Acute Radiation Syndrome: Types, Diagnosis, Treatment, and Safety

This report provides a detailed overview of Acute Radiation Syndrome (ARS), an acute illness caused by high-dose radiation exposure. It explores the different types of ARS based on radiation dose, including bone marrow, gastrointestinal, and neurovascular syndromes, and discusses the underlying mechanisms of damage at the cellular level, including DNA damage. The report covers diagnosis, which can be challenging due to the absence of unique symptoms, and delves into management strategies, emphasizing supportive care, stimulation of hematopoiesis, and psychological support. Furthermore, it highlights crucial radiation protection measures, such as adhering to the ALARA principle, proper use of protective equipment, and the importance of radiation safety education. The report concludes by summarizing the key aspects of ARS and emphasizing the significance of preventive measures to reduce morbidity and mortality rates, drawing from various research studies and guidelines.

Running head: ACUTE RADIATION SYNDROME
Name of the Student:
Name of the University:
Author note:

1
ACUTE RADIATION SYNDROME
Introduction:
Acute radiation syndrome is defined as an acute illness caused by radiation exposure
where a high dose of penetrating radiation in a very short period of time, the usual exposure is
minute (Stenke et al., 2018). Port et al. (2017), suggested that major cause of the syndrome is
depletion of immature parenchyma stem cells present in a specific tissue. A considered number
of individuals were experienced acute radiation syndrome who survived the Hiroshima and
Nagasaki atomic bombs blast in 1986, the firefighters who resounded first after Chernobyl
Nuclear Power Plant event and eventually exposed to sterilization (Singh et al., 2016). The risk
factors of developing the disease are working in the radiology department of health care and who
are working in nuclear plants. Canadian nuclear safety commission highlighted that radiation
exposures posed one of the most severe health risks on population which leads to permanent
disability. This paper will illustrate the dose and types of acute radiation syndrome, diagnosis,
and management, treatment and safety measures that can be taken in the following paragraphs.
Discussion:
Dose and types of acute radiation syndrome:
Farese and MacVittie (2015), suggested that the prevalence of ARC was observed in
individuals who have been medically treated and diagnosed, early uranium mine workers,
workers who manufactured atomic weapons and people exposed to radiations as a result of
Chernobyl nuclear accidents and people exposed to radon gas in their home. The onset and types
of syndrome depend on the amount if rations individuals subjected to irrespective of anyone dose
or cumulative exposure. The underlying mechanism of damage is that radiating affects the health
through breakage of DNA molecules where DNA breaks hydrogen bonds (Krivokrysenko et al.,

2
ACUTE RADIATION SYNDROME
2016). However, due to the repair mechanism of the body, DNA can be repaired but
inappropriate recovery leads to mutated DNA that interferes with normal function of cells.
Therefore, individuals with a mutated DNA tend to experience severe health difficulties which
further affected their perspective of life. For each type of syndrome caused by radiation exposure
four stages are present which further decides the fate of exposed individuals (Singh, Newman, &
Seed, 2015). In order to cause acute radiation syndrome, the radiation dose must be larger than
70 rads, it must be penetrating, external, delivered in a shorter period of time and must affect the
entire body. Relatively smaller doses resulted in bone marrow or hematopoietic syndrome
masked by aplastic anemia, dropped RBC. In this case, the infection observed due to the low
amount of leucocytes present in the cells and due to the loss of platelets and anemia. The onset
exposure to the radiation of approximately 70 rads may cause the bone marrow disease (Patil et
al., 2015`). In this type of syndrome, bone marrow cells begin to repopulate in the marrow. Full
recovery required at least a few weeks to a year after exposure and death may occur during the
period of recovery. Gastrointestinal effects are such as nausea, vomiting, falling RBC counts,
predisposition to infection or bleeding (Singh, Newman, & Seed, 2015). The symptoms
observed within a few hours of onset exposure which lasts for approximately 2days and
symptoms may occur as low as 6 Gy or 600 rads). In this case, the stem cells of bone marrow
and cell lining of GI track May starts dying and consequently patient may feel well. For
recovery, Ld100+ is about 2.5 to 5 GY (whole-body absorbed dose) is required (Patil et al.,
2015). It can also cause death during the recovery period because of damage of cells where the
possibility of regeneration of cells is low.
For severe absorption, more than 3,000 rads, may result in the neurovascular disease
where common illness such as neurological abnormalities, nausea, and vomiting. The death

3
ACUTE RADIATION SYNDROME
occurred in frequently in this syndrome due to the collapse of the circulatory system. The
physical abnormalities remain constant in every case since individuals who experienced
exposure cannot be fully recovered due to the intensity of the dose. In every case, the early
symptoms are observed such as nausea, vomiting, headaches, fatigue, and skin reddening. It is
possible to receive skin damaging dose without causing acute radiation syndrome where blisters
and edema observed in the skin of exposed individuals. In a few cases, hair follicle may be
effective (Goldman et al., 2015).
Diagnosis and management:
The diagnosis of ARS can be difficult since ARS cause no unique syndrome and since it
is dose dependent, early symptoms may not be observed for the patients, or the patients may be
already in the latent stage. If the patient received more than 5rads then it can be measured by
CBC results and radiation expert should conduct the dose assignment (Bray et al., 2016). If no
radiation exposure is suspected initially, the differential diagnosis should be done for the patient.
For management of the ARS, supportive and clean environment need to be provided to the
patients and besides, stimulation of hematopoiesis by using growth factors, stem cells
transfusion, psychological support, careful observation of erythema can be done and consultation
with experts in radiation management is required (Singh et al., 2016)..
Radiation protective measurements:
Radiation protection practice is important in every domain where individuals are
subjected to the radiation on daily basis. The Canadian system of developing radiation protection
guidance now amend by through the radiation health committee where three major legislation

4
ACUTE RADIATION SYNDROME
were imposed such as Canadian nuclear safety act 1998 and environment protection ( nuclear
codes )1978 for following safe radiation practice. According to Canadian nuclear safety
commission, NHMRC code of practice for safe use of radiation gauge (1982) which applies
ALARA principle for assisting individuals in keeping radiations doses arising from radiation
gauge as low as reasonably achievable (Donneys et al., 2016). Other protective measures can be
taken to reduce radiation exposure such as the supplier of fixed radiation gauge must ensure that
all people under suppliers care to follow and comply with the radiation management plan. In the
workplace such as the radiology department or nuclear plan every individual who is in direct
contact with radiation should wear pb suit and distance should be 2cm while working with
radiation gauge Goldman et al., 2015). Location of the installed radiating gauged in need to be
verified for safety measures and within 4 km no locality need to be present (Singh et al., 2016).
Moreover, in order to be a medical radiation technologist, CAMRT competencies need to be
acquired and enhanced. The first competency is a safe radiation practice by applying ALARA
principles as discussed before. Use of protective device and apparel device is required, use of
imaging accessory device, monitoring personal radiation exposure and performing radiation
source survey to ensure the safety of patients and workers(Singh, Newman, & Seed, 2015).. The
responsible person should ensure that a suitable radiation survey is conducted to monitor the X-
ray and gamma radiation level (Anderson et al., 2016). Where neuron-monitoring is required and
a neutron survey meter is not available, the competent person must obtain approval from the
relevant regulatory authority for estimating neutron from gamma measurement. For monitoring
personal device, suspected to have a radiation dose of 1mSv which is resulted in accidents, the
competent person should contact the risk assessment persona to evaluate the incident to take the
safety measures for it (Cuttler, 2016). The second competency is radiation safety education such

5
ACUTE RADIATION SYNDROME
as provide education regarding radiation risks, safe practice, organ sensitivity and protective
practice to every co-works and further education need to gain through literature research. The
third competency is recognizing the radiation emergency situation and responded to prevent
radiation exposure and acute radiation syndrome (Peters et al., 2016). The fourth competency is
to conduct a quality assurance test by expert personal before using the appropriate equipment’s
(Peters et al., 2016). Before using the equipment’s, emission of radiation need to be measured for
the safety purpose of staffs and patient. These measures in the clinical practice are crucial to
prevent exposure of radiation for reducing the mortality rate.
Conclusion:
Thus it can be concluded that acute radiation syndrome is an acute illness caused by
irradiation of the entire body by a high dose of penetrating radiation in a very short period of
time. The prevalence of ARC is observed in individuals who have been medically treated and
diagnosed, early uranium mine workers. The onset and types of syndrome depend on the amount
of rations individuals subjected to irrespective of anyone dose or cumulative exposure. This can
cause bone marrow syndrome, GI tract syndrome and neurovascular syndrome. At milder dose, it
can cause bone marrow disease, at medium exposure of radiation it can cause GI tract disease
and at severe exposure of radiation can cause neurovascular disease and the majority of the cases
individuals die during the recovery period. The diagnosis of ARS can be difficult since ARS
cause no unique syndrome and since it is dose dependent, early symptoms may not be observed
for the patients, or the patients may be already in the latent stage. For radiation protection, a
supplier of fixed radiation gauge must ensure that all people’s under suppliers can be followed

6
ACUTE RADIATION SYNDROME
and comply with the radiation management plan. Other measurements can be taken to reduce the
exposure which reduces the morbidity rate.

7
ACUTE RADIATION SYNDROME
References:
Anderson, T. J., Grégoire, J., Pearson, G. J., Barry, A. R., Couture, P., Dawes, M., ... & Hegele,
R. A. (2016). Canadian Cardiovascular Society guidelines for the management of
dyslipidemia for the prevention of cardiovascular disease in the adult. Canadian Journal
of Cardiology, 32(11), 1263-1282.
Bray, F. N., Simmons, B. J., Wolfson, A. H., & Nouri, K. (2016). Acute and chronic cutaneous
reactions to ionizing radiation therapy. Dermatology and therapy, 6(2), 185-206.
Cuttler, J. M. (2016). Urgent change needed to radiation protection policy. Health
physics, 110(3), 267-270.
Donneys, A., Nelson, N. S., Perosky, J. E., Polyatskaya, Y., Rodriguez, J. J., Figueredo, C., ... &
Buchman, S. R. (2016). Prevention of radiation-induced bone pathology through
combined pharmacologic cytoprotection and angiogenic stimulation. Bone, 84, 245-252.
Farese, A. M., & MacVittie, T. J. (2015). Filgrastim for the treatment of hematopoietic acute
radiation syndrome. Drugs Today, 51(9), 537-548.
Goldman, D. C., Alexeev, V., Lash, E., Guha, C., Rodeck, U., & Fleming, W. H. (2015). The
triterpenoid RTA 408 is a robust mitigator of hematopoietic acute radiation syndrome in
mice. Radiation research, 183(3), 338-344.
Krivokrysenko, V. I., Toshkov, I. A., Gleiberman, A. S., Krasnov, P., Shyshynova, I., Bespalov,
I., ... & Purmal, A. A. (2015). The Toll-like receptor 5 agonist entolimod mitigates lethal
acute radiation syndrome in non-human primates. PLoS One, 10(9), e0135388.

8
ACUTE RADIATION SYNDROME
Patil, R., Szabó, E., Fells, J. I., Balogh, A., Lim, K. G., Fujiwara, Y., ... & Patil, S. (2015).
Combined mitigation of the gastrointestinal and hematopoietic acute radiation syndromes
by an LPA2 receptor-specific nonlipid agonist. Chemistry & biology, 22(2), 206-216.
Peters, C. E., Demers, P. A., Kalia, S., Nicol, A. M., & Koehoorn, M. W. (2016). Levels of
occupational exposure to solar ultraviolet radiation in Vancouver, Canada. Annals Of
Occupational Hygiene, 60(7), 825-835.
Port, M., Pieper, B., Knie, T., Dörr, H., Ganser, A., Graessle, D., ... & Abend, M. (2017). Rapid
prediction of hematologic acute radiation syndrome in radiation injury patients using
peripheral blood cell counts. Radiation research, 188(2), 156-168.
Singh, V. K., Newman, V. L., & Seed, T. M. (2015). Colony-stimulating factors for the
treatment of the hematopoietic component of the acute radiation syndrome (H-ARS): a
review. Cytokine, 71(1), 22-37.
Singh, V., & Hauer-Jensen, M. (2016). γ-tocotrienol as a promising countermeasure for acute
radiation syndrome: Current status. International journal of molecular sciences, 17(5),
663.
Stenke, L., Lindberg, K., Lagergren Lindberg, M., Lewensohn, R., Valentin, J., Powles, R., &
Dainiak, N. (2018). Coordination Of Management Of The Acute Radiation
Syndrome. Radiation protection dosimetry, 182(1), 80-84.