Operational guidance for radiation emergency response organisations in Europe for using biodosimetric tools developed in EU MULTIBIODOSE project

Abstract

In the event of a large-scale radiological emergency, the triage of individuals according to their degree of exposure forms an important initial step of the accident management. Although clinical signs and symptoms of a serious exposure may be used for radiological triage, they are not necessarily radiation specific and can lead to a false diagnosis. Biodosimetry is a method based on the analysis of radiation-induced changes in cells of the human body or in portable electronic devices and enables the unequivocal identification of exposed people who should receive medical treatment. The MULTIBIODOSE (MBD) consortium developed and validated several biodosimetric assays and adapted and tested them as tools for biological dose assessment in a mass-casualty event. Different biodosimetric assays were validated against the 'gold standard' of biological dosimetry-the dicentric assay. The assays were harmonised in such a way that, in an emergency situation, they can be run in parallel in a network of European laboratories. The aim of this guidance is to give a concise overview of the developed biodosimetric tools as well as how and when they can be used in an emergency situation.

RENEB intercomparison exercises analyzing micronuclei (Cytokinesis-block Micronucleus Assay)

“…In the event of large radiological accidents, an initial triage aimed at classifying victims according to the degree of exposure is indicated to guide appropriate clinical responses. In the framework of a previous EU FP7 project MultiBioDose, focusing on radiological emergencies, three triage categories were considered: a low dose category, for exposures to doses lower than 1 Gy, requiring no direct clinical treatment, a medium dose category, with doses ranging from 1-2 Gy, for which medical follow-up is necessary, and a high dose category, following exposure to doses higher than 2 Gy, for which urgent medical intervention is mandatory (Jaworska et al 2015). Estimation of exposure to unknown radiation doses based on symptoms of the prodromal stage such as headache, nausea, diarrhea and others often result in misclassification of the victims, as those symptoms can also be psychogenic of origin as a consequence of anxiety or may be absent in spite of a significant exposure (International Atomic Energy Agency [IAEA] 2011).…”

The second gamma-H2AX assay inter-comparison exercise carried out in the framework of the European biodosimetry network (RENEB)

“…The triage categories used here were those chosen for the MULTIBIODOSE project and implemented in the MULTIBIODOSE emergency triage categorization software (Jaworska et al 2015). Table 2 shows the triage categories for the foci-based dose estimates of coded blood Error bars show the standard deviation between 5 and 7 (blood) and 11-14 (lymphocyte) measurements for each sample taken from Table 2.…”

RENEB – Running the European Network of biological dosimetry and physical retrospective dosimetry

“…cytogenetic assays) and retrospective physical dosimetry (based on EPR/OSL techniques) has been shown to be an essential tool to estimate the individually received (blood or personal device) dose without being influenced by temporal variations in blood counts or confounding factors such as chemical agents or psychogenic reactions. Based on the results of biological and personalized physical dose estimation, people needing extensive medical care due to severe irradiation can be identified and distinguished from individuals with injuries who have not received high doses of ionizing radiation (Turai et al 2001;Voisin et al 2001;Roy et al 2007;Romm et al 2011;Jaworska et al 2015). In those disastrous situations, independently of an accidental or malevolent background, the reassurance of unsettled and anxious people is of high importance.…”