Implementing EPR dosimetry for life-threatening incidents: Factors beyond technical performance

Flood, Ann Barry; Bhattacharyya, Shayan; Nicolalde, Roberto J.; Swartz, Harold M.

doi:10.1016/j.radmeas.2007.05.042

Cited by 11 publications

(10 citation statements)

References 4 publications

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“…Additional challenges such as approval of a new biodosimeter through the regulatory process (Flood et al 2007) and the potential challenge of measuring radiation dose in a special population such as children, pregnant women, or patients who also have burns or trauma injuries in addition to radiation exposure are also worth noting in technology development and deployment. These complexities will all need to be addressed before appropriate biodosimetry architecture can be created.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

Sullivan¹,

Prasanna²,

Grace³

et al. 2013

Health Physics

168

161

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Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual’s radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual’s dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a stand-alone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, we reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point.

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Section: Discussionmentioning

confidence: 99%

Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

Sullivan¹,

Prasanna²,

Grace³

et al. 2013

Health Physics

168

161

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“…Based on the dose-threshold recommendation for medical triage in the case of a radiation event, we utilized 2 Gy as the threshold for ROC analysis. (1,3) . Although the two-component spectral fitting model accurately estimated the RIS amplitude in the clipped nail spectra, this was only accomplished by prior removal of the background signal.…”

Section: Spectral Fitting Modelmentioning

confidence: 99%

Development and validation of an ex vivo electron paramagnetic resonance fingernail biodosimetric method

Swarts

Demidenko

et al. 2014

Radiation Protection Dosimetry

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There is an imperative need to develop methods that can rapidly and accurately determine individual exposure to radiation for screening (triage) populations and guiding medical treatment in an emergency response to a large-scale radiological/nuclear event. To this end, a number of methods that rely on dose-dependent chemical and/or physical alterations in biomaterials or biological responses are in various stages of development. One such method, ex vivo electron paramagnetic resonance (EPR) nail dosimetry using human nail clippings, is a physical biodosimetry technique that takes advantage of a stable radiation-induced signal (RIS) in the keratin matrix of fingernails and toenails. This dosimetry method has the advantages of ubiquitous availability of the dosimetric material, easy and non-invasive sampling, and the potential for immediate and rapid dose assessment. The major challenge for ex vivo EPR nail dosimetry is the overlap of mechanically induced signals and the RIS. The difficulties of analysing the mixed EPR spectra of a clipped irradiated nail were addressed in the work described here. The following key factors lead to successful spectral analysis and dose assessment in ex vivo EPR nail dosimetry: (1) obtaining a thorough understanding of the chemical nature, the decay behaviour, and the microwave power dependence of the EPR signals, as well as the influence of variation in temperature, humidity, water content, and O 2 level; (2) control of the variability among individual samples to achieve consistent shape and kinetics of the EPR spectra; (3) use of correlations between the multiple spectral components; and (4) use of optimised modelling and fitting of the EPR spectra to improve the accuracy and precision of the dose estimates derived from the nail spectra. In the work described here, two large clipped nail datasets were used to test the procedures and the spectral fitting model of the results obtained with it. A 15-donor nail set with 90 nail samples from 15 donors was used to validate the sample handling and spectral analysis methods that have been developed but without the interference of a native background signal. Good consistency has been obtained between the actual RIS and the estimated RIS computed from spectral analysis. In addition to the success in RIS estimation, a linear dose response has also been achieved for all individuals in this study, where the radiation dose ranges from 0 to 6 Gy. A second 16-donor nail set with 96 nail samples was used to test the spectral fitting model where the background signal was included during the fitting of the clipped nail spectra data. Although the dose response for the estimated and actual RIS calculated in both donor nail sets was similar, there was an increased variability in the RIS values that was likely due to the variability in the background signal between donors. Although the current methods of sample handling and spectral analysis show good potential for estimating the RIS in the EPR spectra of nail clippings, there is a remaining degree of v...

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“…It is unlikely that there can be an effective medical response for an event in which large numbers of individuals are potentially exposed to clinically significant levels of radiation without a means to determine the exposure level of individuals (International Atomic Energy Agency [IAEA] 2005, Alexander et al 2007, Flood et al 2007, Gonzalez 2007, Blakely et al 2009, Grace et al 2010). The efficient employment of medical resources, prompt and effective treatment of exposed individuals, and the optimum use of radiation mitigators require knowledge of the dose an individual has received.…”

Section: Introductionmentioning

confidence: 99%

Physically-based biodosimetry using in vivo EPR of teeth in patients undergoing total body irradiation

Williams

Dong

Nicolalde

et al. 2011

International Journal of Radiation Biology

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Purpose The ability to estimate individual exposures to radiation following a large attack or incident has been identified as a necessity for rational and effective emergency medical response. In vivo electron paramagnetic resonance (EPR) spectroscopy of tooth enamel has been developed to meet this need. Materials and methods A novel transportable EPR spectrometer, developed to facilitate tooth dosimetry in an emergency response setting, was used to measure upper incisors in a model system, in unirradiated subjects, and in patients who had received total body doses of 2 Gy. Results A linear dose response was observed in the model system. A statistically significant increase in the intensity of the radiation-induced EPR signal was observed in irradiated versus unirradiated subjects, with an estimated standard error of dose prediction of 0.9 + 0.3 Gy. Conclusions These results demonstrate the current ability of in vivo EPR tooth dosimetry to distinguish between subjects who have not been irradiated and those who have received exposures that place them at risk for acute radiation syndrome. Procedural and technical developments to further increase the precision of dose estimation and ensure reliable operation in the emergency setting are underway. With these developments EPR tooth dosimetry is likely to be a valuable resource for triage following potential radiation exposure of a large population.

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Implementing EPR dosimetry for life-threatening incidents: Factors beyond technical performance

Cited by 11 publications

References 4 publications

Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

Development and validation of an ex vivo electron paramagnetic resonance fingernail biodosimetric method

Physically-based biodosimetry using in vivo EPR of teeth in patients undergoing total body irradiation

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