Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident

TLDR

Mass‑casualty nuclear disasters require rapid triage to save lives, yet the multisystem nature of radiation injury means no single biodosimetry assay can alone provide timely, accurate dose assessment. The study reviews existing and emerging biodosimetry assays to determine their suitability for rapid dose assessment, aiming to guide future technology development and acquisition for emergency response. Triage involves initial assessment of location, symptoms, and physical exam, followed by point‑of‑care dose estimation (<2 Gy or >2 Gy) and secondary high‑throughput screening, with assay selection guided by sample type, detection limits, turnaround time, ease of use, logistics, throughput, and point‑of‑care capability.

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.