Radiation poisoning (chronic and acute)
Radiation poisoning is a complex disease that is split into two: chronic and acute. In this post, I'll explain both to the best of my abilities, as well as include images for the acute part. They are very graphic, so be warned.
Ionising radiation in large dosages is the one that causes harm to living organism and thus to humans as well. It takes three forms: alpha and beta particles, and gamma rays. Alpha particles are very large and cannot penetrate skin. The way that they can enter a human is by swallowing or inhalation, which can cause chromosomal damage and death. Beta particles are smaller and can penetrate living tissue more deeply, leaving burns and genetic damage. While sufficient distance can prevent harm. ingesting them will cause serious issues as the body mistakes them for essential elements and end up being absorbed by the organs. Gamma rays are the most penetrating and therefore the ones that cause the most damage as if a person stands in front of their way, they will pass through them. External radiation exposure was the first kind of radiation exposure to become apparent, and so internal exposure due to how widespread the use of radioactive elements in general life, such as in medicine, was not as understood.
Chronic radiation syndrome (CRS) is defined as the collection of the health effects of radiation occuring months or years of chronic exposure (meaning multiple non-lethal exposures) to ionising radiation. The dosages that can cause CRS are low enough to allow the body to potentially recover but not high enough to result in acute radiation poisoning. Symptoms include an impaired sense of touch and smell and disturbances in the vegetative functions at the early stage, and muscle and skin atrophy, eye cataracts and possible fibrous formations on the skin only if there were radiation burns, at the later stage. Cancer or leukemia can occur at any time. The recovery period ranges from three to twelve months after exposure stops.
CRS has not received much attention in Western medical literature as it is most associated with the Kyshtym disaster on 29/9/1957 in the USSR. Due to a massive explosion in an underground waste storage tank, high levels of radiation were spread across the Ural mountains. One of the first ever doctors to record the disease was a neurologist who treated radiation victims in Chelyabinsk, Angelina Guskova. 66 cases of CRS from Kyshtym have been diagnosed and they consist of most of the date about the disease. Other than the Kyshtym victims, another person known for their CRS is Albert Stevens, who was injected with radioactive material over the course of several years.
Acute radiation syndrome (ARS) is defined as a collection of health effects occuring after exposure to high amounts of ionising radiation in a short amount of time. The dosage that it can occur from is higher than 0.7Gy. The early symptoms are nausea, vomiting, loss of appetite, fatigue, fever and skin reddening. The time needed from exposure to the onset of emesis (when the person will vomit) is a way to determine whether or not the dosage is lethal depending on how fast or slow emesis occurs. Symptoms can start within hours or seconds depending on the dosage and can last for hours, weeks or months until recovery or death, before which occurs a latency period, when the patient seems perfectly healthy regardless of dosage.
It is divided into three types: bone marrow (occuring at 0.7 to 10Gy), gastrointestinal (occuring at 6 to 30Gy), and neurovascular syndrome (occuring at above 50Gy). These syndromes can be diagnosed only if the specific organ is affected(ex. gastrointestinal syndrome requires the stomach and intestines to be irradiated). ARS damages chromosomes and so disrupts the creation of new cells. The ones dividing most rapidly are the most affected. High enough dosages can cause irreperable damage to DNA. Treatments for ARS include blood transfusions, antibiotics and stem cell transplants. Survivors can face leukemia and other cancers, usually after at least 10 years since recovery. It is a very rare disease and the majority of cases belong to the bombings of Hiroshima and Nagasaki, as well as the Chernobyl disaster, with the first ever person whose death was certifiably due to ARS being a survivor of the Hiroshima bombing, Midori Naka, dying eighteen days after her exposure.TRadiation burns can occur without radiation poisoning, most commonly burns from the sun. Different kinds of radiation burns include gamma burns, beta burns and alpha burns. Alpha burns are internal burns causing extensive damage to tissues, external damage is limited to minor reddening of the skin. Beta burns are shallow and similar to sunburns. The damage is intense but localised. Such radiation can be stopped by the cornified keratine layer of the epidermis as well as clothes and shoes, as well as safety goggles since the lens of the eye is very sensitive to beta radiation. Beta burns manifest in 1-2 days by itching and/or burning. Burn symptoms appear 1-2 weeks after exposure, and include reddening, dark patches in the skin and raised areas, loss of body hair and skin lesions. If the reddening lasts for more than three days, it signifies a serious enough injury to cause chronic radiation dermatitis. Any edema occuring withing 2 days after exposure will lead to necrosis. Inhalation leads to beta burns to the lungs and nasopharyngeal region, while ingestion leads to gastrointestinal burns. First degree beta burns cause skin peeling, scabs, and increased skin pigmentation. Second degree beta burns lead to blisters. Third and fourth degree beta burns lead to ulcerated lesions, as well as ulcerated necrotic dermatitis in case of heavy damage to the tissue. Most Chernobyl victims and liquidators as well as victims of Goiânia suffered beta burns. Gamma burns are very deep and can also be accompanied by internal burns.
ARS presents itself in three main ways, hematopoietic, gastrointestinal and neurovascular. Hematopoietic includes symptoms such as aplastic anemia (drop in the number of blood cells) which can result in infections, bleeding and anemia. If the dosage is less than 1Gy, they might not be felt at all. Hematopoietic syndrome can cause poor wound healing, complicating potential burns and trauma. The risk of infection is also why it is common to see ARS patients being isolated and why doctors treating them have to wear protective clothing, as to limit the risk of infection to the patient. Gastrointestinal syndrome includes symptoms such as nausea, vomiting, loss of appetite and abdominal pain. Vomiting in one to two hours after exposure indicates a lethal dosage. The most common treatment is a bone marrow transplant. Death occurs from infection rather than dysfunction of the gastrointestinal system. During the early stage, it is often mistaken as food poisoning due to common symptoms. Neurovascular syndrome includes symptoms such as dizziness, headache, a decreased level of consciousness and an absence of vomiting. It is almost always fatal.
The effects of ARS and the time that takes for them to occur depend on the dosage. For a whole body absorbed dose:
1-2 Gy: Nausea and vomiting occur 2-6 hours after exposure and last less than a day in 5-50% of cases. There is no diarrhea. Slight headache. No fever. No impairment to the central nervous system. Recovery for most. With or without care, up to 5% of cases will die in 6-8 weeks.
2-6 Gy: Nausea and vomiting occur 1-2 hours after exposure and last for 1-2 days in 50-100% of cases. Diarrhea is none to mild, occuring in less than 10% of cases and occurs 3-8 hours after exposure. Mild to moderate headache in 50% of cases occuring 4-24 hours after exposure. Moderate increase in body temperature in 10-100% cases in 1-3 hours after exposure. Cognitive impairment to the central nervous system 6-20 hours after exposure. Latency period ranging from 28-31 days. Complications such as mild to moderate leukopenia (decrease of white blood cells), fatigue and weakness can occur. 5-95% of cases without care and 5-50% of cases with care will die in 4-6 weeks.
6-8 Gy: Nausea and vomiting occur 10-60 minutes after exposure and last for less than two days in 75-100% of cases. Diarrhea is heavy for more than 10% of cases and occurs 1-3 hours after exposure. Moderate headache in 80% of cases occuring 3-4 hours after exposure. Moderate to severe fever in 100% of cases less than an hour of exposure. Cognitive impairment of the central nervous system more than a day after exposure. Latency period ranging from 7-28 days. Complications such as moderate to severe leukopenia, purpura (red and purple spots on the body), hemorrhage, infections, alopecia (loss of hair) can occur. 95-100% of cases without care and 50-100% of cases with care will die in 2-4 weeks.
8-30 Gy: Nausea and vomiting occur at most 10 minutes after exposure and last for less than two days in 90-100% of cases. Diarrhea is heavy for more than 95% of cases and occurs less than an hour after exposure. Severe headache for 80-90% of cases 1-2 hours after exposure. Severe fever in 100% of cases less than an hour after exposure. Rapid incapacitation of the central nervous system after exposure. Latency period up to a week. Complications such as severe leukopenia, high fever, diarrhea, vomiting, dizziness, disorientation, hypotension (low blood pressure) and electrolyte disturbance can occur. 100% of cases without care and 99-100% of cases with care will die between 2 days or 2 weeks.
Over 30 Gy: Nausea and vomiting occur in minutes after exposure however death occurs before their end in 100% of cases. Diarrhea is heavy for 100% of cases and occurs less than an hour after exposure. Severe headache for 100% of cases less than an hour after exposure. Severe fever in 100% of cases less than an hour after exposure. Seizure, tremor, ataxia (lack of voluntary coordination of muscle movements, ex. slurred speech, difficulty walking) and /or lethargy after exposure. No latency period. Before death, electrolyte disturbance and shock can occur. With or without care, 100% of cases will die in 1-2 days.
The diagnosis of ARS is made based on a history of high radiation exposure. The dosage can be estimated by an absolute lymphocyte count. The principle ALARA (As Low As Reasonably Possible) dictates that radiation exposure much be avoided as much as possible either by sufficient distance or shielding, or simply very little time, and is a pillar of nuclear safety.
Treatment depends on the patient, their syndrome and their dosage. Above a lethal dosage, the only thing that can be done is to offer as much comfort as possible to the patient and deal with their pain as much as possible. Most often, treatments include medicine (orally or through an IV, usually antiemetics and analgesics such as morphine), blood transfusions, colony stimulating factors and transplants of skin and hematopoietic stem cells. The latter uses cells from bone marrow, peripheral blood or the blood of an umbilical cord. For bone marrow, the cells are removed through a very large needle that goes through the pelvis, a procedure done under local or general anesthesia. Peripheral blood stem cells are collected from the blood via a process where blood is passed through a machine that removed white blood cells and returns red blood cells to the donor. The yield of the peripheral stem cell is boosted through daily injections of a granulocyte-colony stimulating factor, which stimulates the bone marrow so it can release granulocytes and white blood cells in the blood. The first time such a transplant was performed was after the Tokaimura criticality accident in 1999, with the reciever being Hisashi Ouchi and the donor his sister. The transplant was a success, however the radiation within Ouchi mutated the cells.
As mentioned before, most of the cases of ARS were due to the bombings of Hiroshima and Nagasaki and the Chernobyl disaster, but there have been other accidents and incidents resulting in the disease, most notably the criticality accident in Tokaimura. A short list of deaths from ARS is written below with a bit of information about each patient's case. Some of them will be mentioned in more detail in other posts. The dosages of some Chernobyl victims have been converted from rem for cohesion.
Patient 1-DN - victim of the Lia radiological accident on 2/12/2001 due to exposure to two orphan radiation sources found in the village of Lia. His actual name is not public. He was exposed to 3.6 Gy, most of the exposure was on his back, he received damage on his heart and internal organs, developed tuberculosis and sepsis, and died of heart failure 893 days after exposure.
Alexander Akimov - victim of the Chernobyl disaster on 26/4/1986. Was exposed to 15Gy after going to room 714/2 to open the valves that would allow water to pour from the steam separator to the reactor. Due to swallowing some radioactive water, a lot of the damage done to him was via alpha and beta particles. He died two weeks later with 100% of his body covered in burns. No post-mortem pictures exist.
Anatoly Baranov - victim of the Chernobyl disaster on 26/4/1986. Managed generators and prevented fires from spreading through the generator hall. Received a dosage of 11,4 Gy, suffered lung injuries and died 24 days later.
Vyacheslav Brazhnik - victim of the Chernobyl disaster on 26/4/1986. Fought fires and stabilised the turbine hall and opened the turbine emergency oil drain valves manually. Was exposed to 13,2 Gy and suffered injuries to his skin and intestines and died 18 days later.
Valery Charitonov - attempted to repair the damaged reactor of the submarine K-19 on 4/7/1961. Was exposed to 11 Gy and died 11 days later.
Harry Daghlian - victim of the first demon core criticality accident due to him making a mistake when performing a neutron reflector experiment on the core on 21/8/1945 and suffered hematopoietic syndrome with the dosage of 3.1 Gy and surviving for 25 days.
Leide das Neves Ferreira - accidentally ate an egg contaminated with cesium-137 and played with cesium crystals given to her by her father. Was exposed to 6 Gy, suffered swelling in the upper body, hair loss, damage to the kidneys and lungs, internal bleeding and septicemia and died after 40 days at just 6 years old, making her the youngest fatality of Goiânia.
Admilson Alves de Souza - worked on the radioactive source found in Goiânia, was exposed to 5.3 Gy, suffered lung damage, internal bleeding, heart damage, and died after 45 days.
Israel Batista dos Santos - extracted the lead from the radioactive source found in Goiânia. Was exposed to 4,5 Gy, suffered serious respiratory and lymphatic complications and died 44 days later.
Maria Gabriela Ferreira - came into contact with the source found in Goiânia and turned the material over to authorities. Was exposed to 5,7 Gy and suffered hair loss, internal bleeding in the eyes, limbs and digestive tract, as well as mental confusion, diarrhea, septicemia and acute renal insufficiency, died after 40 days.
Vasily Ignatenko - victim of the Chernobyl disaster on 26/4/1986. Fought fires at the roof of the ventilation block and successfully prevented the spread of fire to the third reactor, as well as carried down three other firefighters. Was exposed to 14,4 Gy, suffered skin necrosis, degradation to his digestive and respiratory systems and died 17 days later.
Yekaterina Ivanenko - victim of the Chernobyl disaster on 26/4/1986. Guarded a gate opposite Reactor Four and was covered by radioactive debris which rained all night upon her. Was exposed to 10,4 Gy, suffered toxicity and respiratory insufficiency, died a month later.
Evgeny Kashenkov - attempted to repair the damaged reactor of the submarine K-19 on 4/7/1961. Was exposed to 10 Gy and died 6 days later.
Cecil Kelley - victim of a criticality accident in Los Alamos due to the mixing tank that he operated in order to reprocess plutonium containing much more plutonium due to improper transfer of the waste, leading in a criticality when he switched on the mixer. Died 38 hours after exposure to 36 Gy.
Viktor Kibenok - victim of the Chernobyl disaster on 26/4/1986. Assisted and coordinated firefighting efforts on the roofs of the ventilation block and third reactor. Was exposed to 11 Gy, suffered burns to his mouth and damage to his lungs due to inhaling burning bitumen, died 15 days later.
Yuri Konoval - victim of the Chernobyl disaster on 26/4/1986. Managed machinery and fought fires in the fourth and fifth block. Was exposed to 8.7 Gy, suffered respiratory insufficiency and cerebral edema (accumulation of extracellulal fluid to the brain) and died 32 days later.
Boris Korchilov - attempted welding work on the damaged reactor of the submarine K-19 on 4/7/1961. He vomited as soon as he took off his gas mask. Was exposed to 54 Gy and died 6 days later.
Alexander Lelechenko - victim of the Chernobyl disaster on 26/4/1986. Protected his younger coworkers by going through radioactive water and debris to switch off the electrolyzers and stop hydrogen flow to the generators, later attempting to supply voltage to the feedwater pumps. He was hospitalised in Kiev as by the time he was convinced to go to the hospital, the others had been already flown to Moscow. His dosage was way overestimated, the true one being between 10.2-12,8 Gy. He suffered skin and intestinal injuries and was the first Chernobyl victim to die from ARS.
Alexander Litvinenko - was poisoned by polonium-210 on 1/11/2006. After being poisoned, he suffered vomiting and bloody diarrhea, as well as inability to walk unassisted, and died from heart failure 21 days later, making him the first person to die from ingesting polonium-210. Could not find the exact dosage.
Vyacheslav Malyshev - inspected a Soviet nuclear power plant before it was safe to do so. His dosage and symptoms are unknown, as when he was being treated for ARS, his name was not mentioned, but the reports of the mysterious patient were during February of 1957.
Midori Naka - victim of the Hiroshima bombing, died on 24/8/1945. Her symptoms included a rising fever, decrease in white blood cells, hair loss, tachycardia and mild purpura. I could not find her exact dosage.
Alexander Novyk - victim of the Chernobyl disaster on 26/4/1986. Fought fires in the turbine hall, stabilised it, and was irradiated by fuel in his attempts to contact the control room. He was exposed to 12,3 Gy, suffered infection and graft versus host disease, died 91 days later.
Yuri Ordochkin - attempted to repair the damaged reactor of the submarine K-19 on 4/7/1961. Was exposed to 11 Gy and died 6 days later.
Ivan Orlov - victim of the Chernobyl disaster on 26/4/1986. Fought fires in the industrial site of the fifth reactor and refused to leave his post. Was exposed to 14,8 Gy, suffered skin and intestinal injuries and died 17 days later.
Hisashi Ouchi - victim of the Tokaimura accident on 30/9/1999 due to the overfilling of the precipitation tank when making uranium fuel for the experimental reactor Joyo, resulting in a criticality accident. He was exposed to 18Gy and died after 83 days. He was the first ever receiver for a peripheral blood stem cell transplant and the only person of his dosage to survive for as long as he did.
Robert Peabody - victim of the Wood River Junction criticality on 24/7/1964 due to an attempt to recover uranium from leftover scraps from fuel production, when he mistakenly poured a uranium solution to the tank instead of trichloroethane as the bottle tag had fallen off. Died 48 hours after exposure to 100 Gy, his dosage is in the range of 70-260Gy, making Peabody the person to have received the highest documented full body radiation dosage.
Semyon Penkov - attempted to repair the damaged reactor of the submarine K-19 on 4/7/1961. Was exposed to 10 Gy and died two weeks later.
Konstantyn Perchuk - victim of the Chernobyl disaster on 26/4/1986. Fought fires in the turbine hall and stabilised it, and was irradiated by fuel when opening manually the turbine emergency oil drain valves. Exposed to 10,3 Gy, suffered, fatal lung injuries and died 24 days later.
Valery Perevozchenko - victim of the Chernobyl disaster on 26/4/1986. Attempted to locate and rescue Valery Khodemchuk, to manually lower the control rods in the reactor hall, restart the flow of feedwater, and made efforts to save other staff. Was exposed to 8,3 Gy, suffered infection and graft versus host disease after a bone marrow transplant and died 48 days later.
Georgi Popov - victim of the Chernobyl disaster on 26/4/1986. Assisted in controlling the turbine hall fires. Was exposed to 7,2 Gy, suffered lung injuries, respiratory insufficiency and cerebral edema, died 48 days later.
Yuri Povstyev - attempted to repair the damaged reactor of the submarine K-19 on 4/7/1961. Was exposed to 7.5 Gy and died 18 days later.
Vladimir Pravyk - victim of the Chernobyl disaster on 26/4/1986. Coordinated firefighting efforts on the roof of the ventilation block, successfully prevented the spread of fire to the roof of the third reactor, was the commander of the scene until 2:00 AM, descending 30 minutes later and having already been exposed to 16,2 Gy, making him the one with the highest radiation dosage out of all the Chernobyl victims. Suffered decrease in white blood cells, skin and intestinal injuries, as well as respiratory failure, dying 15 days later.
Viktor Proskuryakov - victim of the Chernobyl disaster on 26/4/1986. Attempted to manually lower the control rods in the reactor hall and restart the flow of feedwater. Was exposed to 7,5 Gy, suffered radiation burns on 100% of his body, which led to his death 21 days later.
Boris Ryzhikov - attempted to repair the damaged reactor of the submarine K-19 on 4/7/1961. Was exposed to 8,6 Gy and died 21 days later.
Vladimir Savenkov - victim of the Chernobyl disaster on 26/4/1986. Was at Turbine 8 when he was exposed to 8 Gy, and was the first person to be admitted to the hospital in Moscow. Suffered toxicity and respiratory insufficiency.
Nikolai Savkin - attempted to repair the damaged reactor of the submarine K-19 on 4/7/1961. Was exposed to 11 Gy and died 9 days later.
Anatoly Shapovalov - victim of the Chernobyl disaster on 26/4/1986. Fought fires and managed electrical equipment. Was exposed to 11,7 Gy, suffered skin and lung injuries, died 23 days later.
Anatoly Sitnikov - victim of the Chernobyl disaster on 26/4/1986. Surveyed the damage and assisted with the efforts to supply coolant to the reactor. Was exposed to 5,7 Gy, suffered a failed bone marrow transplant which resulted in immunosuppression combined with a fatal infection, and died 34 days later.
Masato Shinohara - victim of the Tokaimura accident on 30/9/1999 due to the overfilling of the precipitation tank when making uranium fuel for the experimental reactor Joyo, resulting in a criticality accident. He was exposed to 10Gy and died after 210 days.
Louis Slotin - victim of the second demon core accident on 21/5/1946 due to another neutron reflector experiment on the core while using a screwdriver instead of the core's shims, which resulted in the slip of the screwdriver and a criticality accident. Suffered gastrointestinal syndrome and received 10Gy.
Keiko Sonoi - victim of the Hiroshima bombing. Suffered a high fever, internal bleeding, delusions, and blood was found in her stool. Died after 15 days. Could not find dosage.
Vladimir Tishura - victim of the Chernobyl disaster on 26/4/1986. Was exposed to 13,4 Gy, suffered skin and intestinal injuries, and died 2 weeks later, making him the first firefighter to die.
Nikolai Titenok - victim of the Chernobyl disaster on 26/4/1986. Assisted in firefighting efforts on the roof of the ventilation block and successfully prevented the spread of fire to the roof of the third reactor. He was exposed to 15 Gy, suffered external and internal radiation burns, intestinal damage and blisters to his heart, and died 20 days later, making him the last of the firefighters to die from ARS.
Leonid Toptunov - victim of the Chernobyl disaster on 26/4/1986. Attempted to restart feedwater flow into the reactor. Was exposed to 13 Gy, suffered skin and intestinal injuries, as well as radiation burns to 90% of his body and injuries to his legs, and died 18 days later. Only one post-mortem picture of him exists but it is classified.
Nikolai Vaschuk - victim of the Chernobyl disaster on 26/4/1986. Assisted in firefighting efforts on the roof of the ventilation block and successfully prevented the spread of fire to the roof of the third reactor, and ran hose lines to and from the roof multiple times. Was exposed to 14, 2 Gy, suffered skin and intestinal injuries and died 18 days later.
Yuri Vershynin - victim of the Chernobyl disaster on 26/4/1986. Fought fires in the turbine hall and stabilised it, was irradiated by fuel when attempting to contact the control room. Was exposed to 9,5 Gy, suffered infections after a bone marrow transplant, and died 86 days later.
A lot of ARS cases do not have pictures of them (ex. Akimov) and some have very few (ex. Peabody). Most of the pictures of ARS out there are of Ouchi and Shinohara, thus the following images include them mostly.
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