Infrastructure to support ultra high throughput biodosimetry screening after a radiological event

Abstract

Purpose: After a large-scale radiological event, there will be a pressing need to assess, within a few days, the radiation doses received by tens or hundreds of thousands of individuals. This is for triage, to prevent treatment locations from being overwhelmed, in what is sure to be a resource limited scenario, as well as to facilitate dose-dependent treatment decisions. In addition there are psycho-social considerations, in that active reassurance of minimal exposure is a potentially effective antidote to mass panic, as well as long-term considerations, to facilitate later studies of cancer and other long-term disease risks.

Materials and methods: As described elsewhere in this issue, we are developing a Rapid Automated Biodosimetry Tool (RABiT). The RABiT allows high throughput analysis of thousands of blood samples per day, providing a dose estimate that can be used to support clinical triage and treatment decisions.

Results: Development of the RABiT has motivated us to consider the logistics of incorporating such a system into the existing emergency response scenarios of a large metropolitan area. We present here a view of how one or more centralized biodosimetry readout devices might be incorporated into an infrastructure in which fingerstick blood samples are taken at many distributed locations within an affected city or region and transported to centralized locations.

Conclusions: High throughput biodosimetry systems offer the opportunity to perform biodosimetric assessments on a large number of persons. As such systems reach a high level of maturity, emergency response scenarios will need to be tweaked to make use of these powerful tools. This can be done relatively easily within the framework of current scenarios.

Figure 1

Layout of the CRC as per CDC guideline. People are initially sorted to: Urgent Medical (UM, red) who are given stabilizing first aid and transported to a medical facility; Previously Decontaminated (PD, blue), who are given a thorough contamination survey and either sent for decontamination or to the clean zone; Not Previously Decontaminated (NPD, green) who are surveyed. Highly Contaminated individuals (HC, orange) are sent immediately to decontamination. Non-contaminated individuals (after the thorough contamination survey, NC, yellow) can go directly to the clean zone while those who are contaminated (C, purple) are decontaminated at the wash area. Once in the clean zone, individuals are registered, a dose assessment is performed and they are discharged. Figure adapted from CDC web page: http://emergency.cdc.gov/radiation/crc/vcrc.asp

Figure 2

Breadboard prototype of the RABiT system.

Figure 3

(a) Sample collection kit, (b) data collection card with capillary, (c) close-up of bar-coded capillary, and (d) wristband.

Figure 4

Scheme of the sample collection. (a) Sample holder with sealing putty (P) and separation medium (M); (b) blood in a capillary (B); (c) capillary loaded into sample holder layering blood above the separation medium without mixing; and (d) photograph of filled capillary holder.