Intended for healthcare professionals

Clinical Review

Medical response to radiation incidents and radionuclear threats

BMJ 2004; 328 doi: (Published 04 March 2004) Cite this as: BMJ 2004;328:568
  1. István Turai, medical officer (,
  2. Katalin Veress, senior lecturer2,
  3. Bengül Günalp, associate professor3,
  4. Gennadi Souchkevitch, deputy director4
  1. 1 Department of Protection of the Human Environment, World Health Organization, Geneva 27, CH-1211, Switzerland
  2. 2 Department of Public Health, Semmelweis University, Budapest, Hungary,
  3. 3 Department of Nuclear Medicine, Gülhane Medical Academy, Ankara, Turkey,
  4. 4 Institute of Pathology and Pathophysiology, Moscow, Russia
  1. Correspondence to: I Turai
  • Accepted 22 December 2003

Events that expose people to radiation are rare, but the threat of radiation injury is increasing. Doctors should know how to recognise and manage suspected exposure or contamination


After the attacks of 11 September 2001, use of sources of radiation by terrorists with the potential to cause human damage has become a greater threat.14 Various professionals have discussed whether malevolent use of these sources could result in radiation sickness or radiation injuries on a large scale and the possible results.57 Radiation sickness is the acute or delayed consequences of exposure of the whole body or a large part to high doses of ionising radiation capable of causing a set of non-specific clinical symptoms and haematological changes. Radiation injury is the acute or delayed consequences of exposure of a small part of the body to high doses of ionising radiation capable of causing burns or other localised organ pathology—for example, cataract, hypothyreosis, and pneumonia.

Responses to recent incidents involving radiation indicate that most general practitioners are uncertain about the health consequences of exposure to ionising radiation and the medical management of exposed patients.810

Clinical manifestations of pathological changes depend on the size of the exposed area of the body. The severity of symptoms depends on the absorbed dose of radiation by the exposed area of the body.

The medical community needs to consider this issue because of the need for emergency medical care after a possible use of radionuclear materials by terrorists.11 12

Medical education and postgraduate training programmes for primary care doctors worldwide seem to lack the appropriate information about radiation incidents as regards recognition, differential diagnosis, and first medical response.7 13 14 We aim to advise on the basic medical management of radiation sickness and radiation injuries, and …

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