Radiation injury: Difference between revisions

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Latest revision as of 17:39, 22 April 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Ogheneochuko Ajari, MB.BS, MS [3]

Overview

Classification

Pathophysiology

Causes

Differentiating Radiation Injury from other Diseases

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

External Links

Template:Consequences of external causes

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-Injury to the skin and underlying tissues from acute exposure to a large external dose of radiation is referred to as cutaneous radiation injury (CRI). Acute radiation syndrome (ARS) 1 will usually be accompanied by some skin damage; however, CRI can occur without symptoms of ARS. This is especially true with acute exposures to beta radiation or low-energy x-rays, because beta radiation and low-energy x-rays are less penetrating and less likely to damage internal organs than gamma radiation is. CRI can occur with radiation doses as low as 2 Gray (Gy) or 200 rads 2 and the severity of CRI symptoms will increase with increasing doses. Most cases of CRI have occurred when people inadvertently came in contact with unsecured radiation sources from food irradiators, radiotherapy equipment, or well depth gauges. In addition, cases of CRI have occurred in people who were overexposed to x-radiation from fluoroscopy units.
+__NOTOC__
+'''For patient information click [[Radiation injury (patient information)|here]]'''
+{{Infobox_Disease |
+  Name           = {{PAGENAME}} |
+  Image          = Radiation warning symbol.svg |
+  Caption        = Radiation [[Hazard symbol]]. |
+}}
+{{Radiation injury}}
+{{CMG}}; {{AE}} {{CZ}}; {{Ochuko}}
-Early signs and symptoms of CRI are itching, tingling, or a transient erythema or edema without a history of exposure to heat or caustic chemicals. Exposure to radiation can damage the basal cell layer of the skin and result in inflammation, erythema, and dry or moist desquamation. In addition, radiation damage to hair follicles can cause epilation. Transient and inconsistent erythema (associated with itching) can occur within a few hours of exposure and be followed by a latent, symptom-free phase lasting from a few days to several weeks. After the latent phase, intense reddening, blistering, and ulceration of the irradiated site are visible. Depending on the radiation dose, a third and even fourth wave of erythema are possible over the ensuing months or possibly years.
+==[[Radiation injury overview|Overview]]==
-In most cases, healing occurs by regenerative means; however, large radiation doses to the skin can cause permanent hair loss, damaged sebaceous and sweat glands, atrophy, fibrosis, decreased or increased skin pigmentation, and ulceration or necrosis of the exposed tissue.
+==[[Radiation injury classification|Classification]]==
-With CRI, it is important to keep the following things in mind:
+==[[Radiation injury pathophysiology|Pathophysiology]]==
-* The visible skin effects depend on the magnitude of the dose as well as the depth of penetration of the radiation.
+==[[Radiation injury causes|Causes]]==
-* Unlike the skin lesions caused by chemical or thermal damage, the lesions caused by radiation exposures do not appear for hours to days following exposure, and burns and other skin effects tend to appear in cycles.
+==[[Radiation injury differential diagnosis|Differentiating Radiation Injury from other Diseases]]==
-* The key treatment issues with CRI are infection and pain management.
+==[[Radiation injury risk factors|Risk Factors]]==
-==Stages and Grades of CRI==
+==[[Radiation injury screening|Screening]]==
-CRI will progress over time in stages and can be categorized by grade, with characteristics of the stages varying by grade of injury, as shown in Table 1. Appendix A gives a detailed description of the various skin responses to radiation, and  Appendix B provides color photographs of examples of some of these responses.
+==[[Radiation injury natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-Prodromal stage  (within hours of exposure)—This stage is characterized by early erythema (first wave of erythema), heat sensations, and itching that define the exposure area. The duration of this stage is from 1 to 2 days.
+==[[Radiation injury diagnosis|Diagnosis]]==
+[[Radiation injury history and symptoms|History and Symptoms]] | [[Radiation injury physical examination|Physical Examination]] | [[Radiation injury laboratory findings|Laboratory Findings]] | [[Radiation injury MRI|MRI]] | [[Radiation injury other imaging findings|Other Imaging Findings]] | [[Radiation injury other diagnostic studies|Other Diagnostic Studies]]
-Latent stage  (1–2 days postexposure)—No injury is evident. Depending on the body part, the larger the dose, the shorter this period will last. The skin of the face, chest, and neck will have a shorter latent stage than will the skin of the palms of the hands or the soles of the feet.
+==Treatment==
+[[Radiation injury medical therapy|Medical Therapy]] | [[Radiation injury surgery|Surgery]] | [[Radiation injury primary prevention|Primary Prevention]]  | [[Radiation injury cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Radiation injury future or investigational therapies|Future or Investigational Therapies]]
-Manifest illness stage  (days to weeks postexposure)—The basal layer is repopulated through proliferation of surviving clonogenic cells. This stage begins with main erythema (second wave), a sense of heat, and slight edema, which are often accompanied by increased pigmentation. The symptoms that follow vary from dry desquamation or ulceration to necrosis, depending on the severity of the CRI (see Table 1).
+==Case Studies==
+[[Radiation injury case study one|Case #1]]
-Third wave of erythema  (10–16 weeks postexposure, especially after beta exposure)—The exposed person experiences late erythema, injury to blood vessels, edema, and increasing pain. A distinct bluish color of the skin can be observed. Epilation may subside, but new ulcers, dermal necrosis, and dermal atrophy (and thinning of the dermis layer) are possible.
+==External Links==
+*[http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp#table1 Centers for Disease Control and Prevention]
+* [http://bjr.birjournals.org/cgi/reprint/Supplement_27/1/41.pdf Radiation accidents with multi-organ failure in the United States]
+* [http://www.johnstonsarchive.net/nuclear/radevents/radaccidents.html List of radiation accidents and other events causing radiation casualties]
+* [http://www-pub.iaea.org/MTCD/publications/PDF/Pub1106_scr.pdf The critical accident in Sarov, International Atomic Energy Agency]
+* [http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp The Center for Disease Control's fact sheet on Acute Radiation Syndrome]
+* [http://courses.cs.vt.edu/~cs3604/lib/Therac_25/Therac_1.html Therac-25 computerized radiation therapy machine accidents]
-Late effects  (months to years postexposure; threshold dose ~10 Gy or 1000 rads)—Symptoms can vary from slight dermal atrophy (or thinning of dermis layer) to constant ulcer recurrence, dermal necrosis, and deformity. Possible effects include occlusion of small blood vessels with subsequent disturbances in the blood supply (telangiectasia); destruction of the lymphatic network; regional lymphostasis; and increasing invasive fibrosis, keratosis, vasculitis, and subcutaneous sclerosis of the connective tissue. Pigmentary changes and pain are often present. Skin cancer is possible in subsequent years.
+{{Consequences of external causes}}
-Recovery  (months to years)
+[[Category:Emergency medicine]]
+[[Category:Dermatology]]
+[[Category:Cardiology]]
+[[Category:Radiology]]
-[[Image:CRI Table 1.jpg|800px|center|thumb]]
+{{WH}}
+{{WS}}

Radiation injury: Difference between revisions

Latest revision as of 17:39, 22 April 2013

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