Lefaix J L, Daburon F
Commissariat à l'Energie Atomique, Département de Radiobiologie et de Radiopathologie, CEA-Saclay, Gif sur Yvette, France.
Health Phys. 1998 Oct;75(4):375-84. doi: 10.1097/00004032-199810000-00003.
In the last 50 years several radiation accidents occurred in which industrial radiographers and others suffered severe radiation injuries from inadvertent contact with radiation sources. Such accidents involving acute localized injuries are characterized by a severe initial reaction progressing through erythema to skin necrosis with a spontaneous resolution of the lesion over a 2-mo period for the lower doses. However, the early symptoms observed on the skin give no indication as to the in-depth pathology, and cutaneous and muscular radionecrosis started generally from early epithelial, microvascular, and vascular lesions and from delayed muscular and connective tissue lesions. In a case of acute localized irradiation, different biophysical techniques are able to give real responses in biological dosimetry. More numerous are the methods, especially imaging methods, that make it possible for the clinician to evaluate the extent of the early injuries and to manage the medical intervention. We have developed animal experimental models of acute localized irradiation: overexposure to the gamma rays of a 192Ir industrial radiographic collimated source (in the pig and the rabbit) and overexposure to the beta rays of a 90Sr-90Y collimated source (in the pig). In these experimental models, most of the imaging techniques used in clinical practice, as infra-red thermography, microwave thermography, cutaneous and tissular vascular scintigraphy (beta or gamma emitters), cutaneous blood flow measurements by cutaneous laser Doppler, x ray computed tomography, nuclear magnetic resonance imaging, and skin topography, were correlated with clinical evaluation and histopathological observations, after high doses of gamma or beta irradiations ranging from 4 to 340 Gy at the skin surface. All these techniques are not for isolated use and the present review indicates that their combination is necessary to give an improved diagnostic and prognostic picture of early and late delayed radiation damage to the skin and subcutaneous tissues.
在过去50年里发生了几起辐射事故，其中工业放射技师和其他人因意外接触辐射源而遭受严重辐射伤害。这类涉及急性局部损伤的事故的特点是，最初反应严重，从红斑发展到皮肤坏死，低剂量情况下损伤在2个月内自然消退。然而，皮肤上观察到的早期症状并不能表明其深层病理情况，皮肤和肌肉放射性坏死通常始于早期上皮、微血管和血管病变以及延迟出现的肌肉和结缔组织病变。在急性局部照射的情况下，不同的生物物理技术能够在生物剂量测定中给出实际反应。有更多的方法，尤其是成像方法，使临床医生能够评估早期损伤的程度并进行医疗干预。我们已经建立了急性局部照射的动物实验模型：猪和兔子过度暴露于192Ir工业射线照相准直源的伽马射线，猪过度暴露于90Sr-90Y准直源的贝塔射线。在这些实验模型中，临床实践中使用的大多数成像技术，如红外热成像、微波热成像、皮肤和组织血管闪烁成像（贝塔或伽马发射体）、皮肤激光多普勒测量皮肤血流、x射线计算机断层扫描、核磁共振成像和皮肤地形图，在皮肤表面接受4至340 Gy的高剂量伽马或贝塔照射后，都与临床评估和组织病理学观察相关。所有这些技术都不能单独使用，本综述表明，它们的组合对于更好地诊断和预测皮肤及皮下组织早期和晚期延迟辐射损伤的情况是必要的。
