**5. Radiation injury**

Although most individuals exposed to radiation contamination are not symptomatic, the consequences of such exposures tend to result in long-term sequelae [47–50]. Providers should be aware of signs and symptoms of radiation injury so that such occurrences can be readily recognized, contained, and victims treated promptly [51, 52]. As demonstrated in our *Clinical Vignette #1*, acute HMRE tends to have organ-specific, regional anatomic manifestations (e.g., pneumonitis, lung fibrosis, gastric ulceration, and radiation proctitis) [52–54]. Systemic manifestations (e.g., acute radiation syndrome) are extremely rare in the healthcare setting and usually involve direct exposures of patients, workers, or otherwise unsuspecting individuals, to the radioactive isotope material, as outlined in our *clinical vignette #2* [18, 55] and *clinical vignette #3* [9, 19, 20].

whole body to radiation exceeding 0.7 Gray (Gy). ARaS manifests most acutely and severely in the hematopoietic, gastrointestinal, and cardiovascular/neurovascular systems [27, 57]. Radiation-induced gastrointestinal manifestations of ARaS manifest as nausea, vomiting, and bloody diarrhea. Severe dermatological injury with burns, desquamation, epilation, and ulceration can occur after significant radiation exposure even in the absence of ARaS [58], as exemplified by our *clinical vignette #1*. The above manifestations are summarized in **Table 4**.

**Syndrome Hematopoietic Gastrointestinal Cardiovascular/neurovascular**

nausea, vomiting, cramps, and diarrhea

Fundamentals of Medical Radiation Safety: Focus on Reducing Short-Term and Long-Term…

feels well for less than a week

Malaise, anorexia, severe diarrhea, fever, dehydration, and electrolyte imbalance

Death occurs within 2 weeks after exposure

The LD100 is about

10 Gy

Extreme nervousness and confusion, severe nausea, vomiting, watery diarrhea, loss of consciousness and burning sensation of the skin

http://dx.doi.org/10.5772/intechopen.85689

63

Patient may return to partial functionality (often lasts less than

Watery diarrhea, convulsions,

Onset occurs 5–6 hours after

Death occurs within 3 days of

No recovery expected

several hours)

and coma

exposure

exposure

Dose >0.3–0.7 Gy >6–10 Gy >20–50 Gy

Latent stage Patient appears well for 1–6 weeks Patient appears and

Anorexia, fever, and malaise Drop in all blood cell counts Primary cause of death is infection

Most deaths within a few months Survival rate is inversely proportional

patients from a few weeks to 2 years

Death may occur in some individuals

and hemorrhage

Recovery Full recovery for large percentage of

after exposure

The LD50/60 is 2.5 to 5 Gy

**Table 4.** Acute radiation syndrome: most common manifestations [13].

at 1.2 Gy

to dose

Anorexia, nausea/vomiting Anorexia, severe

Prodromal stage (minutes—2 days)

Manifest illness

stage

The general principles of protection from radiation injury depend upon four factors: distance, time, shielding, and removal or containment of contamination [27]. When caring for potential radiation contaminated patients, healthcare personnel must minimize the duration of exposure to a source, maximize the distance from source, and establish effective shielding from the source. Identification of the presence of radioactive contamination on or within a patient mandates early removal/containment in order to forestall further damage and contamination [27]. In cases similar to the Goiania incident, hand-held Geiger counters must be utilized in order to focus on accurately identifying anatomic areas of contamination unique

**6. Protection from and screening for radiation contamination**

Acute radiation syndrome (ARaS), unlike radiation injury, is a systemic entity that occurs very rarely in the healthcare setting. It usually involves some form of equipment failure, radioactive isotope release, criminal activity/theft, or inappropriate disposal of equipment or isotope(s) [9, 18–20, 55]. Because ARaS may be the only overt "manifestation" of a major radioactive breach, it is critical that it is promptly recognized, and that it leads to a thorough investigation into associated events. Symptoms of ARaS evolve over time in distinct phases. The duration of each phase and the time of its onset will be approximately inversely proportional to the dose [56]. An initial prodromal phase, with symptoms such as nausea, vomiting, weakness, and fatigue, typically develops within hours to days after exposure of the Fundamentals of Medical Radiation Safety: Focus on Reducing Short-Term and Long-Term… http://dx.doi.org/10.5772/intechopen.85689 63


**Table 4.** Acute radiation syndrome: most common manifestations [13].

[41]. Among their resources, the FDA collaborated with the National Council on Radiation Protection and Measurement to communicate the risk of radiation exposure with patients, particularly imaging involving young children [41, 42]. The FDA advocates for patient and healthcare provider awareness via the Image Wisely and Image Gently radiation risk campaigns, as well as with the International Atomic Energy Agency's "Radiation Protection of Patients" website [41, 43, 44]. The FDA has also advocated for patient and healthcare provider tools to reduce radiation exposure. One particular innovative safety tool is the "Patient Medical Imaging Record Card", which was developed by the FDA in collaboration with Image Wisely [41, 43]. The card can be used to track patient imaging studies by date, type, and location to prevent unnecessary repeat ionizing radiation exposures [41]. Looking toward the future, this card would ideally be integrated into the patient's electronic health record and stored in a nationally accessible database for healthcare providers, such as the Federal Data service Hub, which is established by the

Affordable Care Act and backed by the Health and Human Services department [45].

Agreement States [46].

62 Vignettes in Patient Safety - Volume 4

**5. Radiation injury**

*#3* [9, 19, 20].

The US Nuclear Regulatory Commission was established with The Energy Reorganization Act of 1974 to license and regulate the civilian use of radioactive materials to protect public health and safety and the environment. It is in charge of overseeing nuclear reactors, security, and materials as well as radioactive waste. The commission sets rules and licensing, enforces those rules, evaluates facilities, and provides support and logistics for incident response. Some aspects of management and regulation of certain radioactive materials have been granted to

Although most individuals exposed to radiation contamination are not symptomatic, the consequences of such exposures tend to result in long-term sequelae [47–50]. Providers should be aware of signs and symptoms of radiation injury so that such occurrences can be readily recognized, contained, and victims treated promptly [51, 52]. As demonstrated in our *Clinical Vignette #1*, acute HMRE tends to have organ-specific, regional anatomic manifestations (e.g., pneumonitis, lung fibrosis, gastric ulceration, and radiation proctitis) [52–54]. Systemic manifestations (e.g., acute radiation syndrome) are extremely rare in the healthcare setting and usually involve direct exposures of patients, workers, or otherwise unsuspecting individuals, to the radioactive isotope material, as outlined in our *clinical vignette #2* [18, 55] and *clinical vignette* 

Acute radiation syndrome (ARaS), unlike radiation injury, is a systemic entity that occurs very rarely in the healthcare setting. It usually involves some form of equipment failure, radioactive isotope release, criminal activity/theft, or inappropriate disposal of equipment or isotope(s) [9, 18–20, 55]. Because ARaS may be the only overt "manifestation" of a major radioactive breach, it is critical that it is promptly recognized, and that it leads to a thorough investigation into associated events. Symptoms of ARaS evolve over time in distinct phases. The duration of each phase and the time of its onset will be approximately inversely proportional to the dose [56]. An initial prodromal phase, with symptoms such as nausea, vomiting, weakness, and fatigue, typically develops within hours to days after exposure of the whole body to radiation exceeding 0.7 Gray (Gy). ARaS manifests most acutely and severely in the hematopoietic, gastrointestinal, and cardiovascular/neurovascular systems [27, 57]. Radiation-induced gastrointestinal manifestations of ARaS manifest as nausea, vomiting, and bloody diarrhea. Severe dermatological injury with burns, desquamation, epilation, and ulceration can occur after significant radiation exposure even in the absence of ARaS [58], as exemplified by our *clinical vignette #1*. The above manifestations are summarized in **Table 4**.
