EFFECTS OF RADIATION ON TISSUES AND ORGANS

Deterministic effects

The radio sensitivity of a tissue or organ is measured by its response to irradiation Loss of moderate number of cells does not affect the function of most organs But loss of large number of cells shows observable results Severity of change depends on dose and thus the amount of cell loss Moderate doses to a localized area may lead to irreparable damage

Short term effects

These are effects that are seen in the first day or weeks after exposure Determined primarily by sensitivity of parenchymal cells

On continuously proliferating tissues (bone marrow, oral mucous membrane)

Cells are lost primarily by reproductive death, bystander effect and apoptosis Extent of cell loss depends on damage to the stem cell pools and the proliferative rate of the cell population The effects of radiation becomes apparent quickly as a reduction in the number of mature cells in the series

Effects on tissues composed of cells that rarely or never divide (neurons, muscles)

Shows little or no radiation induced hypoplasia over a short term

Relative radiosensitivity of various organs

HIGH Lymphoid organs Bone marrow Testes Intestines Mucous membranes INTERMEDIATE Fine vasculature Growing cartilage Growing bones Salivary glands Lungs Kidney liver LOW Optics lens muscle

Long term effects

Seen months and years after exposure There is loss of parenchymal cells and replacement with fibrous connective tissue Changes are due to reproductive death of replicating cells, and by damage to fine vasculature Damage to capillaries leads to narrowing and eventual obliteration of vascular lumens This impairs the transport of oxygen, nutrients, and waste products and results in death of all cell types dependent on this vascular supply Thus, both dividing and nondivding parenchymal cells are replaced by fibrous connective tissue, a proggressive fibroatrophy of irradiated tissue

Modifying factors

Nature of tissue irradiated Radiosensitive Radioresistant

Area irradiated For the same dose, if a smaller area is irradiated , the effect of radiation is less Age of patient Younger patients have greater chances of recovery Latent period The period between the time of irradiation and the appearance of the effect Recovery power of tissue Undifferentiated cells have greater power of recovery

Dose Severity depends on amount of radiation received. Usually, clinical threshold dose exists below which no adverse effects are seen. Above the threshold level, the amount of damage is proportional to the dose Dose rate it indicates the rate of exposure Exposure of biologic systems to a given dose at a high dose rate causes more damage than exposure to the same total dose given at a lower dose rate At lower dose rate, there is greater opportunity for repair of damage Although the total dose of diagnostic exposure is low, they are given at a high dose rate compared with background exposure Type of cell Effect of radiation is seen in the same generation if a somatic cell is affected If genetic cell is affected, effect is seen in the next generation Chemical protectors Amino compounds or disulphides and amino groups act as free radical scavangers; prevents the damaging effects of organic free radicals

Oxygen Radioresistance of many biologic systems increases by a factor of 2 or 3 when the exposure is made with reduced oxygen (hypoxia) The greater cell damage sustained in the presence of oxygen is related to the increased amounts of hydrogen peroxide and hydroperoxyl free radicals formed Importance: hyperbaric oxygen therapy may be used during radiation therapy of tumors having hypoxic cells

Linear energy transfer (types of irradation- low energy, high energy, linear energy) In general, the dose required to produce a certain biologic effect is reduced as the linear energy transfer (LET) of the radiation is increased. Thus, higher-LET radiations are more efficient in damaging biologic systems because their high ionization density is more likely than x-rays to induce double-strand breakage in the DNA Low LET radiation such as x-ray deposit their energy more sparsely, or uniformly, in the absorber and thus are more likely to cause single-strand breakage and less biologic damage Stage of development of the tissue Primitive and undifferentiated and still undergoing mitosis when irradiated will produce greater damage Part of the body exposed Hazard of radiation is increased when a larger part of the body is exposed Local or isolated part of the body may receive larger dose without risk, but at the same dose given to the whole body may prove lethal Species and individuals Different species respond differently. The median lethal dose varies in different species; response is also variable among different individuals of the same species This variation of the Maximum Permissible Dose is approximately 50%