Dartmouth Researchers Evaluate Technology to Attend to Mass Casualties in Nuclear Disaster
February 19, 2014
Biodosimetry identified as most promising approach to fill public safety gap
How would a city, state, or country handle a disaster in which hundreds of thousands of people were exposed to radiation? When the number of people involved exceeds the capacity of nearby hospitals, how would a community know who to treat? In a new scientific review published on February 12, 2014 in Radiation Environmental Biophysics, Dartmouth researchers say that by examining a person's teeth or fingernails with specialized equipment, it is possible for first responders to estimate radiation exposure and identify those with the highest risk of illness. The review makes the case for field-based equipment that can easily and quickly allow first responders to decide who needs treatment for radiation exposure in a large-scale event such as major nuclear power plant malfunction or terrorism.
Authors Harold M. Swartz, Benjamin Williams and Ann Flood at the EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, evaluate existing methods for evaluating radiation exposure among hundreds of thousands or even millions of people.
Biodosimetry is the method used to assess the amount of radiation energy a person has absorbed. Swartz and his colleagues identify a physically-based biodosimetry called EPR as the most promising front-line strategy for triage in a nuclear disaster.
Physically based biodosimetry measures tissue changes resulting from radiation exposure. It looks for the number of free radicals in tooth enamel or fingernails. Swartz and his colleagues have developed and tested an EPR biodosimetry device that can be operated in a church basement, tent, or gymnasium in a disaster by people with little training. The device provides the person's dose after only 5-10 minutes from start to finish.
"Teeth and nails serve like 'radiation badges' that everybody always has with them," said Harold M. Swartz, MD, PhD, MSPH, the Alma Hass Milham Distinguished Chair in Clinical Medicine at the Geisel School of Medicine at Dartmouth, and professor of radiology, of medicine, and of physiology. Swartz is also co-director of Norris Cotton Cancer Center's Cancer Imaging and Radiobiology Research Program.
Alternatives have been considered, such as embedding radiation-sensitive materials in objects commonly carried by people such as credit cards, cell phones, or watches. The wide range of materials used in these belongings make it difficult to have a uniform response.
"EPR biodosimetry has been used successfully in small accidents and in major events," said Swartz. "EPR of teeth and nails make them especially suitable for initial triage of large-scale radiation events."
EPR doesn't solve every problem. Blood tests and other diagnostic exams would still need to be done to help physicians develop a treatment plan. EPR evaluates cumulative radiation exposure, including what a person has received from routine X-rays or airline travel. It can't isolate just radiation exposure from the disaster. Its main purpose, however, is to find whether the person's dose is much larger than what people receive from such usual sources, suggesting they might need immediate treatment. Swartz and his colleagues hope to secure FDA approval for their EPR dosimetry device.
The research has been supported by a grant from NIH (U19-A1-91173) and as part of a contract with the Biomedical Advanced Research and Development Authority (BARDA) within the Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services.
About Norris Cotton Cancer Center at Dartmouth-Hitchcock
Norris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.