Triage, monitoring and dose assessment for people exposed to ionising radiation following a malevolent act

Abstract

The part played by individual monitoring within the context of the overall response to incidents involving the malevolent use of radiation or radioactive material is discussed. The main objectives of an individual monitoring programme are outlined, and types of malevolent use scenario briefly described. Some major challenges facing those with responsibilities for planning the monitoring response to such an incident are identified and discussed. These include the need for rapid selection and prioritisation of people for individual monitoring by means of an effective triage system; the need for rapid initiation of individual monitoring; problems associated with monitoring large numbers of people; the particular difficulties associated with incidents involving pure-beta and alpha-emitting radionuclides; the need for techniques that can provide retrospective estimates of external radiation exposures rapidly and the need for rapid interpretation of contamination monitoring data. The paper concludes with a brief review of assistance networks and relevant international projects planned or currently underway.

Multivariate Analysis of Radiation Responsive Proteins to Predict Radiation Exposure in Total-Body Irradiation and Partial-Body Irradiation Models

“…Partial-body exposures are far more likely in the form of external exposure to ionizing radiation or internal contamination from inhaled or ingested radionuclides (16, 17). In this study we tested our TBI generated models for their accuracy predicting partial-body exposures to either percentages of whole-body mass or to specific regions of the body.…”

Gene expression-based biodosimetry for radiological incidents: assessment of dose and time after radiation exposure

“…In the case of large-scale radiological accidents, when physical dosimetry is not available for all the individuals at risk of exposure, these biomarkers could be used to identify individual exposure cases. In such situations triage decisions have to be undertaken as soon as possible in order to split the exposed subjects into different categories, depending on their exposure dose and radiosensitivity (Etherington et al 2011). This kind of triage will allow focusing the medical staff and facilities only on those subjects in need of urgent medical assistance (Etherington et al 2011).…”

Effect of dose and dose rate on temporal γ-H2AX kinetics in mouse blood and spleen mononuclear cells in vivo following Cesium-137 administration

“…There is a need for simple, high throughput and reliable cytogenetics assays which in the event of a mass-casualty radiological incident, could also be used in combination with standard internal dosimetry methods based on excreted systemic activity and biokinetic modelling. The advantage of combining these methods for medical triage is that γ-H2AX and cell death biomarkers also reflect biological damage and injury in blood as opposed to just using purpose-built mobile portal monitors to measure the physical activity of gamma emitters [34]. As far as we are aware, few studies to date have developed models for protracted, continuous, internal whole-body irradiation model to evaluate absorbed dose and quantify DNA damage after radionuclide administration [35, 36].…”