Abstract
In this review, we discuss the value of biological dosimetry and electron paramagnetic resonance (EPR) spectroscopy in the medical management support of acute radiation syndrome (ARS). Medical management of an ionizing radiation scenario requires significant information. For optimal medical aid, this information has to be rapidly (< 3 days) delivered to the health-care provider. Clinical symptoms may initially enable physicians to predict ARS and initiate respective medical treatment. However, in most cases at least further verification through knowledge on radiation exposure details is necessary. This can be assessed by retrospective dosimetry techniques, if it is not directly registered by personal dosimeters. The characteristics and potential of biological dosimetry and electron paramagnetic resonance (EPR) dosimetry using human-derived specimen are presented here. Both methods are discussed in a clinical perspective regarding ARS diagnostics. The presented techniques can be used in parallel to increase screening capacity in the case of mass casualties, as both can detect the critical dose of 2 Gy (whole body single dose), where hospitalization will be considered. Hereby, biological dosimetry based on the analysis of molecular biomarkers, especially gene expression analysis, but also in vivo EPR represent very promising screening tools for rapid triage dosimetry in early-phase diagnostics. Both methods enable high sample throughput and potential for point-of-care diagnosis. In cases of higher exposure or in small-scale radiological incidents, the techniques can be used complementarily to understand important details of the exposure. Hereby, biological dosimetry can be employed to estimate the whole body dose, while EPR dosimetry on nails, bone or teeth can be used to determine partial body doses. A comprehensive assessment will support optimization of further medical treatment. Ultimately, multipath approaches are always recommended. By tapping the full potential of all diagnostic and dosimetric methods, effective treatment of patients can be supported upon exposure to radiation.
Highlights
In this review, we discuss the value of biological dosimetry and electron paramagnetic resonance (EPR) spectroscopy in the medical management support of acute radiation syndrome (ARS)
We present methods for biological and EPR retrospective dosimetry with regard to radiation accident response
Whereas biological dosimetry measures the dose to circulating blood lymphocytes, and provides the absorbed equivalent whole body dose, EPR determines the local dose absorbed by the collected biologically derived specimen or physical sample material located near the victim at time of exposure
Summary
Radiological and nuclear incidents with people exposed to a health-threatening radiation dose are rare. Regarding the central questions and challenges for medical management, the optimal retrospective dosimetry method, similar to a personal dosimeter, should be fast, can be used for triage, cover the relevant dose ranges as well as exhibit a precise, reliable, persistent and radiation-specific indicator. In this manuscript, we present methods for biological and EPR retrospective dosimetry with regard to radiation accident response. We discuss how these methods resemble or complement each other to match the requirements to support medical management in a clinical perspective
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