Radiation Oncology/Radiobiology/Radiation Syndrome

• Acute Radiation Syndrome (ARS) (sometimes known as radiation toxicity or radiation sickness) is an acute illness caused by irradiation of the entire body (or most of the body) by a high dose of penetrating radiation in a very short period of time (usually a matter of minutes)
• The major cause of this syndrome is depletion of immature parenchymal stem cells in specific tissues
• Examples of people who suffered from ARS are the survivors of the Hiroshima and Nagasaki atomic bombs, the firefighters that first responded after the Chernobyl Nuclear Power Plant event in 1986, and some unintentional exposures to sterilization irradiators

The three classic ARS Syndromes:

1. Bone marrow syndrome
2. Gastrointestinal (GI) syndrome
3. Cardiovascular (CV) / Central Nervous System (CNS) syndrome

The four stages of ARS:

1. Prodromal stage (N-V-D stage)
2. Latent stage
3. Manifest illness stage
4. Recovery or death

After consultation, begin the following (as indicated):

1. Supportive care in a clean environment (if available, the use of a burn unit may be quite effective)
2. Prevention and treatment of infections
3. Stimulation of hematopoiesis by use of growth factors
4. Stem cell transfusions or platelet transfusions (if platelet count is too low)
5. Psychological support
6. Careful observation for erythema (document locations), hair loss, skin injury, mucositis, parotitis, weight loss, or fever
7. Confirmation of initial dose estimate using chromosome aberration cytogenetic bioassay when possible (although resource intensive, this is the best method of dose assessment following acute exposures)
8. Consultation with experts in radiation accident management