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Dose Estimator (Biodosimetry Tools) (What Is Biodosimetry?) Estimate Exposure Dose - Dose Estimator: Onset of Vomiting Lymphocyte Depletion Kinetics Dicentric Chromosomes Suggest Hematopoietic Subsyndrome Treatment, Based on Exposure Dose and Event Size Biodosimetry Based on Acute Photon-Equivalent Exposures (PDF - 58 KB) See also: Explaining Biodosimetry Dose Estimator - Onset of Vomiting 13 Time to vomiting after exposure: Select onset time < 30 minutes 30 minutes 40 minutes 45 minutes 1 hour 1 hour 15 minutes 1 hour 45 minutes 2 hours 30 minutes > 4 hours 30 minutes    Time to onset of vomiting and dose (Illustration) Estimated whole-body radiation dose: (Dose shown in units of gray) (Read-only field) Percent victims with vomiting at this dose: (Read-only field) for hematopoietic subsyndrome based on this dose. Note: Remember that in a mass casualty incident, vomiting may be related to many conditions other than radiation exposure, including psychological factors. Dose Estimator - Lymphocyte Depletion Kinetics 13 ONLY ONE blood specimen is available TWO blood specimens are available (* Required field) If ONLY ONE blood specimen available: What are lymphocyte depletion kinetics? (Illustration) * Current absolute lymphocyte count: x 109 cells/L. (2.45 x 109 cells/L is used as the default value for inital lymphocyte count) * Time interval since exposure to radiation : days and hours. Estimated whole-body radiation dose: (Dose shown in units of gray) (Read-only field) for hematopoietic subsyndrome based on this dose. If TWO blood specimens available: What are lymphocyte depletion kinetics? (Illustration) * Initial absolute lymphocyte count:      x 109 cells/L. * Second absolute lymphocyte count:   x 109 cells/L. * Time interval between the two tests:   days and hours. Estimated whole-body radiation dose: (Dose shown in units of gray) (Read-only field) for hematopoietic subsyndrome based on this dose. Note: If all counts are within reference range, e.g., 1.4-3.5 x 109 cells/L, dose calculation may be unreliable. Requires 2-4 days for decline at doses of 4-6 Gy and 4-6 days at 2-4 Gy. 20 Dose Estimator - Dicentric Chromosomes in Peripheral Blood Lymphocytes 13 Number of dicentrics: Select a number 0.05 - 0.1 0.2 - 4 5 - 12 13 - 22 23 - 35 36 - 51 > 51 per 50 cells. What is a dicentric chromosome? (Illustration) Estimated whole-body radiation dose: (Dose shown in units of gray) (Read-only field) for hematopoietic subsyndrome based on this dose. Note: Only qualified cytogenetics laboratories should perform dicentric chromosome assays. Assay results are dependent on radiation dose, dose rate, percent whole body irradiated, and radiation quality (e.g., photon vs. neutron). Obtaining assay results may take up to a week after small incidents and much longer in mass casualty incidents. Potential indications for the dicentric chromsome assay Where to send biodosimetry specimens? Armed Forces Radiobiology Research Institute http://www.afrri.usuhs.mil/ 8901 Wisconsin Avenue Bethesda, MD 20889-5603 Contact Security in Emergencies: 1-301-295-0530 Medical Radiology Advisory Team: 1-301-295-0316 Oak Ridge Institute for Science and Education, Radiation Emergency Assistance Center/Training Site (REAC/TS) Cytogenetic Biodosimetry Laboratory http://orise.orau.gov/reacts/cytogenetics-lab.htm (Video: http://orise.orau.gov/video/reacts/cytolab.htm) Attn: Dr. Doran Christensen/Dr. Gordon Livingston P.O. Box 117, MS 39 Oak Ridge, TN 37831-0117 Emergency: DOE/ORO: 1-865-576-1005 (ask for REAC/TS), this is also the after hours number At other times: 1-865-576-3131 (between 8:30-4:30 CST) Download a brochure (PDF - 280 KB) See references for dicentrics and other biodosimetry assays top of page Hematopoietic Subsyndrome Treatment Consensus Guidance for Treatment, Based on Exposure Dose and Event Size 13 View recommendations by clicking on whole-body dose    (Clear) Click on a whole-body dose (Gy) View consensus treatment guidance based on Number of casualties With or without injury/burn or, Show recommendations for all doses/scenarios    (Clear) Treatment Guidance Whole-body Dose (Gy)     What is Gy (gray)? Event Size, ± Injury/Burn (Small event: ≤ 100 victims Mass event: > 100 victims) 1 2 3 4 5 6 7 8 9 10 NOTE: All potential treatments may not be feasible in a large size event. Prophylactic Antibiotics†   Small/no injury         Mass/no injury           Small/injury + burn           Mass/injury + burn   Cytokines/ Bone Marrow Growth Factors‡     Small/no injury           Mass/no injury           Small/injury + burn           Mass/injury + burn, if resources available   Stem-cell Transplantation (Allogeneic)§             Small/no injury             Mass/no injury, if resources available   Stem-cell Transplantation (Autograft or Syngeneic)§       Small/no injury       Mass/no injury, if resources available † Prophylactic Antibiotics 13,17-18 Consider prophylactic antimicrobials when absolute neutrophil count < 0.500 x 109 cells/L. Intial prophylactic antimicrobials include the following, but need to be modified per patient specifics: Fluoroquinolone when absolute neutrophil count < 0.500 x 109 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 109 cells/L Antibiotic therapy should be continued until neutrophil recovery has occurred. Follow Infectious Diseases Society of America 2002 Guidelines18 for febrile neutropenia, if fever develops while the patient is taking prophylactic medication. More details about antimicrobials and treatment of Acute Radiation Syndrome... ‡ Cytokines/Bone Marrow Growth Factors 19 Initiate treatment with granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor in victims who develop an absolute neutrophil count < 0.500 x 109 cells/L and are not already receiving colony-stimulating factor. Consider initiating therapy at lower whole body exposure dose in nonadolescent children and elderly persons because their marrow reserve may be compromised. More details on dose of cytokines... § Hematopoietic Stem-cell Transplantation13-16 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 top of page References References for Dicentrics and Other Biodosimetry Assays Alexander, G.A., et al., BiodosEPR-2006 Meeting: Acute dosimetry consensus committee recommendations on biodosimetry applications in events involving uses of radiation by terrorists and radiation accidents. Radiat. Meas. (2007), doi: 10.1016/j.radmeas.2007.05.035 (PDF - 518 KB) (In Press) 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] 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 Hughes WT , Armstrong D , Bodey GP , Bow EJ , Brown AE , Calandra T , Feld R , Pizzo PA , Rolston KV , Shenep JL , Young LS. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002 34(6):730-51. [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 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)

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