IE 11 is not supported. For an optimal experience visit our site on another browser.

Brain scan overdose offers glimpse of radiation threat

A wave of nausea washed over Marcie Iseli shortly after her CT scan finished. Then her head started to feel strange, as if heat was emanating from somewhere deep inside. Her face started to feel uncomfortably warm, like she’d been sunburned.

She’d gone in for the brain scan because of headaches and nerve pain on one side of her face, but now doctors had no idea what was wrong with her — especially since the scan showed no abnormalities. Two weeks later, clumps of her hair started falling out, followed by debilitating fatigue and problems with balance and memory.

“I lost a 4-inch wide strip of hair that went from one side of my head to the other, recalls the 36-year-old mother of two from Kenova, W.Va. “I went to my family physician and then to a dermatologist who said he’d never seen anything like it.”

It was two months before Iseli learned the cause of her mysterious symptoms: She’d gotten an overdose of radiation during the scan of her head, a blast almost eight times the expected amount.

Within minutes, Iseli became a victim of radiation poisoning, with some of the same symptoms and possible long-term effects that may face workers now exposed to high levels of radiation at Japan’s ailing Fukushima Daiichi nuclear plant.

While Iseli’s targeted medical overdose is not the same as the full-body blast of a nuclear accident, it does offer some insight into the experience of radiation exposure, doctors say.

“When you overload the system, you’re going to get in trouble,” said Dr. Reuben Mezrich, a professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine.

Q&A: Dr. Nancy Snyderman explains symptoms of radiation sickness

What do you want to know about radiation?

Classic symptoms

Iseli’s symptoms are classic for acute radiation syndrome, but with one big difference, said Andrew Maidment, an associate professor of radiology and chief of physics at the University of Pennsylvania.

“People in the power plant are likely to be exposed all over their bodies,” Maidment says. “Whereas she was exposed only to the head, their livers, lungs and heads will all be exposed.”

That’s evident in the precise swath of hair that Iseli lost. It followed the path of the radiation beam, which damaged the hair follicles.

Iseli was supposed to receive 500 milligrays of radiation during her brain scan, but instead received a 3,875-milligray dose, according to Richard A. Patterson, an attorney who is representing Iseli and others who were overdosed in a spate of medical errors that resulted in a federal investigation.

One milligray absorbed by the whole body is equivalent to 1 millisievert, experts said. At one point, Japanese officials said several dozen workers at the Fukushima plant were exposed to levels detected at 400 millisieverts per hour, which later dropped. For the workers to get a similar dose to what Iseli received, they would have had to stand in the path of that level of radiation for 10 hours, Mezrich said.

“If it was going at that full rate and they were standing right in the middle of it, not hiding behind a wall or a column, if someone was exposed to that for a full day, they are absolutely at risk for having damage,” he added.

The actual exposure to the workers remains unclear. It depends on how the radiation levels varied and what kind of protective gear the workers had. And the worst effects likely will be limited to those in very close proximity to the source of radiation, perhaps affecting the so-called Fukushima 50, workers who stayed behind to grapple with the failing plant. About 120 other workers were evacuated earlier, according to Japanese officials.

Disaster sparks demand for potassium iodide

At the lowest levels of exposure, nuclear plant employees wouldn’t notice any symptoms, Maidment says. But there might be minor chromosomal changes in cells in the blood.

“The next level up, they would be experiencing nausea and vomiting,” Maidment said. “And this level is typically associated with some bone marrow suppression. The next level up you get leucopenia, where there are an insufficient number of white blood cells produced, and you might start to see skin burns and hair loss. The next level you get a GI syndrome, where cells start to slough off and the gut has trouble taking in nutrients. At the highest doses you can get brain death or cardiovascular collapse.”

Iseli’s symptoms, while debilitating, did not rise to that level of severity. The fatigue that Iseli has experienced could be due to bone marrow suppression which can occur with a radiation overdose.

“You get fewer blood cells and thus less oxygen,” Maidment explained.

Despite the threat posed by radiation, treatment options are few. Iseli discovered her overdose too late, but even if technicians had noticed it quickly, there was not much they would have done, noted Mezrich.

A patient like Iseli might have been given potassium iodide, depending on her exposure, to protect her thyroid gland from absorbing radioactive iodine and perhaps some steroid cream to ease the burning and itching of her skin.

The same goes for workers at the plant in Japan, even those exposed to high levels of radiation. Doctors would treat the victims for symptoms, rehydrating with fluids, for instance, and treating any gastrointestinal distress in usual ways.

'No magic potion'

The U.S. Centers for Disease Control and Prevention lists four potential treatments for radiation poisoning, including potassium iodide to protect the thyroid. There’s also Prussian blue, a blue dye that binds to radioactive materials cesium and thallium and prevents them from being reabsorbed by the body.

The CDC also lists DTPA, a medicine called a chelating agent, which also binds and holds radioactive materials, allowing them to be eliminated from the body. It’s best used soon after radioactive material has entered the body. Finally, there’s Neupogen, the brand name for filgrastim, a cancer drug that boosts formation of white blood cells. Some experts believe treating radiation victims with Neupogen can help stave off infection while their own bone marrow recovers.

Except for the potassium iodide, none of these treatments is universally used, Mezrich noted

“There is no magic potion,” he said.

In Japan, officials continue to monitor workers and the public for signs of radiation exposure. Widespread illness likely won’t affect the general population.

“You wouldn’t expect them to demonstrate symptoms of acute radiation syndrome,” Maidment says. “What happens as the plant burns is that radioactive materials are released either as gases or dust which are blown around by the wind and eventually settle on the surrounding area.”

Most of the radioactive material that is blown around is Iodine-131, which can impact the thyroid, Maidment says. There might be a rise in the number of people who develop thyroid cancer as a result of the fallout. However, Maidment noted, thyroid cancer is very curable.

Since the scan in November of 2010, Iseli’s symptoms have not improved, and now she’s been warned she faces an increased risk of thyroid cancer, bone cancer or leukemia.

And then there’s the profound and unrelenting fatigue.

“That’s the biggest problem for my kids,” Iseli says. “Their mom can’t get out and do things like she used to. It’s hard for them.”