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Ebeling M, Bloom A, Boggiano MM, Peterson DT, Peterson T. Employing High-Fidelity Simulation for the High-Risk, Low-Frequency Diagnosis and Management of Acute Radiation Syndrome (ARS). MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11331. [PMID: 37538304 PMCID: PMC10394119 DOI: 10.15766/mep_2374-8265.11331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/21/2023] [Indexed: 08/05/2023]
Abstract
Introduction Acute radiation syndrome (ARS) is a high-risk, low-frequency diagnosis that can be fatal and is difficult to diagnose without an obvious history of ionizing radiation exposure. Methods Twenty-two emergency medicine residents and one pharmacy resident participated in an hour-long simulation session. To accommodate all learners, the simulation was conducted eight times over a block of scheduled time (two to four learners/session). Sessions included a prebriefing, pre/post questionnaires, the ARS case, and a debriefing. Learners evaluated and managed a 47-year-old male (manikin) with the hematopoietic and cutaneous subsyndromes of ARS who presented with hand pain/erythema/edema and underlying signs of infection 2 weeks after an unrecognized radiation exposure. Learners had to perform a history and physical, recognize/manage abnormal vitals, order/interpret labs, consult appropriate disciplines, and initiate supportive care. Results There was a mean reported increase in ability to recognize signs and symptoms of ARS (p < .001) and appropriately manage a patient with this condition (p = .03) even after controlling for baseline confidence in ability to make and manage uncommon diagnoses, respectively. Learners rated this simulation as a valuable learning experience, effective in teaching them how to diagnose and treat ARS, and one they would recommend to other health care professionals. Discussion This simulation aimed to teach the diagnosis and initial management of the hematopoietic and cutaneous subsyndromes of ARS. It should be used to increase awareness of the potential for ionizing radiation exposure under less obvious conditions and raise the index of suspicion for ARS in the undifferentiated patient.
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Affiliation(s)
- Mel Ebeling
- Third-Year Medical Student, University of Alabama at Birmingham Heersink School of Medicine
| | - Andrew Bloom
- Assistant Professor, Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Mary M. Boggiano
- Associate Professor, Department of Psychology, University of Alabama at Birmingham
| | - Dawn Taylor Peterson
- Associate Professor, Department of Medical Education, University of Alabama at Birmingham Heersink School of Medicine
| | - Todd Peterson
- Associate Professor, Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine
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Iddins CJ, DiCarlo AL, Ervin MD, Herrera-Reyes E, Goans RE. Cutaneous and local radiation injuries. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:10.1088/1361-6498/ac241a. [PMID: 34488201 PMCID: PMC8785213 DOI: 10.1088/1361-6498/ac241a] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. This article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.
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Affiliation(s)
- Carol J Iddins
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | - Andrea L DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | - Mark D Ervin
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | | | - Ronald E Goans
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
- MJW Corporation, Buffalo, NY, United States of America
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Burnett LR, Hughes RT, Rejeski AF, Moffatt LT, Shupp JW, Christy RJ, Winkfield KM. Review of the Terminology Describing Ionizing Radiation-Induced Skin Injury: A Case for Standardization. Technol Cancer Res Treat 2021; 20:15330338211039681. [PMID: 34613833 PMCID: PMC8504211 DOI: 10.1177/15330338211039681] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ionizing radiation causes injury to the skin that produces a complex clinical presentation that is managed by various paradigms without clear standards. The situation is further complicated by the fact that clinicians and researchers often use different terms and billing codes to describe the spectrum of cutaneous injury. There is, however, general agreement between the two most commonly-used diagnostic scales, the Radiation Therapy Oncology Group and the Common Terminology Criteria for Adverse Events, and in their use to describe skin injury following radiation therapy. These scales are typically used by radiation oncologists to quantify radiation dermatitis, a component of the radiation-related disorders of the skin and subcutaneous tissue family of diagnoses. In rare cases, patients with severe injury may require treatment by wound care or burn specialists, in which case the disease is described as a “radiation burn” and coded as a burn or corrosion. Further compounding the issue, most US government agencies use the term Cutaneous Radiation Injury to indicate skin damage resulting from large, whole-body exposures. In contrast, the US Food and Drug Administration approves products for radiation dermatitis or “burns caused by radiation oncology procedures.” A review of the literature and comparison of clinical presentations shows that each of these terms represents a similar injury, and can be used interchangeably. Herein we provide a comparative review of the commonly used terminology for radiation-induced skin injury. Further, we recommend standardization across clinicians, providers, and researchers involved in the diagnosis, care, and investigation of radiation-induced skin injury. This will facilitate collaboration and broader inclusion criteria for grant-research and clinical trials and will assist in assessing therapeutic options particularly relevant to patient skin pigmentation response differences.
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Affiliation(s)
| | - Ryan T Hughes
- 12279Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Lauren T Moffatt
- 121577MedStar Health Research Institute, Washington, DC, USA.,12230Georgetown University School of Medicine, Washington, DC, USA
| | - Jeffrey W Shupp
- 121577MedStar Health Research Institute, Washington, DC, USA.,12230Georgetown University School of Medicine, Washington, DC, USA.,8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Christy
- 110230US Army Institute for Surgical Research, San Antonio Texas, USA
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Muhammad M, Shao C, Huang Q. Label-free SERS diagnostics of radiation-induced injury via detecting the biomarker Raman signal in the serum and urine bio-samples based on Au-NPs array substrates. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2019; 223:117282. [PMID: 31247463 DOI: 10.1016/j.saa.2019.117282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/09/2019] [Accepted: 06/15/2019] [Indexed: 05/28/2023]
Abstract
A sensitive approach based on surface enhanced Raman spectroscopy (SERS) has been developed to evaluate the radiation caused biological injury. To achieve the effective SERS substrate, canonical anodic aluminum oxide (AAO) templates with regular array of nanotips were fabricated, and by plasma sputtering the gold nanoparticles (Au-NPs) were distributed on the nanotips to form the Au-NPs array with plenty of hotspots. The SERS substrates were utilized to examine the serum samples taken from the mice with the treatment of total body irradiation (TBI) of X-ray. The impact of TBI on the mice was analyzed and it was found that the SERS peak intensity at 532 cm-1 increased as a function of duration or dose of TBI. We confirmed that this Raman signature belongs to the myoglobin as a biomarker for the muscle damage due to the radiation caused injury. Furthermore, we also tested several blood and urine specimen of cancer patients who received radiotherapy. The results showed that our approach to some extent could distinguish the bio-samples from normal, X-ray treated and untreated individuals. Therefore, the proposed methodology may have the potential for prompt prognosis of radiation injury at early stage.
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Affiliation(s)
- Muhammad Muhammad
- Key Laboratory of High Magnetic Field and Ion Beam Physical Biology, Institute of Technical Biology and Agriculture Engineering, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China; University of Science and Technology of China, Hefei 230026, China
| | - Changsheng Shao
- Key Laboratory of High Magnetic Field and Ion Beam Physical Biology, Institute of Technical Biology and Agriculture Engineering, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China; University of Science and Technology of China, Hefei 230026, China
| | - Qing Huang
- Key Laboratory of High Magnetic Field and Ion Beam Physical Biology, Institute of Technical Biology and Agriculture Engineering, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China; University of Science and Technology of China, Hefei 230026, China.
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Wang YY, Yu DJ, Zhao TL, Dai H, Li Y, Bian HH, Chen WB, Zhang YS, Pu WY, Feng JC, Hu WT, Liu YL. Successful Rescue of the Victim Exposed to a Super High Dose of Iridium-192 during the Nanjing Radiological Accident in 2014. Radiat Res 2019; 191:527-531. [PMID: 30925136 DOI: 10.1667/rr15274.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Here we report on the interventions taken to treat a patient exposed to high-dose radiation and provide a protocol for treating such patients in the future. The patient, Mr. Wang, was a 58-year-old male janitor who was accidentally exposed to a 192Ir source with an activity of 966.4 GBq or 26.1 Ci. The dose estimated to the lower right limb was 4,100 Gy, whereas the whole-body effective dose was 1.51 Gy. The diagnosis was made according to the results of the patient dose estimation and clinical manifestations. Systemic treatment included stimulating bone marrow hematopoietic cells, enhancing immunity, anti-infection and vitamin supplements. The treatment of radiation-induced skin lesions consisted of several debridements, two skin-flap transplantations and application of mesenchymal stem cells (MSCs). Skin-flap transplantations and MSCs play important roles in the recovery of skin wound. A combination of antibiotics and antimycotic was useful in reducing inflammation. The application of vacuum sealing drainage was effective in removing necrotic tissue and bacteria, ameliorating ischemia and hypoxia of wound tissue, providing a fresh wound bed for wound healing and improving skin or flap graft survival rates. The victim survived the accident without amputation, and function of his highly exposed right leg was partially recovered. These results demonstrate the importance of collaboration among members of a multidisciplinary team in the treatment of this patient.
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Affiliation(s)
- You-You Wang
- Departments of Nuclear and Radiation Incident Medical Emergency Office.,Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
| | | | | | - Hong Dai
- Departments of Nuclear and Radiation Incident Medical Emergency Office.,Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
| | - Yuan Li
- Departments of Oncology and Occupational Medicine, Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Hua-Hui Bian
- Departments of Nuclear and Radiation Incident Medical Emergency Office.,Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
| | - Wei-Bo Chen
- Departments of Nuclear and Radiation Incident Medical Emergency Office.,Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
| | - Yu-Song Zhang
- Departments of Nuclear and Radiation Incident Medical Emergency Office.,Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
| | - Wang-Yang Pu
- Departments of Oncology and Occupational Medicine, Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Jun-Chao Feng
- Departments of Nuclear and Radiation Incident Medical Emergency Office.,Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
| | - Wen-Tao Hu
- Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
| | - Yu-Long Liu
- Departments of Nuclear and Radiation Incident Medical Emergency Office.,Departments of State Key Laboratory of Radiation Medicine and Protection.,School of Radiation Medicine and Protection, Soochow University, Suzhou 215004, China.,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Suzhou 215004, China
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Benjegerdes KE, Brown SC, Housewright CD. Focal cutaneous squamous cell carcinoma following radium-223 extravasation. Proc AMIA Symp 2017; 30:78-79. [PMID: 28127143 DOI: 10.1080/08998280.2017.11929538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Long-term sequelae due to extravasation of intravenous radioisotopes resulting in radiation injuries are rarely reported. As the use of radioactive isotopes for the treatment of osteoblastic metastases increases, information regarding the prevention, treatment, and long-term monitoring of suspected extravasation injury will become increasingly important. We present a patient with no previous history of skin cancer who developed an aggressive cutaneous squamous cell carcinoma at the site of prior radium-223 extravasation. We recommend that patients who experience extravasation of therapeutic radioisotopes be monitored by dermatologists for long-term sequelae. Cutaneous squamous cell carcinoma should be recognized as a rare but potential adverse event following cutaneous extravasation of radium-223 and is likely a side effect that is severely underreported.
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Affiliation(s)
- Katie E Benjegerdes
- Texas A&M Health Science Center College of Medicine and the Department of Dermatology, Scott & White Medical Center - Temple, Temple, Texas
| | - Shannon C Brown
- Texas A&M Health Science Center College of Medicine and the Department of Dermatology, Scott & White Medical Center - Temple, Temple, Texas
| | - Chad D Housewright
- Texas A&M Health Science Center College of Medicine and the Department of Dermatology, Scott & White Medical Center - Temple, Temple, Texas
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