Post on 13-Apr-2017
Acute Radiation Syndrome And Its Management
Dr. K. L. Chakraborti, MBBS, M.D, PDCC (Rad)Head, Department of Radiological Imaging,Institute of Nuclear Medicine and Allied Sciences,Timarpur, Delhi-11054drklchakraborti@gmail.com
“Radiation is an energy in the form of electro-magnetic waves or particulate matter, traveling in the air.”
Definition of Radiation
Radiation is classified into:
◦Ionizing radiation◦Non-ionizing radiation
Types of Radiation
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.
Primary Types of Ionizing Radiation
Alpha particlesBeta particlesGamma rays (or photons)X-Rays (or photons)Neutrons
Types or Products of Ionizing Radiation
or X-
rayneutron
Sources Of Radiation
Response During Emergencies
Management
Phases of Acute Radiation Syndrome
ProdromalStage
LatentStage
ManifestIllness
Recovery or Death
Time (days to years)
Exposure
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
ARS - Phases
1. Neurovegetative Syndrome (< 1 Gy)
Vomiting in 5%
Reduced lymphocytes
Chromosomal Aberrations (>100 mSv)
Forms of ARS
2. Haematopoietic Syndrome (1-8 Gy)
Blood forming system is affected
Vomiting in 1 hr. (> 3Gy)
Erythema(redness), Epilation (loss of hair)
Forms of ARS
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.
Forms of ARS
4.Neurovascular syndrome (>30 Gy)
The brain is affected
Vomiting within minutes
Drowsiness, Tremors, Convulsions, Coma
Forms of ARS
Acute Radiation Syndrome (A Spectrum of Disease)
Treatment options
Accident dosimetryPHYSICAL
DOSIMETRYBIOLOGICALDOSIMETRY
CLINICALDOSIMETRY
DOSE RECONSTRUCTION,Personal Dosimeters
CYTOGENETIC DOSIMETRY
Dicentrics, FISH, PCC, MNA
NAUSEA, VOMITING,
CELL COUNTS, SKIN REACTIONS
OTHER BIOINDICATORS
Guidelines for management of radiation injuries on the basis of early symptoms
Symptom Dose Action requiredNo vomiting < 1 Gy Outpatient with 5-week
surveillanceVomiting 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 hDiarrhoeaErythema
> 4 Gy Hospitalization in a well equipped haematological or surgical department with transfer to a specialized centre for GFs / BMT
Definitive 1. Prevention of Infections
• Isolation, Gut sterilization2. Treatment of Infections
• Antibiotics, Antiviral, Antifungal3. Haematological Support
• Packed cells, Platelet transfusion4. Regeneration of Bone-Marrow
• Growth factors (4-8 Gy), BMT (>9 Gy)
Treatment:
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
Prevention of Infections
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)
Prevention of Infections
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)
Prevention of Infections
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
Hematological Support
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
BMT
Combined Injuries
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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