**1. Introduction**

Despite safety precautions and application of modern standards of radiation protection, injury from radiation can be generated from both intentional and unintentional situations

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

and events. Injury can be catastrophic, immediately life-threatening, and survivors of exposure remain with a lifetime risk of secondary events including chronic health changes and malignancies. Even with the development of radiation protection standards and oversite organizations, accidents and misadministration of radiation deviant from intent continue to haunt daily application of radiation therapy. There is no antidote to radiation exposure and the fingerprints of injury remain for a lifetime. In this chapter we will review major incidents of public radiation exposure and accidents in history including cause and effect. We will review the application and evolution of standards and how this affects both the public and healthcare worker in modern care. We will review modern patient care and response assessment to radiation exposure including agents that may protect or mitigate radiation damage from radiation exposure. We will identify strengths of modern radiation therapy and the need for continuous process improvements to ensure optimal application of X-ray in a safe environment.

Joliot Curie from radiation-associated diseases during the discovery of radium in 1898 and the

Essentials in Accident and Emergency Medicine Radiation Injury: Response and Treatment

http://dx.doi.org/10.5772/intechopen.76863

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While the benefits of the application of radium and X-rays were moving forward, the risk of injury was continually recognized at an international level. At the second international congress of radiology in 1928 held in Stockholm, Sweden, participating countries developed standards for radiation protection. These were centered on recommendations from the United Kingdom as guidelines for radiation protection had been employed for the previous decade. The congress established the International X-Ray and Radium Protection Committee which was remodeled after World War II (WWII) into two commissions that are active today. These are the International Commission on Radiological Protection (ICRP) and the International Commission on Radiation Units and Measurements (ICRU). In the United States today, the Environmental Protection Agency (EPA) is charged with the responsibility for providing guidance to federal agencies. The Nuclear Regulatory Commission (NRC) formulates rules for application of product materials and the Department of Energy is responsible for radiation safety regulations through the NRC. Multiple international agencies participate in radiation safety activities and help shape

As the benefits and power of X-rays and radium matured, the use of nuclear tools for weapons of mass destruction came to power. During WWII, efforts for harnessing nuclear power for destruction reached application on August 6, 1945 with the use of a 9000-pound uranium-235 bomb known a "Little Boy" over the manufacturing city of Hiroshima, Japan. The bomb was dropped with a parachute and detonated 2000 feet above the city with blast equal to 15 kilotons About 2–3 days later, a plutonium-239 bomb known as "Fat Man" was dropped over the city of Nagasaki. The primary target was Kokura; however, clouds shrouded the primary target area. The plutonium bomb was more powerful than the bomb used on Hiroshima. The bomb weighed 10,000 pounds and produced a 22-kilotons blast. The topography of Nagasaki limited the radius of impact as the city is in a narrow valley between mountains. Initial destruction and death was due to heat and fire as well as associated trauma related to building damage and other structural/public health-related matters; however, those not at the epicenter of the blast were exposed to radiation as a function of distance from the epicenter. Early impact resulted in microcephaly and mental retardation in the most vulnerable unborn and young population with lifelong health risks including chronic health issues in multiple organ systems and cancer risks affecting all survivors. We have earned much about studying the population of survivors and have been able to apply this knowledge to risk assessment for the general population, healthcare workers, and pregnant/potentially pregnant patients [5–7].

After WWII, there was a significant interest in accelerating the production of nuclear weapons as well as promoting the use of nuclear energy in lieu of fossil fuels and other sources

policy including health applications and strategy for nuclear energy [1–4].

near immediate application of radium to treat cancer.

**3. Intentional injury**

**4. Unintentional injury: nuclear power**

#### **2. History**

X-rays were discovered in 1895 by William Roentgen. In part due to the century old use of electricity in medicine, X-rays were rapidly assimilated into the medical armamentarium portfolio as beneficial applications of X-ray treatment were identified by early radiologists. Due to protracted exposure times and minimal knowledge of risk, early practitioners of the application of X-rays to treatment situations became victims themselves. Friedrich Otto Walkoff took the first dental radiograph in 1895 by placing a photographic plate between his teeth and tongue. He was able to generate an image with a 30-minute exposure time. He applied similar techniques to patients and reported epilation and skin blistering. Walkoff developed the first dental imaging laboratory in 1896 with Fritz Geisel. Geisel died in 1927 of metastatic carcinoma caused by heavy exposure of radiation to his hands. In 1896, a child was accidently shot in the head and was brought to a laboratory at Vanderbilt University (Nashville, TN). Investigators sought the location of the bullet by X-ray and a plate holder was tied to the head of the patient. The X-ray tube was placed at the patient's head. The exposure was 1 hour. About 21 days after exposure there was epilation at the site of X-ray application. In 1896, HD Hawkes gave a demonstration of an X-ray unit in New York City. He had to discontinue work after 4 days due to injury to the skin of his hand and chest. Within 2 weeks he had significant skin injuries, his fingernails deteriorated, and he exhibited systemic signs of radiation injury. In the same year, William Levy sought out to localize a bullet that had been lodged in his skull for 10 years. He was warned about the potential of injury; however, chose to move forward. Images were created over a 14-hour period from three static positions at his forehead, his open mouth, and behind his right ear. Within 24 hours, the dermal surfaces of his head were blistered and within days his mouth and lips had sores and epilation occurred within 3 weeks. The bullet was found within an inch of the occipital protuberance. In this circumstance, the absorbed dose by the victim was at least 15 Gray (Gy). Clarence Dally worked at the Edison laboratory and had the role of being a glassblower for Thomas Edison. He is thought to be the first individual to die from chronic radiation workplace exposure in 1904 from metastatic carcinoma at the age of 39. It is thought that his exposure was at least 30 Gy. Numerous deaths were reported in X-ray manufacturers and workers with noted deaths of Nobel Laureates Marie Curie and her daughter Joliot Curie from radiation-associated diseases during the discovery of radium in 1898 and the near immediate application of radium to treat cancer.

While the benefits of the application of radium and X-rays were moving forward, the risk of injury was continually recognized at an international level. At the second international congress of radiology in 1928 held in Stockholm, Sweden, participating countries developed standards for radiation protection. These were centered on recommendations from the United Kingdom as guidelines for radiation protection had been employed for the previous decade. The congress established the International X-Ray and Radium Protection Committee which was remodeled after World War II (WWII) into two commissions that are active today. These are the International Commission on Radiological Protection (ICRP) and the International Commission on Radiation Units and Measurements (ICRU). In the United States today, the Environmental Protection Agency (EPA) is charged with the responsibility for providing guidance to federal agencies. The Nuclear Regulatory Commission (NRC) formulates rules for application of product materials and the Department of Energy is responsible for radiation safety regulations through the NRC. Multiple international agencies participate in radiation safety activities and help shape policy including health applications and strategy for nuclear energy [1–4].
