radiation injury

Tissue damage caused by exposure to ionizing radiation.

Structures with rapid cell turnover (e.g., skin, stomach or intestinal lining, and bone marrow) are most susceptible. High-dose irradiation of the last two causes radiation sickness. Nausea and vomiting subside in a few hours. They are followed in intestinal cases by abdominal pain, fever, and diarrhea leading to dehydration and a fatal shocklike state, and in bone-marrow cases (two to three weeks later) by fever, weakness, hair loss, infection, and hemorrhage. In severe cases, death occurs from infection and uncontrollable bleeding. Lower radiation doses can cause cancer (notably leukemia and breast cancer), sometimes years later. Radiation exposure in early pregnancy can produce abnormalities in the embryo, whose cells are multiplying rapidly.

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▪ pathology

      tissue damage or changes caused by exposure to ionizing radiation—namely, gamma rays (gamma ray), X-rays (X-ray), and such high-energy particles as neutrons, electrons, and positrons. Sources of ionizing radiation may be natural (e.g., radioactive substances such as the element radium or the radioisotopes potassium-40 and carbon-14) or man-made (X-ray machines, nuclear reactors, particle accelerators, nuclear weapons, etc.).

      A brief treatment of radiation injury follows. For further discussion, see radiation: Biologic effects of ionizing radiation (radiation).

      Radiation injury occurs in various forms, with each type dependent on the ionizing radiation involved, its penetrating ability, the portion of the body exposed, the duration of exposure, and the total dose. Radiation injury occurs most readily in tissues and organs consisting of rapidly proliferating cells, as, for example, the skin, the lining of the gastrointestinal tract, and the bone marrow, where progenitor cells multiply continuously to replace the mature cells that are constantly being lost through normal aging. The effects of radiation on these organs result primarily from the destruction of the progenitor cells and the consequent interference with the replacement of the mature cells, which is so vital to the maintenance of tissue structure and function.

      Symptoms resulting from the intensive irradiation of a large segment of the gastrointestinal tract or portion of the bone marrow constitute a condition called radiation sickness, or acute radiation syndrome (ionizing radiation injury). Early signs of this condition include loss of appetite, nausea, and vomiting within the first few hours after irradiation, followed by a symptom-free period that lasts until the main phase of the illness. In the intestinal form of radiation sickness, the main phase is characterized by abdominal pain, fever, and diarrhea, which lead within several days to dehydration, prostration, and a fatal shocklike state. The main phase of the hemopoietic form (that associated with bone marrow) of the illness begins later (about 2–3 weeks after irradiation), with typical symptoms including fever, weakness, loss of hair, infection, and hemorrhage. When damage to the bone marrow is severe, death may result from infection and uncontrollable bleeding.

      Other manifestations of radiation injury are certain forms of cancer. The survivors of the atomic-bomb blasts at Hiroshima and Nagasaki, some patients subjected to multiple fluoroscopic chest examinations, and certain groups of radiation workers (e.g., women who painted radium watch and clock dials) have exhibited dose-dependent increases in the incidence of cancer, most notably leukemia and breast cancer.

      Radiation injury also includes abnormalities produced in the embryo. The tissues of the embryo, like others composed of rapidly proliferating cells, are extremely sensitive to ionizing radiation. Organs irradiated during the process of formation thus tend to be malformed. Many kinds of radiation-induced abnormalities have been observed in experimentally irradiated rodents. A large number of these are malformations of the nervous system, such as reduced brain size or the failure of the eyes to develop. Nervous-system abnormalities in human infants have been found with higher-than-normal frequency among children born to women who were pregnant and living in Hiroshima and Nagasaki at the time of the atomic-bomb explosions. The incidence of mental retardation and reduced head size in such children increased substantially when exposure occurred between the 8th and 15th weeks of gestation, which has been determined to be the age of greatest susceptibility to ionizing radiation.

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