Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

Abstract

Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual’s radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual’s dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a stand-alone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, we reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point.

Retrospective and emergency dosimetry in response to radiological incidents and nuclear mass-casualty events: A review

“…However, for doses >2.1 Gy, the number of deaths progressively increased as the dose increased (1 death for doses 2.2-4.1 Gy; 7 deaths for 4.2-6.4 Gy; and 20 deaths for 6.1-16.0 Gy). Sullivan et al (2013) describe an idealized model for triage and high-throughput screening of patients after a large-scale radiological incident. The scheme described by these authors is illustrated in Fig.…”

“…Technical requirements of the two screening levels have been proposed by the US Department of Health and Human Services, Biomedical Advanced Research and Development Authority (BARDA) and are described in Table 2. Table 2 The characteristics of the PoC and HT emergency dosimetry methods to be used after a radiological incident are described by Sullivan et al (2013) and include simple sample collection and preparation, field-ready, short time to result, high capacity, standardized method (easily comparable across laboratories; not experimental), radiation-specific (not affected by confounding environmental elements), low interand intra-variation, low uncertainty, stable, and inexpensive. Finding a dosimetry system that complies with all these characteristics is a non-trivial task.…”

“…As applications in retrospective dosimetry progressed (e.g., Ishii et al, 1990, Serezhenkov et al, 1992, Romanyukha et al, 1994, Chumak et al, 1999, so too did technique development. EPR of teeth is now a well-established method for evaluating absorbed doses to individuals under many circumstances (Egersdorfer et al, 1996, Pass, 1997, IAEA, 2002, Fattibene and Callens, 2010, Ainsbury et al, 2011, Sullivan et al, 2013and Degteva et al, 2015. The method has been tested against biodosimetry methods (e.g., Nakamura et al, 1998and Khvostunov et al, 2015 and conventional dosimeters (e.g., Romanyukha et al, 2000b), and in multiple inter-laboratory comparisons (e.g., Chumak et al, 1996, Wieser et al, 2000a.…”

Uncertainty of fast biological radiation dose assessment for emergency response scenarios

“…However, the stress and uncertainty following such an event and the inherent inter-individual variability mean that these criteria are known to be unreliable. Thus the need for more quantitative secondary triage methods, which can be provided by the biodosimetry community, is well documented (Sullivan et al 2013). Although the main focus of large scale accident biodosimetry is rapid dose estimation to assist emergency responders in identifying those in greatest CONTACT Dr Elizabeth A.…”

Biological Dosimetry Using Micronucleus Assay in Simulated Partial-Body Exposure to Ionizing Radiation

“…Scoring of unstable chromosome aberrations (dicentrics, rings, and fragments) is considered as the most reliable method for evaluating individual exposure, and is specific to radiation exposure [8][9][10]. Another well known bioindicator of radiation damage is MN in peripheral blood lymphocytes [11].…”