title: Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations.
abstract: 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 standalone 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, the authors 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.
authors.affiliation: *Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC; †AAAS Science and Technology Policy Fellow, Washington DC; ‡Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD; §Biomedical Advanced Research & Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Sullivan
authors.forename: Pataje G S
authors.initials: PG
authors.lastname: Prasanna
authors.forename: Marcy B
authors.initials: MB
authors.lastname: Grace
authors.forename: Lynne K
authors.initials: LK
authors.lastname: Wathen
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Wallace
authors.forename: John F
authors.initials: JF
authors.lastname: Koerner
authors.forename: C Norman
authors.initials: CN
authors.lastname: Coleman
mesh_terms: D001681:Biological Assay; D015415:Biomarkers / Q000378:metabolism; D055592:Biophysical Phenomena; D002877:Chromosomes, Human / Q000235:genetics / Q000528:radiation effects; D020732:Cytogenetic Analysis; D048749:Cytokinesis / Q000528:radiation effects; D004249:DNA Damage; D006405:Hematology; D006801:Humans; D008214:Lymphocytes / Q000166:cytology / Q000528:radiation effects; D054527:Mass Casualty Incidents; D035683:MicroRNAs / Q000235:genetics; D015162:Micronucleus Tests; D009504:Neutrophils / Q000166:cytology / Q000528:radiation effects; D018788:Radioactive Hazard Release; D011874:Radiometry / Q000379:methods*; D059467:Transcriptome / Q000528:radiation effects; D014218:Triage / Q000379:methods*
chemical_list: D015415:Biomarkers; D035683:MicroRNAs