive iodine if inhaled. However, as the New York Times explains : Dr. [David J.][healthland.time.com]
  • How can radiation exposure be prevented? There are steps you can take to prevent or reduce radiation exposure: If your health care provider recommends a test that uses radiation, ask about its risks and benefits.[nlm.nih.gov]

References

Article

  1. Heslet L, Bay C, Nepper-Christensen S. Acute radiation syndrome (ARS) – treatment of the reduced host defense. Int J Gen Med. 2012;5:105-115.
  2. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
  3. Macià i Garau M, Lucas Calduch A, López EC. Radiobiology of the acute radiation syndrome. Rep Pract Oncol Radiother. 2011;16(4):123-130.
  4. Peter RU, Gottlöber P. Management of cutaneous radiation injuries: diagnostic and therapeutic principles of the cutaneous radiation syndrome. Mil Med. 2002;167(2):110-112.
  5. Dörr H, Meineke V. Acute radiation syndrome caused by accidental radiation exposure - therapeutic principles. BMC Med. 2011;9:126.
  6. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.

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Last updated: 2019-07-11 21:21