Radiation poisoning was a major concern after the Nuclear power plant reactor accident. Radiation poisoning, radiation sickness or a creeping dose, is a form of damage to organ tissue caused by excessive exposure to ionizing radiation. The term is generally used to refer to acute problems caused by a large dosage of radiation in a short period, though this also has occurred with long term exposure. The clinical name for radiation sickness is acute radiation syndrome (ARS) as described by the CDC. A short exposure can result in acute radiation syndrome; chronic radiation syndrome requires a prolonged high level of exposure.

Radiation exposure can also increase the probability of developing some other diseases, mainly cancer, tumours, and genetic damage. These are referred to as the stochastic effects of radiation, and are not included in the term radiation sickness.

The use of radionuclides in science and industry is strictly regulated in most countries. In the event of an accidental or deliberate release of radioactive material, either evacuation or sheltering in place are the recommended measures.

## Signs and symptoms

Radiation sickness is generally associated with acute (a single large) exposure. Nausea and vomiting are usually the main symptoms. The amount of time between exposure to radiation and the onset of the initial symptoms may be an indicator of how much radiation was absorbed, as symptoms appear sooner with higher doses of exposure. The symptoms of radiation sickness become more serious (and the chance of survival decreases) as the dosage of radiation increases. A few symptom-free days may pass between the appearance of the initial symptoms and the onset of symptoms of more severe illness associated with higher doses of radiation. Nausea and vomiting generally occur within 24–48 hours after exposure to mild (1–2 Sv) doses of radiation. Radiation damage to the intestinal tract lining will cause nausea, bloody vomiting and diarrhea. This occurs when the victim's exposure is 200 rems (1 Sv = 100 rems) or more. The radiation will begin to destroy the cells in the body that divide rapidly. These including blood, GI tract, reproductive and hair cells, and harms the DNA and RNA of surviving cells. Headache, fatigue, and weakness are also seen with mild exposure. Moderate (2–3.5 Sv of radiation) exposure is associated with nausea and vomiting beginning within 12–24 hours after exposure. In addition to the symptoms of mild exposure, fever, hair loss, infections, bloody vomit and stools, and poor wound healing are seen with moderate exposure. Nausea and vomiting occur in less than 1 hour after exposure to severe (3.5–5.5 Sv) doses of radiation, followed by diarrhea and high fever in addition to the symptoms of lower levels of exposure. Very severe (5.5–8 Sv of radiation) exposure is followed by the onset of nausea and vomiting in less than 30 minutes followed by the appearance of dizziness, disorientation, and low blood pressure in addition to the symptoms of lower levels of exposure. Severe exposure is fatal about 50% of the time. See criticality accident for a number of incidents in which humans have been accidentally exposed to such levels of radiation.

Longer term exposure to radiation, at doses less than that which produces serious radiation sickness, can induce cancer as cell-cycle genes are mutated. The probability cancer will develop is a function of radiation dose. In radiation-induced cancer the disease, the speed at which the condition advances, the prognosis, the degree of pain, and every other feature of the disease are not functions of the radiation dose to which the person is exposed.

Since tumors grow by abnormally rapid cell division, the ability of radiation to disturb cell division is also used to treat cancer (radiotherapy), and low levels of ionizing radiation have been claimed to lower one's risk of cancer.

The concept of cutaneous radiation syndrome (CRS) was introduced in recent years to describe the complex pathological syndrome that results from acute radiation exposure to the skin.

Acute radiation syndrome (ARS) usually will be accompanied by some skin damage. It is also possible to receive a damaging dose to the skin without symptoms of ARS, especially with acute exposures to beta radiation or X-rays. Sometimes this occurs when radioactive materials contaminate skin or clothes.

When the basal cell layer of the skin is damaged by radiation, inflammation, erythema, and dry or moist desquamation can occur. Also, hair follicles may be damaged, causing hair loss. Within a few hours after irradiation, a transient and inconsistent erythema (associated with itching) can occur. Then, a latent phase may occur and last from a few days up to several weeks, when intense reddening, blistering, and ulceration of the irradiated site are visible. In most cases, healing occurs by regenerative means; however, very large skin doses 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.

### Exposure levels

A gray (Gy) is a unit of radiation dose absorbed by matter. To gauge biological effects the dose is multiplied by a 'quality factor' which is dependent on the type of ionising radiation. Such measurement of biological effect is called "dose equivalent" and is measured in sievert (Sv). For electron and photon radiation (e.g. gamma), 1 Gy = 1 Sv.

The corresponding non-SI units are the rad (radiation absorbed dose; 1 rad = 0.01 Gy), and rem (roentgen equivalent mammal/man; 1 rem=0.01 Sv).

Annual limit on intake (ALI) is the derived limit for the amount of radioactive material taken into the body of an adult worker by inhalation or ingestion in a year. ALI is the intake of a given radionuclide in a year that would result in:

• a committed effective dose equivalent of 0.05 Sv (5 rems) for a "reference human body", or
• a committed dose equivalent of 0.5 Sv (50 rems) to any individual organ or tissue,

## Prevention

The best prevention for radiation sickness is to minimize the dose suffered by the human, or to reduce the dose rate.

### Distance

Increasing distance from the radiation source reduces the dose according to the inverse-square law for a point source. Distance can sometimes be effectively increased by means as simple as handling a source with forceps rather than fingers.

### Time

The longer that humans are subjected to radiation the larger the dose will be. The advice in the nuclear war manual entitled "Nuclear War Survival Skills" published by Cresson Kearny in the U.S. was that if one needed to leave the shelter then this should be done as rapidly as possible to minimize exposure.

In chapter 12 he states that "Quickly putting or dumping wastes outside is not hazardous once fallout is no longer being deposited. For example, assume the shelter is in an area of heavy fallout and the dose rate outside is 400 R/hr enough to give a potentially fatal dose in about an hour to a person exposed in the open. If a person needs to be exposed for only 10 seconds to dump a bucket, in this 1/360th of an hour he will receive a dose of only about 1 R. Under war conditions, an additional 1-R dose is of little concern."

In peacetime, radiation workers are taught to work as quickly as possible when performing a task which exposes them to radiation. For instance, the recovery of a lost radiography source should be done as quickly as possible.

$\text{Dose} \propto t$

### Reduction of incorporation into the human body

Potassium iodide (KI), administered orally immediately after exposure, may be used to protect the thyroid from ingested radioactive iodine in the event of an accident or attack at a nuclear power plant, or the detonation of a nuclear explosive. KI would not be effective against a dirty bomb unless the bomb happened to contain radioactive iodine, and even then it would only help to prevent thyroid cancer.

### Fractionation of dose

Devair Alves Ferreira received a large dose during the Goiânia accident of 7.0 Gy. He lived, while his wife received a dose of 5.7 Gy and died. The most likely explanation is that his dose was fractionated into many smaller doses which were absorbed over a length of time, while his wife stayed in the house more and was subjected to continuous irradiation without a break, giving her body less time to repair some of the damage done by the radiation. In the same way, some of the people who worked in the basement of the wrecked Chernobyl plant received doses of 10 Gy, but in small fractions, so the acute effects were avoided.

It has been found in radiation biology experiments that if a group of cells is irradiated, then as the dose increases, the number of cells which survive decreases. It has also been found that if a population of cells is irradiated, then set aside for a length of time before being irradiated again, the radiation causes less cell death. The human body contains many types of cells and a human can be killed by the loss of a single type of cells in a vital organ. For many short term radiation deaths (3 days to 30 days), the loss of two important types of cells that are constantly being regenerated causes death. The loss of cells forming blood cells (bone marrow) and the cells in the digestive system (microvilli which form part of the wall of the intestines is fatal.

In the graph below, dose/survival curves for a hypothetical group of cells have been drawn, with and without a rest time for the cells to recover. Other than the recovery time partway through the irradiation, the cells would have been treated identically.

## Treatment

Treatment reversing the effects of radiation is currently not possible. Anaesthetics and antiemetics are administered to counter the symptoms of exposure, as well as antibiotics for countering secondary infections caused by the resulting immune system deficiency.

There are also a number of substances used to mitigate the prolonged effects of radiation poisoning, by eliminating the remaining radioactive materials, post exposure.

### Whole body vs. part of body exposure

In the case of a person who has had only part of their body irradiated then the treatment is easier, as the human body can tolerate very large exposures to the non-vital parts such as hands and feet, without having a global effect on the entire body. For instance, if the hands get a 100 Gy dose which results in the body receiving a dose (averaged over the entire body) of less than 1 Gy then the hands may be lost but radiation poisoning may not occur. The resulting injury would be described as localized radiation burn.

As described below, one of the primary dangers of whole-body exposure is immunodeficiency caused by the destruction of bone marrow and consequent shortage of white blood cells. It is treated by maintaining a sterile environment, bone marrow transplants (see hematopoietic stem cell transplantation), and blood transfusions.

### Experimental treatments

Neumune, an androstenediol, was introduced as a radiation countermeasure by the US Armed Forces Radiobiology Research Institute, and was under joint development with Hollis-Eden Pharmaceuticals until March, 2007. Neumune is in Investigational New Drug (IND) status and Phase I trials have been performed.

Some work has been published in which Cordyceps sinensis, a Chinese herbal medicine, has been used to protect the bone marrow and digestive systems of mice from whole body irradation.

Recent lab studies conducted with bisphosphonate compounds have shown promise of mitigating radiation exposure effects.