TABLE 90.12 INTENSE RADIATION SOURCES Type of source Examples Likely injuries Sealed Industrial radiography Contamination unlikely Brachytherapy Local radiation injury with small source Some radiation therapy machines Industrial sterilizers Whole-body exposure with large source Unsealed Medical radionuclides (e.g., External and internal 131 I, 32 P) contamination likely Accidental release by a reactor Radium dial painters Radiation devices Cyclotron Linear accelerator Uncontrolled fission Fluoroscopy unit Nuclear reactor Uranium enrichment Local radiation injury likely Large whole-body doses likely On- and off-site contamination possible for nuclear reactors Weapons production The acute radiation syndrome consists of three distinct phases ( Table 90.14 ): prodromal, latent, and manifest illness The prodromal phase begins minutes to hours after the radiation exposure, lasts for to days, and common symptoms are nausea, vomiting, diarrhea, fatigue, and/or headache The prodromal phase is followed by the latent phase, in which the patient is relatively asymptomatic and generally lasts days or weeks after the exposure The manifest illness phase poses the greatest risk for infection and bleeding due to bone marrow suppression and GI epithelial damage As the radiation dose increases, the duration of the prodromal phase increases and the length of the latent phase decreases