Abstract
Accidental, excessive radiation exposure of the hands is rare in industry. This report describes two such cases with subsequent long-term follow-up. In the first case, a middle-aged pipefitter received a dose of 2500 rem to the fingers of his left hand and 2000 rem to small areas of his right hand. He was accidentally exposed to this beta radiation while attempting to recap a flow of highly radioactive waste of cerium-144 and praseodymium-144 from a large transport cask. Over several months, the fingers slowly healed, but the skin would easily break down with slight trauma. Sixteen years later the injured fingertips were thickened with dense fibrosis, and the dorsum of the right hand showed a small linear scar. He has full function of his hands except for cold sensitivity of the injured fingertips. No signs of significant vasoconstrictive disease were evident in a complete upper-extremity occlusive disease evaluation and provocative cold testing by a vascular surgeon. In the second case, a young chemist incurred X-ray burns with an estimated radiation dose of 71,000 rad to his right hand while wiping out the target chamber of an X-ray spectrometer. This injury resulted in severe sloughing of the skin and prolonged suffering. Complete healing did not occur until 20 months after the injury, when the distal phalanx of the index finger was amputated and an area of the middle finger was grafted. Subsequently, he has had difficulties with mechanical work requiring fine motor skills. He has learned to compensate and has continued to work as a chemist for the past 26 years.