Acute radiation syndrome

Last updated
Acute radiation syndrome
Other namesRadiation poisoning, radiation sickness, radiation toxicity
Radiation causes cellular degradation by autophagy.
Specialty Critical care medicine
SymptomsEarly: Nausea, vomiting, loss of appetite [1]
Later: Infections, bleeding, dehydration, confusion [1]
Usual onsetWithin days [1]
TypesBone marrow syndrome, gastrointestinal syndrome, neurovascular syndrome [1] [2]
CausesLarge amounts of ionizing radiation over a short period of time [1]
Diagnostic method Based on history of exposure and symptoms [3]
Treatment Supportive care (blood transfusions, antibiotics, colony stimulating factors, stem cell transplant) [2]
PrognosisDepends on the exposure dose [3]
FrequencyRare [2]

Acute radiation syndrome (ARS), also known as radiation sickness or radiation poisoning, is a collection of health effects due to exposure to high amounts of ionizing radiation over a short period of time. [1] Within the first days symptoms may include nausea, vomiting, and loss of appetite. [1] This may then be followed by a few hours or weeks with little symptoms. [1] After this, depending on the total dose of radiation, people may develop infections, bleeding, dehydration, and confusion, or there may be a period with few symptoms. [1] This is finally followed by either recovery or death. [1] The symptoms can begin within one hour and may last for several months. [2] [4]

Absorbed dose is a dose quantity which is the measure of the energy deposited in matter by ionizing radiation per unit mass. Absorbed dose is used in the calculation of dose uptake in living tissue in both radiation protection, and radiology. It is also used to directly compare the effect of radiation on inanimate matter such as in radiation hardening.

Ionizing radiation Radiation that carries enough light energy to liberate electrons from atoms or molecules

Ionizing radiation is radiation that carries sufficient energy to detach electrons from atoms or molecules, thereby ionizing them. Ionizing radiation is made up of energetic subatomic particles, ions or atoms moving at high speeds, and electromagnetic waves on the high-energy end of the electromagnetic spectrum.


The radiation generally occurs from a source outside the body, is applied over minutes with most of the body being exposed, and involves a total dose of greater than 0.7  Gy (70 rads). [1] It is generally divided into three types: (i) bone marrow syndrome (0.7 to 10 Gy); (ii) gastrointestinal syndrome (10 to 50 Gy); and (iii) neurovascular syndrome (> 50 Gy). [1] [2] Sources of such radiation may include nuclear reactors, cyclotrons, and certain devices used in cancer therapy. [3] The cells that are most affected are generally those that are rapidly dividing. [2] Diagnosis is based on a history of exposure and symptoms. [3] Repeated complete blood counts (CBCs) can indicate the severity of exposure. [1]

The gray is a derived unit of ionizing radiation dose in the International System of Units (SI). It is defined as the absorption of one joule of radiation energy per kilogram of matter.

Cell (biology) The basic structural and functional unit of all organisms; the smallest unit of life.

The cell is the basic structural, functional, and biological unit of all known organisms. A cell is the smallest unit of life. Cells are often called the "building blocks of life". The study of cells is called cell biology or cellular biology.

Complete blood count medical laboratory test

A complete blood count (CBC) is a blood panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood, such as the cell count for each blood cell type and the concentrations of hemoglobin. A scientist or lab technician performs the requested testing and provides the requesting medical professional with the results of the CBC.

Treatment of acute radiation syndrome is generally supportive care. [2] This may include blood transfusions, antibiotics, colony-stimulating factors, or stem cell transplant. [2] If radioactive material remains on the skin or in the stomach it should be removed. [3] If radioiodine was breathed in or ingested, potassium iodide may be recommended. [3] Complications such as leukemia and other cancers among those who survive are managed as usual. [3] Short term outcomes depend on the exposure dose. [3]

Potassium iodide chemical compound

Potassium iodide is a chemical compound, medication, and dietary supplement. As a medication it is used to treat hyperthyroidism, in radiation emergencies, and to protect the thyroid gland when certain types of radiopharmaceuticals are used. In the developing world it is also used to treat skin sporotrichosis and phycomycosis. As a supplement it is used in those who have low intake of iodine in the diet. It is given by mouth.

Leukemia group of cancers that usually begin in the bone marrow

Leukemia, also spelled leukaemia, is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called blasts or leukemia cells. Symptoms may include bleeding and bruising, feeling tired, fever, and an increased risk of infections. These symptoms occur due to a lack of normal blood cells. Diagnosis is typically made by blood tests or bone marrow biopsy.

ARS is generally rare. [2] A single event, however, can affect a relatively large number of people. [5] Notable cases occurred following the atomic bombing of Hiroshima and Nagasaki and the Chernobyl nuclear power plant disaster. [1] ARS differs from chronic radiation syndrome, which occurs following prolonged exposures to relatively low doses of radiation. [6] [7]

Atomic bombings of Hiroshima and Nagasaki the use of atomic weapons by the United States on Japan towards the end of World War II

The United States detonated two nuclear weapons over the Japanese cities of Hiroshima and Nagasaki on August 6 and 9, 1945, respectively, with the consent of the United Kingdom, as required by the Quebec Agreement. The two bombings killed between 129,000 and 226,000 people, most of whom were civilians, and remain the only use of nuclear weapons in armed conflict.

Chernobyl disaster 1986 nuclear accident

The Chernobyl disaster was a nuclear accident that occurred on 26 April 1986 at the No. 4 nuclear reactor in the Chernobyl Nuclear Power Plant, near the city of Pripyat in the north of the Ukrainian Soviet Socialist Republic. It is considered the worst nuclear disaster in history and is one of only two nuclear energy disasters rated at seven—the maximum severity—on the International Nuclear Event Scale, the other being the 2011 Fukushima Daiichi nuclear disaster in Japan.

Chronic radiation syndrome (CRS) is a constellation of health effects of radiation that occur after months or years of chronic exposure to high amounts of radiation. Chronic radiation syndrome develops with a speed and severity proportional to the radiation dose received, i.e., it is a deterministic effect of exposure to ionizing radiation, unlike radiation-induced cancer. It is distinct from acute radiation syndrome in that it occurs at dose rates low enough to permit natural repair mechanisms to compete with the radiation damage during the exposure period. Dose rates high enough to cause the acute form are fatal long before onset of the chronic form. The lower threshold for chronic radiation syndrome is between 0.7 and 1.5 Gy, at dose rates above 0.1 Gy/yr. This condition is primarily known from the Kyshtym disaster, where 66 cases were diagnosed. It has received little mention in Western literature; but see the ICRP’s 2012 Statement.

Signs and symptoms

Radiation sickness Radiation Sickness.png
Radiation sickness

Classically acute radiation syndrome is divided into three main presentations: hematopoietic, gastrointestinal, and neurological/vascular. These syndromes may or may not be preceded by a prodrome. [2] The speed of onset of symptoms is related to radiation exposure, with greater doses resulting in a shorter delay in symptom onset. [2] These presentations presume whole-body exposure and many of them are markers that are not valid if the entire body has not been exposed. Each syndrome requires that the tissue showing the syndrome itself be exposed. The gastrointestinal syndrome is not seen if the stomach and intestines are not exposed to radiation. Some areas affected are:[ citation needed ]

Haematopoiesis the formation of blood cellular components

Haematopoiesis (from Greek αἷμα, "blood" and ποιεῖν "to make"; also hematopoiesis in American English; sometimes also h(a)emopoiesis) is the formation of blood cellular components. All cellular blood components are derived from haematopoietic stem cells. In a healthy adult person, approximately 1011–1012 new blood cells are produced daily in order to maintain steady state levels in the peripheral circulation.

In medicine, a prodrome is an early sign or symptom, which often indicate the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.

  1. Hematopoietic. This syndrome is marked by a drop in the number of blood cells, called aplastic anemia. This may result in infections due to a low number of white blood cells, bleeding due to a lack of platelets, and anemia due to too few red blood cells in the circulation. [2] These changes can be detected by blood tests after receiving a whole-body acute dose as low as 0.25 grays (25  rad ), though they might never be felt by the patient if the dose is below 1 gray (100 rad). Conventional trauma and burns resulting from a bomb blast are complicated by the poor wound healing caused by hematopoietic syndrome, increasing mortality.
  2. Gastrointestinal. This syndrome often follows absorbed doses of 6–30 grays (600–3,000 rad). [2] The signs and symptoms of this form of radiation injury include nausea, vomiting, loss of appetite, and abdominal pain. [8] Vomiting in this time-frame is a marker for whole body exposures that are in the fatal range above 4 grays (400 rad). Without exotic treatment such as bone marrow transplant, death with this dose is common. [2] The death is generally more due to infection than gastrointestinal dysfunction.
  3. Neurovascular. This syndrome typically occurs at absorbed doses greater than 30 grays (3,000 rad), though it may occur at 10 grays (1,000 rad). [2] It presents with neurological symptoms such as dizziness, headache, or decreased level of consciousness, occurring within minutes to a few hours, and with an absence of vomiting. It is invariably fatal. [2]

Early symptoms of ARS typically includes nausea and vomiting, headaches, fatigue, fever, and a short period of skin reddening. [2] These symptoms may occur at radiation doses as low as 0.35 grays (35 rad). These symptoms are common to many illnesses, and may not, by themselves, indicate acute radiation sickness. [2]

Nausea medical symptom or condition

Nausea is an unpleasant, diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged, and has been described as placing discomfort on the chest, upper abdomen, or back of the throat.

Vomiting involuntary, forceful expulsion of stomach contents, typically via the mouth

Vomiting is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.

Headache Pain in the head or neck

Headache is the symptom of pain anywhere in the region of the head or neck. It can occur as a migraine, tension-type headache, or cluster headache. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches.

Dose effects

PhaseSymptomWhole-body absorbed dose (Gy)
1–2  Gy 2–6  Gy 6–8  Gy 8–30  Gy > 30  Gy
Immediate Nausea and vomiting 5–50%50–100%75–100%90–100%100%
Time of onset2–6 h1–2 h10–60 min< 10 minMinutes
Duration< 24 h24–48 h< 48 h< 48 hN/A (patients die in < 48 h)
Diarrhea NoneNone to mild (< 10%)Heavy (> 10%)Heavy (> 95%)Heavy (100%)
Time of onset3–8 h1–3 h< 1 h< 1 h
Headache SlightMild to moderate (50%)Moderate (80%)Severe (80–90%)Severe (100%)
Time of onset4–24 h3–4 h1–2 h< 1 h
Fever NoneModerate increase (10–100%)Moderate to severe (100%)Severe (100%)Severe (100%)
Time of onset1–3 h< 1 h< 1 h< 1 h
CNS functionNo impairmentCognitive impairment 6–20 hCognitive impairment > 24 hRapid incapacitation Seizures, tremor, ataxia, lethargy
Latent period 28–31 days7–28 days< 7 daysNoneNone
Illness Mild to moderate Leukopenia
Moderate to severe Leukopenia
Alopecia after 3  Gy
Severe leukopenia
High fever
Dizziness and disorientation
Electrolyte disturbance
Severe diarrhea
High fever
Electrolyte disturbance
N/A (patients die in < 48h)
MortalityWithout care0–5%5–95%95–100%100%100%
With care0–5%5–50%50–100%99–100%100%
Death6–8 weeks4–6 weeks2–4 weeks2 days – 2 weeks1–2 days
Table Source [9]

Skin changes

Cutaneous radiation syndrome (CRS) refers to the skin symptoms of radiation exposure. [1] Within a few hours after irradiation, a transient and inconsistent redness (associated with itching) can occur. Then, a latent phase may occur and last from a few days up to several weeks, when intense reddening, blistering, and ulceration of the irradiated site is visible. In most cases, healing occurs by regenerative means; however, very large skin doses can cause permanent hair loss, damaged sebaceous and sweat glands, atrophy, fibrosis (mostly keloids), decreased or increased skin pigmentation, and ulceration or necrosis of the exposed tissue. [1] Notably, as seen at Chernobyl, when skin is irradiated with high energy beta particles, moist desquamation (peeling of skin) and similar early effects can heal, only to be followed by the collapse of the dermal vascular system after two months, resulting in the loss of the full thickness of the exposed skin. [10] This effect had been demonstrated previously with pig skin using high energy beta sources at the Churchill Hospital Research Institute, in Oxford. [11]


According to the linear no-threshold model, any exposure to ionizing radiation, even at doses too low to produce any symptoms of radiation sickness, can induce cancer due to cellular and genetic damage. Under the assumption, survivors of acute radiation syndrome face an increased risk of developing cancer later in life. The probability of developing cancer is a linear function with respect to the effective radiation dose. In radiation-induced cancer, the speed at which the condition advances, the prognosis, the degree of pain, and every other feature of the disease are not believed to be functions of the radiation dosage.[ citation needed ]

However, some studies contradict the linear no-threshold model. These studies indicate that some low levels of radiation do not increase cancer risk at all and that there may exist a threshold dosage of ionizing radiation below which exposure should be considered safe. Nonetheless, the 'no safe amount' assumption is the basis of US and most national regulatory policies regarding "man-made" sources of radiation.[ citation needed ]


Both dose and dose rate contribute to the severity of acute radiation syndrome. The effects of dose fractionation or rest periods before repeated exposure, also shifts the LD50 dose, upwards. Death by haematopoietic syndrome of radiation sickness- influence of dose rate.png
Both dose and dose rate contribute to the severity of acute radiation syndrome. The effects of dose fractionation or rest periods before repeated exposure, also shifts the LD50 dose, upwards.
Comparison of Radiation Doses - includes the amount detected on the trip from Earth to Mars by the RAD on the MSL (2011-2013). PIA17601-Comparisons-RadiationExposure-MarsTrip-20131209.png
Comparison of Radiation Doses – includes the amount detected on the trip from Earth to Mars by the RAD on the MSL (20112013).

Radiation sickness is caused by exposure to a large dose of ionizing radiation (> ~0.1 Gy) over a short period of time. (> ~0.1 Gy/h) This might be the result of a nuclear explosion, a criticality accident, a radiotherapy accident as in Therac-25, a solar flare during interplanetary travel, misplacement of radioactive waste as in the 1987 Goiânia accident, human error in a nuclear reactor, or other possibilities. Acute radiation sickness due to ingestion of radioactive material is possible, but rare; examples include the 1987 contamination of Leide das Neves Ferreira and the 2006 poisoning of Alexander Litvinenko.[ citation needed ]

Alpha and beta radiation have low penetrating power and are unlikely to affect vital internal organs from outside the body. Any type of ionizing radiation can cause burns, but alpha and beta radiation can only do so if radioactive contamination or nuclear fallout is deposited on the individual's skin or clothing. Gamma and neutron radiation can travel much further distances and penetrate the body easily, so whole-body irradiation generally causes ARS before skin effects are evident. Local gamma irradiation can cause skin effects without any sickness. In the early twentieth century, radiographers would commonly calibrate their machines by irradiating their own hands and measuring the time to onset of erythema. [16]


During spaceflight, particularly flights beyond low Earth orbit (LEO), astronauts are exposed to both galactic cosmic radiation (GCR) and solar particle event (SPE) radiation. Evidence indicates past SPE radiation levels that would have been lethal for unprotected astronauts. [17] One possible such event occurred in 1859, but another occurred during the Space Age, in fact in a few months gap between Apollo missions, in early August 1972. [18] GCR levels that might lead to acute radiation poisoning are less well understood. [19]


The most commonly used predictor of acute radiation symptoms is the whole-body absorbed dose. Several related quantities, such as the equivalent dose, effective dose, and committed dose, are used to gauge long-term stochastic biological effects such as cancer incidence, but they are not designed to evaluate acute radiation syndrome. [20] To help avoid confusion between these quantities, absorbed dose is measured in units of grays (in SI, unit symbol Gy) or rads (in CGS), while the others are measured in sieverts (in SI, unit symbol Sv) or rems (in CGS). 1 rad = 0.01 Gy and 1 rem = 0.01 Sv. [21]

In most of the acute exposure scenarios that lead to radiation sickness, the bulk of the radiation is external whole-body gamma, in which case the absorbed, equivalent and effective doses are all equal. There are exceptions, such as the Therac-25 accidents and the 1958 Cecil Kelley criticality accident, where the absorbed doses in Gy or rad are the only useful quantities, because of the targeted nature of the exposure to the body.

Radiotherapy treatments are typically prescribed in terms of the local absorbed dose, which might be 60 Gy or higher. The dose is fractionated (about 2 Gy per day for curative treatment), which allows for the normal tissues to undergo repair, allowing it to tolerate a higher dose than would otherwise be expected. The dose to the targeted tissue mass must be averaged over the entire body mass, most of which receives negligible radiation, to arrive at a whole-body absorbed dose that can be compared to the table above.[ citation needed ]

DNA damage

High radiation doses can cause DNA damage. If left unrepaired, this damage can create serious and even lethal chromosomal aberrations. Ionizing radiation can produce reactive oxygen species, which are very damaging to DNA. [22]

Ionizing radiation does direct damage to cells by causing localized ionization events, creating clusters of DNA damage. [23] This damage includes loss of nucleobases and breakage of the sugar-phosphate backbone that binds to the nucleobases. Breakages can happen to one or both of the backbone strands. Single-stranded breakages are easier to repair than double-stranded breakages, because there is still an unbroken complementary strand to use as a template. The DNA organization at the level of histones, nucleosomes, and chromatin also affects its susceptibility to radiation damage. [24]

Clustered damage, defined as at least two lesions within a helical turn, is especially harmful. [23] While DNA damage happens frequently and naturally in the cell from endogenous sources, clustered damage is a unique effect of radiation exposure. [25] Clustered damage takes longer to repair than isolated breakages, and is less likely to be repaired at all. [26] Larger radiation doses are more prone to cause tighter clustering of damage, and closely localized damage is increasingly less likely to be repaired. [23]

Somatic mutations cannot be passed down from parent to offspring, but these mutations can propagate in cell lines within an organism. Radiation damage can also cause chromosome and chromatid aberrations, and their effect depends on what stage of the mitotic cycle the cell is currently in when the irradiation occurs. If the cell is in interphase, while it is still a single strand of chromatin, the damage will be replicated during the S1 phase of cell cycle, and there will be a break on both chromosome arms. Then the damage will be apparent in both daughter cells. If the irradiation occurs after replication, only one arm will bear the damage. This damage will only be apparent in one daughter cell. A damaged chromosome may cyclize, binding to another chromosome, or to itself. [27]


Diagnosis is typically made based on a history of significant radiation exposure and suitable clinical findings. [2] An absolute lymphocyte count can give a rough estimate of radiation exposure. [2] Time from exposure to vomiting can also give estimates of exposure levels if they are less than 10 Gray (1000 rad). [2]



The longer that humans are subjected to radiation the larger the dose will be. The advice in the nuclear war manual entitled Nuclear War Survival Skills published by Cresson Kearny in the U.S. was that if one needed to leave the shelter then this should be done as rapidly as possible to minimize exposure. [28]

In chapter 12, he states that "[q]uickly putting or dumping wastes outside is not hazardous once fallout is no longer being deposited. For example, assume the shelter is in an area of heavy fallout and the dose rate outside is 400  roentgen (R) per hour, enough to give a potentially fatal dose in about an hour to a person exposed in the open. If a person needs to be exposed for only 10 seconds to dump a bucket, in this 1/360 of an hour he will receive a dose of only about 1 R. Under war conditions, an additional 1-R dose is of little concern." In peacetime, radiation workers are taught to work as quickly as possible when performing a task that exposes them to radiation. For instance, the recovery of a radioactive source should be done as quickly as possible.[ citation needed ]


Increasing distance from the radiation source reduces the dose according to the inverse-square law for a point source. Distance can sometimes be effectively increased by means as simple as handling a source with forceps rather than fingers. This could reduce erythema to the fingers, but the extra few centimeters distance from the body will give little protection from acute radiation syndrome. [ citation needed ]


Matter attenuates radiation in most cases, so placing any mass (e.g., lead, dirt, sandbags, vehicles) between humans and the source will reduce the radiation dose. This is not always the case, however; care should be taken when constructing shielding for a specific purpose. For example, although high atomic number materials are very effective in shielding photons, using them to shield beta particles may cause higher radiation exposure due to the production of bremsstrahlung x-rays, and hence low atomic number materials are recommended. Also, using material with a high neutron activation cross section to shield neutrons will result in the shielding material itself becoming radioactive and hence more dangerous than if it were not present.[ citation needed ]

There are many types of shielding strategies that can be used to reduce the effects of radiation exposure. Internal contamination protective equipment such as respirators are used to prevent internal deposition as a result of inhalation and ingestion of radioactive material. Dermal protective equipment, which protects against external contamination, provides shielding to prevent radioactive material from being deposited on external structures. [29] While these protective measures do provide a barrier from radioactive material deposition, they do not shield from externally penetrating gamma radiation. This leaves anyone exposed to penetrating gamma rays at high risk of Acute Radiation Syndrome.

Naturally, shielding the entire body from high energy gamma radiation is optimal, but the required mass to provide adequate attenuation makes functional movement nearly impossible. In the event of a radiation catastrophe, medical and security personnel need mobile protection equipment in order to safely assist in containment, evacuation, and many other necessary public safety objectives.

Research has been done exploring the feasibility of partial body shielding, a radiation protection strategy that provides adequate attenuation to only the most radio-sensitive organs and tissues inside the body. Irreversible stem cell damage in the bone marrow is the first life-threatening effect of intense radiation exposure and therefore one of the most important bodily elements to protect. Due to the regenerative property of hematopoietic stem cells, it is only necessary to protect enough bone marrow to repopulate the exposed areas of the body with the shielded supply. [30] This concept allows for the development of lightweight mobile radiation protection equipment, which provides adequate protection, deferring the onset of Acute Radiation Syndrome to much higher exposure doses. One example of such equipment is the 360 gamma, a radiation protection belt that applies selective shielding to protect the bone marrow stored in the pelvic area as well as other radio sensitive organs in the abdominal region without hindering functional mobility.

More information on bone marrow shielding can be found in the "Health Physics Radiation Safety Journal". article "Selective Shielding of Bone Marrow: An Approach to Protecting Humans from External Gamma Radiation"., or in the Organisation for Economic Co-operation and Development (OECD) and the Nuclear Energy Agency (NEA)'s 2015 report: "Occupational Radiation Protection in Severe Accident Management" (PDF)..

Reduction of incorporation

Where radioactive contamination is present, a gas mask, dust mask, or good hygiene practices may offer protection, depending on the nature of the contaminant. Potassium iodide (KI) tablets can reduce the risk of cancer in some situations due to slower uptake of ambient radioiodine. Although this does not protect any organ other than the thyroid gland, their effectiveness is still highly dependent on the time of ingestion, which would protect the gland for the duration of a twenty-four-hour period. They do not prevent acute radiation syndrome as they provide no shielding from other environmental radionuclides. [31]

Fractionation of dose

If an intentional dose is broken up into a number of smaller doses, with time allowed for recovery between irradiations, the same total dose causes less cell death. Even without interruptions, a reduction in dose rate below 0.1 Gy/h also tends to reduce cell death. [20] This technique is routinely used in radiotherapy.[ citation needed ]

The human body contains many types of cells and a human can be killed by the loss of a single type of cells in a vital organ. For many short term radiation deaths (3–30 days), the loss of two important types of cells that are constantly being regenerated causes death. The loss of cells forming blood cells (bone marrow) and the cells in the digestive system (microvilli, which form part of the wall of the intestines) is fatal.[ citation needed ]


Effect of medical care on acute radiation syndrome Death by haematopoietic syndrome of radiation sickness- influence of medical care.png
Effect of medical care on acute radiation syndrome

Treatment is supportive with the possible use of antibiotics, blood products, colony stimulating factors, and stem cell transplant. [2] Symptomatic measures may also be employed. [2]


There is a direct relationship between the degree of the neutropenia that emerges after exposure to radiation and the increased risk of developing infection. Since there are no controlled studies of therapeutic intervention in humans, most of the current recommendations are based on animal research.[ citation needed ]

The treatment of established or suspected infection following exposure to radiation (characterized by neutropenia and fever) is similar to the one used for other febrile neutropenic patients. However, important differences between the two conditions exist. Individuals that develop neutropenia after exposure to radiation are also susceptible to irradiation damage in other tissues, such as the gastrointestinal tract, lungs and central nervous system. These patients may require therapeutic interventions not needed in other types of neutropenic patients. The response of irradiated animals to antimicrobial therapy can be unpredictable, as was evident in experimental studies where metronidazole [32] and pefloxacin [33] therapies were detrimental.

Antimicrobials that reduce the number of the strict anaerobic component of the gut flora (i.e., metronidazole) generally should not be given because they may enhance systemic infection by aerobic or facultative bacteria, thus facilitating mortality after irradiation. [34]

An empirical regimen of antimicrobials should be chosen based on the pattern of bacterial susceptibility and nosocomial infections in the affected area and medical center and the degree of neutropenia. Broad-spectrum empirical therapy (see below for choices) with high doses of one or more antibiotics should be initiated at the onset of fever. These antimicrobials should be directed at the eradication of Gram-negative aerobic bacilli (i.e., Enterobacteriace, Pseudomonas) that account for more than three quarters of the isolates causing sepsis. Because aerobic and facultative Gram-positive bacteria (mostly alpha-hemolytic streptococci) cause sepsis in about a quarter of the victims, coverage for these organisms may also be needed. [35]

A standardized management plan for people with neutropenia and fever should be devised. Empirical regimens contain antibiotics broadly active against Gram-negative aerobic bacteria (quinolones: i.e., ciprofloxacin, levofloxacin, a third- or fourth-generation cephalosporin with pseudomonal coverage: e.g., cefepime, ceftazidime, or an aminoglycoside: i.e. gentamicin, amikacin). [36]


Acute effects of ionizing radiation were first observed when Wilhelm Röntgen intentionally subjected his fingers to X-rays in 1895. He published his observations concerning the burns that developed, though he misattributed them to ozone, a free radical produced in air by X-rays. Other free radicals produced within the body are now understood to be more important. His injuries healed later.

Ingestion of radioactive materials caused many radiation-induced cancers in the 1930s, but no one was exposed to high enough doses at high enough rates to bring on acute radiation syndrome. Marie Curie died of aplastic anemia caused by radiation, a possible early incident of acute radiation syndrome.

The Radium Girls were female factory workers who contracted radiation poisoning from painting watch dials with self-luminous paint at the United States Radium factory in Orange, New Jersey, around 1917.

The atomic bombings of Hiroshima and Nagasaki resulted in high acute doses of radiation to a large number of Japanese, allowing for greater insight into its symptoms and dangers. Red Cross Hospital Surgeon Terufumi Sasaki led intensive research into the syndrome in the weeks and months following the Hiroshima bombings. Dr Sasaki and his team were able to monitor the effects of radiation in patients of varying proximities to the blast itself, leading to the establishment of three recorded stages of the syndrome. Within 25–30 days of the explosion, the Red Cross surgeon noticed a sharp drop in white blood cell count and established this drop, along with symptoms of fever, as prognostic standards for Acute Radiation Syndrome. [37] Actress Midori Naka, who was present during the atomic bombing of Hiroshima, was the first incident of radiation poisoning to be extensively studied. Her death on 24 August 1945 was the first death ever to be officially certified as a result of acute radiation syndrome (or "Atomic bomb disease").

Notable incidents

There are two major databases that track radiation accidents: The American ORISE REAC/TS and the European IRSN ACCIRAD. REAC/TS shows 417 accidents occurring between 1944 and 2000, causing about 3000 cases of acute radiation syndrome, of which 127 were fatal. [38] ACCIRAD lists 580 accidents with 180 ARS fatalities for an almost identical period. [39] The two deliberate bombings are not included in either database, nor are any possible radiation-induced cancers from low doses. The detailed accounting is difficult because of confounding factors. ARS may be accompanied by conventional injuries such as steam burns, or may occur in someone with a pre-existing condition undergoing radiotherapy. There may be multiple causes for death, and the contribution from radiation may be unclear. Some documents may incorrectly refer to radiation-induced cancers as radiation poisoning, or may count all overexposed individuals as survivors without mentioning if they had any symptoms of ARS. The table below attempts to catalog some cases of ARS. Many of these incidents involved additional fatalities from other causes, such as cancer, which are excluded from this table.

YearTypeIncidentARS fatalitiesARS survivorsLocation
1945 criticality Exposure of Harry Daghlian 10 Los Alamos, New Mexico, United States
1946criticality Pajarito accident, including exposure of Louis Slotin 12Los Alamos, New Mexico, United States
1957alleged crime Nikolay Khokhlov assassination attempt [40] 01Frankfurt, West Germany
1958criticality Cecil Kelley criticality accident 10Los Alamos, New Mexico, United States
1961reactor Soviet submarine K-19 [41] 8many North Atlantic, near Southern Greenland
1961criticality SL-1 experimental reactor explosion 30 NRTS, near Idaho Falls, Idaho, United States
1962 orphan source Radiation accident in Mexico City 4? Mexico City, Mexico
1968reactor Soviet submarine K-27 [42] 940near Gremikha Bay, Russia
1984orphan source Radiation accident in Morocco [43] 83 Mohammedia, Morocco
1985reactor Soviet submarine K-431 [44] 1049 Chazhma Bay naval facility near Vladivostok, USSR
1985 radiotherapy Therac-25 radiation overdose accidents 33
1986reactor Chernobyl disaster 28206 - 209 Chernobyl Nuclear Power Plant, Ukrainian SSR
1987orphan source Goiânia accident [45] 4? Goiânia, Brazil
1990radiotherapy Radiotherapy accident in Zaragoza [46] 11? Zaragoza, Spain
1996radiotherapy Radiotherapy accident in Costa Rica [47] 7 to 2046 San José, Costa Rica
1999criticality Tokaimura nuclear accident 21 Tōkai, Ibaraki, Japan
2000orphan source Samut Prakan radiation accident [48] 37 Samut Prakan Province, Thailand
2000radiotherapy Instituto Oncologico Nacional accident [49] [50] 3 to 7? Panama City, Panama
2004alleged murder Yasser Arafat's alleged poisoning with Polonium-210 1 (disputed)0 Palestina (was hospitalized and died in France)
2006homicide Poisoning of Alexander Litvinenko [40] [51] [52] [53] [54] 10 London, United Kingdom
2010orphan source Mayapuri radiological accident [48] 17 Mayapuri, India
2011reactor Fukushima Daiichi nuclear disaster Ōkuma, Fukushima Prefecture, Japan

Other animals

Thousands of scientific experiments have been performed to study acute radiation syndrome in animals.[ citation needed ] There is a simple guide for predicting survival / death in mammals, including humans, following the acute effects of inhaling radioactive particles. [55]

See also

Related Research Articles

Nuclear fallout residual radioactive material following a nuclear blast

Nuclear fallout, or fallout, is the residual radioactive material propelled into the upper atmosphere following a nuclear blast, so called because it "falls out" of the sky after the explosion and the shock wave have passed. It commonly refers to the radioactive dust and ash created when a nuclear weapon explodes. The amount and spread of fallout is a product of the size of the weapon and the altitude at which it is detonated. Fallout may get entrained with the products of a pyrocumulus cloud and fall as black rain. This radioactive dust, usually consisting of fission products mixed with bystanding atoms that are neutron-activated by exposure, is a form of radioactive contamination.

Sievert SI derived unit of equivalent dose of ionizing radiation

The sievert is a derived unit of ionizing radiation dose in the International System of Units (SI) and is a measure of the health effect of low levels of ionizing radiation on the human body. The sievert is of importance in dosimetry and radiation protection, and is named after Rolf Maximilian Sievert, a Swedish medical physicist renowned for work on radiation dose measurement and research into the biological effects of radiation.

Radiation dosimetry in the fields of health physics and radiation protection is the measurement, calculation and assessment of the ionizing radiation dose absorbed by an object, usually the human body. This applies both internally, due to ingested or inhaled radioactive substances, or externally due to irradiation by sources of radiation.

Radiation protection, also known as radiological protection, is defined by the International Atomic Energy Agency (IAEA) as "The protection of people from harmful effects of exposure to ionizing radiation, and the means for achieving this". Exposure can be from a source of radiation external to the human body or due to internal irradiation caused by the ingestion of radioactive contamination.

The roentgen equivalent man is an older, CGS unit of equivalent dose, effective dose, and committed dose which are measures of the health effect of low levels of ionizing radiation on the human body.

Radiation hormesis hypothesis on hormesis induced in response to exposure at (low level) ionizing radiation

Radiation hormesis is the hypothesis that low doses of ionizing radiation are beneficial, stimulating the activation of repair mechanisms that protect against disease, that are not activated in absence of ionizing radiation. The reserve repair mechanisms are hypothesized to be sufficiently effective when stimulated as to not only cancel the detrimental effects of ionizing radiation but also inhibit disease not related to radiation exposure. This hypothesis has captured the attention of scientists and public alike in recent years.

The rad is a unit of absorbed radiation dose, defined as 1 rad = 0.01 Gy = 0.01 J/kg. It was originally defined in CGS units in 1953 as the dose causing 100 ergs of energy to be absorbed by one gram of matter. The material absorbing the radiation can be human tissue or silicon microchips or any other medium.

Radioresistance is the level of ionizing radiation that organisms are able to withstand.

Radiation burn damage to the skin or other biological tissue caused by exposure to radiation

A radiation burn is damage to the skin or other biological tissue as an effect of radiation. The radiation types of greatest concern are thermal radiation, radio frequency energy, ultraviolet light and ionizing radiation.

The symptoms of radiation poisoning includes a phenomenon where, following a dose of ionizing radiation, a person may have a period of apparent health, lasting for days or weeks, despite a terminal illness. The lag time of the effects of even severe radiation poisoning are a result of many biological processes, manifesting damage in different ways.

Radiobiology is a field of clinical and basic medical sciences that involves the study of the action of ionizing radiation on living things, especially health effects of radiation. Ionizing radiation is generally harmful and potentially lethal to living things but can have health benefits in radiation therapy for the treatment of cancer and thyrotoxicosis. Its most common impact is the induction of cancer with a latent period of years or decades after exposure. High doses can cause visually dramatic radiation burns, and/or rapid fatality through acute radiation syndrome. Controlled doses are used for medical imaging and radiotherapy.

Radiation-induced cognitive decline describes the possible correlation between radiation therapy and mild cognitive impairment. Radiation therapy is used mainly in the treatment of cancer. Radiation therapy can be used to cure care or shrink tumors that are interfering with quality of life. Sometimes radiation therapy is used alone; other times it is used in conjunction with chemotherapy and surgery. For people with brain tumors, radiation can be an effective treatment because chemotherapy is often less effective due to the blood–brain barrier. Unfortunately for some patients, as time passes, people who received radiation therapy may begin experiencing deficits in their learning, memory, and spatial information processing abilities. The learning, memory, and spatial information processing abilities are dependent on proper hippocampus functionality. Therefore, any hippocampus dysfunction will result in deficits in learning, memory, and spatial information processing ability.

Gamma ray Energetic electromagnetic radiation arising from radioactive decay of atomic nuclei

A gamma ray, or gamma radiation, is a penetrating electromagnetic radiation arising from the radioactive decay of atomic nuclei. It consists of the shortest wavelength electromagnetic waves and so imparts the highest photon energy. Paul Villard, a French chemist and physicist, discovered gamma radiation in 1900 while studying radiation emitted by radium. In 1903, Ernest Rutherford named this radiation gamma rays based on their relatively strong penetration of matter; he had previously discovered two less penetrating types of decay radiation, which he named alpha rays and beta rays in ascending order of penetrating power.

Effects of nuclear explosions on human health

The medical effects of the atomic bomb on Hiroshima upon humans can be put into the four categories below, with the effects of larger thermonuclear weapons producing blast and thermal effects so large that there would be a negligible number of survivors close enough to the center of the blast who would experience prompt/acute radiation effects, which were observed after the 16 kiloton yield Hiroshima bomb, due to its relatively low yield:

Up to 10% of invasive cancers are related to radiation exposure, specifically ionizing radiation. Additionally, the vast majority of non-invasive cancers are non-melanoma skin cancers caused by ultraviolet radiation. Ultraviolet's position on the electromagnetic spectrum is on the boundary between ionizing and non-ionizing radiation. Non-ionizing radio frequency radiation from mobile phones, electric power transmission, and other similar sources have been described as a possible carcinogen by the World Health Organization's International Agency for Research on Cancer, but the link remains unproven.

Travel outside the Earth's protective atmosphere, magnetosphere, and gravitational field can harm human health, and understanding such harm is essential for successful manned spaceflight. Potential effects on the central nervous system (CNS) are particularly important. A vigorous ground-based cellular and animal model research program will help quantify the risk to the CNS from space radiation exposure on future long distance space missions and promote the development of optimized countermeasures.


  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 "A Fact Sheet for Physicians". CDC . CDC Radiation Emergencies Acute Radiation Syndrome. 22 April 2019. Retrieved 17 May 2019.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Donnelly, EH; Nemhauser, JB; Smith, JM; Kazzi, ZN; Farfán, EB; Chang, AS; Naeem, SF (June 2010). "Acute radiation syndrome: assessment and management". Southern Medical Journal. 103 (6): 541–6. doi:10.1097/SMJ.0b013e3181ddd571. PMID   20710137.
  3. 1 2 3 4 5 6 7 8 "Radiation Sickness". National Organization for Rare Disorders. Retrieved 6 June 2019.
  4. Xiao M, Whitnall MH (January 2009). "Pharmacological countermeasures for the acute radiation syndrome". Curr Mol Pharmacol. 2 (1): 122–133. doi:10.2174/1874467210902010122. PMID   20021452.
  5. Acosta, R; Warrington, SJ (January 2019). "Radiation Syndrome". PMID   28722960.Cite journal requires |journal= (help)
  6. Akleyev, Alexander V. (2014). "chronic%20radiation%20syndrome"&pg=PA1 Chronic Radiation Syndrome. Springer Science & Business Media. p. 1. ISBN   9783642451171.
  7. Gusev, Igor; Guskova, Angelina; Mettler, Fred A. (2001). Medical Management of Radiation Accidents. CRC Press. p. 18. ISBN   9781420037197.
  8. Christensen DM, Iddins CJ, Sugarman SL (February 2014). "Ionizing radiation injuries and illnesses". Emerg Med Clin North Am. 32 (1): 245–65. doi:10.1016/j.emc.2013.10.002. PMID   24275177.
  9. "Radiation Exposure and Contamination - Injuries; Poisoning - Merck Manuals Professional Edition". Merck Manuals Professional Edition. Retrieved 2017-09-06.
  10. The medical handling of skin lesions following high-level accidental irradiation, IAEA Advisory Group Meeting, September 1987 Paris.
  11. Wells J; et al. (1982), "Non-Uniform Irradiation of Skin: Criteria for limiting non-stochastic effects", Proceedings of the Third International Symposium of the Society for Radiological Protection, Advances in Theory and Practice, 2, pp. 537–542, ISBN   978-0-9508123-0-4
  12. Kerr, Richard (31 May 2013). "Radiation will make astronauts' trip to Mars even riskier". Science . 340 (6136): 1031. Bibcode:2013Sci...340.1031K. doi:10.1126/science.340.6136.1031. PMID   23723213.
  13. Zeitlin, C.; et al. (31 May 2013). "Measurements of Energetic Particle Radiation in Transit to Mars on the Mars Science Laboratory". Science . 340 (6136): 1080–1084. Bibcode:2013Sci...340.1080Z. doi:10.1126/science.1235989. PMID   23723233.
  14. Chang, Kenneth (30 May 2013). "Data Point to Radiation Risk for Travelers to Mars". New York Times. Archived from the original on 31 May 2013. Retrieved 31 May 2013.
  15. Gelling, Cristy (June 29, 2013). "Mars trip would deliver big radiation dose; Curiosity instrument confirms expectation of major exposures". Science News . 183 (13): 8. doi:10.1002/scin.5591831304. Archived from the original on July 15, 2013. Retrieved July 8, 2013.
  16. Inkret, William C.; Meinhold, Charles B.; Taschner, John C. (1995). "A Brief History of Radiation Protection Standards" (PDF). Los Alamos Science (23): 116–123. Archived (PDF) from the original on 29 October 2012. Retrieved 12 November 2012.
  17. "Superflares could kill unprotected astronauts". New Scientist. 21 March 2005. Archived from the original on 27 March 2015.
  18. Lockwood, Mike; M. Hapgood (2007). "The Rough Guide to the Moon and Mars". Astron. Geophys. 48 (6): 11–17. Bibcode:2007A&G....48f..11L. doi:10.1111/j.1468-4004.2007.48611.x.
  19. National Research Council (U.S.). Ad Hoc Committee on the Solar System Radiation Environment and NASA's Vision for Space Exploration (2006). Space Radiation Hazards and the Vision for Space Exploration. National Academies Press. doi:10.17226/11760. ISBN   978-0-309-10264-3. Archived from the original on 2010-03-28.
  20. 1 2 Icrp (2007). "The 2007 Recommendations of the International Commission on Radiological Protection". Annals of the ICRP. ICRP publication 103. 37 (2–4). ISBN   978-0-7020-3048-2. Archived from the original on 16 November 2012. Retrieved 17 May 2012.
  21. The Effects of Nuclear Weapons (Revised ed.). US Department of Defense. 1962. p. 579.
  22. Yu, Y.; Cui, Y.; Niedernhofer, L.; Wang, Y. (2016). "Occurrence, biological consequences and human health relevance of oxidative stress-induced DNA damage". Chemical Research in Toxicology. 29 (12): 2008–2039. doi:10.1021/acs.chemrestox.6b00265. PMC   5614522 . PMID   27989142.
  23. 1 2 3 Eccles, L.; O'Neill, P.; Lomax, M. (2011). "Delayed repair of radiation induced DNA damage: Friend or foe?". Mutation Research. 711 (1–2): 134–141. doi:10.1016/j.mrfmmm.2010.11.003. PMC   3112496 . PMID   21130102.
  24. Lavelle, C.; Foray, N. (2014). "Chromatin structure and radiation-induced DNA damage: From structural biology to radiobiology". International Journal of Biochemistry & Cell Biology. 49: 84–97. doi:10.1016/j.biocel.2014.01.012. PMID   24486235.
  25. Goodhead, D. (1994). "Initial events in the cellular effects of ionizing radiations: Clustered damage in DNA". International Journal of Radiation Biology. 65 (1): 7–17. doi:10.1080/09553009414550021. PMID   7905912.
  26. Georgakilas, A.; Bennett, P.; Wilson, D.; Sutherland, B. (2004). "Processing of bistranded abasic DNA clusters in gamma-irradiated human hematopoietic cells". Nucleic Acids Research. 32 (18): 5609–5620. doi:10.1093/nar/gkh871. PMC   524283 . PMID   15494449.
  27. Hall, E.; Giaccia, A. (2006). Radiobiology for the Radiobiologist (6th ed.). Lippincott Williams & Wilkins.
  28. Kearny, Cresson H. (1988). Nuclear War Survival Skills. Oregon Institute of Science and Medicine. ISBN   978-0-942487-01-5. Archived from the original on 17 October 2017.
  29. "Personal Protective Equipment (PPE) in a Radiation Emergency". Radiation Emergency Medical Management. Retrieved 26 June 2018.
  30. Waterman, Gideon; Kase, Kenneth; Orion, Itzhak; Broisman, Andrey; Milstein, Oren (September 2017). "Selective Shielding of Bone Marrow". Health Physics. 113 (3): 195–208. doi:10.1097/hp.0000000000000688. ISSN   0017-9078. PMID   28749810.
  31. "Radiation and its Health Effects". Nuclear Regulatory Commission. Archived from the original on 14 October 2013. Retrieved 19 November 2013.
  32. Brook, I.; Ledney, G.D. (1994). "Effect of antimicrobial therapy on the gastrointestinal bacterial flora, infection and mortality in mice exposed to different doses of irradiation". Journal of Antimicrobial Chemotherapy . 33 (1): 63–74. doi:10.1093/jac/33.1.63. ISSN   1460-2091. PMID   8157575.
  33. Patchen ML, Brook I, Elliott TB, Jackson WE (1993). "Adverse effects of pefloxacin in irradiated C3H/HeN mice: correction with glucan therapy". Antimicrobial Agents and Chemotherapy. 37 (9): 1882–1889. doi:10.1128/AAC.37.9.1882. ISSN   0066-4804. PMC   188087 . PMID   8239601.
  34. Brook I, Walker RI, MacVittie TJ (1988). "Effect of antimicrobial therapy on the bowel flora and bacterial infection in irradiated mice". International Journal of Radiation Biology . 53 (5): 709–718. doi:10.1080/09553008814551081. ISSN   1362-3095.
  35. Brook I, Ledney D (1992). "Quinolone therapy in the management of infection after irradiation". Crit Rev Microbiol : 18235–18246.
  36. Brook I, Elliot TB, Ledney GD, Shomaker MO, Knudson GB (2004). "Management of postirradiation infection: lessons learned from animal models". Military Medicine . 169 (3): 194–197. doi:10.7205/MILMED.169.3.194. ISSN   0026-4075. PMID   15080238.
  37. Carmichael, Ann G. (1991). Medicine: A Treasury of Art and Literature. New York: Harkavy Publishing Service. p. 376. ISBN   978-0-88363-991-7.
  38. Turai, István; Veress, Katalin (2001). "Radiation Accidents: Occurrence, Types, Consequences, Medical Management, and the Lessons to be Learned". Central European Journal of Occupational and Environmental Medicine. 7 (1): 3–14. Archived from the original on 15 May 2013. Retrieved 1 June 2012.
  39. Chambrette, V.; Hardy, S.; Nenot, J.C. (2001). "Les accidents d'irradiation: Mise en place d'une base de données "ACCIRAD" à I'IPSN" (PDF). Radioprotection. 36 (4): 477–510. doi:10.1051/radiopro:2001105. Archived (PDF) from the original on 4 March 2016. Retrieved 13 June 2012.
  40. 1 2 Goldfarb, Alex; Litvinenko, Marina (2007). Death of a Dissident: The poisoning of Alexander Litvinenko and the return of the KGB. Simon & Schuster UK. ISBN   978-1-4711-0301-8. Archived from the original on 2016-12-22 via Google Books.
  41. Johnston, Wm. Robert. "K-19 submarine reactor accident, 1961". Database of radiological incidents and related events. Johnston's Archive. Archived from the original on 4 February 2012. Retrieved 24 May 2012.
  42. Johnston, Wm. Robert. "K-27 submarine reactor accident, 1968". Database of radiological incidents and related events. Johnston's Archive. Archived from the original on 8 February 2012. Retrieved 24 May 2012.
  43. "Lost Iridium-192 Source". Archived from the original on 2014-11-29.
  44. Johnston, Wm. Robert. "K-431 submarine reactor accident, 1985". Database of radiological incidents and related events. Johnston's Archive. Archived from the original on 31 May 2012. Retrieved 24 May 2012.
  45. "The Radiological Accident in Goiania" (PDF). p. 2. Archived from the original (PDF) on 2016-03-12.
  46. "Strengthening the Safety of Radiation Sources" (PDF). p. 15. Archived from the original (PDF) on 2009-03-26.
  47. Gusev, Igor; Guskova, Angelina; Mettler, Fred A. (12 December 2010). Medical Management of Radiation Accidents (Second ed.). CRC Press. pp. 299–303. ISBN   978-1-4200-3719-7. Archived from the original on 13 September 2014 via Google Books.
  48. 1 2 Bagla, Pallava (7 May 2010). "Radiation Accident a 'Wake-Up Call' For India's Scientific Community". Science . 328 (5979): 679. Bibcode:2010Sci...328..679B. doi:10.1126/science.328.5979.679-a. PMID   20448162.
  49. International Atomic Energy Agency. "Investigation of an accidental Exposure of radiotherapy patients in Panama" (PDF). Archived (PDF) from the original on 2013-07-30.
  50. Johnston, Robert (September 23, 2007). "Deadliest radiation accidents and other events causing radiation casualties". Database of Radiological Incidents and Related Events. Archived from the original on 23 October 2007.
  51. Patterson AJ (2007). "Ushering in the era of nuclear terrorism". Critical Care Medicine. 35 (3): 953–954. doi:10.1097/01.CCM.0000257229.97208.76. PMID   17421087.
  52. Acton JM, Rogers MB, Zimmerman PD (September 2007). "Beyond the Dirty Bomb: Re-thinking Radiological Terror". Survival. 49 (3): 151–168. doi:10.1080/00396330701564760.
  53. Sixsmith, Martin (2007). The Litvinenko File: The Life and Death of a Russian Spy . True Crime. p. 14. ISBN   978-0-312-37668-0.
  54. Bremer Mærli, Morten. "Radiological Terrorism: "Soft Killers"". Bellona Foundation . Archived from the original on 2007-12-17.
  55. Wells, J. (1976). "A guide to the prognosis for survival in mammals following the acute effects of inhaled radioactive particles". Journal of the Institute of Nuclear Engineers. 17 (5): 126–131. ISSN   0368-2595.
This article incorporates public domain material from websites or documents of the U.S. Armed Forces Radiobiology Research Institute and the U.S. Centers for Disease Control and Prevention
External resources