GB 16389-1996 Diagnostic criteria and treatment principles for external radiation-induced bone injury
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles of managementfor external radiation bone injuries1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles for external radiation bone injuries. GB16389-1996
This standard applies to radiation workers (including emergency personnel) with bone injuries caused by occupational radiation. Bone injuries caused by non-occupational radiation can also be diagnosed and treated with reference to this standard. 2 Terminology
2.1 Radiation bone injuries A series of metabolic and clinical pathological changes in bone tissue caused by the whole body or part of the human body being exposed to a single or short-term high-dose external radiation, or to long-term and multiple external radiation that exceeds the dose equivalent limit. According to its pathological changes, it is divided into osteoporosis, osteomyelitis, pathological fracture, osteonecrosis and bone development disorder.
2.2 Radiation osteoporosis After the bone tissue is exposed to ionizing radiation, the bone cells degenerate and necrotize, resulting in a series of pathological changes characterized by decreased bone density. 2.3 Osteoradiomyelitis After the bone tissue is exposed to a certain dose of ionizing radiation, the bone tissue is infected with bacteria on the basis of osteoporosis and produces inflammatory changes. 2.4 Radiation pathologic fracture After the bone tissue is exposed to osteoporosis and osteomyelitis, the bone tissue produces continuous destruction of the bone. 2.5 Osteoradionecrosis After the bone tissue is exposed to ionizing radiation, the bone cells or bone nutrient blood vessels are damaged, and the blood circulation is impaired, resulting in necrosis of bone blocks or bone fragments. 2.6 Radiation dysostosis After the bone cartilage is exposed to ionizing radiation, the growth and development of the bone is impaired, making the length and circumference of the bone smaller than that of the normally developed bone tissue. 3 Diagnostic principles
A comprehensive analysis must be conducted based on the history of exposure, exposure dose, dose rate, clinical manifestations, X-ray imaging or bone density measurement, and bone diseases caused by other reasons must be excluded before a diagnosis can be made. 4 Basis for classification diagnosis
Bone damage within the exposure range (or irradiation field) caused by a single or short-term (several days) high-dose exposure to a part of the body, the reference threshold for bone damage dose is 20Gy; the reference threshold for bone damage caused by long-term exposure to radiation is 50Gy. 4.1 Radiation osteoporosis
4.1.1 Often accompanied by radiation dermatitis changes in the local skin. Approved by the State Administration of Technical Supervision on May 23, 1996, and implemented on December 1, 1996
GB16389—1996
4.1.2 X-ray signs: In mild cases, the trabeculae are sparse and rough; in severe cases, the trabeculae are sparse, with patchy translucent areas, and the cortical bone is significantly thickened in a lamellar shape or the white line of the cortex disappears.
4.2 Radiation osteomyelitis
4.2.1 Often accompanied by ulcers of local skin and soft tissue deep into the bone, often accompanied by varying degrees of bacterial infection. 4.2.2 X-ray signs: The density of the cortical bone decreases, becomes thinner, the surface is not smooth, the bone is irregularly destroyed with nearby osteoporosis, and irregular patchy translucent areas can be seen, occasionally accompanied by bone hyperplasia or dead bone formation. 4.3 Radioactive fractures
4.3.1 This type of fracture is a pathological fracture secondary to radiation bone damage (osteoporosis, osteomyelitis, osteonecrosis). 4.3.2 There is radiation dermatitis or ulcer in the local skin. 4.3.3 Before the fracture occurs, there are usually different degrees of excessive activity, external force and other predisposing factors, but sometimes the predisposing factors are not obvious. 4.3.4 Fractures often occur in weight-bearing bones (vertebral body, femoral neck, radial head, tibia, clavicle and ribs, etc.). 4.3.5 X-ray signs: There is an osteoporotic basis, there are osteoporotic changes at both ends, and the fracture line is generally neat. 4.4 Radioactive osteonecrosis
4.4.1 It often occurs on the basis of bone atrophy, osteomyelitis or fracture. 4.4.2 Accompanied by severe radiation damage to local skin and soft tissue. 4.4.3 X-ray signs: Irregular, dense, flake-like shadows appear in the osteoporotic area or near the fracture ends, interspersed with some translucent areas. 4.5 Radioactive bone development disorder
4.5.1 It is more common in children whose bones show active hyperplasia when irradiated (about 6 years old or adolescent children). 4.5.2 There may be no obvious radiation damage changes in the local skin, or there may be mild radiation dermatitis changes. 4.5.3 X-ray signs: Bone and cartilage growth and development are slow or even stagnant. Long bones have obstacles in both longitudinal and transverse growth, shortened length, thinner bone shafts, and thinner cortices.
5 Treatment principles
5.1 For those whose local radiation dose has been determined to exceed the reference threshold dose for bone damage, regardless of whether there is clinical or X-ray manifestation of bone damage, they should be separated from the radiation. Those with bone damage should be separated from the radiation, or switched to non-radioactive work depending on the overall condition. 5.2 To prevent and reduce the occurrence of radiation-induced bone injury, a diet rich in calcium and protein should be given, and proper exercise should be taken. 5.3 Drugs that improve microcirculation and promote bone tissue repair and regeneration should be used: such as compound danshen, glutathione, ascorbic acid, calcitonin, vitamin A, vitamin D, stanozolol and other protein anabolic hormones, as well as calcium-containing preparations. 5.4 Hyperbaric oxygen therapy can also be used if conditions permit. 5.5 Pay attention to avoid trauma or infection of the bone injury site, avoid biopsy, and promptly handle and take surgical treatment when obvious skin atrophy or ulceration occurs, and cover with a flap or muscle flap with good blood circulation to improve local blood circulation and eliminate the wound surface. 5.6 When osteomyelitis occurs, anti-infection treatment should be given, and surgical treatment should be taken in time to completely remove necrotic bone, and fill the cavity and repair the wound surface with a muscle flap with a vascular pedicle.
5.7 When osteomyelitis occurs in a single phalanx or toe, the finger (toe) should be amputated in time. If multiple fingers (toes) are accumulated and the remaining individual fingers (toes) are no longer functional, amputation can be considered, but it should be done with caution. The height of the amputation should exceed the proximal end of the injury by 3~5cm. 362
GB 163891996
Appendix A
Instructions for the correct use of this standardbZxz.net
(reference)
A1 The purpose of this standard is to enable personnel who suffer bone injuries from local external radiation exceeding the dose equivalent limit to receive timely and correct diagnosis and treatment, prevent the development of the disease, and promote recovery. A2 Radioactive bone injury is a deterministic effect with a dose threshold. However, due to the different energies of various rays, different irradiation conditions, different thicknesses of soft tissues in various parts of the body, and different post-irradiation treatments, it is currently difficult to determine an accurate universal dose. The radiation dose value for bone injury given in this standard is only a reference value range. A3 The degree of bone damage is related to factors such as the nature of the radiation source, irradiation dose, dose rate, number of irradiations, interval time, irradiation site and range. Those with large irradiation doses, short interval time and large range will appear earlier and be more severe. One large dose of irradiation is more severe than multiple small doses of irradiation. A4 Osteoporosis, osteomyelitis, pathological fractures and bone necrosis are a development and evolution of injuries. The degree of bone damage and changes in X-ray signs are consistent with the irradiation dose and the time after irradiation. It is also related to whether the irradiated area is properly treated and protected. A5 The diagnosis and treatment of radiation-induced bone damage is a cross-disciplinary and highly technical task. Therefore, this standard should be carefully implemented by professional radiological medicine institutions and (or) radiation disease diagnosis teams at all levels. Additional notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the 307th Hospital affiliated to the Academy of Military Medical Sciences of the Chinese People's Liberation Army. The main drafters of this standard are Yang Zhixiang, Chen Zhong, Wang Fangxin, Li Fengchu and Ye Genyao. This standard is interpreted by the Ministry of Health's Industrial Hygiene Laboratory, the technical unit entrusted by the Ministry of Health. 363
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