Radiation Injuries

Radiation Injuries

 

Definition

Radiation injuries are caused by ionizing radiation emitted by sources such as the sun, x-ray and other diagnostic machines, tanning beds, and radioactive elements released in nuclear power plant accidents and detonation of nuclear weapons during war and as terrorist acts.

Description

Ionizing radiation is made up of unstable atoms that contain an excess amount of energy. In an attempt to stabilize, the atoms emit the excess energy into the atmosphere, creating radiation. Radiation can either be electromagnetic or particulate.
The energy of electromagnetic radiation is a direct function of its frequency. The high-energy, high-frequency waves that can penetrate solids to various depths cause damage by separating molecules into electrically charged pieces, a process known as ionization. X rays are a type of electromagnetic radiation. Atomic particles come from radioactive isotopes as they decay to stable elements. Electrons are called beta particles when they radiate. Alpha particles are the nuclei of helium atoms—two protons and two neutrons—without the surrounding electrons. Alpha particles are too large to penetrate a piece of paper unless they are greatly accelerated in electric and magnetic fields. Both beta and alpha particles are types of particulate radiation. When over-exposure to ionizing radiation occurs, there is chromosomal damage in deoxyribonucleic acid (DNA). DNA is very good at repairing itself; both strands of the double helix must be broken to produce genetic damage.
Because radiation is energy, it can be measured. There are a number of units used to quantify radiation energy. Some refer to effects on air, others to effects on living tissue. The roentgen, named after Wilhelm Conrad Roentgen, who discovered x rays in 1895, measures ionizing energy in air. A rad expresses the energy transferred to tissue. The rem measures tissue response. A roentgen generates about a rad of effect and produces about a rem of response. The gray and the sievert are international units equivalent to 100 rads and rems, respectively. A curie, named after French physicists who experimented with radiation, is a measure of actual radioactivity given off by a radioactive element, not a measure of its effect. The average annual human exposure to natural background radiation is roughly 3 milliSieverts (mSv).
Any amount of ionizing radiation will produce some damage, however, there is radiation everywhere, from the sun (cosmic rays) and from traces of radioactive elements in the air (radon) and the ground (uranium, radium, carbon-14, potassium-40 and many others). Earth's atmosphere protects us from most of the sun's radiation. Living at 5,000 feet altitude in Denver, Colorado, doubles exposure to radiation, and flight in a commercial airliner increases it 150-fold by lifting us above 80% of that atmosphere. Because no amount of radiation is perfectly safe and because radiation is ever present, arbitrary limits have been established to provide some measure of safety for those exposed to unusual amounts. Less than 1% of them reach the current annual permissible maximum of 20 mSv.
A 2001 ruling by the Federal Court of Australia indicated that two soldiers died from cancer caused by minimal exposure to radiation while occupying Hiroshima in 1945. The soldiers were exposed to less than 5 mSv of radiation. The international recommendation for workers is safety level of up to 20 mSv. The ruling and its support by many international agencies suggests that even extremely low doses of radiation can be potentially harmful.

Ultraviolet (uv) radiation exposure from the sun and tanning beds

UV radiation from the sun and tanning beds and lamps can cause skin damage, premature aging, and skin cancers. Malignant melanoma is the most dangerous of skin cancers and there is a definite link between type UVA exposure used in tanning beds and its occurrence. UVB type UV radiation is associated with sunburn, and while not as penetrating as UVA, it still damages the skin with over exposure. Skin damage accumulates over time, and effects do not often manifest until individuals reach middle age. Light-skinned people who most often burn rather than tan are at a greater risk of skin damage than darker-skinned individuals that almost never burn. The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) discourage the use of tanning beds and sun lamps and encourage the use of sunscreen with at least an SPF of 15 or greater.

Over exposure during medical procedures

Ionizing radiation has many uses in medicine, both in diagnosis and in treatment. X rays, CT scanners, and fluoroscopes use it to form images of the body's insides. Nuclear medicine uses radioactive isotopes to diagnose and to treat medical conditions. In the body, radioactive elements localize to specific tissues and give off tiny amounts of radiation. Detecting that radiation provides information on both anatomy and function. During the past 10 years, skin injuries caused by too much exposure during a medical procedure have been documented. In 1995, the FDA issued a recommendation to physicians and medical institutions to record and monitor the dosage of radiation used during medical procedures on patients in order to minimize the amount of skin injuries. The FDA suggested doses of radiation not exceed 1 Grey (Gy). (A Grey is roughly equivalent to a sievert.) As of 2001, the FDA was preparing further guidelines for fluoroscopy, the procedure most often associated with medical-related radiation skin injuries such as rashes and more serious burns and tissue death. Injuries occurred most often during angioplasty procedures using fluoroscopy.
CT scans of children have also been problematic. Oftentimes the dosage of radiation used for an adult isn't decreased for a child, leading to radiation over exposure. Children are more sensitive to radiation and a February 2001 study indicates 1,500 out of 1.6 million children under 15 years of age receiving CT scans annually will develop cancer. Studies show that decreasing the radiation by half for CT scans of children will effectively decrease the possibility of over exposure while still providing an effective diagnostic image. The benefits to receiving the medical treatment utilizing radiation is still greater than the risks involved, however, more stringent control over the amount of radiation used during the procedures will go far to minimize the risk of radiation injury to the patient.

Radiation exposure from nuclear accidents, weaponry, and terrorist acts

Between 1945 and 1987, there were 285 nuclear reactor accidents, injuring over 1,550 people and killing 64. The most striking example was the meltdown of the graphite core nuclear reactor at Chernobyl in 1986, which spread a cloud of radioactive particles across the entire continent of Europe. Information about radiation effects is still being gathered from that disaster, however 31 people were killed in the immediate accident and 1,800 children have thus far been diagnosed with thyroid cancer. In a study published in May 2001 by the British Royal Society, children born to individuals involved in the cleanup of Chernobyl and born after the accident are 600% more likely to have genetic mutations than children born before the accident. These findings indicate that exposure to low doses of radiation can cause inheritable effects.
Since the terrorist attack on the World Trade Center and the Pentagon on September 11, 2001, the possibility of terrorist-caused nuclear accidents has been a growing concern. All 103 active nuclear power plants in the United States are on full alert, but they are still vulnerable to sabotage such as bombing or attack from the air. A no-fly zone of 12 miles below 18,000 feet has been established around nuclear power plants by the Federal Aviation Administration (FAA). There is also growing concern over the security of spent nuclear fuel—more than 40,000 tons of spent fuel is housed in buildings at closed plants around the country. Unlike the active nuclear reactors that are enclosed in concrete-reinforced buildings, the spent fuel is stored in non-reinforced buildings. Housed in cooling pools, the spent fuel could emit dangerous levels of radioactive material if exploded or used in makeshift weaponry. Radioactive medical and industrial waste could also be used to make "dirty bombs." Since 1993, the Nuclear Regulatory Commission (NRC) has reported 376 cases of stolen radioactive materials.

Causes and symptoms

Radiation can damage every tissue in the body. The particular manifestation will depend upon the amount of radiation, the time over which it is absorbed, and the susceptibility of the tissue. The fastest growing tissues are the most vulnerable, because radiation as much as triples its effects during the growth phase. Bone marrow cells that make blood are the fastest growing cells in the body. A fetus in the womb is equally sensitive. The germinal cells in the testes and ovaries are only slightly less sensitive. Both can be rendered useless with very small doses of radiation. More resistant are the lining cells of the body—skin and intestines. Most resistant are the brain cells, because they grow the slowest.
The length of exposure makes a big difference in what happens. Over time the accumulating damage, if not enough to kill cells outright, distorts their growth and causes scarring and/or cancers. In addition to leukemias, cancers of the thyroid, brain, bone, breast, skin, stomach, and lung all arise after radiation. Damage depends, too, on the ability of the tissue to repair itself. Some tissues and some types of damage produce much greater consequences than others.
There are three types of radiation injuries.
  • External irradiation: as with x-ray exposure, all or part of the body is exposed to radiation that either is absorbed or passes through the body.
  • Contamination: as with a nuclear accident, the environment and its inhabitants are exposed to radiation. People are affected internally, externally, or with both internal and external exposure.
  • Incorporation: dependent on contamination, the bodies of individuals affected incorporate the radiation chemicals within cells, organs, and tissues and the radiation is dispersed throughout the body.
Immediately after sudden irradiation, the fate of those affected depends mostly on the total dose absorbed. This information comes mostly from survivors of the atomic bomb blasts over Japan in 1945.
  • Massive doses incinerate immediately and are not distinguishable from the heat of the source.
  • A sudden whole body dose over 50 Sv produces such profound neurological, heart, and circulatory damage that patients die within the first two days.
  • Doses in the 10-20 Sv range affect the intestines, stripping their lining and leading to death within three months from vomiting, diarrhea, starvation, and infection.
  • Victims receiving 6-10 Sv all at once usually escape an intestinal death, facing instead bone marrow failure and death within two months from loss of blood coagulation factors and the protection against infection provided by white blood cells.
  • Between 2-6 Sv gives a fighting chance for survival if victims are supported with blood transfusions and antibiotics.
  • One or two Sv produces a brief, non-lethal sickness with vomiting, loss of appetite, and generalized discomfort.

Treatment

It is clearly important to have some idea of the dose received as early as possible, so that attention can be directed to those victims in the 2-10 Sv range that might survive with treatment. Blood transfusions, protection from infection in damaged organs, and possibly the use of newer stimulants to blood formation can save many victims in this category.
Local radiation exposures usually damage the skin and require careful wound care, removal of dead tissue, and skin grafting if the area is large. Again infection control is imperative.
One of the best known, and perhaps even mainstream, treatments of radiation injury is the use of Aloe vera preparations on damaged areas of skin. It has demonstrated remarkable healing properties even for chronic ulcerations resulting from radiation exposure.

Alternative treatment

There is considerable interest these days in benevolent chemicals called "free radical scavengers." How well they work is yet to be determined, but population studies strongly suggest that certain diets are better than others, and that those diets are full of free radical scavengers, otherwise known as antioxidants. The recommended ingredients are beta-carotene, vitamins E and C, and selenium, all available as commercial preparations. Beta-carotene is yellow-orange and is present in yellow and orange fruits and vegetables. Vitamin C can be found naturally in citrus fruits. Traditional Chinese medicine (TCM) and acupuncture, botanical medicine, and homeopathy all have contributions to make to recovery from the damage of radiation injuries. The level of recovery will depend on the exposure. Consulting practitioners trained in these modalities will result in the greatest benefit.

Resources

Periodicals

Grunwald, Michael, and Peter Behr. "Are Nuclear Plants Secure? Industry Called Unprepared for Sept. 11-Style Attack." The Washington Post November 3, 2001, p. A01.
Vergano, Dan. "'Dirty' Bombs Latest Fear." USA Today November 3, 2001.

Key terms

DNA — Deoxyribonucleic acid. The chemical of chromosomes and hence the vehicle of heredity.
Isotope — An unstable form of an element that gives off radiation to become stable. Elements are characterized by the number of electrons around each atom. One electron's negative charge balances the positive charge of each proton in the nucleus. To keep all those positive charges in the nucleus from repelling each other (like the same poles of magnets), neutrons are added. Only certain numbers of neutrons work. Other numbers cannot hold the nucleus together, so it splits apart, giving off ionizing radiation. Sometimes one of the split products is not stable either, so another split takes place. The process is called radioactivity.
References in periodicals archive ?
According to experts at the First Conference on Radiation Safety in Interventional Cardiology organised at the HMC's Heart Hospital on Friday, the commonmost of radiation injuries during interventional cardiology procedures were loss of hair and cataract among medical staff and skin injuries among the patients which could lead to skin ulcers if left untreated.
The actions by Tokyo Electric Power led to radiation injuries, said the contract worker, known only as Shinichi, who was with a six-member team working at the crippled Fukushima Daiichi plant's unit three reactor in the early days of last year's crisis.
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Work has also been interrupted by hosing operations to lower rising temperatures in the reactor cores and spent fuel pools and spikes in radioactivity, as well as an occasional fire and radiation injuries.
It has also been used to help treat soft tissue radiation injuries, another symptom of excess radiation.
The protesters marched from Yaizu Station to the grave of Aikichi Kuboyama, who died from radiation injuries sustained in the 1954 U.
Her study, which compares 2,601 survivors of the Hiroshima atom bomb who suffered from acute radiation injuries with 63,072 who did not, found that people over 55 at the time of the explosion were twice as likely to die of cancer than those aged between ten and 55, and children under ten were three times as likely to die of cancer as other age groups.
Preliminary data suggest that the drug also may be useful in treating radiation injuries to the gastrointestinal system.
Representatives from the National Nuclear Security Administration (NNSA) are in South Africa conducting two International Medical Management of Radiation Injuries (I-MED) courses.
The same team had previously discovered novel synthetic antioxidants that effectively mitigate radiation injuries, but had to be given by injection.
Of those 10, Saga prefecture said only patients with slight radiation injuries can be appropriately treated in the prefecture.