Early-response multiple-parameter biodosimetry and dosimetry: risk predictions

Abstract

The accepted generic multiple-parameter and early-response biodosimetry and dosimetry assessment approach for suspected high-dose radiation (i.e. life-threatening) exposure includes measuring radioactivity associated with the exposed individual (if appropriate); observing and recording prodromal signs/symptoms; obtaining serial complete blood counts with white-blood-cell differential; sampling blood for the chromosome-aberration cytogenetic bioassay using the ‘gold standard’ dicentric assay (premature chromosome condensation assay for exposures >5 Gy photon acute doses equivalent), measurement of proteomic biomarkers and gene expression assays for dose assessment; bioassay sampling, if appropriate, to determine radioactive internal contamination; physical dose reconstruction, and using other available opportunistic dosimetry approaches. Biodosimetry and dosimetry resources are identified and should be setup in advance along with agreements to access additional national, regional, and international resources. This multifaceted capability needs to be integrated into a biodosimetry/dosimetry ‘concept of operations’ for use in a radiological emergency. The combined use of traditional biological-, clinical-, and physical-dosimetry should be use in an integrated approach to provide: (a) early-phase diagnostics to guide the development of initial medical-management strategy, and (b) intermediate and definitive assessment of radiation dose and injury. Use of early-phase (a) clinical signs and symptoms, (b) blood chemistry biomarkers, and (c) triage cytogenetics shows diagnostic utility to predict acute radiation injury severity.

RENEB Inter-Laboratory Comparison 2021: Inter-Assay Comparison of Eight Dosimetry Assays

“…Within the RENEB ILC 2021, established cytogenetic (DCA, CBMN, FISH, PCC) and emerging biological dosimetry assays (gH2AX, GE), as well as physical dosimetry-based assays (EPR, LUM), were run in parallel to determine and compare the dose-assessment quality. Exposure estimates are important to support medical management decision-making ( 2 ), which is the primary task of RENEB in emergency situations. From the clinical point of view, groups of unexposed to lower exposed, moderate exposed (no severe acute health effects expected) and highly exposed individuals requiring early intensive medical health care need to be identified and discriminated ( 5, 6, 8 ).…”

“…Knowledge of individual radiation exposure is an important aspect of identifying the above groups and supporting medical care for individuals exposed to radiation (2)(3)(4). Recent discussions have identified limitations of this approach (deducing acute health effects from dose estimates), but nonetheless argue not against but specify the value of individual dose estimates for this purpose (5)(6)(7)(8).…”

High Resolution and Automatable Cytogenetic Biodosimetry Using In Situ Telomere and Centromere Hybridization for the Accurate Detection of DNA Damage: An Overview

“…Direct molecular consequences such as single and double-strand breaks in the DNA molecule detected by fluorochrome-labeled antibodies specific for, e.g., γH2AX, MR11 proteins, or p53-binding protein (53BP1) that are markers of double-strand breaks (DSB) [ 19 , 20 ]. The preparation and analysis of the immunostainings can be automated [ 4 , 21 ].…”

Responding to radiation accidents: what more do we need to know?

“…Subsequently, simple data from contamination monitoring is likely to become available and, in the longer-term, various measures of radiation exposure and of the likely response of the victim will become available. The various measurements that may be acquired and their interpretation are addressed by Blakely et al (2021). They emphasise that dose estimation may be of limited value in determining risks to health and appropriate approaches to treatment, particularly in most cases in which irradiation is to only part of the body or is substantially inhomogeneous.…”