Radiation burn - Wikipedia https://en.wikipedia.

org/wiki/Radiation_burn

Radiation burn
From Wikipedia, the free encyclopedia

A radiation burn is damage to the skin or other biological

tissue caused by exposure to radiation. The radiation types of Radiodermatitis
greatest concern are thermal radiation, radio frequency energy, Classification and external resources
ultraviolet light and ionizing radiation. Specialty dermatology

The most common type of radiation burn is a sunburn caused ICD-10 L58 (http://apps.who.int
by UV radiation. High exposure to X-rays during diagnostic /classifications/icd10/browse
medical imaging or radiotherapy can also result in radiation /2016/en#/L58)
burns. As the ionizing radiation interacts with cells within the ICD-9- 692.82 (http://www.icd9data.com
bodydamaging themthe body responds to this damage,
CM /getICD9Code.ashx?icd9=692.82)
typically resulting in erythemathat is, redness around the
damaged area. Radiation burns are often associated with
radiation-induced cancer due to the ability of ionizing radiation to
interact with and damage DNA, occasionally inducing a cell to
become cancerous. Cavity magnetrons can be improperly used to
create surface and internal burning. Depending on the photon
energy, gamma radiation can cause very deep gamma burns, with
60Co internal burns are common. Beta burns tend to be shallow as
beta particles are not able to penetrate deep into the person; these
burns can be similar to sunburn.
Ionizing radiation burn: Large red
patches of skin on the back and arm
Radiation burns can also occur with high power radio transmitters at
from multiple prolonged fluoroscopy
any frequency where the body absorbs radio frequency energy and
procedures.
converts it to heat.[2] The U.S. Federal Communications
Commission (FCC) considers 50 watts to be the lowest power above
which radio stations must evaluate emission safety. Frequencies
considered especially dangerous occur where the human body can
become resonant, at 35 MHz, 70 MHz, 80-100 MHz, 400 MHz, and
1 GHz.[3] Exposure to microwaves of too high intensity can cause
microwave burns.

Contents
1 Types
1.1 Acute
1.2 Chronic
1.3 Other
Deformity of hand due to an X-ray
1.4 Delayed effects
burn. These burns are accidents. X-rays
2 Beta burns
were not shielded when they were first
2.1 Energy vs penetration depth discovered and used, and people
2.2 Treatment of radiation burns received radiation burns. [1]
3 Causes
3.1 Medical Imaging
3.2 Radioactive fallout
3.3 Nuclear accidents
4 See also
5 References

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6 External links

Types
Radiation dermatitis (also known as radiodermatitis) is a skin disease associated with prolonged
exposure to ionizing radiation.[4]:1312 Radiation dermatitis occurs to some degree in most patients
receiving radiation therapy, with or without chemotherapy.[5]

There are three specific types of radiodermatitis: acute radiodermatitis, chronic radiodermatitis, and
eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy.[4]:3940 Radiation therapy can
also cause radiation cancer.[4]:40

With interventional fluoroscopy, because of the high skin doses that can be generated in the course of the
intervention, some procedures have resulted in early (less than two months after exposure) and/or late (two
months or more after exposure) skin reactions, including necrosis in some cases.[6]:773

Radiation dermatitis, in the form of intense erythema and vesiculation of the skin, may be observed in
radiation ports.[4]:131

As many as 95% of patients treated with radiation therapy for cancer will experience a skin reaction. Some
reactions are immediate, while others may be later (e.g., months after treatment).[7]

Acute

Acute radiodermatitis occurs when an "erythema dose" of ionizing radiation is given to the skin, after
which visible erythema appears up to 24 hours after.[4]:39 Radiation dermatitis generally manifests within a
few weeks after the start of radiotherapy.[5]:143 Acute radiodermatitis, while presenting as red patches, may
sometimes also present with desquamation or blistering.[8] Erythema may occur at a dose of 2 Gy radiation
or greater.[9]

Chronic

Chronic radiodermatitis occurs with chronic exposure to "sub-erythema" doses of ionizing radiation over
a prolonged period, producing varying degrees of damage to the skin and its underlying parts after a variable
latent period of several months to several decades.[4]:40 In the distant past this type of radiation reaction
occurred most frequently in radiologists and radiographers who were constantly exposed to ionizing
radiation, especially before the use of x-ray filters.[4]:40 Restated, chronic radiodermatitis, squamous and
basal cell carcinomas may develop months to years after radiation exposure.[8]:130[10] Clinically, chronic
radiodermatitis presents as atrophic indurated plaques, often whitish or yellowish, with telangiectasia,
sometimes with hyperkeratosis.[8]:130

Other

Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy is a skin condition that
occurs most often in women receiving cobalt radiotherapy for internal cancer.[4]:3940

Radiation-induced erythema multiforme may occur when phenytoin is given prophylactically to

neurosurgical patients who are receiving whole-brain therapy and systemic steroids.[4]:130

Delayed effects

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Radiation acne is a cutaneous condition characterized by comedo-like papules occurring at sites of

previous exposure to therapeutic ionizing radiation, skin lesions that begin to appear as the acute phase of
radiation dermatitis begins to resolve.[11]:501

Radiation recall reactions occur months to years after radiation treatment, a reaction that follows recent
administration of a chemotherapeutic agent and occurs with the prior radiation port, characterized by
features of radiation dermatitis.[4][12] Restated, radiation recall dermatitis is an inflammatory skin reaction
that occurs in a previously irradiated body part following drug administration.[13] There does not appear to
be a minimum dose, nor an established radiotherapy dose relationship.[13]

Beta burns
"Beta burns" are shallow surface burns, usually of skin and less often of lungs or gastrointestinal tract,
caused by beta particles, typically from hot particles or dissolved radionuclides that came to direct contact
with or close proximity to the body. They can appear similar to sunburn. Unlike gamma rays, beta emissions
are stopped much more effectively by materials and therefore deposit all their energy in only a shallow layer
of tissue, causing more intense but more localized damage. On cellular level, the changes in skin are similar
to radiodermatitis.

High doses of radiation can cause rapid browning of skin, known as "nuclear tan".

The dose is influenced by relatively low penetration of beta emissions through materials. The cornified
keratine layer of epidermis has enough stopping power to absorb beta radiation with energies lower than
70 keV. Further protection is provided by clothing, especially shoes. The dose is further reduced by limited
retention of radioactive particles on skin; a 1 millimeter particle is typically released in 2 hours, while a 50
micrometer particle usually does not adhere for more than 7 hours. Beta emissions are also severely
attenuated by air; their range generally does not exceed 6 feet (1.8 m) and intensity rapidly diminishes with
distance.[14]

The eye lens seems to be the most sensitive organ to beta radiation,[15] even in doses far below maximum
permissible dose. Safety goggles are recommended to attenuate strong beta.[16]

Beta burns can occur also to plants. An example of such damage is the Red Forest, a victim of the
Chernobyl accident.

Careful washing of exposed body surface, removing the radioactive particles, may provide significant dose
reduction. Exchanging or at least brushing off clothes also provides a degree of protection.

If the exposure to beta radiation is intense, the beta burns may first manifest in 2448 hours by itching
and/or burning sensation that last for one or two days, sometimes accompanied by hyperaemia. After 13
weeks burn symptoms appear; erythema, increased skin pigmentation (dark colored patches and raised
areas), followed by epilation and skin lesions. Erythema occurs after 515 Gy, dry desquamation after
17 Gy, and bullous epidermitis after 72 Gy.[14] Chronic radiation keratosis may develop after higher doses.
Primary erythema lasting more than 72 hours is an indication of injury severe enough to cause chronic
radiation dermatitis. Edema of dermal papillae, if present within 48 hours since the exposition, is followed
by transepidermal necrosis. After higher doses, the malpighian layer cells die within 24 hours; lower doses
may take 1014 days to show dead cells.[17] Inhalation of beta radioactive isotopes may cause beta burns of
lungs and nasopharyngeal region, ingestion may lead to burns of gastrointestinal tract; the latter being a risk
especially for grazing animals.

In first degree beta burns the damage is largely limited to epidermis. Dry or wet desquamation occurs;
dry scabs are formed, then heal rapidly, leaving a depigmented area surrounded with irregular area of
increased pigmentation. The skin pigmentation returns to normal within several weeks.

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Second degree beta burns lead to formation of blisters.

Third and fourth degree beta burns result in deeper, wet ulcerated lesions, which heal with routine
medical care after covering themselves with dry scab. In case of heavy tissue damage, ulcerated
necrotic dermatitis may occur. Pigmentation may return to normal within several months after wound
healing.[14]

Lost hair begins regrowing in 9 weeks and is completely restored in about half a year.[18]

The acute dose-dependent effects of beta radiation on skin are as follows:[19]

06 Gy no acute effect

620 Gy moderate early erythema

2040 Gy early erythema in 24 hours, skin breakdown in 2 weeks

40100 Gy severe erythema in less than 24 hours

100150 Gy severe erythema in less than 4 hours, skin breakdown in 12 weeks

1501000 Gy blistering immediate or up to 1 day

According to other source:[20]

26 Gy transient erythema 224 h

35 Gy dry desquamation in 36 weeks

34 Gy temporary epilation in 3 weeks

1015 Gy erythema 1820 days

1520 Gy moist desquamation

25 Gy ulceration with slow healing

3050 Gy blistering, necrosis in 3 weeks

100 Gy blistering, necrosis in 13 weeks

As shown, the dose thresholds for symptoms vary by source and even individually. In practice, determining
the exact dose tends to be difficult.

Similar effects apply to animals, with fur acting as additional factor for both increased particle retention and
partial skin shielding. Unshorn thickly wooled sheep are well protected; while the epilation threshold for
sheared sheep is between 2347 Gy (25005000 rep) and the threshold for normally wooled face is
4793 Gy (500010000 rep), for thickly wooled (33 mm hair length) sheep it is 93140 Gy (1000015000
rep). To produce skin lesions comparable with contagious pustular dermatitis, the estimated dose is between
4651395 Gy.[21]

Energy vs penetration depth

The effects depend on both the intensity and the energy of the radiation.
Medium-lived
Low-energy beta (sulfur-35, 170 keV) produces shallow ulcers with
fission products
little damage to dermis, while cobalt-60 (310 keV), caesium-137
(550 keV), phosphorus-32 (1.71 MeV), strontium-90 (650 keV) and its Prop: t Yield Q * *
daughter product yttrium-90 (2.3 MeV) damage deeper levels of the Unit: (a) (%) (keV)
dermis and can result in chronic radiation dermatitis. Very high energies 155Eu 4.76 0.0803 252
from electron beams from particle accelerators, reaching tens of 85Kr 10.76 0.2180 687

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megaelectronvolts, can be deeply penetrating. Conversely, megavolt- 113mCd 14.1 0.0008 316
scale beams can deposit their energy deeper with less damage to the 90Sr 28.9 4.505 2826
dermis; modern radiotherapy electron beam accelerators take advantage
137Cs 30.23 6.337 1176
of this. At yet higher energies, above 16 MeV, the effect does not show
significantly anymore, limiting the usefulness of higher energies for 121mSn 43.9 0.00005 390
radiotherapy. As a convention, surface is defined as the topmost 0.5 mm 151
Sm 96.6 0.5314 77
of skin.[22] High-energy beta emissions should be shielded with plastic
instead of lead, as high-Z elements generate deeply penetrating gamma bremsstrahlung.

The electron energies from beta decay are not discrete but form a continuous spectrum with a cutoff at
maximum energy. The rest of the energy of each decay is carried off by an antineutrino which does not
significantly interact and therefore does not contribute to the dose. Most energies of beta emissions are at
about a third of the maximum energy.[16] Beta emissions have much lower energies than what is achievable
from particle accelerators, no more than few megaelectronvolts.

The energy-depth-dose profile is a curve starting with a surface dose, ascending to the maximum dose in a
certain depth dm (usually normalized as 100% dose), then descends slowly through depths of 90% dose
(d90) and 80% dose (d80), then falls off linearly and relatively sharply though depth of 50% dose (d50). The
extrapolation of this linear part of the curve to zero defines the maximum electron range, Rp. In practice,
there is a long tail of weaker but deep dose, called "bremsstrahlung tail", attributable to bremsstrahlung. The
penetration depth depends also on beam shape, narrower beam tend to have less penetration. In water, broad
electron beams, as is the case in homogeneous surface contamination of skin, have d80 about E/3 cm and Rp
about E/2 cm, where E is the beta particle energy in MeV.[23]

The penetration depth of lower-energy beta in water (and soft tissues) is about 2 mm/MeV. For a 2.3 MeV
beta the maximum depth in water is 11 mm, for 1.1 MeV it is 4.6 mm. The depth where maximum of the
energy is deposited is significantly lower.[24]

The energy and penetration depth of several isotopes is as follows:[25]

specific in
half- avg. max. in air
isotope activity tissue comment
life (keV) (keV) (mm)
(TBq/g) (mm)

no beta passes the dead layer of skin;

12.3
tritium 357 5.7 18.6 6 0.006 however tritium and its compounds may
years
diffuse through skin

5730 about 1% of beta passes through the dead

carbon-14 0.165 49 156 240 0.28
years layer of skin

87.44
sulfur-35 1580 48.8 167.47 260 0.32
days

25.3
phosphorus-33 5780 76.4 248.5 500 0.6
days

14.29
phosphorus-32 10600 695 1710 6100 7.6 risk of bremsstrahlung if improperly shielded
days

For a wide beam, the depth-energy relation for dose ranges is as follows, for energies in megaelectronvolts
and depths in millimeters. The dependence of surface dose and penetration depth on beam energy is clearly
visible.[23]

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surface max.
MeV 90% 80% 50% 10% Rp
dose % depth

5 74% 9 12 14 17 22 23

7 76% 16 20 22 27 33 34

10 82% 24 31 34 39 48 49

13 88% 32 40 43 51 61 64

16 93% 34 51 56 65 80 80

19 94% 2636 59 67 78 95 95

22 96% 2636 65 76 93 113 114

25 96% 2636 65 80 101 124 124

Treatment of radiation burns

Radiation burns should be covered by a clean, dry dressing as soon as possible to prevent infection. Wet
dressings are not recommended.[26] The presence of combined injury (exposure to radiation plus trauma or
radiation burn) increases the likelihood of generalized sepsis.[27] This requires administration of systemic
antimicrobial therapy.[28]

Causes
Radiation burns are caused by exposure to high levels of radiation. Levels high enough to cause burn are
generally lethal if received as a whole-body dose, whereas they may be treatable if received as a shallow or
local dose.

Medical Imaging

Fluoroscopy may cause burns if performed repeatedly or for too long.[11]

Similarly, Computed Tomography and traditional Projectional Radiography have the potential to cause
radiation burns if the exposure factors and exposure time are not appropriately controlled by the operator.

A study of radiation induced skin injuries[29][30] has been performed by the Food and Drug Administration
(FDA) based on results from 1994,[31] followed by an advisory to minimize further fluoroscopy-induced
injuries.[32] The problem of radiation injuries due to fluoroscopy has been further investigated in review
articles in 2000,[33] 2001,[34][35] 2009[36] and 2010.[37][38][39]

Radioactive fallout

Beta burns are frequently the result of exposure to radioactive fallout after nuclear explosions or nuclear
accidents. Shortly after the explosion, the fission products have very high beta activity, with about two beta
emissions per each gamma photon.

After the Trinity test, the fallout caused localized burns on the backs of cattle in the area downwind.[40] The
fallout had the appearance of small flaky dust particles. The cattle showed temporary burns, bleeding, and
loss of hair. Dogs were also affected; in addition to localized burns on their backs, they also had burned
paws, likely from the particles lodged between their toes as hoofed animals did not show problems with
feet. About 350600 cattle were affected by superficial burns and localized temporary loss of dorsal hair;
the army later bought 75 most affected cows as the discolored regrown hair lowered their market value.[41]

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The cows were shipped to Los Alamos and Oak Ridge, where they were observed. They healed, now
sporting large patches of white fur; some looked like being scalded.[42]

The fallout produced by the Castle Bravo test was unexpectedly strong. A white snow-like dust, nicknamed
by the scientists "Bikini snow" and consisting of contaminated crushed calcined coral, fell for about 12
hours upon the Rongelap Atoll, depositing a layer of up to 2 cm. Residents suffered beta burns, mostly on
the backs of their necks and on their feet,[40] and were resettled after three days. After 2448 hours their
skin was itching and burning; in a day or two the sensations subsided, to be followed after 23 weeks by
epilation and ulcers. Darker-colored patches and raised areas appeared on their skin, blistering was
uncommon. Ulcers formed dry scabs and healed. Deeper lesions, painful, weeping and ulcerated, formed on
more contaminated residents; the majority healed with simple treatment. In general, the beta burns healed
with some cutaneous scarring and depigmentation. Individuals who bathed and washed the fallout particles
from their skin did not develop skin lesions.[19] The fishing ship Daigo Fukuryu Maru was affected by the
fallout as well; the crew suffered skin doses between 1.76.0 Gy, with beta burns manifesting as severe skin
lesions, erythema, erosions, sometimes necrosis, and skin atrophy. 23 U.S. radar servicemen of the 28-
member weather station on Rongerik[43] were affected, experiencing discrete 14 mm skin lesions which
healed quickly, and ridging of fingernails several months later. Sixteen crew members of the aircraft carrier
USS Bairoko received beta burns and there was an increased cancer rate.[14]

During the Zebra test of the Operation Sandstone in 1948 three men suffered beta burns on their hands when
removing sample collection filters from drones flying through the mushroom cloud; their estimated skin
surface dose was 28 to 149 Gy and their disfigured hands required skin grafts. A fourth man showed weaker
burns after the earlier Yoke test.[44]

The UpshotKnothole Harry test at the Frenchman Flat site released a large amount of fallout. A significant
amount of sheep died after grazing on contaminated areas. The AEC however had a policy to compensate
farmers only for animals showing external beta burns, so many claims were denied. Other tests on the
Nevada Test Site also caused fallout and corresponding beta burns to sheep, horses and cattle.[45] During the
Operation UpshotKnothole, sheep as far as 50 miles (80 km) from the test site suffered beta burns to their
backs and nostrils.[44]

During underground nuclear testing in Nevada, several workers developed burns and skin ulcers, in part
attributed to exposure to tritium.[46]

Nuclear accidents

Beta burns were a serious medical issue for some victims of the Chernobyl disaster; from 115 patients
treated in Moscow, 30% had burns covering 1050% of body surface, 11% were affected on 50100% of
skin; the massive exposure was often caused by clothes drenched with radioactive water. Some firefighters
suffered beta burns of lungs and nasopharyngeal region after inhalation of massive amounts of radioactive
smoke. Out of 28 deaths, 16 had skin injuries listed among the causes. The beta activity was extremely high,
with beta/gamma ratio reaching 1030 and beta energy high enough to damage basal layer of the skin,
resulting in large area portals for infections, exacerbated by damage to bone marrow and weakened immune
system. Some patients received skin dose of 400500 Gy. The infections caused more than half of the acute
deaths. Several died of fourth degree beta burns between 928 days after dose of 616 Gy. Seven died after
dose of 46 Gy and third degree beta burns in 46 weeks. One died later from second degree beta burns and
dose 1-4 Gy.[46] The survivors have atrophied skin which is spider veined and with underlying fibrosis.[14]

The burns may manifest at different times at different body areas. The Chernobyl liquidators burns first
appeared on wrists, face, neck and feet, followed by chest and back, then by knees, hips and buttocks.[47]

Industrial radiography sources are a common source of beta burns in workers.

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Radiation therapy sources can cause beta burns during exposure of the patients. The sources can be also lost
and mishandled, as in the Goinia accident, during which several people suffered external beta burns and
more serious gamma burns, and several died. Numerous accidents also occur during radiotherapy due to
equipment failures, operator errors, or wrong dosage.

Electron beam sources and particle accelerators can be also sources of beta burns.[48] The burns may be
fairly deep and require skin grafts, tissue resection or even amputation of fingers or limbs.[49]

See also
Effective radiated power
Radiation poisoning
Radiation protection
Therac-25

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External links
ARRL: RF Exposure Safety (http://www.arrl.org/rf-exposure)
FCC: Radio Frequency Safety FAQ (http://www.fcc.gov/oet/rfsafety/rf-faqs.html)

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