Radiation poisoning

Measuring radiation dosage

The gray (Gy), which is defined as 1 joule of deposited energy per kilogram of tissue. Thus one gray is equal to 100 rad.

To accurately assess the risk of radiation, the absorbed dose energy in rad is multiplied by the relative biological effectiveness (RBE) of the radiation to get the biological dose equivalent in sieverts (Sv). The sievert is equal to 100 rem.

The RBE is a "quality factor," often denoted by the letter Q, which assesses the damage to tissue caused by a particular type and energy of radiation. For sievert article for a more complete list of Q values.

Acute (short-term) vs chronic (long-term) effects

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Radiation sickness is generally associated with acute exposure and has a characteristic set of symptoms that appear in an orderly fashion. The symptoms of radiation sickness become more serious (and the chance of survival decreases) as the dosage of radiation increases. These effects are described as the deterministic effects of radiation.

Longer term exposure to radiation, at doses less than that which produces serious radiation sickness, can induce cancer as cell-cycle genes are mutated. If a cancer is radiation-induced, then the disease, the speed at which the condition advances, the prognosis, the degree of pain, and every other feature of the disease are not functions of the radiation dose to which the sufferer is exposed.

Since tumors grow by abnormally rapid cell division, the ability of radiation to disturb cell division is also used to treat cancer (see hormesis).

Exposure

External vs internal exposure

External

External exposure is exposure which occurs when the radioactive source (or other radiation source) is outside (and remains outside) the organism which is exposed. Below are a series of three examples of external exposure.

• A person who places a sealed radioactive source in their pocket
• A space traveller who is irradiated by cosmic rays
• A person who is treated for cancer by either teletherapy or brachytherapy. While in brachytherapy the source is inside the person it is still external exposure because the active part of the source never comes into direct contact with the biological tissues of the person.

One of the key points is that external exposure is often relatively easy to estimate, and if the irradated objects do not become radioactive (except for a case where the radiation is an intense activation of the object'). It is possible for an object to be contaminated on the outer surfaces, assuming that no radioactivity enters the object it is still a case of external exposure and it is normally the case that decontamination is easy (wash the surface)..

Internal

Internal exposure is when the radioactive material enters the organism, and the radioactive atoms become incorporated into the organism. Below are a series of examples of internal exposure.

• The exposure due to ⁴⁰K present within a normal person.
• The exposure to the ingestion of a soluble radioactive substance, such as ⁹⁰Sr in cow’s milk.
• A person who is being treated for cancer by means of an open source radiotherapy method where a radioisotope is used as a drug. A review of this topic was published in 1999.^[1]

Because the radioactive material becomes intimately mixed with the affected object it is often difficult to decontaminate the object or person in a case where internal exposure is occurring. While some very insoluble materials such as uranium dioxide matrix might never be able to truly become part of an organism, it is normal to consider such particles in the lungs as a form of internal contamination which results in internal exposure. The reasoning is that the particles have entered via an orifice and can not be removed with ease from what the lay person (non biologist) would regard as within the animal. It is important to note that strictly speaking the contents of the digestive tract and the air within the lungs are outside the body of a mammal.

Nuclear warfare

 

Nuclear warfare is more complex because a person can be irradiated by at least three processes. The first (the major cause of burns) is not caused by ionizing radiation.

• Thermal burns from infrared heat radiation.
• local fallout would be likely to have very high activities because they would be deposited so soon after detonation and it is likely that one such particle upon the skin would be able to cause a localised burn); however, these particles are very weakly penetrating and have a short range.
• Gamma burns from highly penetrating radiation. This would likely cause deep gamma penetration within the body, which would result in uniform whole body irradiation rather than only a surface burn. In cases of whole body gamma irradiation (circa 10 Gy) due to accidents involving medical product irradiators, some of the human subjects have developed injuries to their skin between the time of irradiation and death.

In the picture on the right, the normal clothing that the woman was wearing would have been unable to attenuate the gamma radiation and it is likely that any such effect was evenly applied to her entire body. Beta burns would be likely all over the body due to contact with fallout, but thermal burns are often on one side of the body as heat radiation does not penetrate the human body. In addition, the pattern on her clothing has been burnt into the skin. This is because white fabric reflects more infra-red light than dark fabric. As a result, the skin close to dark fabric is burned more than the skin covered by white clothing.

There is also the risk of internal radiation poisoning by ingestion of fallout particles.

Nuclear reactor accidents

Radiation poisoning was a major concern after the Chernobyl reactor accident. It is important to note that in humans the acute effects were largely confined to the accident site. Thirty-one people died as an immediate result.

Of the 100 million curies (4 ⁹⁰Sr (with a half-life of 28.78 years) as main dangers.

Other accidents

Improper handling of radioactive and nuclear materials lead to radiation release and radiation poisoning. The Therac-25.

Ingestion and inhalation

When radioactive compounds enter the human body, the effects are different from those resulting from exposure to an external radiation source. Especially in the case of alpha radiation, which normally does not penetrate the skin, the exposure can be much more damaging after ingestion or inhalation. The radiation exposure is normally expressed as a committed effective dose equivalent (CEDE).

Deliberate poisoning

See also: Alexander Litvinenko poisoning

On November 23, 2006, Alexander Litvinenko died due to suspected deliberate poisoning with heavy water.

Prevention

The best prevention for radiation sickness is to minimize the dose suffered by the human, or to reduce the dose rate.

Time

The longer that the humans are subjected to radiation the larger the dose will be. The advice in the nuclear war manual entitled "Nuclear War Survival Skills" published by Cresson Kearny in the U.S. was that if one needed to leave the shelter then this should be done as rapidly as possible to minimize exposure.

In chapter 12 he states that "Quickly putting or dumping wastes outside is not hazardous once fallout is no longer being deposited. For example, assume the shelter is in an area of heavy fallout and the dose rate outside is 400 R/hr enough to give a potentially fatal dose in about an hour to a person exposed in the open. If a person needs to be exposed for only 10 seconds to dump a bucket, in this 1/360th of an hour he will receive a dose of only about 1 R. Under war conditions, an additional 1-R dose is of little concern."

In peacetime radiation workers are taught to work as quickly as possible when performing a task which exposes them to irradiation. For instance, the recovery of a lost radiography source should be done as quickly as possible.

Distance

The radiation due to any point source will obey the inverse square law: by doubling the distance the dose rate is quartered. This is why radiation workers are always taught to pick up a gamma source with a pair of tongs rather than their hand.

Shielding

By placing a layer of a material which will absorb the radiation between the source and the human, the dose and dose rate can be reduced. For instance, in the event of a nuclear war, it would be a good idea to shelter within a building with thick stone walls (photoelectric effect; again, by covering the high Z material with a low Z material, this potential additional source of exposure to humans can be avoided. Furthermore, gamma rays can scatter off a dense object; this enables gamma rays to "go around corners" to a small degree. Hence, to obtain a very high protection factor, the path in/out of the shielded enclosure should have several 90 degree turns rather than just one.

Reduction of incorporation into the human body

radioactive iodine in the event of an accident or terrorist attack at a nuclear power plant, or the detonation of a nuclear explosive. KI would not be effective against a dirty bomb unless the bomb happened to contain radioactive iodine, and even then it would only help to prevent thyroid cancer.

Fractionation of dose

While Devair Alves Ferreira received a large dose during the Goiânia accident of 7.0 Gy, he lived while his wife received a dose of 5.7 Gy and died. The most likely explanation is that his dose was fractionated into many smaller doses which were absorbed over a length of time, while his wife stayed in the house more and was subjected to continuous irradiation without a break, giving her body less time to repair some of the damage done by the radiation. In the same way, some of the people who worked in the basement of the wrecked Chernobyl plant received doses of 10 Gy, but in small fractions, so the acute effects were avoided.

It has been found in radiation biology experiments that if a group of cells are irradiated, then as the dose increases, the number of cells which survive decreases. It has also been found that if a population of cells is given a dose before being set aside (without being irradiated) for a length of time before being irradiated again, then the radiation causes less cell death. The human body contains many types of cells and the human can be killed by the loss of a single type of cells in a vital organ. For many short term radiation deaths (3 days to 30 days), the loss of cells forming blood cells (bone marrow) and the cells in the digestive system (microvilli which form part of the wall of the intestines are constantly being regenerated in a healthy human) causes death.

In the graph below, dose/survival curves for a hypothetical group of cells have been drawn, with and without a rest time for the cells to recover. Other than the recovery time partway through the irradiation, the cells would have been treated identically.

Treatment

Treatment reversing the effects of irradiation is currently not possible. Anaesthetics and antiemetics are administered to counter the symptoms of exposure, as well as antibiotics for countering secondary infections due to the resulting immune system deficiency.

There are also a number of substances used to mitigate the prolonged effects of radiation poisoning, by eliminating the remaining radioactive materials, post exposure.

Whole body vs. part of body exposure

In the case of a person who has had only part of their body irradiated then the treatment is easier, as the human body can tolerate very large exposures to the non-vital parts such as hands and feet, without having a global effect on the entire body. For instance, if the hands get a 100 Sv dose which results in the body receiving a dose (averaged over your entire body of 5 Sv) then the hands may be lost but Radiation poisoning would not occur. The resulting injury would be described as localized radiation burn.

Experimental treatments designed to mitigate the effect on bone marrow

Phase I trials have been performed.

Some work has been published in which Cordyceps sinensis, a Chinese Herbal Medicine has been used to protect the bone marrow and digestive systems of mice from whole body irradation.^[2]

Table of exposure levels and symptoms

Dose-equivalents are presently stated in sieverts:

0.05–0.2 Sv (5–20 REM)

No symptoms. Potential for cancer and mutation of genetic material, according to the hormesis). A few researchers contend that low dose radiation may be beneficial. [5] [6] [7] 50 mSv is the yearly federal limit for radiation workers in the United States. In the UK the yearly limit for a classified radiation worker is 20 mSv. In Canada, the single-year maximum is 50 mSv, but the maximum 5-year dose is only 100 mSv. Company limits are usually stricter so as not to violate federal limits. [8]

0.2–0.5 Sv (20–50 REM)

No noticeable symptoms. Red blood cell count decreases temporarily.

0.5–1 Sv (50–100 REM)

Mild radiation sickness with headache and increased risk of infection due to disruption of immunity cells. Temporary male sterility is possible.

1–2 Sv (100–200 REM)

Light radiation poisoning, 10% fatality after 30 days (LD 10/30). Typical symptoms include mild to moderate nausea (50% probability at 2 Sv), with occasional vomiting, beginning 3 to 6 hours after irradiation and lasting for up to one day. This is followed by a 10 to 14 day latent phase, after which light symptoms like general illness and fatigue appear (50% probability at 2 Sv). The immune system is depressed, with convalescence extended and increased risk of infection. Temporary male sterility is common. Spontaneous abortion or stillbirth will occur in pregnant women.

2–3 Sv (200–300 REM)

Moderate radiation poisoning, 35% fatality after 30 days (LD 35/30). Nausea is common (100% at 3 Sv), with 50% risk of vomiting at 2.8 Sv. Symptoms onset at 1 to 6 hours after irradiation and last for 1 to 2 days. After that, there is a 7 to 14 day latent phase, after which the following symptoms appear: loss of hair all over the body (50% probability at 3 Sv), fatigue and general illness. There is a massive loss of leukocytes (white blood cells), greatly increasing the risk of infection. Permanent female sterility is possible. Convalescence takes one to several months.

3–4 Sv (300–400 REM)

Severe radiation poisoning, 50% fatality after 30 days (LD 50/30). Other symptoms are similar to the 2–3 Sv dose, with uncontrollable bleeding in the mouth, under the skin and in the kidneys (50% probability at 4 Sv) after the latent phase.

4–6 Sv (400–600 REM)

Acute radiation poisoning, 60% fatality after 30 days (LD 60/30). Fatality increases from 60% at 4.5 Sv to 90% at 6 Sv (unless there is intense medical care). Symptoms start half an hour to two hours after irradiation and last for up to 2 days. After that, there is a 7 to 14 day latent phase, after which generally the same symptoms appear as with 3-4 Sv irradiation, with increased intensity. Female sterility is common at this point. Convalescence takes several months to a year. The primary causes of death (in general 2 to 12 weeks after irradiation) are infections and internal bleeding.

6–10 Sv (600–1,000 REM)

Acute radiation poisoning, near 100% fatality after 14 days (LD 100/14). Survival depends on intense medical care. Bone marrow is nearly or completely destroyed, so a bone marrow transplant is required. Gastric and intestinal tissue are severely damaged. Symptoms start 15 to 30 minutes after irradiation and last for up to 2 days. Subsequently, there is a 5 to 10 day latent phase, after which the person dies of infection or internal bleeding. Recovery would take several years and probably would never be complete.

Devair Alves Ferreira received a dose of approximately 7.0 Sv (700 REM) during the fractionated exposure.

10–50 Sv (1,000–5,000 REM)

Acute radiation poisoning, 100% fatality after 7 days (LD 100/7). An exposure this high leads to spontaneous symptoms after 5 to 30 minutes. After powerful fatigue and immediate nausea caused by direct activation of chemical receptors in the brain by the irradiation, there is a period of several days of comparative well-being, called the latent (or "walking ghost") phase^{[citation needed]}. After that, cell death in the gastric and intestinal tissue, causing massive diarrhea, intestinal bleeding and loss of water, leads to water-electrolyte imbalance. Death sets in with delirium and coma due to breakdown of circulation. Death is currently inevitable; the only treatment that can be offered is pain therapy.

Louis Slotin was exposed to approximately 21 Sv in a criticality accident on 21 May 1946, and died nine days later on 30 May.

More than 50 Sv (>5,000 REM)

A worker receiving 100 Sv (10,000 REM) in an accident at Wood River, Rhode Island, USA on 24 July 1964 survived for 49 hours after exposure, and an operator receiving between 60 and 180 Sv (18,000 REM) to his upper body in an accident at Los Alamos, New Mexico, USA on 30 December 1958 survived for 36 hours; details of this accident can be found on page 16 (page 30 in the PDF version) of Los Alamos' 2000 Review of Criticality Accidents [9].

References

Further reading

• Michihiko Hachiya, Hiroshima Diary (Chapel Hill: University of North Carolina, 1955), ISBN 0-8078-4547-7.
• John Hersey, Hiroshima (New York: Vintage, 1946, 1985 new chapter), ISBN 0-679-72103-7.
• Ibuse Masuji, Black Rain (1969) ISBN 0-87011-364-X
• Ernest J. Sternglass, Secret Fallout: low-level radiation from Hiroshima to Three-Mile Island (1981) ISBN 0-07-061242-0 (online)
• Norman Solomon, Harvey Wasserman Killing Our Own: The Disaster of America's Experience with Atomic Radiation, 1945-1982, New York: Dell, 1982. ISBN 0-385-28537-X, ISBN 0-385-28536-1, ISBN 0-440-04567-3 (online)

See also

• Hibakusha (Japanese atomic bomb survivors)
• Radioactive quackery
• List of military nuclear accidents
• List of civilian nuclear accidents

Aerosinusitis - Hypoxia - Barotrauma - Altitude sickness - Chronic mountain sickness - Decompression sickness - Asphyxia - Starvation

maltreatment (Physical abuse, Sexual abuse, Psychological abuse)

Motion sickness (Airsickness, Sea-sickness)

Electric shock - Anaphylaxis - Angioedema

Hypersensitivity (Allergy, Arthus reaction)