Swab Each Nostril Separately to Help Estimate Level of Internal (Lung) Contamination

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  • In a mass casualty event, collecting and analyzing nasal swabs may not be feasible due to numbers of patients, transportation issues, and limited laboratory capacity
  • Swabs collected >1 hour after contamination may provide unreliable results
  • Remember that measuring radioactivity is not the same as measuring absorbed dose
  • Nasal swab samples can provide valuable information about inhaled radioactive material including
    • Identification of radioisotope and mode of isotope decay
    • A crude estimate of the amount of radioactivity deposited deep in the lung
    • The level of radioactivity measured from nasal swabs (in units of Bq) can then be used to estimate the dose of radiation received deep in the lung (in units of rad, cGy, rem, or Sv)
  • How to collect nasal swabs
    • Use only one moist, clean, cotton-tipped applicator or nasal swab per nostril
    • Collect sample from anterior portion of the nose
    • Place each swab into its own container and label with name, date, time
    • Analyze each sample separately for radiation contamination
    • NOTE: Alpha-emitting radioisotopes will be masked by any water on the swab. Swabs must be allowed to dry fully before surveying for alpha emitters.
  • Radioactivity levels measured at the nostril are estimated to represent ~5% of the radioactivity inhaled into the deep lung
    • If inhaled particles are 0.2 - 5 microns in diameter, measured radioactivity from nasal swabs is estimated to be ~1-10% of lung contamination
    • If inhaled particles are 1-5 microns in diameter, measured radioactivity from nasal swabs is estimated to be ~5-10% of lung contamination
    • Significant over- or underestimation of radioactivity levels may occur depending on particle size, shape, chemistry, physical stability, individual inhalation patterns and underlying physical health
    • Parameters affecting actual dose to lung include isotope solubility, particle size and mode of radioactive decay
  • Caveats
    • Klumpp J, Bertelli L, Waters T. Interpretation of Nasal Swab Measurements Following Suspected Releases of Actinide Aerosols. Health Phys. 2017 May;112(5):465-469. [PubMed Citation]
    • Distribution of inhaled radioactive material throughout the broncho-pulmonary system is not likely to be homogeneous
    • ≥ 10-fold discrepancy in radioactivity levels between left and right nostril suggests
      • Contamination by other means, as by patient's hands or from surrounding facial contamination
      • Deviated septum, other anatomical obstruction
    • Factors limiting utility of nasal radioactivity to estimate lung dose
      • Obligate mouth breather
      • Nasal obstruction
      • Swabs collected post-decontamination (i.e., after a person showers, blows nose, or wipes contamination from nose)
      • Swabs collected > 1 hour after contamination are unreliable due to normal mucociliary clearance
        • > 30 minutes after suspected contamination: uncertain value
        • > 45-60 minutes after suspected contamination: probably not reliable
  • Other considerations
    • Assume that when external contamination has occurred, some victims may also be internally contaminated
    • Using nasal swab information to manage patients, requires collaboration between health physics/radiation safety personnel and clinical subject matter experts
    • Need to consider possibility of multiple isotopes in radiological dispersal incident (e.g., "dirty bomb")
References:
  1. Illum L. Nasal clearance in health and disease. J Aerosol Med. 2006 Spring;19(1):92-9. [PubMed Citation]
  2. Lund VJ. Nasal physiology: neurochemical receptors, nasal cycle, and ciliary action. Allergy Asthma Proc. 1996 Jul-Aug;17(4):179-84. [PubMed Citation]
  3. Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008, Radiation Exposures from Internal Depositions of Radionuclides (pp. 54-55), Information about the Contaminating Incident (pp. 144-146).
  4. Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases (NCRP Report No. 161, Vol. II), National Council on Radiation Protection and Measurements, Bethesda, MD, 2010, Routes of Entry into the Body (pp. 300-308), Indirect (In Vitro) Measurements of Body or Organ Content (p. 467).
  5. Management of Terrorist Events Involving Radioactive Material (NCRP Report No. 138), National Council on Radiation Protection and Measurements, Bethesda, MD, October 2001. (See Chapter 4: Medical Management of Radiation Casualties.)
  6. Moussa HM. Dust particle size effects on absorbed fraction values in the anterior nose. Health Phys. 2007 Oct;93(4):307-11. [PubMed Citation]
  7. Proctor DF, Anderson I, Lundqvist G. Clearance of inhaled particles from the human nose. Arch Intern Med. 1973 Jan;131(1):132-9. [PubMed Citation]
  8. Soane RJ, Carney AS, Jones NS, Frier M, Perkins AC, Davis SS, Illum L. The effect of the nasal cycle on mucociliary clearance. Clin Otolaryngol Allied Sci. 2001 Feb;26(1):9-15. [PubMed Citation]
  9. Voelz GL. Assessment and Treatment of Internal Contamination: General Principles. In: Gusev IA, Guskova AK, Mettler FA Jr, eds.: Medical Management of Radiation Accidents, 2nd ed. Boca Raton, Fl: CRC Press, 2001, pp. 321-2.

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