Acute radiation syndrome and its management dr. k. l. chakraborti

1. Dr. K. L. Chakraborti, MBBS, M.D, PDCC (Rad)
Head, Department of Radiological Imaging,
Institute of Nuclear Medicine and Allied Sciences,
Timarpur, Delhi-11054
drklchakraborti@gmail.com

2.  “Radiation is an energy in the form of electro-
magnetic waves or particulate matter,
traveling in the air.”

3.  Radiation is classified into:
◦Ionizing radiation
◦Non-ionizing radiation

4. Ionizing Versus Non-
ionizing Radiation
Ionizing Radiation
– Higher energy electromagnetic waves
(gamma) or heavy particles (beta and alpha).
– High enough energy to pull electron from
orbit.
Non-ionizing Radiation
– Lower energy electromagnetic waves.
– Not enough energy to pull electron from
orbit, but can excite the electron.

5. Primary Types of Ionizing
Radiation
Alpha particles
Beta particles
Gamma rays (or photons)
X-Rays (or photons)
Neutrons

6. Types or Products of
Ionizing Radiation

or X-rayneutron

7. Sources Of Radiation

10. Management

11. Prodromal
Stage
Latent
Stage
Manifest
Illness
Recovery
or Death
Time (days to years)
Exposure

12.  Prodromal Phase - 48 to 72 hours
◦ nausea, vomiting, and anorexia.
 Latent Phase - 2 to 2 ½ weeks.
◦ leukocytes, platelets are decreasing as a
result of bone marrow insult
 Manifest Illness Phase
◦ Hematopoietic, GI, CNS
 Recovery Phase or Death
◦ may take weeks or months

13. 1. Neurovegetative Syndrome (< 1 Gy)
Vomiting in 5%
Reduced lymphocytes
Chromosomal Aberrations (>100 mSv)

14. 2. Haematopoietic Syndrome (1-8 Gy)
Blood forming system is affected
Vomiting in 1 hr. (> 3Gy)
Erythema(redness), Epilation (loss of hair)

15. 3. Gastrointestinal syndrome (8-30 Gy)
The lining of the intestines is damaged
Vomiting and diarrhoea in less than 1 hr.
Lymphocytes less than 100/cubic mm in 48 hrs.

16. 4.Neurovascular syndrome (>30 Gy)
The brain is affected
Vomiting within minutes
Drowsiness, Tremors, Convulsions, Coma

19. PHYSICAL
DOSIMETRY
BIOLOGICAL
DOSIMETRY
CLINICAL
DOSIMETRY
DOSE
RECONSTRUCTION,
Personal Dosimeters
CYTOGENETIC
DOSIMETRY
Dicentrics, FISH,
PCC, MNA
NAUSEA,
VOMITING,
CELL COUNTS,
SKIN REACTIONS
OTHER
BIOINDICATORS

20. Symptom Dose Action required
No vomiting < 1 Gy Outpatient with 5-week
surveillance
Vomiting in 2-3 h 1-2 Gy Surveillance in a general hospital
(or outpatient for 3 weeks)
followed by hospitalization
Vomiting in 1-2 h 2-4 Gy Hospitalization in a
haematological department
Vomiting in < 1 h
Diarrhoea
Erythema
> 4 Gy Hospitalization in a well
equipped haematological or
surgical department with transfer
to a specialized centre for GFs /
BMT

21. Definitive
1. Prevention of Infections
• Isolation, Gut sterilization
2. Treatment of Infections
• Antibiotics, Antiviral, Antifungal
3. Haematological Support
• Packed cells, Platelet transfusion
4. Regeneration of Bone-Marrow
• Growth factors (4-8 Gy), BMT (>9 Gy)

22.  Barrier nursing / reverse isolation
◦ Laminar flow isolation with microbial filters
◦ Strict hand washing before and after patient care
◦ Surgical scrubs for staff
◦ Gowns, caps, gloves, masks for staff
◦ Double bagging of all disposables

23.  Reduction of microbial acquisition
◦ Low-microbial content food
(Cooked food only, avoid salads/fruits)
◦ Acceptable water supply
◦ Air filtration to reduce aspergillus infection
◦ Avoid invasive procedures
(e.g. nasogastric tubes, catheters)

24.  Suppression of micro-organisms
◦ Physiological interventions like
 Maintenance of gastric acidity
 Avoidance of antacids and H2 blockers
 Use of Sucralfate for stress ulcer prophylaxis when
indicated to reduce gastric colonization and
pneumonia
 Early oral enteral nutrition (when feasible)

25.  Hematological support
◦ Platelets maintained at > 20 000/L.
If surgery > 75 000/L
◦ Transfusion of packed red blood cells (PRBCs) to
maintain Hb > 8 g/dl
◦ All blood products should receive 15-20 Gy of
radiation before infusion to prevent graft-versus-
host disease through infusion of mononuclear cells
present in the products

26.  Consider allo-BMT if
◦ Fully matched sibling donor available
◦ Patient has absolute lymphocyte count (ALC)
<100/l
◦ Radiation dose unknown or likely to be 8-12 Gy
◦ No other injuries preclude survival or
transplantation (e.g. severe burns)
◦ Irradiation is not continuing from an internal
contamination

28. For long term effects surveillance
and screening at regular intervals
are required and if any body found
to be suffering from cancer then the
management will be done by a
cancer specialist.

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