DETERMINISTIC EFFECT MEAN SURVIVAL TIME

• Radiation response occurs within days to As the whole-body radiation dose increases,
months the average time between exposure and death
• Radiation response increases in severity decreases. This time is known as the mean
survival time.
Death, of course, is the most devastating
human response to radiation exposure. Acute • Whole-body radiation dose increases
radiation-induced human lethality is of only average time between exposure and
academic interest in diagnostic radiology. death
Diagnostic x-ray beams are neither intense
Hematologic Syndrome: dose dependednt
enough nor large enough to cause death
GI Syndrome: Remain constant at 4 days
NOTE: Diagnostic x-ray beams always result in CNS Syndrome: dose dependent
partial-body exposure, which is less harmful
than whole-body exposure

ACUTE RADIATION SYNDROME

Sequence that follow high-level radiation
exposure leading to death within days or
weeks.

PRODROMAL PERIOD
This immediate response of radiation sickness
is the prodromal period.

Approximate Dose: >1 Gyt

Clinical Signs and Symptoms: Nausea,
Vomiting, and Diarrhea

LATENT PERIOD
The latent period is the time after exposure THREE SYNDROMES
during which there is no sign of radiation 1. CENTRAL NERVOUS SYNDROME
sickness. 2. GASTROINTESTINA L SYNDROME
3. HEMATOLOGIC SYNDROME
• After the period of initial radiation
sickness, a period of Apparent well- CENTRAL NERVOUS SYNDROME
being occurs the ultimate cause of death in CNS syndrome
is elevated fluid content of the brain.
Approximate Dose: 1-100 Gyt
Clinical Signs and Symptoms: None GASTROINTESTINAL PERIOD
Severe damage to the cells lining the intestines
MANIFEST ILLNESS
The period of manifest illness is characterized HEMATOLOGIC SYNDROME
by possible vomiting, mild diarrhea, malaise, Reduction of red, white blood cells, and
lethargy, and fever. platelets.
At very high radiation doses, the latent period
disappears altogether. At very low radiation
doses, there may be no prodromal period at all.
 LOCAL TISSUE DAMAGE
When only part of the body is irradiated, in
contrast to whole-body irradiation, a higher
dose is required to produce a response.
Every organ and tissue of the body can be
affected by partial-body irradiation. The effect
is cell death, which results in shrinkage of the
organ or tissue.

Atrophy is the shrinkage of an organ or tissue

caused by cell death.

LOCAL TISSUE DAMAGE

LD 50/60 1. SKIN
The LD 50/60 is the dose of radiation to the 2. GONADS
whole body that causes 50% of irradiated 3. BONE MARROW
subjects to die within 60 days. 1. EFFECTS ON THE SKIN
At the lower dose of approximately 1 Gy t (100 Skin is the most the most familiar to us.
rad), no one is expected to die. Above Normal Layers:
approximately 6 Gyt (600 rad), all those • Outer - Epidermis
irradiated die unless vigorous medical support • Intermediate - Dermis
is available. Above 10 Gy, (1000 rad), even • Subcutaneous Layer of Fat and
vigorous medical support does not prevent Connective tissue
death. Accessory structures: Hair follicles, Sweat
glands, and Sensory receptors Cell
Replacement Rate: 2% per day (50% per day to
GI cells)
• Skin Effect follows a Nonlinear Threshold
Dose

Acute radiation lethality follows a nonlinear,

threshold dose-response relationship.

If death is to occur, it usually happens within 60

days of exposure. Acute radiation lethality is
measured quantitatively by the LD 50/ 60,
which is approximately 3.5 Gy, (350 rad) for
The epidermis consists of several layers of
humans. With clinical support, humans can
cells; the lowest layer consists of basal cells.
tolerate much higher doses; the maximum is
Basal cells are the stem cells that mature as
reported to be 8.5 Gy, (850 rad).
they migrate to the surface of the epidermis.
Damage to basal cells results in the earliest
manifestation of radiation injury to the skin.

In earlier times, the tolerance of the patient’s

skin determined the limitations of radiation
oncology with orthovoltage x-rays (200-300
kVp x-rays). The object of x-ray therapy was to
deposit energy in the tumor while sparing the
surrounding normal tissue. Because the x-rays
had to pass through the skin to reach the
tumor, the skin was necessarily subjected to 2. EFFECTS ON THE GONADS
higher radiation doses than the tumor. The Human gonads are critically important target
resultant skin damage was seen as erythema organs.
(a sunburn-like reddening of the skin)
followed by desquamation (ulceration and Testes - Male Gonads;
denudation of the skin), which often required • produces germ cell produces
interruption of treatment. spermatogonia and matures into sperm

Analysis of persons irradiated therapeutically Ovaries - Female Gonad; produces germ cell
with superficial x-rays has shown that the skin • produces oogonia and matures into ovum
erythema dose required to affect 50% of those Germ cells are produced by both ovaries and
irradiated (SED 50 ) is about 5 Gyt (500 rad). testes, but they develop from the stem cell
Before the Roentgen was defined and accurate phase to the mature cell phase at different
radiation-measuring apparatus was developed, rates and at different times. This process of
the skin was observed, and its response to development is called gametogenesis.
radiation was used in formulating radiation
protection practices. The unit used was the
SED 50 , and permissible radiation exposures
were specified in fractions of SED 50 .

Another response of the skin to radiation

exposure is epilation, or loss of hair. For many
years, soft x-rays (10-20 kVp), called grenz
rays, were used as the treatment of choice for
persons with skin diseases, such as tinea
capitis (ringworm)

Tinea capitis of the scalp, which is common in THE MATURATION PROCESS FROM STEM CELL
children, was successfully treated by grenz TO SPERM CELL IS 3-5 WEEKS
radiation; unfortunately, the patient’s hair
Oogonia - is the stem cell of the ovaries
would fall out for weeks or even months.
Sometimes an unnecessarily high dose of Primordial Follicle - grow to encapsulate
grenz rays resulted in permanent epilation. oogonia

Mature Follicle - most radiosensitive

Oocyte - matured oogonia

Ovum- is the matured female cell Produces:
1. lymphocytes (those involved in the
400-500 ova are available for fertilization
immune response),
Spermatogonia - is the stem cell of male 2. granulocytes (scavenger type of cells
testes, most radiosensitive used to fight bacteria),
Spermatocyte - matured spermatogonia 3. thrombocytes (also called platelets and
Spermatid - matured spermatocyte involved in the clotting of blood to prevent
Spermatozoa or Sperm - matured germ cell hemorrhage)
4. erythrocytes (red blood cells that are the
Ovaries
transportation agents for oxygen).
• irradiation causes atrophy in early life and
suppression in menstruation after puberty. Is also a cell renewal system. Normal cell
growth and development determine the effects
Radiation effects on the ovaries depend
of radiation on this system
somewhat on age. At fetal life and in early
childhood, the ovaries are especially HEMATOPOIETIC CELL SURVIVAL
radiosensitive. The principal response of the hematopoietic
system to radiation exposure is a decrease in
10 rad - suppress menstruation
the numbers of all types of blood cells in the
200 rad - temporary infertility
circulating peripheral blood.
500 rad - permanent sterility
25-50 rad - increased genetic mutation After exposure, the first cells to become
affected are the lymphocytes. These cells are
Testes
reduced in number (lymphopenia) within
• similar to the ovaries, atrophy after high
minutes or hours after exposure, and they are
doses of radiation. A large volume of data
very slow to recover. Because the response is
on testicular damage has been gathered
so immediate, the radiation effect is apparently
from observations of volunteer convicts
a direct one on the lymphocytes themselves
and patients treated for carcinoma in one
rather than on the stem cells.
testis while the other was shielded.
The lymphocytes and the spermatogonia are
10 rad - reduces the number of sperm cells
the most radiosensitive cells in the body.
200 rad - temporary infertility, 2-12months
500 rad - permanent sterility Granulocytes experience a rapid rise in
number (granulocytosis) followed first by a
HEMATOPOIETIC SYSTEM
rapid decrease and then a slower decrease in
• consists of bone marrow, circulating
number (granulocytopenia). If the radiation
blood, and lymphoid tissue. Lymphoid
dose is moderate, then an abortive rise in
tissues are the lymph nodes, spleen, and
granulocyte count may occur 15 to 20 days
thymus. With this system, the principal
after irradiation. Minimum granulocyte levels
effect of radiation is a depressed number
are reached approximately 30 days after
of blood cells in the peripheral circulation.
irradiation. Recovery, if it is to occur, takes
Pluripotential stem cell because it can approximately 2 months.
develop into several different types of mature
cells. From the single pluripotential stem cell,
a number of cell types are produced.
CYTOGENETIC EFFECTS Chromosome damage takes
1.Chromatid depletion
2.Dicentric chromosome aberration
3.Reciprocal Translocations

Cytogenetics is the study of the genetics of

cells, particularly cell chromosomes.

Normal Karyotype
The human chromosome consists of many long
strings of DNA mixed with a protein and folded
back on itself many times. Refer to Figure 29-
11, which shows a normal chromosome as it
would appear in the G1 phase of the cell cycle
when only two chromatids are present and in
the G2 phase of the cell cycle after DNA
replication. The chromosome structure of four
chromatids represented for the G2 phase is
that which is visualized in the metaphase
portion of mitosis.

For certain types of cytogenetic analysis of

chromosomes, photographs are taken and
enlarged so that each chromosome can be cut
out like a paper doll and paired with its sister
into a chromosome map, which is called a
karyotype

CHROMOSOMES STRUCTURAL RADIATION

DAMAGE
Single-Hit Chromosome Aberrations
• produces a linear nonthreshold dose-
response relationship
• two (2) single hit abberations per 10mGyt
per 100 cells

Multi-Hit Chromosome Aberrations

• most significant in terms of latent human
damage
• produces a nonlinear, nonthreshold dose-
response relationship
• one (1) multi-hit aberrations per 100mGyt
per 100 cells