Organ tissue	0	Grade 1	Grade 2	Grade 3	Grade 4	5
Skin	None	Slight atrophy Pigmentation change Some hair loss	Patch atrophy Moderate telangiectasia Total hair loss	Marked atrophy Gross telangiectasia	Ulceration	D E A T H D I R E C T L Y R E L A T E D T O R A D I A T I O N L A T E E F F E C T S
Subcutaneous tissue	None	Slight induration (fibrosia) and loss of subcutaneous fat	Moderate fibrosis but asymptomatic Slight field contracture < 10% linear reduction	Severe induration and loss of subcutaneous tissue Field contracture > 10% linear measurement	Necrosis
Mucous membrane	None	Slight atrophy and dryness	Moderate atrophy and telangiectasia Little mucous	Marked atrophy with complete dryness Severe telangiectasia	Ulceration
Salivary glands	None	Slight dryness of mouth Good response on stimulation	Moderate dryness of mouth Poor response on stimulation	Complete dryness of mouth No response on stimulation	Fibrosis
Spinal cord	None	Mild Lhermitte's syndrome	Severe Lhermitte's syndrome	Objective neurological findings at or below cord level treated	Mono, para, quadraplegia
Brain	None	Mild headache Slight lethargy	Moderate headache Great lethargy	Severe headaches Severe central nervous system dysfunction (partial loss of power or dyskinesia)	Seizures or paralysis Coma
Eye	None	Asymptomatic cataract Minor corneal ulceration or keratitis	Symptomatic cataract Moderate corneal ulceration Minor retinopathy or glaucoma	Severe keratitis Severe retinopathy or detachment Severe glaucoma	Panopthalmitis/Blindness
Larynx	None	Hoarseness Slight arytenoid oedema	Moderate arytenoid oedema Chondritis	Severe oedema Severe chondritis	Necrosis
Lung	None	Asymptomatic or mild symptoms (dry cough) Slight radiographic appearances	Moderate symptomatic fibrosis or pneumonitis (severe cough) Low‐grade fever Patchy radiographic appearances	Severe symptomatic fibrosis or pneumonitis Dense radiographic changes	Severe respiratory insufficiency/Continuous O2/Assisted ventilation
Heart	None	Asymptomatic or mild symptoms Transient T wave inversion and ST changes Sinus tachycardia > 110 (at rest)	Moderate angina on effort Mild pericarditis Normal heart size Persistent abnormal T wave and ST changes Low ORS	Severe angina Pericardial effusion Constrictive pericarditis Moderate heart failure Cardiac enlargement electrocardiogram abnormalities	Tamponade/Severe heart failure/Severe constrictive pericarditis
Esophagus	None	Mild fibrosis Slight difficulty in swallowing solids No pain on swallowing	Unable to take solid food normally Swallowing semi‐solid food Dilatation may be indicated	Severe fibrosis Able to swallow only liquids May have pain on swallowing Dilatation required	Necrosis/Perforation Fistula
Small/large intestine	None	Mild diarrhoea Mild cramping Bowel movement 5 times daily Slight rectal discharge or bleeding	Moderate diarrhoea and colic Bowel movement > 5 times daily Excessive rectal mucus or intermittent bleeding	Obstruction or bleeding requiring surgery	Necrosis/Perforation Fistula
Liver	None	Mild lassitude Nausea, dyspepsia Slightly abnormal liver function	Moderate symptoms Some abnormal liver function tests Serum albumin normal	Disabling hepatitic insufficiency Liver function tests grossly abnormal Low albumin Oedema or ascites	Necrosis/Hepatic coma or encephalopathy
Kidney	None	Transient albuminuria No hypertension Mild impairment of renal function Urea 25 to 35 mg% Creatinine 1.5 to 2.0 mg% Creatinine clearance > 75%	Persistent moderate albuminuria (2+) Mild hypertension No related anaemia Moderate impairment of renal function Urea > 36 to 60 mg% Creatinine clearance (50% to 74%)	Severe albuminuria Severe hypertension Persistent anaemia (< 10 g%) Severe renal failure Urea > 60 mg% Creatinine > 4.0 mg% Creatinine clearance < 50%	Malignant hypertension Uraemic coma/Urea > 100%
Bladder	None	Slight epithelial atrophy Minor telangiectasia (microscopic haematuria)	Moderate frequency Generalised telangiectasia Intermittent macroscopic haematuria	Severe frequency and dysuria Severe generalised telangiectasia (often with petechiae) Frequent haematuria Reduction in bladder capacity (< 150 cc)	Necrosis/Contracted bladder (capacity < 100 cc) Severe haemorrhagic cystitis
Bone	None	Asymptomatic No growth retardation Reduced bone density	Moderate pain or tenderness Growth retardation Irregular bone sclerosis	Severe pain or tenderness Complete arrest of bone growth Dense bone sclerosis	Necrosis/Spontaneous fracture
Joint	None	Mild joint stiffness Slight limitation of movement	Moderate stiffness Intermittent or moderate joint pain Moderate limitation of movement	Severe joint stiffness Pain with severe limitation of movement	Necrosis/Complete fixation