View source for Radiation burn

{{Short description|Damage to skin or biological tissue from radiation exposure}}
{{Infobox medical condition (new)
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| synonyms        = Radiodermatitis
| image           = Fluoroscopy burn.jpg
| caption         = Ionizing radiation burn: large red patches of skin on the back and arm from multiple prolonged [[fluoroscopy]] procedures
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A '''radiation burn''' is a damage to the [[skin]] or other [[biological tissue]] and organs as an [[Radiobiology|effect of radiation]]. The radiation types of greatest concern are [[thermal radiation]], radio frequency energy, [[ultraviolet light]] and [[ionizing radiation]].

The most common type of radiation [[burn]] is a [[sunburn]] caused by UV radiation. High exposure to [[X-rays]] during diagnostic [[medical imaging]] or [[radiotherapy]] can also result in radiation burns. As the ionizing radiation interacts with [[cell (biology)|cells]] within the body—damaging them—the body responds to this damage, typically resulting in [[erythema]]—that is, redness around the damaged area. Radiation burns are often discussed in the same context as [[radiation-induced cancer]] due to the ability of ionizing radiation to interact with and damage [[DNA]], occasionally inducing a cell to become cancerous. [[Cavity magnetron]]s can be improperly used to create surface and internal burning. Depending on the [[photon]] [[energy]], [[gamma ray|gamma radiation]] can cause deep '''gamma burns''', with [[cobalt-60|<sup>60</sup>Co]] internal burns common. '''Beta burns''' tend to be shallow as [[beta particles]] are not able to penetrate deeply into a body; these burns can be similar to sunburn. [[Alpha particle]]s can cause internal '''alpha burns''' if inhaled, with external damage (if any) being limited to minor erythema.

Radiation burns can also occur with high power [[radio transmitter]]s at any frequency where the body absorbs radio frequency energy and converts it to heat.<ref>[http://www.arrl.org/news/rfsafety/ ARRL: RF Exposure Regulations News] {{webarchive|url=https://web.archive.org/web/20080517081221/http://www.arrl.org/news/rfsafety |date=2008-05-17 }}</ref> The U.S. [[Federal Communications Commission]] (FCC) considers 50 watts to be the lowest power above which radio stations must evaluate emission safety. Frequencies considered especially dangerous occur where the human body can become [[resonance|resonant]], at 35&nbsp;MHz, 70&nbsp;MHz, 80-100&nbsp;MHz, 400&nbsp;MHz, and 1&nbsp;GHz.<ref>[http://www.arrl.org/rf-radiation-and-electromagnetic-field-safety ARRL: RF Radiation and Electromagnetic Field Safety]</ref> Exposure to [[microwave]]s of too high intensity can cause [[microwave burn]]s.

== Types ==
'''Radiation dermatitis''' (also known as '''radiodermatitis''') is a [[skin disease]] associated with prolonged exposure to ionizing radiation.<ref name="Andrews" />{{rp|131–2}} Radiation dermatitis occurs to some degree in most patients receiving radiation therapy, with or without chemotherapy.<ref name="pmid17785763">{{cite journal |title=Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck |journal= Annals of Oncology|volume=19 |issue=1 |pages=142–9 |date=January 2008 |pmid=17785763 |doi=10.1093/annonc/mdm400 |url= http://www.zora.uzh.ch/13930/2/Bernier_AnnofOncol_2008V.pdf|last1=Bernier |first1=J. |last2=Bonner |first2=J |last3=Vermorken |first3=J. B. |last4=Bensadoun |first4=R.-J. |last5=Dummer |first5=R. |last6=Giralt |first6=J. |last7=Kornek |first7=G. |last8=Hartley |first8=A. |last9=Mesia |first9=R.|last10= Robert|first10= C.|last11= Segaert|first11= S.|last12= Ang|first12= K. K.|display-authors= 8|doi-access=free }}</ref>

There are three specific types of radiodermatitis: acute radiodermatitis, chronic radiodermatitis, and eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy.<ref name="Andrews" />{{rp|39–40}} Radiation therapy can also cause radiation cancer.<ref name="Andrews" />{{rp|40}}

With interventional fluoroscopy, because of the high skin [[absorbed dose|dose]]s that can be generated in the course of the intervention, some procedures have resulted in early (less than two months after exposure) and/or late (two months or more after exposure) skin reactions, including necrosis in some cases.<ref name="pmid10580952">{{cite journal |title=Severe skin reactions from interventional fluoroscopy: case report and review of the literature |journal=Radiology |volume=213 |issue=3 |pages=773–6 |date=December 1999 |pmid=10580952 |doi= 10.1148/radiology.213.3.r99dc16773|last1=Wagner |first1=LK |last2=McNeese |first2=MD |last3=Marx |first3=MV |last4=Siegel |first4=EL}}</ref>{{rp|773}}

Radiation dermatitis, in the form of intense erythema and [[blister|vesiculation]] of the skin, may be observed in radiation ports.<ref name="Andrews" />{{rp|131}}

As many as 95% of patients treated with radiation therapy for cancer will experience a skin reaction. Some reactions are immediate, while others may be later (e.g., months after treatment).<ref name="pmid12024597">{{cite journal |vauthors=Porock D, Nikoletti S, Kristjanson L |title=Management of radiation skin reactions: literature review and clinical application |journal=Plast Surg Nurs |volume=19 |issue=4 |pages=185–92, 223; quiz 191–2 |year=1999 |pmid=12024597 |doi= 10.1097/00006527-199901940-00004|url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=12024597.ui|doi-access=free }}</ref>

=== Acute ===
'''Acute radiodermatitis''' occurs when an "erythema dose" of ionizing radiation is given to the skin, after which visible erythema appears up to 24 hours after.<ref name="Andrews">{{cite book |author1=James, William D. |author2=Berger, Timothy G. |display-authors=etal |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 }}</ref>{{rp|39}}  Radiation dermatitis generally manifests within a few weeks after the start of radiotherapy.<ref name="pmid17785763"/>{{rp|143}}  Acute radiodermatitis, while presenting as red patches, may sometimes also present with [[desquamation]] or blistering.<ref name="Rapini2005">{{cite book |author=Rapini, Ronald P. |title=Practical dermatopathology |publisher=Elsevier Mosby |year=2005 |isbn=978-0-323-01198-3 }}</ref>  Erythema may occur at a dose of 2&nbsp;[[Gray (unit)|Gy]] radiation or greater.<ref name="pmid11459599">{{cite journal |author=Valentin J |title=Avoidance of radiation injuries from medical interventional procedures |journal=Ann ICRP |volume=30 |issue=2 |pages=7–67 |year=2000 |pmid=11459599 |doi= 10.1016/S0146-6453(01)00004-5|s2cid=70923586 |doi-access=free }}</ref>

=== Chronic ===
[[File:Sequeira Plate 7.jpg|thumb|Chronic radiodermatitis on the neck and jaw from X-ray exposure]]
'''Chronic radiodermatitis''' occurs with chronic exposure to "sub-erythema" doses of ionizing radiation over a prolonged period, producing varying degrees of damage to the skin and its underlying parts after a variable latent period of several months to several decades.<ref name="Andrews"/>{{rp|40}}  In the past this type of radiation reaction occurred most frequently in [[radiologist]]s and [[radiographer]]s who were constantly exposed to ionizing radiation, especially before the use of [[X-ray filter]]s.<ref name="Andrews" />{{rp|40}}  Chronic radiodermatitis, squamous and
basal cell carcinomas may develop months to years after radiation exposure.<ref name="Rapini2005"/>{{rp|130}}<ref name="pmid10026359">{{cite journal |vauthors=Dehen L, Vilmer C, Humilière C |display-authors=etal |title=Chronic radiodermatitis following cardiac catheterisation: a report of two cases and a brief review of the literature |journal=Heart |volume=81 |issue=3 |pages=308–12 |date=March 1999 |pmid=10026359 |pmc=1728981 |doi= 10.1136/hrt.81.3.308 }}</ref>  Chronic radiodermatitis presents as atrophic indurated plaques, often whitish or yellowish, with telangiectasia, sometimes with [[hyperkeratosis]].<ref name="Rapini2005"/>{{rp|130}}

=== Other ===
'''Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy''' is a skin condition that occurs most often in women receiving cobalt radiotherapy for internal cancer.<ref name="Andrews"/>{{rp|39–40}}

'''Radiation-induced [[erythema multiforme]]''' may occur when [[phenytoin]] is given prophylactically to neurosurgical patients who are receiving whole-brain therapy and systemic steroids.<ref name="Andrews"/>{{rp|130}}

=== Delayed effects===
'''Radiation acne''' is a cutaneous condition characterized by comedo-like [[papule]]s occurring at sites of previous exposure to therapeutic ionizing radiation, skin lesions that begin to appear as the acute phase of radiation dermatitis begins to resolve.<ref name="Bolognia">{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}</ref>{{rp|501}}

'''Radiation recall reactions''' occur months to years after radiation treatment, a reaction that follows recent administration of a chemotherapeutic agent and occurs with the prior radiation port, characterized by features of radiation dermatitis.<ref name="Andrews"/><ref>Hird AE, Wilson J, Symons S, Sinclair E, Davis M, Chow E. Radiation recall dermatitis: case report and review of the literature. Current Oncology. 2008 February; 15(1):53-62.</ref>  Restated, radiation recall dermatitis is an inflammatory skin reaction that occurs in a previously irradiated body part following drug administration.<ref name="pmid17110631">{{ cite journal |author1=Ayoola, A. |author2=Lee, Y. J. | title = Radiation recall dermatitis with cefotetan: a case study | journal = The Oncologist | volume = 11 | issue = 10 | pages = 1118–1120 | year = 2006 | pmid = 17110631 | doi = 10.1634/theoncologist.11-10-1118 |s2cid=10211887 | doi-access = free }}</ref>  There does not appear to be a minimum dose, nor an established radiotherapy dose relationship.<ref name="pmid17110631"/>

== Alpha burns ==
'''"Alpha burns"''' are caused by [[alpha particle]]s, which can cause extensive tissue damage if inhaled.<ref>{{cite journal
|title=Radiation injury |journal = Indian Journal of Plastic Surgery |volume = 43|issue = Suppl|pages = S91–S93|pmc = 3038400|year = 2010|last1 = Bhattacharya|first1 = S.|doi = 10.1055/s-0039-1699465 |pmid = 21321665}}</ref> Due to the keratin in the [[Epidermis|epidermal layer]] of the skin, external alpha burns are limited to only mild reddening of the outermost layer of skin.<ref>{{cite web
|url=http://www.rri.kyoto-u.ac.jp/NSRG/reports/kr139/pdf/kr139.pdf |title=Multi-side Approach to the Realities of the Chernobyl NPP Accident |access-date=May 16, 2019 |publisher=[[Kyoto University|Kyoto University, Research Reactor Institute]] }}</ref>

== Beta burns ==
'''"Beta burns"'''—caused by [[beta particle]]s—are shallow surface burns, usually of skin and less often of [[lung]]s or [[gastrointestinal tract]], caused by beta particles, typically from [[hot particle]]s or dissolved [[radionuclide]]s that came to direct contact with or close proximity to the body. They can appear similar to sunburn. Unlike gamma rays, beta emissions are stopped much more effectively by materials and therefore deposit all their energy in only a shallow layer of tissue, causing more intense but more localized damage. On cellular level, the changes in skin are similar to radiodermatitis.

The dose is influenced by relatively low penetration of beta emissions through materials. The [[Keratin#Cornification|cornified]] [[keratine]] layer of [[epidermis (skin)|epidermis]] has enough stopping power to absorb beta radiation with energies lower than 70&nbsp;keV. Further protection is provided by clothing, especially shoes. The dose is further reduced by limited retention of radioactive particles on skin; a 1 millimeter particle is typically released in 2 hours, while a 50 micrometer particle usually does not adhere for more than 7 hours. Beta emissions are also severely attenuated by air; their range generally does not exceed {{convert|6|ft|m}} and intensity rapidly diminishes with distance.<ref name="medmagrad">{{cite book|url=https://books.google.com/books?id=Y-k5h07NkFcC&q=%22beta+burns%22&pg=PA77 |title=Medical management of radiation accidents|author1=Igor A. Gusev |author2=Angelina Konstantinovna Guskova |author3=Fred Albert Mettler |page=77|publisher=CRC Press|year=2001|isbn=978-0-8493-7004-5}}</ref>

The [[eye lens]] seems to be the most sensitive organ to beta radiation,<ref>{{cite book|url=https://books.google.com/books?id=OqbAS0E_b3QC&q=%22beta+burns%22&pg=PA305 |page=35|title=Security Manager's Guide to Disasters: Managing Through Emergencies, Violence, and Other Workplace Threats|author=Anthony Manley|publisher=CRC Press|year=2009|isbn=978-1-4398-0906-8}}</ref> even in doses far below maximum permissible dose. [[Safety goggles]] are recommended to attenuate strong beta.<ref name="google1">{{cite book|url=https://books.google.com/books?id=k90iAnFereYC&q=beta+radiation+energies+isotopes&pg=PA36|page=36|title=Isotopes in the Earth Sciences|author1=H. -G. Attendorn |author2=Robert Bowen |publisher=Springer|year=1988|isbn=978-0-412-53710-3}}</ref>

Careful washing of exposed body surface, removing the radioactive particles, may provide significant dose reduction. Exchanging or at least brushing off clothes also provides a degree of protection.

If the exposure to beta radiation is intense, the beta burns may first manifest in 24–48 hours by itching and/or burning sensation that last for one or two days, sometimes accompanied by [[hyperaemia]]. After 1–3 weeks burn symptoms appear; erythema, increased [[skin pigmentation]] (dark colored patches and raised areas), followed by [[epilation]] and [[skin lesion]]s. Erythema occurs after 5–15&nbsp;[[gray (unit)|Gy]], dry desquamation after 17&nbsp;Gy, and [[bullous]] [[epidermitis]] after 72&nbsp;Gy.<ref name="medmagrad"/> [[Chronic radiation keratosis]] may develop after higher doses. Primary erythema lasting more than 72 hours is an indication of injury severe enough to cause chronic radiation dermatitis. Edema of [[dermal papillae]], if present within 48 hours since the exposition, is followed by transepidermal [[necrosis]]. After higher doses, the [[malpighian layer]] cells die within 24 hours; lower doses may take 10–14 days to show dead cells.<ref>{{cite book|url=https://books.google.com/books?id=8fXzJrDfFgUC&q=fallout+particles+morphology&pg=PA690 |title=Veterinary pathology|page=690|author1=Thomas Carlyle Jones |author2=Ronald Duncan Hunt |author3=Norval W. King |publisher=Wiley-Blackwell|year=1997|isbn=978-0-683-04481-2}}</ref> Inhalation of beta radioactive isotopes may cause beta burns of lungs and [[nasopharyngeal]] region, ingestion may lead to burns of gastrointestinal tract; the latter being a risk especially for [[grazing]] animals.

* In first degree beta burns the damage is largely limited to epidermis. Dry or wet desquamation occurs; dry [[Wound healing#Proliferative phase|scabs]] are formed, then heal rapidly, leaving a depigmented area surrounded with irregular area of increased pigmentation. The skin pigmentation returns to normal within several weeks.
* Second degree beta burns lead to formation of [[blister]]s.
* Third and fourth degree beta burns result in deeper, wet [[Ulcer (dermatology)|ulcer]]ated lesions, which heal with routine medical care after covering themselves with dry scab. In case of heavy tissue damage, ulcerated necrotic [[dermatitis]] may occur. Pigmentation may return to normal within several months after wound healing.<ref name="medmagrad"/>

Lost hair begins regrowing in nine weeks and is completely restored in about half a year.<ref>{{cite book|url=https://books.google.com/books?id=JelgwgVx-P0C&q=%22beta+burns%22&pg=PA125 |title=Nuclear, Biological and Chemical Warfare|author1=K. Bhushan |author2=G. Katyal |page=125|publisher=APH Publishing|year=2002|isbn=978-81-7648-312-4}}</ref>

The acute dose-dependent effects of beta radiation on skin are as follows:<ref name="nuchandb"/>
{|class="wikitable"
| 0–6&nbsp;Gy
| no acute effect
|-
| 6–20&nbsp;Gy
| moderate early erythema
|-
| 20–40&nbsp;Gy
| early erythema in 24 hours, [[skin breakdown]] in 2 weeks
|-
| 40–100&nbsp;Gy
| severe erythema in less than 24 hours
|-
| 100–150&nbsp;Gy
| severe erythema in less than 4 hours, skin breakdown in 1–2 weeks
|-
| 150–1000&nbsp;Gy
| blistering immediate or up to 1 day
|}

According to other source:<ref>[http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/NucEventPrepWS/METTLERIOMNuclearWorkshop1.ashx Medical decision making and care of casualties from delayed effects of a nuclear detonation]{{dead link|date=January 2018 |bot=InternetArchiveBot |fix-attempted=yes }}, Fred A. Mettler Jr., New Mexico Federal Regional Medical Center</ref>

{|class="wikitable"
| 2–6&nbsp;Gy
| transient erythema 2–24 h
|-
| 3–5&nbsp;Gy
| dry desquamation in 3–6 weeks
|-
| 3–4&nbsp;Gy
| temporary epilation in 3 weeks
|-
| 10–15&nbsp;Gy
| erythema 18–20 days
|-
| 15–20&nbsp;Gy
| moist desquamation
|-
| 25&nbsp;Gy
| ulceration with slow healing
|-
| 30–50&nbsp;Gy
| blistering, necrosis in 3 weeks
|-
| 100&nbsp;Gy
| blistering, necrosis in 1–3 weeks
|}

As shown, the dose thresholds for symptoms vary by source and even individually. In practice, determining the exact dose tends to be difficult.

Similar effects apply to animals, with fur acting as additional factor for both increased particle retention and partial skin shielding. Unshorn thickly wooled sheep are well protected; while the epilation threshold for sheared sheep is between 23 and 47&nbsp;Gy (2500–5000 [[Roentgen equivalent physical|rep]]) and the threshold for normally wooled face is 47–93&nbsp;Gy (5000–10000 rep), for thickly wooled (33&nbsp;mm hair length) sheep it is 93–140&nbsp;Gy (10000–15000 rep). To produce skin lesions comparable with [[orf (disease)|contagious pustular dermatitis]], the estimated dose is between 465 and 1395&nbsp;Gy.<ref>{{cite book|url=https://books.google.com/books?id=gzsrAAAAYAAJ&q=%22beta+burns%22+plants&pg=PA224 |title=A guide to environmental research on animals|author=National Research Council (U.S.). Committee on Physiological Effects of Environmental Factors on Animals|page=224 |publisher=National Academies|year=1971 |isbn=9780309018692}}</ref>

=== Energy vs penetration depth ===
{{Medium-lived fission products}}
The effects depend on both the intensity and the energy of the radiation. Low-energy beta (sulfur-35, 170&nbsp;keV) produces shallow ulcers with little damage to dermis, while [[cobalt-60]] (310&nbsp;keV), [[caesium-137]] (550&nbsp;keV), [[phosphorus-32]] (1.71&nbsp;MeV), [[strontium-90]] (650&nbsp;keV) and its daughter product [[yttrium-90]] (2.3&nbsp;MeV) damage deeper levels of the [[dermis]] and can result in [[Chronic (medicine)|chronic]] radiation dermatitis. Very high energies from [[electron beam]]s from [[particle accelerator]]s, reaching tens of megaelectronvolts, can be deeply penetrating. Conversely, megavolt-scale beams can deposit their energy deeper with less damage to the dermis; modern radiotherapy electron beam accelerators take advantage of this. At yet higher energies, above 16&nbsp;MeV, the effect does not show significantly anymore, limiting the usefulness of higher energies for radiotherapy. As a convention, surface is defined as the topmost 0.5&nbsp;mm of skin.<ref>{{cite book|url=https://books.google.com/books?id=v68J1dgCEn8C&q=radiotherapy+electron+beam+penetration+depth+mev&pg=PA522|page=522 |title=Handbook of radiotherapy physics: theory and practice|author1=Philip Mayles |author2=Alan E. Nahum |author3=Jean-Claude Rosenwald |publisher=CRC Press|year=2007|isbn=978-0-7503-0860-1}}</ref> High-energy beta emissions should be shielded with plastic instead of lead, as [[heavy metal (chemistry)|high-Z]] elements generate deeply penetrating gamma [[bremsstrahlung]].

The electron energies from [[beta decay]] are not discrete but form a continuous spectrum with a cutoff at maximum energy. The rest of the energy of each decay is carried off by an [[antineutrino]] which does not significantly interact and therefore does not contribute to the dose. Most energies of beta emissions are at about a third of the maximum energy.<ref name="google1"/> Beta emissions have much lower energies than what is achievable from particle accelerators, no more than few megaelectronvolts.

The energy-depth-dose profile is a curve starting with a surface dose, ascending to the maximum dose in a certain depth d<sub>m</sub> (usually normalized as 100% dose), then descends slowly through depths of 90% dose (d<sub>90</sub>) and 80% dose (d<sub>80</sub>), then falls off linearly and relatively sharply though depth of 50% dose (d<sub>50</sub>). The extrapolation of this linear part of the curve to zero defines the maximum electron range, R<sub>p</sub>. In practice, there is a long tail of weaker but deep dose, called "bremsstrahlung tail", attributable to [[bremsstrahlung]]. The penetration depth depends also on beam shape, narrower beam tend to have less penetration. In water, broad electron beams, as is the case in homogeneous surface contamination of skin, have d<sub>80</sub> about E/3&nbsp;cm and R<sub>p</sub> about E/2&nbsp;cm, where E is the beta particle energy in MeV.<ref name="cliradphys">{{cite book|url=https://books.google.com/books?id=y3s0mI_BmZ4C&q=accelerator+burns+electron&pg=PA328|page=328 |title=Handbook of urology: diagnosis and therapy|author1=Mike Benjamin Siroky |author2=Robert D. Oates |author3=Richard K. Babayan |publisher=Lippincott Williams & Wilkins|year=2004|isbn=978-0-7817-4221-4}}</ref>

The penetration depth of lower-energy beta in water (and soft tissues) is about 2&nbsp;mm/MeV. For a 2.3&nbsp;MeV beta the maximum depth in water is 11&nbsp;mm, for 1.1&nbsp;MeV it is 4.6&nbsp;mm. The depth where maximum of the energy is deposited is significantly lower.<ref>{{cite book|url=http://www.fas.harvard.edu/~scidemos/QuantumRelativity/PenetrationandShielding/PenetrationandShielding.html |title=α, β, γ Penetration and Shielding |publisher=Fas.harvard.edu }}</ref>

The energy and penetration depth of several isotopes is as follows:<ref>[http://ehs.whoi.edu/ehs/radsafety/isotope.pdf Isotope Safety Data Sheets]</ref>
{| class="wikitable"
|-
! [[Isotope]]
! Half-life
! [[Specific activity]]<br/>([[becquerel|TBq]]/g)
! Avg.<br/>({{abbr|keV|Kiloelectronvolt}})
! Max.<br/>({{abbr|keV|Kiloelectronvolt}})
! In air<br/>(mm)
! In tissue<br/>(mm)
! Comments
|-
| [[Tritium]]
| 12.3 years
| 357
| 5.7
| 18.6
| 6
! 0.006
| no beta passes the dead layer of skin; however, tritium and its compounds may diffuse through skin
|-
| [[Carbon-14]]
| 5730 years
| 0.165
| 49
| 156
| 240
! 0.28
| about 1% of beta passes through the dead layer of skin
|-
| [[Sulfur-35]]
| 87.44 days
| 1580
| 48.8
| 167.47
| 260
! 0.32
| 
|-
| [[Phosphorus-33]]
| 25.3 days
| 5780
| 76.4
| 248.5
| 500
! 0.6
| 
|-
| [[Phosphorus-32]]
| 14.29 days
| 10600
| 695
| 1710
| 6100
! 7.6
| risk of ''Bremsstrahlung'' if improperly shielded
|}

For a wide beam, the depth-energy relation for dose ranges is as follows, for energies in [[megaelectronvolt]]s and depths in millimeters. The dependence of surface dose and penetration depth on beam energy is clearly visible.<ref name="cliradphys"/>
{|class="wikitable"
|-
! {{abbr|MeV|Megaelectronvolts}}
! Surface<br/>dose %
! Max.<br/>depth
! 90%
! 80%
! 50%
! 10%
! R<sub>p</sub>
|-
| 5
| 74%
| 9
| 12
| 14
| 17
| 22
| 23
|-
| 7
| 76%
| 16
| 20
| 22
| 27
| 33
| 34
|-
| 10
| 82%
| 24
| 31
| 34
| 39
| 48
| 49
|-
| 13
| 88%
| 32
| 40
| 43
| 51
| 61
| 64
|-
| 16
| 93%
| 34
| 51
| 56
| 65
| 80
| 80
|-
| 19
| 94%
| 26–36
| 59
| 67
| 78
| 95
| 95
|-
| 22
| 96%
| 26–36
| 65
| 76
| 93
| 113
| 114
|-
| 25
| 96%
| 26–36
| 65
| 80
| 101
| 124
| 124
|}

== Causes ==
Radiation burns are caused by exposure to high levels of radiation. Levels high enough to cause burn are generally lethal if received as a whole-body dose, whereas they may be treatable if received as a shallow or local dose.

=== Medical imaging ===
[[Fluoroscopy]] may cause burns if performed repeatedly or for too long.<ref name="Bolognia"/>

Similarly, X-ray [[Computed Tomography|computed tomography]] and traditional [[Projectional Radiography|projectional radiography]] have the potential to cause radiation burns if the exposure factors and exposure time are not appropriately controlled by the operator.

A study of radiation-induced skin injuries<ref>{{ cite web | url = https://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm116682.htm | archive-url = https://web.archive.org/web/20090710074455/http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm116682.htm | url-status = dead | archive-date = July 10, 2009 | author = Shope, T. B. | title = Radiation-induced Skin Injuries from Fluoroscopy | publisher = FDA / Center for Devices and Radiological Health | year = 1995 }}</ref><ref>{{Cite journal | last1 = Shope | first1 = T. B. | title = Radiation-induced skin injuries from fluoroscopy | journal = Radiographics | volume = 16 | issue = 5 | pages = 1195–1199 | year = 1996 | pmid = 8888398| doi=10.1148/radiographics.16.5.8888398}}</ref> has been performed by the [[Food and Drug Administration]] (FDA) based on results from 1994,<ref>{{Cite journal | last1 = Wagner | first1 = L. K. | last2 = Eifel | first2 = P. J. | last3 = Geise | first3 = R. A. | title = Potential biological effects following high X-ray dose interventional procedures | journal = Journal of Vascular and Interventional Radiology | volume = 5 | issue = 1 | pages = 71–84 | year = 1994 | pmid = 8136601 | doi=10.1016/s1051-0443(94)71456-1}}</ref> followed by an advisory to minimize further fluoroscopy-induced injuries.<ref>{{ cite web | url = https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/UCM063084 | archive-url = https://web.archive.org/web/20100214084220/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/UCM063084 | url-status = dead | archive-date = February 14, 2010 | title = FDA Public Health Advisory: Avoidance of Serious X-Ray-Induced Skin Injuries to Patients During Fluoroscopically-Guided Procedures | publisher = FDA / Center for Devices and Radiological Health | date = September 30, 1994 }}</ref> The problem of radiation injuries due to fluoroscopy has been further investigated in review articles in 2000,<ref>{{Cite journal | last1 = Valentin | first1 = J. | title = Avoidance of radiation injuries from medical interventional procedures | journal = Annals of the ICRP | volume = 30 | issue = 2 | pages = 7–67 | year = 2000 | pmid = 11459599| doi = 10.1016/S0146-6453(01)00004-5| s2cid = 70923586 | doi-access = free }}</ref> 2001,<ref>{{Cite journal | last1 = Vano     | first1 = E. | last2 = Goicolea | first2 = J. | last3 = Galvan   | first3 = C. | last4 = Gonzalez | first4 = L. | last5 = Meiggs   | first5 = L. | last6 = Ten      | first6 = J. I. | last7 = Macaya   | first7 = C. | title = Skin radiation injuries in patients following repeated coronary angioplasty procedures | journal = The British Journal of Radiology | volume = 74 | issue = 887 | pages = 1023–1031 | year = 2001 | pmid = 11709468| doi=10.1259/bjr.74.887.741023}}</ref><ref>{{Cite journal | last1 = Koenig | first1 = T. R. | last2 = Mettler | first2 = F. A. | last3 = Wagner | first3 = L. K. | title = Skin injuries from fluoroscopically guided procedures: Part 2, review of 73 cases and recommendations for minimizing dose delivered to patient | journal = AJR. American Journal of Roentgenology | volume = 177 | issue = 1 | pages = 13–20 | year = 2001 | pmid = 11418390| doi=10.2214/ajr.177.1.1770013}}</ref> 2009<ref>{{Cite journal | last1 = Ukisu | first1 = R. | last2 = Kushihashi | first2 = T. | last3 = Soh | first3 = I. | doi = 10.2214/AJR.07.7140 | title = Skin Injuries Caused by Fluoroscopically Guided Interventional Procedures: Case-Based Review and Self-Assessment Module | journal = American Journal of Roentgenology | volume = 193 | issue = 6_Supplement | pages = S59–S69 | year = 2009 | pmid = 19933677 }}</ref> and 2010.<ref>{{Cite journal | doi = 10.1269/jrr.09112 | last1 = Chida | first1 = K. | last2 = Kato | first2 = M. | last3 = Kagaya | first3 = Y. | last4 = Zuguchi | first4 = M. | last5 = Saito | first5 = H. | last6 = Ishibashi | first6 = T. | last7 = Takahashi | first7 = S. | last8 = Yamada | first8 = S. | last9 = Takai | first9 = Y. | title = Radiation dose and radiation protection for patients and physicians during interventional procedure | journal = Journal of Radiation Research | volume = 51 | issue = 2 | pages = 97–105 | year = 2010 | pmid = 20339253 | bibcode = 2010JRadR..51...97C | doi-access = free }}</ref><ref>{{Cite journal | last1 = Balter   | first1 = S. | last2 = Hopewell | first2 = J. W. | last3 = Miller   | first3 = D. L. | last4 = Wagner   | first4 = L. K. | last5 = Zelefsky | first5 = M. J. | title = Fluoroscopically Guided Interventional Procedures: A Review of Radiation Effects on Patients' Skin and Hair | doi = 10.1148/radiol.2542082312 | journal = Radiology | volume = 254 | issue = 2 | pages = 326–341 | year = 2010 | pmid = 20093507 | doi-access =  }}</ref><ref>{{Cite journal | last1 = Miller | first1 = D. L. | last2 = Balter | first2 = S. | last3 = Schueler | first3 = B. A. | last4 = Wagner | first4 = L. K. | last5 = Strauss | first5 = K. J. | last6 = Vano | first6 = E. | doi = 10.1148/radiol.10091269 | title = Clinical Radiation Management for Fluoroscopically Guided Interventional Procedures | journal = Radiology | volume = 257 | issue = 2 | pages = 321–332 | year = 2010 | pmid = 20959547 | doi-access =  }}</ref>

=== Radioactive fallout ===
Beta burns are frequently the result of exposure to [[radioactive fallout]] after [[nuclear explosion]]s or [[nuclear accident]]s. Shortly after the explosion, the [[fission product]]s have very high beta activity, with about two beta emissions per each gamma photon.

After the [[Trinity test]], the fallout caused localized burns on the backs of [[cattle]] in the area downwind.<ref name="massburns">{{cite book|url=https://books.google.com/books?id=sDQrAAAAYAAJ&q=%22beta+burns%22&pg=PA248 |page=248|title=Mass burns: proceedings of a workshop, 13–14 March 1968|author=National Research Council (U.S.). Committee on Fire Research, United States. Office of Civil Defense|publisher=National Academies|year=1969}}</ref> The fallout had the appearance of small flaky dust particles. The cattle showed temporary burns, bleeding, and loss of hair. Dogs were also affected; in addition to localized burns on their backs, they also had burned paws, likely from the particles lodged between their toes as hoofed animals did not show problems with feet. About 350–600 cattle were affected by superficial burns and localized temporary loss of dorsal hair; the army later bought 75 most affected cows as the discolored regrown hair lowered their market value.<ref>{{cite book|url=https://archive.org/details/dragonstailradia0000hack|url-access=registration|quote=beta burns.|page=[https://archive.org/details/dragonstailradia0000hack/page/105 105] |title=The dragon's tail: radiation safety in the Manhattan Project, 1942–1946|author=Barton C. Hacker|publisher=University of California Press|year=1987|isbn=978-0-520-05852-1}}</ref> The cows were shipped to Los Alamos and Oak Ridge, where they were observed. They healed, now sporting large patches of white fur; some looked as if they had been scalded.<ref>{{cite book|url=https://books.google.com/books?id=ES9HmzCXPrwC&q=%22beta+burns%22&pg=PA134|page=134 |title=The day the sun rose twice: the story of the Trinity Site nuclear explosion, July 16, 1945|author=Ferenc Morton Szasz|publisher=UNM Press|year=1984|isbn=978-0-8263-0768-2}}</ref>

The fallout produced by the [[Castle Bravo]] test was unexpectedly strong. A white snow-like dust, nicknamed by the scientists "Bikini snow" and consisting of contaminated crushed [[calcined]] [[coral]], fell for about 12 hours upon the [[Rongelap Atoll]], depositing a layer of up to 2&nbsp;cm. Residents developed beta burns, mostly on the backs of their necks and on their feet,<ref name="massburns"/> and were resettled after three days. After 24–48 hours their skin was itching and burning; in a day or two the sensations subsided, to be followed after 2–3 weeks by epilation and ulcers. Darker-colored patches and raised areas appeared on their skin, blistering was uncommon. Ulcers formed dry scabs and healed. Deeper lesions, painful, weeping and ulcerated, formed on more contaminated residents; the majority healed with simple treatment. In general, the beta burns healed with some cutaneous [[scarring]] and depigmentation. Individuals who bathed and washed the fallout particles from their skin did not develop skin lesions.<ref name="nuchandb">{{cite book|url=https://books.google.com/books?id=CAUYAAAAYAAJ&q=%22beta+burns%22&pg=PA18 |title=Nuclear handbook for medical service personnel|author=United States. Dept. of the Army|page=18|year=1990}}</ref> The fishing ship [[Daigo Fukuryu Maru]] was affected by the fallout as well; the crew suffered skin doses between 1.7 and 6.0&nbsp;Gy, with beta burns manifesting as severe skin lesions, erythema, [[erosion (dermatopathology)|erosions]], sometimes necrosis, and skin [[atrophy]]. Twenty-three U.S. radar servicemen of the 28-member weather station on [[Rongerik]]<ref>{{cite book|url=https://books.google.com/books?id=cr81ZHY-6H0C&q=%22beta+burns%22&pg=PA29|page=29 |title=America's nuclear legacy|author=Wayne D. LeBaron|publisher=Nova Publishers|year=1998|isbn=978-1-56072-556-5}}</ref><!-- mixing two sources together. are both the same? --> were affected, experiencing discrete 1–4&nbsp;mm skin lesions which healed quickly, and ridging of [[fingernail]]s several months later. Sixteen crew members of the aircraft carrier {{USS|Bairoko|CVE-115|6}} received beta burns, and there was an increased cancer rate.<ref name="medmagrad"/>

During the Zebra test of the [[Operation Sandstone]] in 1948, three men had beta burns on their hands when removing sample collection filters from [[unmanned aerial vehicle|drones]] flying through the [[mushroom cloud]]; their estimated skin surface dose was 28 to 149&nbsp;Gy, and their disfigured hands required [[skin graft]]s. A fourth man showed weaker burns after the earlier Yoke test.<ref name="elemcontr">{{cite book|url=https://books.google.com/books?id=uKp3ridsHrYC&q=%22beta+burns%22&pg=PA107 |title=Elements of controversy: the Atomic Energy Commission and radiation safety in nuclear weapons testing, 1947–1974|author=Barton C. Hacker|publisher=University of California Press|year= 1994|isbn=978-0-520-08323-3}}</ref>

The [[Upshot-Knothole Harry|Upshot–Knothole Harry]] test at the [[Frenchman Flat]] site released a large amount of fallout. A significant number of sheep died after grazing on contaminated areas. The [[United States Atomic Energy Commission|AEC]] however had a policy to compensate farmers only for animals showing external beta burns, so many claims were denied. Other tests on the Nevada Test Site also caused fallout and corresponding beta burns to sheep, horses and cattle.<ref>{{cite book|url=https://books.google.com/books?id=eQfG-U5iAPYC&q=%22beta+burns%22&pg=PA65 |page=65|title=Bombs in the backyard: atomic testing and American politics|author=A. Costandina Titus|publisher=University of Nevada Press|year=2001|isbn=978-0-87417-370-3}}</ref> During the [[Operation Upshot–Knothole]], sheep as far as {{convert|50|mi|km}} from the test site developed beta burns to their backs and nostrils.<ref name="elemcontr"/>

During [[Underground nuclear weapons testing|underground nuclear testing]] in Nevada, several workers developed burns and skin ulcers, in part attributed to exposure to [[tritium]].<ref name="radhorm">{{cite book|url=https://books.google.com/books?id=FK7EayQN9dYC&q=%22beta+burns%22&pg=PA143|page=143 |title=Radiation hormesis|author=Thomas D. Luckey|publisher=CRC Press|year=1991|isbn=978-0-8493-6159-3}}</ref>

=== Nuclear accidents ===
Beta burns were a serious medical issue for some victims of the [[Chernobyl disaster]]; from 115 patients treated in Moscow, 30% had burns covering 10–50% of body surface, 11% were affected on 50–100% of skin; the massive exposure was often caused by clothes drenched with radioactive water. Some firefighters developed beta burns of lungs and nasopharyngeal region after inhalation of massive amounts of radioactive [[smoke]]. Out of 28 deaths, 16 had skin injuries listed among the causes. The beta activity was extremely high, with beta/gamma ratio reaching 10–30 {{clarify|date=June 2019}} and beta energy high enough to damage [[basal layer]] of the skin, resulting in large area portals for [[infection]]s, exacerbated by damage to [[bone marrow]] and weakened [[immune system]]. Some patients received skin dose of 400–500&nbsp;Gy. The infections caused more than half of the acute deaths. Several died of fourth degree beta burns between 9–28 days after dose of 6–16&nbsp;Gy. Seven died after dose of 4–6&nbsp;Gy and third degree beta burns in 4–6 weeks. One died later from second degree beta burns and dose 1-4&nbsp;Gy.<ref name="radhorm"/> The survivors have atrophied skin which is [[telangiectasia|spider veined]] and with underlying [[fibrosis]].<ref name="medmagrad"/>

The burns may manifest at different times at different body areas. The [[Chernobyl liquidators]]' burns first appeared on wrists, face, neck and feet, followed by chest and back, then by knees, hips and buttocks.<ref>{{cite book|url=https://books.google.com/books?id=qKPofdNV2C8C&q=%22beta+burns%22&pg=PA174|page=174 |title=Bioterrorism: psychological and public health interventions|author1=Robert J. Ursano |author2=Ann E. Norwood |author3=Carol S. Fullerton |publisher=Cambridge University Press|year=2004|isbn=978-0-521-81472-0}}</ref>

[[Industrial radiography]] sources are a common source of beta burns in workers.

Radiation therapy sources can cause beta burns during exposure of the patients. The sources can be also lost and mishandled, as in the [[Goiânia accident]], during which several people had external beta burns and more serious gamma burns, and several died. Numerous accidents also occur during radiotherapy due to equipment failures, operator errors, or wrong dosage.

Electron beam sources and particle accelerators can be also sources of beta burns.<ref>{{cite journal|pmid=7396251|journal=Annals of Emergency Medicine|year=1980|volume=9|title=Accidental beta radiation burns from an electron accelerator|vauthors=Burguieres TH, Stair T, Rolnick MA, Mossman KL |issue=7|doi=10.1016/S0196-0644(80)80115-6|pages=371–3}}</ref> The burns may be fairly deep and require skin grafts, tissue [[Segmental resection|resection]] or even [[amputation]] of fingers or limbs.<ref>{{cite journal|title=High Energy Electron Injury from Accelerator Machines (Cathode Rays): Radiation Burns of Chest Wall and Neck: 17-Year Follow Up of Atomic Burns|author=J. B. Brown|year=1965|pmc=1476928|pmid=5318671|volume=162|issue=3|pages=426–37|journal=Annals of Surgery|doi=10.1097/00000658-196509000-00012|last2=Fryer|first2=MP}}</ref>

== Treatment ==
Radiation burns should be covered by a clean, dry dressing as soon as possible to prevent infection.  Wet dressings are not recommended.<ref>{{cite book|url=https://books.google.com/books?id=CAUYAAAAYAAJ&q=%22beta+burns%22&pg=PA18|title=Nuclear handbook for medical service personnel|author1=Of The Army, United States. Dept|year=1982}}</ref> The presence of combined injury (exposure to radiation plus trauma or radiation burn) increases the likelihood of generalized sepsis.<ref>{{cite journal |vauthors=Palmer JL, Deburghgraeve CR, Bird MD, Hauer-Jensen M, Kovacs EJ | title = Development of a combined radiation and burn injury model | journal = J Burn Care Res | year = 2011 | volume = 32 | pages = 317–23 | doi = 10.1097/BCR.0b013e31820aafa9 | pmid = 21233728 | issue = 2 | pmc = 3062624}}</ref> This requires [[Treatment of infections after exposure to ionizing radiation|administration of systemic antimicrobial]] therapy.<ref>{{cite journal | pmid = 15080238 | year = 2004 | last1 = Brook | first1 = I | last2 = Elliott | first2 = TB | last3 = Ledney | first3 = GD | last4 = Shoemaker | first4 = MO | last5 = Knudson | first5 = GB | title = Management of postirradiation infection: Lessons learned from animal models | volume = 169 | issue = 3 | pages = 194–7 | journal = Military Medicine| doi = 10.7205/MILMED.169.3.194 | doi-access = free }}</ref>

== See also ==
*[[Effective radiated power]]
*[[Radiation poisoning]]
*[[Radiation protection]]
*[[Therac-25]]

== References ==
{{Reflist}}

== External links ==

{{Commons category|Radiation burns}}
{{Medical resources
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|  ICD10       = {{ICD10|L|58||l|55}} 
|  ICD9        = {{ICD9|692.82}} 
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|  eMedicineSubj  =  
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}}
*[http://www.arrl.org/rf-exposure ARRL: RF Exposure Safety]
*[http://www.fcc.gov/oet/rfsafety/rf-faqs.html FCC: Radio Frequency Safety FAQ]

{{Radiation-related disorders}}
{{Consequences of external causes}}
{{Portal bar|Nuclear technology|Medicine}}
{{Authority control}}

[[Category:Burns]]
[[Category:Ionizing radiation-induced cutaneous conditions]]
[[Category:Radiation therapy]]
[[Category:Sun tanning]]