Evaluating the Special Needs of The Military for Radiation Biodosimetry for Tactical Warfare Against Deployed Troops

Abstract

Objectives The aim of this paper is to delineate characteristics of biodosimetry most suitable for assessing individuals who have potentially been exposed to significant radiation from a nuclear device explosion, when the primary population targeted by the explosion and needing rapid assessment for triage is civilians vs. deployed military personnel. Methods We first carry out a systematic analysis of the requirements for biodosimetry to meet the military's needs to assess deployed troops in a warfare situation, which include accomplishing the military mission. We then systematically compare and contrast the military's special capabilities to respond and carry out biodosimetry for deployed troops in warfare, in contrast to those available to respond and conduct biodosimetry for civilians who have been targeted, e.g., by terrorists. We then compare the effectiveness of different biodosimetry methods to address military vs. civilian needs and capabilities in these scenarios and, using five representative types of biodosimetry with sufficient published data to be useful for the simulations, we estimate the number of individuals who could be assessed by military vs. civilian responders within the timeframe needed for triage decisions. Conclusions Analyses based on these scenarios indicate that, in comparison to responses for a civilian population, a wartime military response for deployed troops has both more complex requirements for and greater capabilities to utilize different types of biodosimetry to evaluate radiation exposure in a very short timeframe after the exposure occurs. Greater complexity for the deployed military is based on factors such as a greater likelihood of partial or whole body exposure, conditions that include exposure to neutrons, and a greater likelihood of combined injury. Our simulations showed, for both the military and civilian response, that a very fast rate of initiating the processing (24,000 per day) is needed to have at least some methods capable of completing the assessment of 50,000 people within a 2 or 6 day timeframe following exposure. This in turn suggests a very high capacity (i.e., laboratories, devices, supplies and expertise) would be necessary to achieve these rates. These simulations also demonstrated the practical importance of the military's superior capacity to minimize time to transport samples to offsite facilities and utilize the results to carry out triage quickly. Assuming sufficient resources and the fastest daily rate to initiate processing victims, the military scenario revealed that two biodosimetry methods could achieve the necessary throughput to triage 50,000 victims in 2 days (i.e., the timeframe needed for injured victims) and all five achieved the targeted throughput within 6 days. In contrast, simulations based on the civilian scenario revealed that no method could process 50,000 people in 2 days and only two could succeed within 6 days.

Metabolomic applications in radiation biodosimetry: exploring radiation effects through small molecules

“…In the case of radiation biodosimetry, an estimated 50,000 individuals will need to be evaluated within 2 to 6 days after a 10 kt bomb, according to military scenarios for planning (Flood et al, 2016a), although in a city such as New York, NY or Washington, DC the number may well be much higher. Complete blood count (CBC) differential for lymphocyte depletion kinetics, premature chromosome condensation (PCC), dicentric measurement, gene expression, γ-H2AX, cytokinesis block micronucleus assay (CBMN), protein biomarkers, metabolic biomarkers, and electron paramagnetic resonance (EPR) or optically stimulated luminescence (OSL) of teeth have been proposed as some of the methods for radiation biodosimetry (Amundson and Fornace, 2003, Brengues et al, 2010, Coy et al, 2011, Gruel et al, 2013, Lamadrid Boada et al, 2013, Sharma and Moulder, 2013, Sullivan et al, 2013, Xu et al, 2013, Hu et al, 2015, Flood et al, 2016b, Garty et al, 2016, Sproull and Camphausen, 2016).…”

“…In addition, the FDA approved radioprotector Amifostine ® has a very narrow window for administration in order to protect normal tissue and is unfortunately associated with severe side effects (Singh et al, 2016). In the case of first responders and military personnel, personal dosimetry will provide an accurate estimation of the external exposure and banked biological samples will serve as a point of reference for biodosimetry (Flood et al, 2016a), which is not currently feasible for the general population.…”

Gas Chromatography/Mass Spectrometry Metabolomics of Urine and Serum from Nonhuman Primates Exposed to Ionizing Radiation: Impacts on the Tricarboxylic Acid Cycle and Protein Metabolism

“…A recent paper compared five common biodosimetry methods (cytokinesis blocked micronucleus, dicentric chromosome analysis, lymphocyte numbers or depletion, γ -H2AX levels, and in vivo tooth electron paramagnetic resonance) among civilian and military populations, concluding that no methods were capable of processing samples for a civilian population of 50 000 within 2 days, and a combination of two methods was capable within 6 days. 1 However, these results assumed higher time periods for sample transportation, lab processing, and reporting results that may be reduced by specialized robotic platforms, such as the rapid automated biodosimetry tool (RABiT). 2 Thus high-throughput biodosimetry that would reduce time to determine an individual’s level of exposure would aid in reducing mortality through triage, physiological turmoil, and economic burden.…”

Evolution and Optimization of Tooth Models for TestingIn VivoEPR Tooth Dosimetry

“…The materials used in constructing and testing the tooth models include: Details of the EPR in vivo tooth dosimetry device have been reported elsewhere (1)(2)(3)(8)(9)(10)(11)(12)(13)(14) . The tooth being queried by the device reported here was one or both of central incisors in the maxillary jaw.…”

“…In addition to these more generic complexities, the design and testing of dosimetry devices, such as those at the EPR Center that are intended for use in a large-scale terrorist event involving radiation, present additional challenges (8)(9)(10)(11) . Examples of the additional and special challenges for biodosimetry include: being able to meet the technical requirements to correctly assess dose of large numbers of people within the timeframe needed as well as being able to be operated by people without expertise and with virtually no training and under conditions of a severely compromised infrastructure (such as loss of usual power, water, food, transport and communication networks).…”