IAEA Post Graduate Educational Course in Radiation Protection and Safety of Radiation Sources

Biological Effects of Ionizing Radiation

Deterministic effects

Effects of partial body irradiation

Lecture

IAEA Post Graduate Educational Course Radiation Protection and Safe Use of Radiation Sources
Introduction

 Partial body irradiation may cause local

radiation injury of the part of the body
 Sources of data for deterministic effects in
man:
 side effects of radiotherapy
 effects on the early radiologists
 effects amongst survivors of the atomic
bombs at Hiroshima and Nagasaki in Japan
 consequences of severe accidents

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Content

 Threshold doses for deterministic

effects in different organs
 Radiation-induced damage of the:
 Skin
 Eye
 Lung
 Gonads
 Thyroid
 Skeleton

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Overview
 Partial body irradiation may cause
local radiation injury of the part of
the body
 Possible target:
 Skin
 Thyroid
 Lung
 Eye lens
 Gonads, etc

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Threshold of occurrence for local
injury
Deterministic effects
Dose in
Organ or
less than 2 Time of
tissue Type of effect
days, Gy occurrence

Skin 3 Erythema 1 – 3 weeks

1st – several
Thyroid 5 Hypothyroidism
years
Lens of the 6 months -
2 Cataract
eye several years
Permanent
Gonads 3 weeks
sterility
Lung 8 Pneumonitis 1-3 months

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Time of Onset of Clinical Signs of Skin
Injury vs Dose Received

Symptoms Dose range Time of

onset
(Gy) (day)

Erythema 3-10 14-21

Epilation >3 14-18
Dry desquamation 8-12 25-30
Moist desquamation 15-20 20-28
Blister formation 15-25 15-25
Ulceration >20 14-21
Necrosis >25 >21
Radiation injury of the skin: acute
phase
 Inflammation: redness (erythema), swelling
(oedema), elevated temperature
 Passive tissue compression: thrombosis,
circulation disorders (insufficient blood supply)
 Tissue atrophy, necrosis: pain, acute ulceration
 moderate doses ( > 20 Gy): epidermal cell depletion
(denudation) due to the mitotic death of the epidermal
cells basal and viable upper layers with consecutive dry
or moist desquamation, blistering of the epidermis and
secondary dermal ulceration
 very high doses (>100 Gy surface dose): acute dermal
necrosis within 2-3 weeks (interphase death of
endothelial and fibroblast type cells; sometimes moist
desquamation and blisters)

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Radiation injury of the skin: late
phase
 Epidermal and dermal atrophy: (fragile skin)
 Insufficient blood supply
 Late necrosis with skin ulceration
 Occlusion of lymphatic vessels with local lymph
stagnation: pain, late oedema
 Hyperkeratotic and fibrotic degeneration of the
skin
 Decreased immunological defence of the skin
with increased sensitivity against infections, etc
 Persistent or recurring pain
 Increased risk of skin malignancies
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Radiation injury of the eye

 Observations:
 X-ray treatment of eye tumors
 Radiation injuries:
 Lid erythema
 Conjunctivitis
 Cataract
 Retinopathy

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Cataract

 Cataract - any detectable change of the

normally transparent lens of the eye
 Reason of development:
 Some abnormal metabolic disorder
 Chronic ocular infection
 Trauma
 Old age
 Ionizing radiation (radiation-induced cataract)

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Radiation-induced cataract

 The threshold dose following a single exposure

of low-LET radiation is 2 Gy, for neutrons 0.2 Gy
 Lowering the dose rate or extending the exposure
period increases the ED50 value to an average of
9.3 Gy
 Estimated latency periods: 6 month to 35 years
 Doses of less than 0.1 Sv/year are not thought to
present appreciable risk for detectable visual
impairment
 Occupational exposure limit for the eye is 0.15 Sv
(ICRP-60)

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Radiation-induced retinopathy

 Threshold dose of retinal damage: 15 - 35 Gy

depending on: radiation quality, dose rate,
fractionation, fraction size
 threshold for visual impairment: ~ 50 Gy
 occurrence: 35 Gy ~ 10%; 45 Gy ~ 66 %; 80 Gy ~ 100 %
 Latency period: 6 months to 3 years
 Clinical manifestation:
 microaneurysms of the capillaries
 “cotton-wool spots”
 intraretinal haemorrhages, and
 leakage of retinal vessels with exudates

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Radiation-induced hypothyroidism

 Threshold dose – 5 Gy of acute

exposure within 2 days
 Latent period – years
 Pathophysiological mechanism
involved:
 direct lesions to follicular cells
 alterations of vascular system
 immunological reactions

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Deterministic radiation injury of
the lung
 Pheumonitis
 Threshold dose – 8 Gy of acute
exposure
 Latent period – 1-3 months
 Fibrosis
 At the late stage and as a consequence
of acute pneumonitis
 Latent period – 6 months
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Radiation-induced pulmonary
reactions
 Phases of development:
 Latency
 degenerative changes of pneumocytes and of
endothelial cells
 Acute pneumonitis
 dose-dependent leakage of proteins in the alveolar
space
 thickening of alveolar septa
 oedema of the interstitium, and
 changes to the capillaries in the number of type II
pneumocytes and alveolar macrophages
 Fibrosis
 capillary loss
 further decrease in the number of type I pneumocytes
 increased collagen deposition
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Deterministic radiation injury of
the gonads
 Sterility:
 Temporary
 Permanent

 Target organ:
 Testes
 Ovarium

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Deterministic radiation injury of
the gonads (Cont’d)

Threshold absorbed dose of

Organ / consequence exposure
of exposure
Acute, Sv Protracted, Sv/year

Testes
 temporary sterility 0.15 0.4
 permanent sterility 3.0 2.0
Ovary
2.5 0.2
 permanent sterility

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Deterministic radiation injury of
the skeleton
 Threshold dose – 5-10 Gy
 Children bones are more sensitive
 The severity of radiation-induced damage
to growing bone depends on:
 the total radiation dose
 fractionation
 dose homogeneity
 volume irradiated
 symmetry of the volume irradiated
 patient's age, etc
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Summary

 This lecture presented materials about

effects of partial body irradiation
 The following topics were covered in
the lecture: threshold doses for
deterministic effects in different
organs, radiation-induced damage of
the skin, eye, lung, gonads, thyroid and
skeleton
 Comments are welcomed

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Where to Get More Information
 UNSCEAR, Sources and Effects of
Ionizing Radiation, 2000 Report to the
General Assembly with Scientific
Annexes, United Nations, New York,2000
 IAEA - WHO. Diagnosis and treatment of
radiation injuries, Safety Reports Series
No. 2, IAEA, Vienna, 1998
 Hopewell JW. The skin: It's structure and
response to ionizing radiation. Int J
Radiat Biol 1990; 57:751-73
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