Video Tutorial (2:33)
Dose Estimator for Exposure: 3 Biodosimetry Tools
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To estimate radiation dose,
the Dicentric Chromosome Assay
should be performed in a
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Hematopoietic Subsyndrome Treatment
Consensus Guidance for Treatment, Based on Estimated Dose and Event Size
NOTE: All potential treatments may not be feasible in a large size event.
Small/injury + burn
Mass/injury + burn
Small/injury + burn
Mass/injury + burn,
if resources available
if resources available
if resources available
† Prophylactic Antibiotics
Consider prophylactic antimicrobials when absolute neutrophil count < 0.500 x 10 9 cells/L.
Intial prophylactic antimicrobials include the following, but need to be modified per patient specifics:
Fluoroquinolone when absolute neutrophil count < 0.500 x 10 9 cells/L
Acyclovir (if patient is seropositive for herpes simplex virus or has a medical history of this virus)
Fluconazole when absolute neutrophil count is < 0.500 x 10 9 cells/L
Antibiotic therapy should be continued until neutrophil recovery has occurred.
Follow Infectious Diseases Society of America 2010 Guidelines for febrile neutropenia, if fever develops while the patient is taking prophylactic medication.
22 More details about antimicrobials and treatment of Acute Radiation Syndrome...
‡ Cytokines/Bone Marrow Growth Factors
Initiate treatment with granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor in victims who develop an absolute neutrophil count < 0.500 x 10 9 cells/L and are not already receiving colony-stimulating factor.
Consider initiating therapy at lower whole body dose from exposure in non-adolescent children and elderly persons because their marrow reserve may be compromised.
More details on dose of cytokines...
§ Hematopoietic Stem-cell Transplantation
Consider stem cell transplantation if marrow recovery unlikely
Feasibility in large mass casualty settings is unsure
Requires patient transfer to transplant center
See references for hematopoietic subsyndrome treatment
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References for Dicentrics and Other Biodosimetry Assays
Swartz HM, Flood AB, Gougelet RM, Rea ME, Nicolalde RJ, Williams BB. A critical assessment of biodosimetry methods for large-scale incidents. Health Phys. 2010 Feb;98(2):95-108. [PubMed Citation]
Alexander GA, et al., BiodosEPR-2006 Meeting: Acute dosimetry consensus committee recommendations on biodosimetry applications in events involving uses of radiation by terrorists and radiation accidents. (PDF - 518 KB) Radiat Meas. 2007 July;42(6-7):972-96. Sine RC, Levine IH, Jackson WE, Hawley AL, Prasanna PG, Grace MB, Goans RE, Greenhill RG, Blakely WF. Biodosimetry Assessment Tool: a post-exposure software application for management of radiation accidents. Mil Med. 2001 Dec;166(12 Suppl):85-7 [PubMed Citation]
Goans RE, Holloway EC, Berger ME, Ricks RC. Early dose assessment in criticality accidents. Health Phys. 2001;81:446-9. [PubMed Citation]
Bender MA, Gooch PC. Somatic chromosome aberrations induced by human whole-body irradiation: the "Recuplex" criticality accident. Radiat Res. 1966;29:568-82. [PubMed Citation]
Lloyd DC, Edwards AA, Moquet JE, Guerrero-Carbajal YC. The role of cytogenetics in early triage of radiation casualties. Appl Radiat Isot 2000 May;52(5):1107-12. [PubMed Citation]
Prasanna PG, Escalada ND, Blakely WF. Induction of premature chromosome condensation by a phosphatase inhibitor and a protein kinase in unstimulated human peripheral blood lymphocytes: a simple and rapid technique to study chromosome aberrations using specific whole-chromosome DNA hybridization probes for biological dosimetry. Mutat Res 2000 Mar 23;466(2):131-41. [PubMed Citation]
Blakely WF, Salter CA, Prasanna PGS. Early-response biological dosimetry-Recommended countermeasure enhancements for mass-casualty radiological incidents and terrorism. Health Phy 2005 89(5):494-504 [PubMed Citation]
Prasanna PGS, Blakely WF. Premature chromosome condensation in human resting peripheral blood lymphocytes for chromosome aberration analysis using specific whole-chromosome DNA hybridization probes. 2005 Methods Mol boil 291:49-57 [PubMed Citation]
Bauchinger M, Blakely WF, Darroudi F, Edwards A, Fenech M, Hayata I, Koteles GJ, Lindholm C, Lloyd D, Lucas J, Prasanna PGS, Roy L, Sorokine-Durm I, Turai I, Voisin P: Cytogenetic Analysis for Radiation Dose Assessment: A Manual. (PDF - 859 KB) IAEA Technical Report Series No. 405, pp.127, Vienna, 2001
Dainiak N, Berger P, Albanese J. Relevance and feasibility of multi-parameter assessment for management of mass casualties from a radiological event. Exp Hematol. 2007 Apr;35(4 Suppl 1):17-23. [PubMed Citation]
Chao NJ. Accidental or intentional exposure to ionizing radiation: biodosimetry and treatment options. Exp Hematol. 2007 Apr;35(4 Suppl 1):24-7. [PubMed Citation]
Albanese J, Martens K, Karkanitsa LV, Dainiak N. Multivariate analysis of low-dose radiation-associated changes in cytokine gene expression profiles using microarray technology. Exp Hematol. 2007 Apr;35(4 Suppl 1):47-54. [PubMed Citation]
Global Nuclear Response Network Launches (IAEA)
WHO BioDoseNet (World Health Organization)
Biodosimetry based on acute photon-equivalent exposures (PDF - 58 KB)
References for Hematopoietic Subsyndrome Treatment
Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004; Vol. 140:1037-51. [PubMed Citation]
Dainiak N, Ricks RC. The evolving role of haematopoietic cell transplantation in radiation injury: potentials and limitations. BJR Suppl. 2005; 27:169-74. [PubMed Citation]
Weisdorf D, Chao N, Waselenko JK, Dainiak N, Armitage JO, McNiece I, Confer D. Acute radiation injury: contingency planning for triage, supportive care, and transplantation. Biol Blood Marrow Transplant. 2006 Jun;12(6):672-82. [PubMed Citation]
Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006 Apr 27; 354(17):1813-26. [PubMed Citation]
Brook I, Elliott TB, Shoemaker MO, Ledney GD, Antimicrobials in the Management of Post-Irradiation Infection, (PDF - 61 KB) NATO RTG-099, 2005
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011 Feb 15;52(4):427-31. [PubMed Citation] Kaushansky K N. Lineage-specific hematopoietic growth factors. N Engl J Med. 2006 May 11;354(19):2034-45. [PubMed Citation]
Dainiak N, Waselenko JK, Armitage JO, MacVittie TJ, Farese AM. The hematologist and radiation casualties. Hematology Am Soc Hematol Educ Program. 2003;:473-96. [PubMed Citation]
Fliedner TM. Nuclear terrorism: the role of hematology in coping with its health consequences. Curr Opin Hematol. 2006 Nov;13(6):436-44. [PubMed Citation] Radiation Injury Treatment Network
Acute Radiation Syndrome Treatment Guidelines (PDF - 1.26 MB) (Radiation Injury Treatment Network, September 2010)
Weisdorf D, Apperley J, Courmelon P, Gorin NC, Wingard J, Chao N. Radiation Emergencies: Evaluation, Management, and Transplantation. Biol Blood Marrow Transplant. 2007;13:103-6. (PDF - 82 KB)