Radiation Injury Diagnosis, Triage and Exposure Assessment

Some skin damage frequently accompanies ARS. However, the cutaneous syndrome can also result from localized acute radiation exposure to the skin, usually from direct handling of radioactive sources or from contamination of the skin or clothes (2,8) (see Figs. 4.1 and 4.2) With localized exposure, even with high doses, the victim frequently survives, because the whole body usually does not receive the localized dose. However, if a patient with localized radiation induced cutaneous injury has also received whole body irradiation from an external source, the cutaneous damage increases the risk for death from the whole body exposure (2). Patients with the hematopoietic syndrome due to whole body irradiation will recover more slowly, if at all, from cutaneous injury due to bleeding, infection and poor wound healing (2). 

Compared to thermal bums, radiation induced bums develop more than a week after exposure. Therefore, patients presenting with bum injuries immediately after exposure are suffering from thermal rather than radiation bums. Table 4.3 illustrates the relationship between exposure dose and cutaneous injury. 

Radiation Injury Diagnosis, Triage and Exposure Assessment 

In the past, radiation accidents have frequently resulted in a delayed diagnosis. In a study of four radiation accidents due to lost sources (Mit Haifa, Egypt, May 2000, 

Bangkok, Thailand, February 2000, Tammiku, Estonia, October 1994 and Goiania, Brazil, September 1987) a mean 22 days elapsed between exposure and diagnosis (5). 

---