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In the last 50 years, the public’s concern with radiation injuries centered around nuclear power plant accidents and the threat of nuclear warfare. However, with today’s widespread use of radiation technology in medicine, research, industry, power production, and national defense, there is a growing potential for radiation injuries. Of further concern is the potential for large numbers of casualties from a terrorist attack using a nuclear weapon or radioactive material. The emergency physician must be prepared to recognize and treat signs and symptoms of radiation injury.

Radiation events may be accidental or intentional. Accidents may occur at any facility using a radioactive source or during transport of radioactive materials. Accidents can occur in the medical setting, involving erroneous dosing of radiotherapy. In 2006, polonium-210 was used in the intentional poisoning and assassination of Russian dissident Alexander Litvinenko.

“Orphan” radioactive sources are a growing concern and can result in accidental exposure to radiation. Sealed medical and industrial sources, such as cobalt-60, cesium-137, strontium-90, and iridium-192, can be abandoned, lost, or stolen, thereby ending up in the wrong or unsuspecting hands. Four major cases of this occurred in Thailand (2000), Egypt (2000), Estonia (1994), and Brazil (1987), in which unsuspecting villagers gained possession of lost or abandoned radioactive sources (scavenging scrap metal in two of the incidents) and were exposed to radiation. The average time from first exposure to diagnosis for these four events was 22 days.1 A radiation event could result from use of a “dirty bomb.” A “dirty bomb” is one in which radioactive materials are combined with conventional explosives to disperse radioactive particles over a large area. In addition to radiation injuries, the ensuing panic and psychological distress could be devastating. An attack upon a nuclear installation (such as a power plant or waste repository) or use of nuclear weapons can cause large-scale radiation disasters.

The U.S. Department of Energy, the Radiation Emergency Assistance Center/Training Site (REAC/TS) maintains an international registry of radiation accidents. Since the inception of the registry in 1944, 432 radiation accidents have been recorded worldwide (250 within the U.S.). Of the 133,811 victims, 3082 had significant exposure, and there were 127 fatalities (26 in the U.S.). The 1986 Chernobyl accident accounted for 116,500 individuals and 28 acute fatalities. The most frequent radiation accident is one of high-dose local exposure, usually to the hands, from a radiation device. The majority of these accidents have occurred in the industrial setting with inadvertent exposure from radiation devices used in radiography to verify integrity of metals such as pipe welds.2,3

An understanding of basic radiation physics and pathogenesis of injury is needed to properly recognize and triage radiation injuries.

Nonionizing and Ionizing Radiation

Radiation is energy emitted from a source. The electromagnetic radiation spectrum includes long-wavelength, low-frequency, low-energy forms of nonionizing radiation and progresses to short-wavelength, high-frequency, and high-energy forms of ionizing radiation. ...

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