Radiation poisoning 151196 226005787 2008-07-16T12:16:48Z 200.189.195.217 /* External */ {{Infobox_Disease |<<>> Name = {{PAGENAME}} | Image = Radiation warning symbol.svg | Caption = Radiation [[Hazard symbol]]. | DiseasesDB = | ICD10 = {{ICD10|T|66||t|66}} | ICD9 = {{ICD9|990}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = | }} '''Radiation poisoning''', also called "'''radiation sickness'''" or a "'''creeping dose'''", is a form of damage to organ tissue due to 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 to low level radiation. Many of the symptoms of radiation poisoning occur as ionizing radiation interferes with cell division. This interference allows for treatment of [[cancer]] cells; such cells are among the fastest-dividing in the body, and may be destroyed by a radiation dose that adjacent normal cells are likely to survive. It can be very dangerous. The clinical name for "radiation sickness" is ''[[Acute (medical)|acute]] radiation [[syndrome]]'' as described by the [[Centers for Disease Control and Prevention|CDC]].<ref> {{cite web | title = Acute Radiation Syndrome | publisher = Centers for Disease Control and Prevention | date = 2005-05-20 | url = http://www.bt.cdc.gov/radiation/ars.asp}}</ref><ref>{{Citation | publisher = National Center for Environmental Health/Radiation Studies Branch | title = Acute Radiation Syndrome | date = 2002-04-09 | url = http://www.umt.edu/research/Eh/pdf/AcuteRadiationSyndrome.pdf}}</ref><ref>{{cite web | title = Acute Radiation Syndrome: A Fact Sheet for Physicians | publisher = Centers for Disease Control and Prevention | date = 2005-03-18 | url = http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp}}</ref> A [[chronic (medicine)|chronic]] radiation syndrome does exist but is very uncommon; this has been observed among workers in early [[radium]] source production sites and in the early days of the [[Soviet]] nuclear program. A short exposure can result in acute radiation syndrome; chronic radiation syndrome requires a prolonged high level of exposure. The use of [[radionuclide]]s in science and industry is strictly regulated in most countries (in the U.S. by the [[Nuclear Regulatory Commission]]). In the event of an accidental or deliberate release of radioactive material, either evacuation or sheltering in place will be the recommended measures. ==Measuring radiation dosage== The [[rad (unit)|rad]] is a unit of [[Absorbed dose|absorbed radiation dose]] defined in terms of the [[energy]] actually deposited in the tissue. One rad is an absorbed dose of 0.01 [[joule]]s of energy per kilogram of tissue. The more recent [[SI derived unit|SI unit]] is the [[Gray (unit)|gray]] (Gy), which is defined as 1 joule of deposited [[energy]] per kilogram of tissue. Thus one gray is equal to 100 rad. To accurately assess the risk of radiation, the absorbed dose energy in rad is multiplied by the relative biological effectiveness (RBE) of the radiation to get the biological dose equivalent in [[Röntgen equivalent man|rems]]. Rem stands for "[[Röntgen]] equivalent in man (''sic'')." In SI units, the absorbed dose energy in grays is multiplied by the same RBE to get a biological dose equivalent in [[Sievert|sieverts (Sv)]]. The sievert is equal to 100 rem. The RBE is a "quality factor," often denoted by the letter ''Q'', which assesses the damage to tissue caused by a particular type and energy of radiation. For [[alpha particle]]s ''Q'' may be as high as 20, so that one rad of alpha radiation is equivalent to 20 rem. The ''Q'' of [[neutron]] radiation depends on their energy. However, for [[beta particle]]s, [[x-ray]]s, and [[gamma ray]]s, ''Q'' is taken as one, so that the rad and rem are equivalent for those radiation sources, as are the gray and sievert. See the [[sievert]] article for a more complete list of ''Q'' values. ==Acute (short-term) vs chronic (long-term) effects== {{Expand-section|date=December 2007}} {{Refimprovesect|date=June 2008}} Radiation sickness is generally associated with acute exposure and has a characteristic set of symptoms that appear in an orderly fashion. The symptoms of radiation sickness become more serious (and the chance of survival decreases) as the dosage of radiation increases. These effects are described as the [[deterministic]] effects 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. If a cancer is radiation-induced, then 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 sufferer is exposed. Since [[tumor]]s grow by abnormally rapid cell division, the ability of radiation to disturb cell division is also used to treat cancer (see [[radiotherapy]]), and low levels of [[ionizing radiation]] have been claimed to lower one's risk of cancer (see [[hormesis]]). ==Exposure== === External vs internal exposure === ====External==== External exposure is exposure which occurs when the radioactive source (or other radiation source) is outside (and remains outside) the organism which is exposed. Below are a series of three examples of external exposure. * A person who places a sealed [[radioactive source]] in their pocket * A space traveller who is irradiated by [[cosmic ray]]s * A person who is treated for [[cancer]] by either [[teletherapy]] or [[brachytherapy]]. While in brachytherapy the source is inside the person it is still external exposure because the active part of the source never comes into direct contact with the biological tissues of the person. [[Image:Externalsource.jpg|thumb|350px|centre|A diagram showing a hypothetical animal being irradiated by radioactive contamination (shown in yellow), being irradiated by an external source (in red) of radiation]] One of the key points is that external exposure is often relatively ''easy'' to estimate, and if the irradiated objects do not become radioactive (''except for a case where the radiation is an intense [[neutron]] beam which causes [[neutron activation|activation]] of the object''). It is possible for an object to be contaminated on the outer surfaces, assuming that no radioactivity enters the object it is still a case of external exposure and it is normally the case that decontamination is easy (wash the surface). [[Image:Contaminationonskin.jpg|thumb|350px|centre|A diagram showing a hypothetical animal being irradiated by radioactive contamination (shown in red) which is present on an external surface such as the skin, this emits radiation (shown in yellow) which can enter the animal's body]] ====Internal==== Internal exposure is when the radioactive material enters the organism, and the radioactive atoms become incorporated into the organism. Below are a series of examples of internal exposure. * The exposure due to [[Isotopes of potassium#40K|<sup>40</sup>K]] present within a ''normal'' person. * The exposure to the ingestion of a soluble radioactive substance, such as [[Strontium-90|<sup>90</sup>Sr]] in [[cow]]’s [[milk]]. * A person who is being treated for cancer by means of an ''open source'' radiotherapy method where a radioisotope is used as a drug. A review of this topic was published in 1999.<ref>{{Citation | last = Wynn | first = Volkert | last2 = Hoffman | first2 = Timothy | title = Therapeutic Radiopharmaceuticals | journal = Chemical Reviews | volume = 99 | issue = 9 | pages = 2269–2292 | date = 1999 | url = http://pubs.acs.org/cgi-bin/article.cgi/chreay/1999/99/i09/pdf/cr9804386.pdf | format = [[PDF]] | doi = 10.1021/cr9804386}}</ref> Because the radioactive material becomes intimately mixed with the affected object it is often difficult to decontaminate the object or person in a case where internal exposure is occurring. While some very insoluble materials such as [[fission product]]s within a [[uranium dioxide]] matrix might never be able to truly become part of an organism, it is normal to consider such particles in the lungs as a form of internal contamination which results in internal exposure. The reasoning is that the particles have entered ''via'' an [[orifice]] and can not be removed with ease from ''what the lay person (non biologist)'' would regard as within the animal. It is important to note that strictly speaking the contents of the digestive tract and the air within the lungs are outside the body of a mammal. [[Image:Hotspecsinlung.jpg|thumb|350px|centre|A diagram showing a hypothetical animal (after it has evolved into one with an orifice and a lung) being irradiated by radioactive contamination (shown in red) which is present within its lung, this emits radiation (shown in yellow) which can enter the animal's body]] ===Nuclear warfare=== [[Image:Radiation burns on a Japanese woman after a nuclear explosion in 1945.jpg|thumb|Japanese woman suffering burns from thermal radiation after a nuclear bomb explosion in 1945.]] Nuclear warfare is more complex because a person can be irradiated by at least three processes. The first (the major cause of burns) is not caused by ionizing radiation. * Thermal burns from [[infrared]] heat radiation. * [[Beta particle|Beta]] burns from shallow ionizing radiation (this would be from [[Nuclear fallout|fallout]] particles; the largest particles in [[Nuclear fallout#Local|local fallout]] would be likely to have very high activities because they would be deposited so soon after detonation and it is likely that one such particle upon the skin would be able to cause a localised burn); however, these particles are very weakly penetrating and have a short range. * [[Gamma ray|Gamma]] burns from highly penetrating radiation. This would likely cause deep gamma penetration within the body, which would result in uniform whole body irradiation rather than only a surface burn. In cases of whole body gamma irradiation (''circa'' 10 Gy) due to accidents involving medical product irradiators, some of the human subjects have developed injuries to their skin between the time of irradiation and death. In the picture on the right, the normal clothing that the woman was wearing would have been unable to attenuate the gamma radiation and it is likely that any such effect was evenly applied to her entire body. Beta burns would be likely all over the body due to contact with fallout, but thermal burns are often on one side of the body as heat radiation does not penetrate the human body. In addition, the pattern on her clothing has been burnt into the skin. This is because white fabric reflects more infra-red light than dark fabric. As a result, the skin close to dark fabric is burned more than the skin covered by white clothing. There is also the risk of internal radiation poisoning by ingestion of fallout particles. ===Nuclear reactor accidents=== Radiation poisoning was a major concern after the [[Chernobyl disaster|Chernobyl]] reactor accident. It is important to note that in humans the acute effects were largely confined to the accident site. Thirty-one people died as an immediate result. Of the 100 million [[curie]]s (4 [[becquerel|exabecquerels]]) of radioactive material, the short lived radioactive isotopes such as [[iodine-131|<sup>131</sup>I]] Chernobyl released were initially the most dangerous. Due to their short half-lives of 5 and 8 days they have now<!-- ({{CURRENTYEAR}}) --> decayed, leaving the more long-lived [[caesium-137|<sup>137</sup>Cs]] (with a half-life of 30.07 years) and [[strontium-90|<sup>90</sup>Sr]] (with a half-life of 28.78 years) as main dangers. ===Other accidents=== Improper handling of radioactive and nuclear materials lead to radiation release and radiation poisoning. The [[Goiânia accident|most serious]] of these, due to improper disposal of a medical device containing a radioactive source ([[teletherapy]]), occurred in [[Goiânia]], Brazil in 1987. ===Ingestion and inhalation=== When radioactive compounds enter the human body, the effects are different from those resulting from exposure to an external radiation source. Especially in the case of alpha radiation, which normally does not penetrate the skin, the exposure can be much more damaging after ingestion or inhalation. The radiation exposure is normally expressed as a [[committed effective dose equivalent (CEDE)]]. ====Deliberate poisoning==== {{Seealso|Alexander Litvinenko poisoning}} On November 23, 2006, [[Alexander Litvinenko]] died due to suspected deliberate [[poisoning]] with [[polonium]]-210.<ref> "Ushering in the era of nuclear terrorism", by Patterson, Andrew J. MD, PhD, ''Critical Care Medicine'', v. 35, p.953-954, 2007.</ref> <ref>"Beyond the Dirty Bomb: Re-thinking Radiological Terror", by James M. Acton; M. Brooke Rogers; Peter D. Zimmerman, ''Survival'', Volume 49, Issue 3 September 2007, pages 151 - 168 </ref><ref>"The Litvinenko File: The Life and Death of a Russian Spy", by Martin Sixsmith, True Crime, 2007 ISBN 0-312-37668-5, page 14. </ref> <ref name="Bellona"> [http://www.bellona.org/articles/polonium Radiological Terrorism: “Soft Killers”] by Morten Bremer Mærli, [[Bellona Foundation]] </ref> <ref name="dissident"> [[Alexander Goldfarb (author)|Alex Goldfarb]] and Marina Litvinenko. "[[Death of a dissident|Death of a Dissident: The Poisoning of Alexander Litvinenko and the Return of the KGB.]]" Free Press, New York, 2007. ISBN 978-1416551652. </ref>. His is the first case of confirmed death due to such a cause, although it is also known that there have been other cases of attempted assassination such as in the cases of KGB defector [[Nikolay Khokhlov]] and journalist [[Yuri Shchekochikhin]] where radioactive [[thallium]] was used. In addition, an incident occurred in 1990 at [[Point Lepreau Nuclear Generating Station]] where several employees acquired small doses of radiation due to the contamination of water in the office watercooler with [[tritium]] contaminated [[heavy water]] <ref>[http://2004.novayagazeta.ru/nomer/2004/46n/n46n-s10.shtml Meeting with past (Russian)] </ref> <ref name="Halloran">[http://news.bbc.co.uk/2/hi/programmes/file_on_4/6324241.stm ''Russia's poisoning 'without a poison' '' &ndash; Julian O'Halloran, BBC Radio 4, 6 February 2007].Retrieved on [[2007-07-30]].</ref> ==Prevention== The best prevention for radiation sickness is to minimize the dose suffered by the human, or to reduce the dose rate. ===Time=== The longer that the humans are subjected to radiation the larger the dose will be. The advice in the [[Nuclear warfare|nuclear war]] manual entitled "[[Nuclear War Survival Skills]]" published by [[Cresson Kearny]] in the [[United States|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 irradiation. For instance, the recovery of a lost [[radiography]] source should be done as quickly as possible. ::<math> \text{Dose} \propto t </math> ===Shielding=== By placing a layer of a material which will absorb the radiation between the source and the human, the dose and dose rate can be reduced. For instance, in the event of a nuclear war, it would be a good idea to shelter within a building with thick stone walls ([[Fallout shelter]]). During the height of the [[cold war]], [[fallout shelter]]s were identified in many urban areas. It is interesting to note that, under some conditions, shielding can increase the dose rate. For instance, if the electrons from a high energy beta source (such as <sup>32</sup>P) strike a lead surface, X-ray photons will be generated (radiation produced in this way is known as [[bremsstrahlung]]). It is best for this reason to cover any [[Atomic number|high Z]] materials (such as [[lead]] or [[tungsten]]) with a low Z material such as [[aluminium]], [[wood]], [[plastic]]. This effect can be significant if a person wearing lead-containing gloves picks up a strong beta source. Also, gamma photons can induce the emission of electrons from very dense materials by the [[photoelectric]] effect; again, by covering the high Z material with a low Z material, this potential additional source of exposure to humans can be avoided. Furthermore, gamma rays can scatter off a dense object; this enables gamma rays to "''go around corners''" to a small degree. Hence, to obtain a very high protection factor, the path in/out of the shielded enclosure should have several [[right angle|90 degree turns]] rather than just one. ===Reduction of incorporation into the human body=== [[Potassium iodide]] (KI), administered orally immediately after exposure, may be used to protect the [[thyroid]] from ingested [[radioiodine|radioactive iodine]] in the event of an accident or terrorist 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=== While 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 are 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 given a dose before being set aside (without being irradiated) for a length of time before being irradiated again, then the radiation causes less [[cell death]]. The human body contains many types of [[cell (biology)|cell]]s and the 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 cells forming [[blood cells]] ([[bone marrow]]) and the cells in the digestive system ([[Villus|microvilli]] which form part of the wall of the [[intestines]] are constantly being regenerated in a healthy human) causes death. 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. [[Image:Effectofselfrepair.png|center|600px|This is a graph showing the effect of fractionation on the ability of gamma rays to cause cell death. The blue line is for cells which were not given any time to recover, while the red line is for cells which were allowed to stand for a time and recover.]] ==Treatment== Treatment reversing the effects of irradiation is currently not possible. [[Anaesthetics]] and [[antiemetics]] are administered to counter the symptoms of exposure, as well as [[antibiotics]] for countering secondary infections due to 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 [[Foot|feet]], without having a global effect on the entire body. For instance, if the hands get a 100 Sv dose which results in the body receiving a dose (averaged over your entire body of 5 Sv) then the hands may be lost but ''Radiation poisoning'' would not occur. The resulting injury would be described as localized [[radiation burn]]. === Experimental treatments designed to mitigate the effect on bone marrow === [[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 [[clinical trial|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.<ref>{{Citation | last = Liu | first = Wei-Chung | last2 = Wang | first2 = Shu-Chi | last3 = Tsai | first3 = Min-Lung | last4 = Chen | first4 = Meng-Chi | last5 = Wang | first5 = Ya-Chen | last6 = Hong | first6 = Ji-Hong | last7 = McBride | first7 = William H. | last8 = Chiang | title = Protection against Radiation-Induced Bone Marrow and Intestinal Injuries by ''Cordyceps sinensis'', a Chinese Herbal Medicine | journal = Radiation Research | volume = 166 | issue = 6 | pages = 900–907 | date = 2006-12 | doi = 10.1667/RR0670.1 | unused_data = |first8 Chi-Shiun}}</ref> ==Table of exposure levels and symptoms== {{Refimprovesect|date=June 2008}} Dose-equivalents are presently stated in [[sievert]]s: ===0.05&ndash;0.2 Sv (5&ndash;20 [[Roentgen equivalent man|REM]])=== No symptoms. Potential for [[cancer]] and mutation of genetic material, according to the [[Linear no threshold model|LNT model]]: this is disputed (Note: see [[Radiation hormesis|hormesis]]). A few researchers contend that low dose radiation may be beneficial.<ref>{{cite web | last = Luan | first = Yuan-Chi | title = Chronic Radiation Is Beneficial to Human Beings | publisher = The Science Advisory Board | url = http://www.scienceboard.net/community/perspectives.122.html}}</ref><ref>{{cite web | title = Information on hormesis | publisher = Health PHysics Society | url=http://hps.org/publicinformation/ate/q299.html}}{{Dead link|url=http://hps.org/publicinformation/ate/q299.html|date=February 2008}}</ref><ref>{{cite journal | last = Luckey | first = Thomas | title = Nurture With Ionizing Radiation: A Provocative Hypothesis | journal = Nutrition and Cancer | volume = 34 | issue = 1 | pages = 1–11 | date = 1999-05 | url = http://www.informaworld.com/smpp/content?content=10.1207/S15327914NC340101 | doi = 10.1207/S15327914NC340101}}</ref> 50 mSv is the yearly federal limit for radiation workers in the United States. In the [[UK]] the yearly limit for a classified radiation worker is 20 mSv. In Canada and Brazil, the single-year maximum is 50 mSv, but the maximum 5-year dose is only 100 mSv. Company limits are usually stricter so as not to violate federal limits.<ref>{{cite web | title = 10 CFR 20.1201 Occupational dose limits for adults. | publisher = United States Nuclear Regulatory Commission | date = 1991-05-21 | url = http://www.nrc.gov/reading-rm/doc-collections/cfr/part020/part020-1201.html}}</ref> ===0.2&ndash;0.5 Sv (20&ndash;50 REM) === No noticeable symptoms. [[Red blood cell]] count decreases temporarily. ===0.5&ndash;1 Sv (50&ndash;100 REM) === Mild radiation sickness with headache and increased risk of infection due to disruption of immunity cells. Temporary male sterility is possible. ===1&ndash;2 Sv (100&ndash;200 REM) === ''Light radiation poisoning, 10% fatality after 30 days ([[Lethal dose|LD]] 10/30).'' Typical symptoms include mild to moderate nausea (50% probability at 2 Sv), with occasional [[vomiting]], beginning 3 to 6 hours after irradiation and lasting for up to one day. This is followed by a 10 to 14 day latent phase, after which light symptoms like general illness and [[Fatigue (physical)|fatigue]] appear (50% probability at 2 Sv). The [[immune system]] is depressed, with convalescence extended and increased risk of infection. Temporary male sterility is common. [[Spontaneous abortion]] or [[stillbirth]] will occur in pregnant women. ===2&ndash;3 Sv (200&ndash;300 REM) === ''Moderate radiation poisoning, 35% fatality after 30 days ([[Lethal dose|LD]] 35/30)''. Nausea is common (100% at 3 Sv), with 50% risk of vomiting at 2.8 Sv. Symptoms onset at 1 to 6 hours after irradiation and last for 1 to 2 days. After that, there is a 7 to 14 day latent phase, after which the following symptoms appear: loss of hair all over the body (50% probability at 3 Sv), fatigue and general illness. There is a massive loss of [[leukocytes]] (white blood cells), greatly increasing the risk of infection. Permanent female sterility is possible. [[Convalescence]] takes one to several months. ===3&ndash;4 Sv (300&ndash;400 REM) === ''Severe radiation poisoning, 50% fatality after 30 days ([[Lethal dose|LD]] 50/30)''. Other symptoms are similar to the 2&ndash;3 Sv dose, with uncontrollable bleeding in the mouth, under the skin and in the kidneys (50% probability at 4 Sv) after the latent phase. ===4&ndash;6 Sv (400&ndash;600 REM) === ''Acute radiation poisoning, 60% fatality after 30 days ([[Lethal dose|LD]] 60/30)''. Fatality increases from 60% at 4.5 Sv to 90% at 6 Sv (unless there is intense medical care). Symptoms start half an hour to two hours after irradiation and last for up to 2 days. After that, there is a 7 to 14 day latent phase, after which generally the same symptoms appear as with 3-4 Sv irradiation, with increased intensity. Female sterility is common at this point. Convalescence takes several months to a year. The primary causes of death (in general 2 to 12 weeks after irradiation) are infections and [[internal bleeding]]. ===6&ndash;10 Sv (600&ndash;1,000 REM) === ''Acute radiation poisoning, near 100% fatality after 14 days ([[Lethal dose|LD]] 100/14).'' Survival depends on intense medical care. [[Bone marrow]] is nearly or completely destroyed, so a [[bone marrow transplant]] is required. Gastric and intestinal tissue are severely damaged. Symptoms start 15 to 30 minutes after irradiation and last for up to 2 days. Subsequently, there is a 5 to 10 day latent phase, after which the person dies of infection or [[internal bleeding]]. Recovery would take several years and probably would never be complete. Devair Alves Ferreira received a dose of approximately 7.0 Sv (700 REM) during the [[Goiânia accident]] and survived, partially due to his [[Dose fractionation|fractionated exposure]]. ===10&ndash;50 Sv (1,000&ndash;5,000 REM) === <!-- According to information on this very article, the person pictured should not be alive 21 days after such high exposure. --> ''Acute radiation poisoning, 100% fatality after 7 days ([[Lethal dose|LD]] 100/7).'' An exposure this high leads to spontaneous symptoms after 5 to 30 minutes. After powerful fatigue and immediate nausea caused by direct activation of chemical receptors in the brain by the irradiation, there is a period of several days of comparative well-being, called the latent (or "[[walking ghost phase|walking ghost]]") phase.{{Fact|date=August 2007}} After that, cell death in the gastric and intestinal tissue, causing massive [[diarrhea]], intestinal bleeding and loss of water, leads to water-electrolyte imbalance. Death sets in with [[delirium]] and coma due to breakdown of circulation. Death is currently inevitable; the only treatment that can be offered is [[pain therapy]]. [[Louis Slotin]] was exposed to approximately 21 Sv in a [[criticality accident]] on 21 May 1946, and died nine days later on 30 May. ===More than 50 Sv (>5,000 REM) === A worker receiving 100 Sv (10,000 REM) in an accident at Wood River, Rhode Island, USA on [[24 July]] [[1964]] survived for 49 hours after exposure, and an operator receiving between 60 and 180 Sv (18,000 REM) to his upper body in an accident at Los Alamos, New Mexico, USA on [[30 December]] [[1958]] survived for 36 hours; details of this accident can be found on page 16 (page 30 in the PDF version) of Los Alamos' 2000 Review of Criticality Accidents.<ref>{{Citation | title = A Review of Criticality Accidents | publisher = Los Alamos National Laboratory | year = 2000 | url = http://www.orau.org/ptp/Library/accidents/la-13638.pdf | format = [[PDF]]}}</ref> <!-- --> ==References== {{reflist}} ==Further reading== *[[Michihiko Hachiya]], ''Hiroshima Diary'' (Chapel Hill: University of North Carolina, 1955), ISBN 0-8078-4547-7. *[[John Hersey]], ''[[Hiroshima (Hersey)|Hiroshima]]'' (New York: Vintage, 1946, 1985 new chapter), ISBN 0-679-72103-7. *Ibuse Masuji, ''Black Rain'' (1969) ISBN 0-87011-364-X *[[Ernest J. Sternglass]], ''Secret Fallout: low-level radiation from Hiroshima to Three-Mile Island'' (1981) ISBN 0-07-061242-0 ([http://www.ratical.org/radiation/SecretFallout/ online]) *[[Norman Solomon]], [[Harvey Wasserman]] ''Killing Our Own: The Disaster of America's Experience with Atomic Radiation, 1945-1982'', New York: Dell, 1982. ISBN 0-385-28537-X, ISBN 0-385-28536-1, ISBN 0-440-04567-3 ([http://www.ratical.org/radiation/KillingOurOwn/ online]) == See also == *[[Hibakusha]] (Japanese atomic bomb survivors) * [[Radioactive quackery]] * [[List of military nuclear accidents]] * [[List of civilian nuclear accidents]] ==External links== * [http://bjr.birjournals.org/cgi/reprint/Supplement_27/1/41.pdf Radiation accidents with multi-organ failure in the United States] * [http://www.johnstonsarchive.net/nuclear/radevents/radaccidents.html List of radiation accidents and other events causing radiation casualties] * [http://www-pub.iaea.org/MTCD/publications/PDF/Pub1106_scr.pdf The criticality accident in Sarov], [[International Atomic Energy Agency]], 2001 &mdash; well documented account of the biological effects of a criticality accident * [http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp The Center for Disease Control's fact sheet on Acute Radiation Syndrome] * [http://courses.cs.vt.edu/~cs3604/lib/Therac_25/Therac_1.html Therac-25 computerized radiation therapy machine accidents] * [http://www.bomb-shelter.net/nuclear-weapons 50-KT to 1-MT surface burst thermal burns and radiation doses] {{Consequences of external causes}} <!--Featured articles--> {{Poisoning and toxicity}} <!-- Categories --> [[Category:Causes of death]] [[Category:Radiation health effects]] [[Category:Radioactivity]] [[Category:Radiobiology]] [[Category:Radiology]] {{Link FA|fr}} <!--Interwiki--> [[ar:متلازمة الإشعاع الحادة]] [[bg:Остра лъчева болест]] [[cs:Akutní radiační syndrom]] [[de:Strahlenkrankheit]] [[es:Envenenamiento por radiación]] [[fr:Syndrome d'irradiation aiguë]] [[ko:피폭]] [[it:Avvelenamento da radiazione]] [[nl:Stralingsziekte]] [[ja:被曝]] [[pl:Choroba popromienna]] [[ru:Лучевая болезнь]] [[simple:Radiation poisoning]] [[fi:Säteilysairaus]] [[sv:Strålsjuka]] [[uk:Променева хвороба]]