the range of 100 Gy and at weeks after dose levels of 30 to 50 Gy Treatment is required to prevent infection and to relieve pain Skin grafting, especially musculocutaneous flaps, may be appropriate if the radiation exposure was localized and superficial Progressive gangrene, due to the obliterative changes in the small vessels, will occur if the radiation exposure is large and involves deep structures Under these circumstances, amputation may be necessary FIGURE 90.13 Effect of whole-body radiation on blood cell counts in the days after exposure Contamination Contamination represents the other major type of radiation injury Contamination occurs when radioactive dirt or liquid remains on the patient (external contamination) or, when inhaled or ingested, inside the patient (internal contamination) Contamination is the only type of radiation injury that requires the medical staff to take radiation-related precautions Although there is usually little danger to the medical staff when caring for a contaminated person once they are in the hospital, medical personnel who respond to the accident site may be exposed to large, potentially life-threatening doses of radiation For these rescue workers, 0.5 Gy is the voluntary limit suggested by the National Council on Radiation Protection and Measurements (NCRP) for lifesaving activities External contamination External contamination rarely is a significant medical problem To prevent additional radiation exposure to the patient, medical staff, and the public, external contamination should be removed, and dispersal of radioactive materials should be prevented The goal of treatment of any contaminated patient is to keep radiation exposures “as low as reasonably achievable.” This is called the ALARA principle and requires advance planning, specific supplies, and appropriate protective clothing Preventing the dispersal of