Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations.
Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations.
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DOI：
10.1097/hp.0b013e31829cf221
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发表时间：
2013-12
期刊：
影响因子：
2.2
通讯作者：
Coleman CN
中科院分区：
文献类型：
--
作者：
Sullivan JM;Prasanna PG;Grace MB;Wathen LK;Wallace RL;Koerner JF;Coleman CN
在造成大规模伤亡的核灾难之后，有效的医疗分诊有可能挽救数万人的生命。为了最好地利用可用的稀缺资源，迫切需要生物剂量测定工具来确定个人的辐射剂量。辐射暴露的初步分类将包括事件发生时的位置、症状和体检。逐步分类将包括小于或大于 2 Gy 的护理点评估，然后进行二次评估，可能进行高通量筛查，以进一步确定个人的剂量。鉴于辐射损伤的多系统性质，任何单一的生物剂量测定法都不可能用作独立工具来满足容量激增的需求以及所需的及时性和准确性。作为国家核或放射性事件准备和规划的一部分，我们回顾了主要文献，以确定目前可用或正在开发的用于患者初次和二次分诊的多种生物剂量测定方法的能力和局限性。从响应的角度了解需求以及各种检测的能力和后勤将有助于为未来生物剂量测定技术的开发和采购提供信息。考虑的因素包括：所需样品类型、剂量检测限度、生物学上可行的测定时间间隔、样品制备和分析时间、易用性、后勤要求、潜在通量、护理点能力以及在治疗相关时间点内支持患者诊断和治疗的能力。
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 stand-alone 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, we 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.