Current use and future needs of biodosimetry in studies of long-term health risk following radiation exposure

Multiwell-based G0-PCC assay for radiation biodosimetry

In major radiological events, rapid assays to detect ionizing radiation exposure are crucial for effective medical interventions. The purpose of these assays is twofold: to categorize affected individuals into groups for initial treatments, and to provide definitive dose estimates for continued care and epidemiology. However, existing high-throughput cytogenetic biodosimetry assays take about 3 days to yield results, which delays critical interventions. We have developed a multiwell-based variant of the chemical-induced G0-phase Premature Chromosome Condensation Assay that delivers same-day results. Our findings revealed that using a concentration of phosphatase inhibitor lower than recommended significantly increases the yield of cells with highly condensed chromosomes. These chromosomes exhibited increased fragmentation in a dose-dependent manner, enabling to quantify radiation damage using a custom Deep Learning algorithm. This algorithm demonstrated reasonable performance in categorizing doses into distinct treatment groups (84% and 80% accuracy for three and four iso-treatment dose bins, respectively) and showed reliability in determining the actual doses received (correlation coefficient of 0.879). This method is amendable to full automation and has the potential to address the need for same-day, high-throughput cytogenetic test for both dose categorization and dose reconstruction in large-scale radiation emergencies.

Chromosomal damage in occupationally exposed health professionals assessed by two cytogenetic methods

The study assessed occupationally induced chromosomal damage in hospital personnel at risk of exposure to antineoplastic drugs and/or low doses of ionizing radiation by two cytogenetic methods. Cultured peripheral blood lymphocytes of eighty-five hospital workers were examined twice over 2 to 3 years by classical chromosomal aberration analysis and fluorescence in situ hybridization. The comparison of the 1^st and the 2^nd sampling of hospital workers showed a significant increase in chromatid and chromosomal aberrations (all p < .05) examined by classical chromosomal aberration analysis, and in unstable aberrations (all p < .05) detected by fluorescence in situ hybridization. Both cytogenetic methods were able to detect an increase of unstable aberrations in the 2^nd sampling. The raised frequency of unstable cytogenetic parameters suggested higher recent exposure to genotoxic agents.

The use of portable OSL and IRSL measurements of NaCl in low dose assessments following a radiological or nuclear emergency

During recovery phases following a nuclear or radiological incident analyses of doses received by members of the public and responders are often required. Several methods have been investigated for use at different timescales after the incident, including assessments based on measurements of materials present at the time of the incident. Common salt has previously been shown to have potential for retrospective dosimetry in the mGy dose range using laboratory instrumentation. This preliminary study investigates the use of portable instruments, with unprepared commercially sourced salt, in dose ranges below 100 μGy. Responses from pulsed IRSL and portable OSL instruments were compared. For OSL measurements, detection limits of 7 μGy have been demonstrated, with detection limits of 30-340 μGy for the other instruments investigated. Dose responses in the 0-500 μGy range were determined for the most sensitive systems, which show a linear response over this dose range with a non-zero intercept representing doses received from environmental sources since manufacture of the salt. For use as a dosimeter, methods of removing or accounting for inherited signals will be required in this low dose range. The results demonstrate that salt has considerable potential for use in retrospective dosimetry below 100 μGy, and that measurements can be conducted with portable OSL instruments.

Retrospective biodosimetry techniques: Focus on cytogenetics assays for individuals exposed to ionizing radiation

In the absence of physical data, biodosimetry tools are required for fast dose and risk assessment in the event of radiological or nuclear mass accidents or attacks to triage exposed humans and take immediate medical countermeasures. Biodosimetry tools have mostly been developed for retrospective dose assessment and the follow-up of victims of irradiation. Among them, cytogenetics analyses, to reveal chromosome damage, are the most developed and allow the determination of doses from blood samples as low as 100 mGy. Various cytogenetic tests have already allowed retrospective dose assessment of Chernobyl liquidators and military personnel exposed to nuclear tests after decades. In this review, we discuss the properties of various biodosimetry techniques, such as their sensitivity and limitations as a function of the time from exposure, using multiple examples of nuclear catastrophes or working exposure. Among them, chromosome FISH hybridization, which reveals chromosome translocations, is the most reliable due to the persistence of translocations for decades, whereas dicentric chromosome and micronuclei assays allow rapid and accurate dose assessment a short time after exposure. Both need to be adjusted through mathematical algorithms for retrospective analyses, accounting for the time since exposure and the victims' age. The goal for the future will be to better model chromosome damage, reduce the time to result, and develop new complementary biodosimetry approaches, such as mutation signatures.

Chromosome Translocations, Inversions and Telomere Length for Retrospective Biodosimetry on Exposed U.S. Atomic Veterans

It has now been over 60 years since U.S. nuclear testing was conducted in the Pacific islands and Nevada, exposing military personnel to varying levels of ionizing radiation. Actual doses are not well-established, as film badges in the 1950s had many limitations. We sought a means of independently assessing dose for comparison with historical film badge records and dose reconstruction conducted in parallel. For the purpose of quantitative retrospective biodosimetry, peripheral blood samples from 12 exposed veterans and 12 age-matched (>80 years) veteran controls were collected and evaluated for radiation-induced chromosome damage utilizing directional genomic hybridization (dGH), a cytogenomics-based methodology that facilitates simultaneous detection of translocations and inversions. Standard calibration curves were constructed from six male volunteers in their mid-20s to reflect the age range of the veterans at time of exposure. Doses were estimated for each veteran using translocation and inversion rates independently; however, combining them by a weighted-average generally improved the accuracy of dose estimations. Various confounding factors were also evaluated for potential effects on chromosome aberration frequencies. Perhaps not surprisingly, smoking and age-associated increases in background frequencies of inversions were observed. Telomere length was also measured, and inverse relationships with both age and combined weighted dose estimates were observed. Interestingly, smokers in the non-exposed control veteran cohort displayed similar telomere lengths as those in the never-smoker exposed veteran group, suggesting that chronic smoking had as much effect on telomere length as a single exposure to radioactive fallout. Taken together, we find that our approach of combined chromosome aberration-based retrospective biodosimetry provided reliable dose estimation capability, particularly on a group average basis, for exposures above statistical detection limits.

Radiation-Induced Phosphorylation of Serine 360 of SMC1 in Human Peripheral Blood Mononuclear Cells

In the event of a mass casualty radiation scenario, biodosimetry has the potential to quantify individual exposures for triaging and providing dose-appropriate medical intervention. Structural maintenance of chromosomes 1 (SMC1) is phosphorylated in response to ionizing radiation. The goal of this study was to develop a new biodosimetry method using SMC1 phosphorylation as a measure of exposure to radiation. In the initial experiments, two normal human cell lines (WI-38VA-13 and HaCaT) and four lymphoblastoid cell lines were irradiated, and the levels of SMC1 phosphorylation at Ser-360 and Ser-957 were assessed using Western blotting. Subsequently, similar experiments were performed using peripheral blood mononuclear cells (PBMCs) obtained from 20 healthy adults. Phosphorylation of SMC1 at Ser-957 and Ser-360 was increased by exposure in a dose-dependent manner, peaked at 1-3 h postirradiation and then decreased gradually. Ser-360 was identified as a new phosphorylation site and was more sensitive to radiation than Ser-957, especially at doses below 1 Gy. Our results demonstrate a robust ex vivo response of phospho-SMC1-(Ser-360) to ionizing radiation in human PBMCs. Detection of phosphorylation at Ser-360 in SMC1 could be used as a marker of radiation exposure. Our findings suggest that it is feasible to measure blood cell-based changes in the phosphorylation level of a protein as an ex vivo radiation exposure detection method, even after low-dose exposure.

Cytogenetic status of interventional radiology unit workers occupationally exposed to low-dose ionising radiation: A pilot study

Interventional radiology unit workers represent one of the occupationally most exposed populations to low-dose ionizing radiation. Since there are many uncertainties in research of doses below 100 mSv, this study attempted to evaluate DNA damage levels in chronically exposed personnel. The study group consisted of 24 subjects matched with a control population by the number of participants, age, gender ratio, active smoking status, the period of blood sampling, and residence. Based on regular dosimetry using thermoluminiscent dosimeters, our study group occupationally received a dose of 1.82 ± 3.60 mSv over the last year. The results of the cytokinesis-block micronucleus assay and the comet assay showed a higher nuclear buds frequency (4.09 ± 1.88) and tail length (15.46 ± 1.47 μm) than in the control group (2.96 ± 1.67, 14.05 ± 1.36 μm, respectively). Differences in other descriptors from both tests did not reach statistical significance. Further investigations are needed to develop algorithms for improving personal dosimetry and those that would engage larger biomonitoring study groups.

Dose-dependent decrease in anti-oxidant capacity of whole blood after irradiation: A novel potential marker for biodosimetry

Many reports have demonstrated that radiation stimulates reactive oxygen species (ROS) production by mitochondria for a few hours to a few days after irradiation. However, these studies were performed using cell lines, and there is a lack of information about redox homeostasis in irradiated animals and humans. Blood redox homeostasis reflects the body condition well and can be used as a diagnostic marker. However, most redox homeostasis studies have focused on plasma or serum, and the anti-oxidant capacity of whole blood has scarcely been investigated. Here, we report changes in the anti-oxidant capacity of whole blood after X-ray irradiation using C57BL/6 J mice. Whole-blood anti-oxidant capacity was measured by electron spin resonance (ESR) spin trapping using a novel spin-trapping agent, 2-diphenylphosphinoyl-2-methyl-3,4-dihydro-2H-pyrrole N-oxide (DPhPMPO). We found that whole-blood anti-oxidant capacity decreased in a dose-dependent manner (correlation factor, r > 0.9; P < 0.05) from 2 to 24 days after irradiation with 0.5-3 Gy. We further found that the red blood cell (RBC) glutathione level decreased and lipid peroxidation level increased in a dose-dependent manner from 2 to 6 days after irradiation. These findings suggest that blood redox state may be a useful biomarker for estimating exposure doses during nuclear and/or radiation accidents.

LONG-TERM BIODOSIMETRY REDUX

This paper revisits and reiterates the needs, purposes and requirements of biodosimetric assays for long-term dose and health risk assessments. While the most crucial need for biodosimetric assays is to guide medical response for radiation accidents, the value of such techniques for improving our understanding of radiation health risk by supporting epidemiological (long-term health risk) studies is significant. As new cohorts of exposed persons are identified and new health risk studies are undertaken with the hopes that studying the exposed will result in a deeper understanding of radiation risk, the value of reliable dose reconstruction is underscored. The ultimate application of biodosimetry in long-term health risk studies would be to completely replace model-based dose reconstruction-a complex suite of methods for retrospectively estimating dose that is commonly fraught with large uncertainties due to the absence of important exposure-related information, as well as imperfect models. While biodosimetry could potentially supplant model-based doses, there are numerous limitations of presently available techniques that constrain their widespread application in health risk research, including limited ability to assess doses received far in the past, high cost, great inter-individual variability, invasiveness, higher than preferred detection limits and the inability to assess internal dose (for the most part). These limitations prevent the extensive application of biodosimetry to large cohorts and should be considered a challenge to researchers to develop new and more flexible techniques that meet the demands of long-term health risk research. Events in recent years, e.g. the Fukushima reactor accident and the increased threat of nuclear terrorism, underscore that any event that results in significant radiation exposures of a group of people will also produce a much larger population, exposed at lower levels, but that likewise needs (or demands) an exposure assessment. Hence, the needs for retrospective dose estimation are likely to be greater in the future. The value of biodosimetry can be considerably enhanced with the development of new or improved methods, particularly with suitability for application at long periods of time after exposure.

A New Era of Low-Dose Radiation Epidemiology

The last decade has introduced a new era of epidemiologic studies of low-dose radiation facilitated by electronic record linkage and pooling of cohorts that allow for more direct and powerful assessments of cancer and other stochastic effects at doses below 100 mGy. Such studies have provided additional evidence regarding the risks of cancer, particularly leukemia, associated with lower-dose radiation exposures from medical, environmental, and occupational radiation sources, and have questioned the previous findings with regard to possible thresholds for cardiovascular disease and cataracts. Integrated analysis of next generation genomic and epigenetic sequencing of germline and somatic tissues could soon propel our understanding further regarding disease risk thresholds, radiosensitivity of population subgroups and individuals, and the mechanisms of radiation carcinogenesis. These advances in low-dose radiation epidemiology are critical to our understanding of chronic disease risks from the burgeoning use of newer and emerging medical imaging technologies, and the continued potential threat of nuclear power plant accidents or other radiological emergencies.

Eight-year follow-up study of three individuals accidentally exposed to (60)Co radiation: Chromosome aberration and micronucleus analysis

We assessed dose levels and the persistence of chromosomal aberrations and micronuclei in three individuals in the 8 year following accidental (60)Co radiation exposure. Venous blood samples were collected and used for analyses: traditional chromosome aberration (CA) measurement, G-banding, and the cytokinesis-block micronucleus (CBMN) assay. For CA analysis, we scored dicentric chromosomes (dic) and rings (r) in peripheral blood lymphocytes. The radiation doses (Gy) suffered by the individuals were estimated as: 1.79-2.43 (A), 2.36-2.86 (B), 1.58-1.82 (C), based on CA analysis; and 1.8-2.34 (A), 2.52-2.98 (B), 1.53-1.77 (C), based on CBMN frequencies. G-banding analysis was used to record translocations (t), inversions (inv), and deletions (del). Following the accident, unstable CAs reduced gradually, but stable aberrations persisted. Unstable CAs and CBMN may be valuable biomarkers for dose estimation shortly after high-dose radiation accidents, while stable aberrations may be more useful for assessing long-term effects.

Threshold limits for biological indication of prolonged radiation exposure using mFISH

Chromosome aberration (translocation) yield was investigated by mFISH in peripheral blood lymphocytes of Mayak Production Association (PA) workers with prolonged occupational exposure to ionizing radiation (IR). A dose threshold for cytogenetic indication of a prolonged occupational radiation exposure was estimated for Mayak PA workers using functions of dose distributions. Two limits were estimated for the indication of IR exposure to workers with a prolonged external gamma-ray exposure: These are a background translocation yield of N₀ = 0.812 ± 0.149% and a dose threshold of indication D₀ estimated to be approximately 1 Gy.

Guidelines for exposure assessment in health risk studies following a nuclear reactor accident

BACKGROUND

Worldwide concerns regarding health effects after the Chernobyl and Fukushima nuclear power plant accidents indicate a clear need to identify short- and long-term health impacts that might result from accidents in the future. Fundamental to addressing this problem are reliable and accurate radiation dose estimates for the affected populations. The available guidance for activities following nuclear accidents is limited with regard to strategies for dose assessment in health risk studies.

OBJECTIVES

Here we propose a comprehensive systematic approach to estimating radiation doses for the evaluation of health risks resulting from a nuclear power plant accident, reflected in a set of seven guidelines.

DISCUSSION

Four major nuclear reactor accidents have occurred during the history of nuclear power production. The circumstances leading to these accidents were varied, as were the magnitude of the releases of radioactive materials, the pathways by which persons were exposed, the data collected afterward, and the lifestyle factors and dietary consumption that played an important role in the associated radiation exposure of the affected populations. Accidents involving nuclear reactors may occur in the future under a variety of conditions. The guidelines we recommend here are intended to facilitate obtaining reliable dose estimations for a range of different exposure conditions. We recognize that full implementation of the proposed approach may not always be feasible because of other priorities during the nuclear accident emergency and because of limited resources in manpower and equipment.

CONCLUSIONS

The proposed approach can serve as a basis to optimize the value of radiation dose reconstruction following a nuclear reactor accident.

Review of retrospective dosimetry techniques for external ionising radiation exposures

The current focus on networking and mutual assistance in the management of radiation accidents or incidents has demonstrated the importance of a joined-up approach in physical and biological dosimetry. To this end, the European Radiation Dosimetry Working Group 10 on 'Retrospective Dosimetry' has been set up by individuals from a wide range of disciplines across Europe. Here, established and emerging dosimetry methods are reviewed, which can be used immediately and retrospectively following external ionising radiation exposure. Endpoints and assays include dicentrics, translocations, premature chromosome condensation, micronuclei, somatic mutations, gene expression, electron paramagnetic resonance, thermoluminescence, optically stimulated luminescence, neutron activation, haematology, protein biomarkers and analytical dose reconstruction. Individual characteristics of these techniques, their limitations and potential for further development are reviewed, and their usefulness in specific exposure scenarios is discussed. Whilst no single technique fulfils the criteria of an ideal dosemeter, an integrated approach using multiple techniques tailored to the exposure scenario can cover most requirements.

Prevention of future incidents and investigational lines

All radiation devices in use nowadays are subject to cause serious incidents and accidents, with potential risks in exposed population groups. These risks may have immediate or long term health implications. The detection of radioactive incidents is a procedure that should be systematized in economically developed societies. International organizations may provide support to other states in the event of a radioactive incident. Prevention, mitigation and treatment of the radiation effects are done by anticipating the moment of exposure and by establishing new efforts for investigation of radioprotective products. In this article we will analyze the causes of radiological incidents, the means to detect them, and the current preventive and therapeutic procedures available, with special emphasis on new biodosimetry methods for triage and investigational radioprotective drugs. Finally, we will explore the most efficient measures, for future prevention.

A critical assessment of biodosimetry methods for large-scale incidents

Recognition is growing regarding the possibility that terrorism or large-scale accidents could result in potential radiation exposure of hundreds of thousands of people and that the present guidelines for evaluation after such an event are seriously deficient. Therefore, there is a great and urgent need for after-the-fact biodosimetric methods to estimate radiation dose. To accomplish this goal, the dose estimates must be at the individual level, timely, accurate, and plausibly obtained in large-scale disasters. This paper evaluates current biodosimetry methods, focusing on their strengths and weaknesses in estimating human radiation exposure in large-scale disasters at three stages. First, the authors evaluate biodosimetry's ability to determine which individuals did not receive a significant exposure so they can be removed from the acute response system. Second, biodosimetry's capacity to classify those initially assessed as needing further evaluation into treatment-level categories is assessed. Third, we review biodosimetry's ability to guide treatment, both short- and long-term, is reviewed. The authors compare biodosimetric methods that are based on physical vs. biological parameters and evaluate the features of current dosimeters (capacity, speed and ease of getting information, and accuracy) to determine which are most useful in meeting patients' needs at each of the different stages. Results indicate that the biodosimetry methods differ in their applicability to the three different stages, and that combining physical and biological techniques may sometimes be most effective. In conclusion, biodosimetry techniques have different properties, and knowledge of their properties for meeting the different needs for different stages will result in their most effective use in a nuclear disaster mass-casualty event.