Early treatment of victims of high level acute whole-body x-ray or gamma exposure has been shown to improve their likelihood of survival. However, in such cases, both the magnitude of the exposure and the dosimetry profile(s) of the victim(s) are often not known in detail for days to weeks. A simple dose-prediction algorithm based on lymphocyte kinetics as documented in prior radiation accidents is presented here. This algorithm provides an estimate of dose within the first 8 h following an acute whole-body exposure. Early lymphocyte depletion kinetics after a severe radiation accident follow a single exponential, L(t) = L(o)e(-k(D¿t), where k(D) is a rate constant, dependent primarily on the average dose, D. Within the first 8 h post-accident, K(D) may be calculated utilizing serial lymphocyte counts. Data from the REAC/TS Radiation Accident Registry were used to develop a dose-prediction algorithm from 43 gamma exposure cases where both lymphocyte kinetics and dose reconstruction were felt to be reasonably reliable. The inverse relationship D(K) may be modeled by a simple two parameter curve of the form D = a/(1 + b/K) in the range 0 < or = D < or = 15 Gy, with fitting parameters (mean +/- SD): a = 13.6 +/- 1.7 Gy, and b = 1.0 +/- 0.20 d(-1). Dose estimated in this manner is intended to serve only as a first approximation to guide initial medical management.

Early estimation of dose is useful in the medical evaluation of severe radiation accidents. In a prior publication, lymphocyte depletion kinetics were shown to follow an exponential decline for gamma accidents in which the average whole-body dose was in the range 50 cGy < D < 8-10 Gy. In that study, the depletion rate constant was linearly related to dose, within the statistical variation of the historical hematological data. This simple technique has now been extended to include analysis of various types of criticality accidents (liquid process; water moderated systems; metallic systems). Lymphocyte depletion in high-level mixed gamma/neutron accidents is found to be approximately equal, at a given effective dose, to that for gamma accidents. This universality would indicate a neutron RBE for human lymphocytes close to unity. Furthermore, the technique appears to be insensitive to the shape of gamma and neutron spectra, therefore making it especially robust for initial, approximate dose estimation.

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