Radiation Injury

2021 ◽  
Author(s):  
Maryann Mazer-Amirshahi
Keyword(s):  
Radiation Dose ◽  
Diagnostic Imaging ◽  
Radiation Exposure ◽  
Radiation Injury ◽  
Acute Radiation ◽  
Radiation Sickness ◽  
Radioactive Isotopes ◽  
Smoke Inhalation ◽  
X Rays ◽  
Radiation Contamination

Since the development of x-rays in the late 19th century, radiation has increasingly been used for diagnostic imaging and various industrial purposes. The human health consequences of radiation exposure can range from minor asymptomatic exposures to the development of potentially fatal acute radiation sickness depending on the characteristics of the exposure. This review provides an overview of radiation injury, including historical perspective and principles of toxicity; assessment and stabilization (bedside evaluation, supportive care, and empirical therapy); diagnosis (estimation of radiation dose, laboratory assessment, biodosimetry and bioassays, smoke inhalation, and psychiatric sequelae); treatment and disposition (hematologic acute radiation illness, countermeasures and antidotes, gastrointestinal symptoms, fluid and electrolyte management, surgical intervention, local radiation injury, psychiatric treatment, radiation exposure during pregnancy, palliative care, and disposition); and outcomes (carcinogenesis, noncancer effects). Tables include the characteristic of common radioactive isotopes, common radiation dose equations and conversions, prescribing information for colony-stimulating factors, recommended antimicrobial prophylaxis and treatment regimens, and radioisotope decorporation or blocking agents. Figures show types of ionizing radiation, comparison of radiation contamination and exposure, patterns of early lymphocyte response based on radiation dose, the relationship between time to onset of vomiting and radiation dose, and a sample body chart for documentation of radiation contamination. This review contains 5 figures, 5 tables, and 82 references. Key Words: radiation, radiation exposure, radiation sickness, diagnostic imaging, pregnancy, carcinogenesis, toxicity, acute radiation syndrome (ARS)

scholarly journals Radiation dose from common radiological investigations and cumulative exposure in children with cystic fibrosis: an observational study from a single UK centre

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017548 ◽  
Author(s):  
Rebecca Ward ◽  
William D Carroll ◽  
Paula Cunningham ◽  
Sheng-Ang Ho ◽  
Mary Jones ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Cumulative Exposure ◽  
X Rays ◽  
Modern Equipment ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
The Mean ◽  
Cumulative Radiation Exposure

ObjectivesCumulative radiation exposure is associated with increased risk of malignancy. This is important in cystic fibrosis (CF) as frequent imaging is required to monitor disease progression and diagnose complications. Previous estimates of cumulative radiation are outdated as the imaging was performed on older equipment likely to deliver higher radiation. Our objectives were to determine the radiation dose delivered to children during common radiological investigations using modern equipment and to identify the number of such investigations performed in a cohort of children with CF to calculate their cumulative radiation exposure.Design, setting and participantsData including age at investigation and radiation exposure measured as estimated effective dose (EED) were collected on 2827 radiological studies performed on children at one UK paediatric centre. These were combined with the details of all radiological investigations performed on 65 children with CF attending the same centre to enable calculation of each child’s cumulative radiation exposure.ResultsThe mean EED for the common radiological investigations varied according to age. The range was 0.01–0.02 mSv for chest X-rays, 0.03–0.11 mSv for abdominal X-rays, 0.57–1.69 mSv for CT chest, 2.9–3.9 mSv for abdominal and pelvic CT, 0.20–0.21 mSv for sinus CT and 0.15–0.52 mSv for fluoroscopy-guided procedures. The mean EED was three to five times higher for helical compared with axial chest CT scans. The mean annual cumulative EED for our cohort of children with CF was 0.15 mSv/year with an estimated cumulative paediatric lifetime EED (0–18 years) of 3.5 mSv.ConclusionsThis study provides up-to-date estimations of the radiation exposure when using common radiological investigations. These doses and the estimates of cumulative radiation exposure in children with CF are lower than previously reported. This reflects the reduced EED associated with modern equipment and the use of age-specific scanning protocols.

Radiation Exposure From Diagnostic Imaging in Patients with Lymphoma - The Cost Of The Cure?

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 557-557
Author(s):  
Maeve P Crowley ◽  
Siobhan B O'Neill ◽  
Damien C O'Neill ◽  
Joesph A Eustace ◽  
Brian R Healey Bird ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Ionizing Radiation ◽  
Diagnostic Imaging ◽  
Radiation Exposure ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Cumulative Exposure ◽  
Pet Ct ◽  
Radiological Procedures

Abstract Introduction The American Cancer Society anticipates the diagnosis of 80,000 new cases of lymphoma in the US in 2013. Cancer Research UK estimates that more than 80% of Hodgkin Lymphoma (HL) patients and more than 60% of Non-Hodgkin Lymphoma (NHL) patients will be alive 5 or more years after diagnosis. As survival rates improve, focus shifts to ensuring quality of life in survivors and decreasing potential toxicity. Radiological procedures play a prominent role in diagnosis, staging and assessment of treatment response. Exposure to ionizing radiation has been linked to an increased risk of malignancy (Pearce et al 2012, Miglioretti et al 2013, Mathews et al 2013). Cumulative exposure in excess of 75mSv has been estimated to increase cancer mortality by 7.3% (Cardis et al 2007). There is a paucity of data in the literature regarding cumulative radiation exposure in patients with lymphoma. In cancer treatment, the aim is individualized management strategies. This should also be the goal for diagnostic procedures (O' Neill et al 2011, Fletcher et al 2012). Methods A retrospective review of all patients on a prospectively maintained database with biopsy proven HL or NHL between January 2009 and July 2012 was conducted in a University hospital group. The cumulative effective radiation dose (CED) was calculated using standardized procedure-specific radiation dose levels. Results Four hundred and eighty six patients were included in the study. Mean (SD) age at diagnosis was 59 (17) years and 15% were aged < 40. Fifty-nine percent were men. Sixteen percent had HL; 84% had NHL. There were a total of 1127 patient-years of follow-up, with 15% having <1 year and 10% having 5 or more years of follow-up. Ninety-nine per cent of patients had diagnostic imaging. A total of 5748 radiological procedures were performed, equivalent to one procedure every 70 patient days of follow-up. The median estimated total CED ( IQR) per subject was 69mSv (42-118). Forty- six percent had a total CED >75mSv and 14% had a total CED >150mSv – SeeFigure 1. CT contributed 89% of the radiation dose and PET-CT contributed 8%. Patients aged <40 had a median CED (IQR) of 89mSv (55-124). Seventy-five per cent of these patients had a potentially curable malignancy (66% had HL; 5% had Diffuse Large B Cell Lymphoma; 4% had Burkitt Lymphoma). Patients who underwent stem cell transplantation had a median CED (IQR) of 162mSv (135-225) with 59% having radiotherapy as part of their management. Univariate analysis showed that age (p<0.001), duration of lymphoma (p<0.001) and stage (<0.001) were associated with CED. Discussion This study highlights the considerable ionizing radiation exposure from diagnostic imaging in patients with lymphoma. This is especially relevant in young people who would be considered the most radiosensitive and at highest risk for secondary malignancies. Low grade lymphomas are relapsing and remitting in nature and frequently require re-staging imaging over many years. Longer follow-up will be required here to potentially explain the non-significant trend between histological subtype and different CED. The American College of Radiology stated in 2013 that when used appropriately, the benefits of ionizing radiation far outweigh the risks. However, to minimize risk, institutions should participate in national dose registries. With the widespread use of Picture Archiving and Communication System (PACS), this will be feasible. Low dose CT imaging has emerged as a mechanism for minimizing CED. Dose reduction strategies incorporating patient-specific information would optimize imaging while minimizing the harmful effects (Shah et al 2012). Novel CT reconstruction algorithms allow diagnostic quality imaging to be obtained at reduced radiation doses without the prohibitive noise that would otherwise be present (Prakash et al 2010). Procedures which do not involve ionizing radiation such as MRI and ultrasound are becoming increasingly popular. There is growing interest in PET-MRI for staging of malignancies (Appenzeller 2013) but as yet, PET-CT remains superior. For patients with potentially curable lymphoma, particularly young patients with higher CED, consideration should be given to these strategies. Disclosures: No relevant conflicts of interest to declare.

Salivary biochemical markers as potential acute toxicity parameters for acute radiation injury

2015 ◽  
Vol 35 (3) ◽  
pp. 221-228 ◽  
Author(s):  
S Soni ◽  
P Agrawal ◽  
N Kumar ◽  
G Mittal ◽  
DK Nishad ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Effect Size ◽  
Total Protein ◽  
Radiation Injury ◽  
Large Population ◽  
Acute Radiation ◽  
Whole Body ◽  
Sprague Dawley ◽  
Acute Radiation Injury ◽  
Before And After

Researchers have been evaluating several biodosimetric/screening approaches to assess acute radiation injury, related to mass causality. Keeping in mind this background, we hypothesized that effect of whole-body irradiation in single fraction in graded doses can affect the secretion of various salivary components that could be used as acute radiation injury/toxicity marker, which can be used in screening of large population at the time of nuclear accidents/disaster. Thirty Sprague Dawley rats treated with whole-body cobalt-60 gamma irradiation of dose 1–5 Gy (dose rate: 0.95 Gy/min) were included in this study. Whole mixed saliva was collected from all animals before and after radiation up to 72 h postradiation. Saliva was analyzed for electrolytes, total protein, urea, and amylase. Intragroup comparison of salivary parameters at different radiation doses showed significant differences. Potassium was significantly increased as the dose increased from 1 Gy to 5 Gy ( p < 0.01) with effect size of difference ( r > 0.5). Sodium was significantly altered after 3–5 Gy ( p < 0.01, r > 0.5), except 1 and 2 Gy, whereas changes in sodium level were nonsignificant ( p > 0.5). Urea, total protein, and amylase levels were also significantly increased as the radiation dose increased ( p < 0.01) with large effect size of difference ( r > 0.5). This study suggests that salivary parameters were sensitive toward radiation even at low radiation dose which can be used as a predictor of radiation injury.

scholarly journals The Fluoroscopic Technique for Monitoring Distraction of a Non-Invasive Lengthening Device in Early Onset Scoliosis

2014 ◽  
Vol 1 (1) ◽  
pp. 23-28 ◽  
Author(s):  
C. Thakar ◽  
S. Sonecha ◽  
D. Rolton ◽  
C. Nnadi
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
X Rays ◽  
Growing Rod ◽  
Non Invasive ◽  
Rod System ◽  
Effects Of Radiation

Study Design: Prospective non-randomised. Objective: To evaluate radiation exposure using fluoroscopy compared to x-rays in the monitoring of a growing rod system. Background: The integrity of implants in the treatment of early onset scoliosis (EOS) is usually monitored with repeated plain x-rays. The cumulative dosage of ionizing radiation may be high. Children are highly sensitive to the carcinogenic effects of radiation and have a longer life span in which to reflect this risk. Fluoroscopy is commonly used to obtain focused images in other areas of orthopaedics. It has the advantage of less radiation intensity due to flash exposure. We have used fluoroscopy to monitor the lengthening of a non-invasive growing rod system in the treatment of EOS. We report on the results. Methods: The technique was initially refined in vitro by performing an audit in which 10 radiographers screened a phantom spine (Plastic dummy) with an implanted non - invasive growing rod device. Pulse rate setting was 3. Average exposure time was 0.01 seconds. Average radiation dose was 0.04 μGym2. A plain x-ray of the same phantom spine yielded a radiation dose of 0.5 μGym2. Radiation exposure using fluoroscopy was compared to that received using plain radiographs in ten consecutive patients treated for EOS. There were 8 males and 2 females. Average age 5.2 years. Results: Mean radiation exposure using fluoroscopy was 0.0046 mSv compared to an average radiation exposure of 0.115 mSv using standard x-rays (p<0.003). Mean cancer induction risk was calculated to potentially reduce from 1:225,000 to 1:4.9 million. Conclusion: We would recommend fluoroscopy as a useful technique to monitor the lengthening of a non-invasive growing rod system due to the significantly smaller radiation exposure.

scholarly journals SP9.1.3 Abdominal X-Rays in the Emergency Setting- A Review of Current Practice

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lará Armstrong ◽  
Helen Monaghan ◽  
Sarah Jeffers
Keyword(s):  
Diagnostic Imaging ◽  
Radiation Exposure ◽  
Diagnostic Yield ◽  
Hospital Costs ◽  
Radiology Department ◽  
Emergency Setting ◽  
X Rays ◽  
X Ray ◽  
Imaging Results ◽  
Patient Radiation Exposure

Abstract Aim Abdominal radiographs (AXRs) are commonly used in the setting of acute abdominal pain. However, with low diagnostic yield, they can increase workload within the radiology department, increase patient radiation exposure and ultimately delay further diagnostic imaging. The average cost of an abdominal film, excluding staffing costs, is £45. This study aimed to investigate the appropriate use of AXRs in the emergency setting, as per the Royal College of Radiologists Guidelines (RCR). Methods A single centre retrospective review was conducted of all patients referred to the emergency surgical team over a 21 day period. Data was retrieved from electronic handover records. Demographics, radiology request forms and imaging results were obtained from up to date electronic care records. Results A total of 160 patients presented within the audit window, with a median age 49 (16-94) and 61.3% male. Overall, 36.9% of patients underwent an abdominal x-ray, 66.1% of which were not indicated in accordance with RCR guidelines. 71.2% of patients who underwent an abdominal x-ray required further diagnostic imaging by means of CT or USS. Only 10.2% of AXRs provided diagnostic information. Total cost expenditure for inappropriate AXRs = £1,755, excluding staffing costs. Conclusions Approximately two thirds of AXRs performed did not comply with the published RCR guidelines. Adherence to RCR guidelines can reduce needless radiation exposure, hospital costs and delay to diagnosis. We plan to conduct a teaching session on the RCR guidelines alongside the development of information posters, and re-audit our results.

Evaluation of Gamma Radiation-Induced Biochemical Changes in Skin for Dose Assesment: A Study on Small Experimental Animals

2018 ◽  
Vol 13 (02) ◽  
pp. 197-202
Author(s):  
Sandeep Kumar Soni ◽  
Mitra Basu ◽  
Priyanka Agrawal ◽  
Aseem Bhatnagar ◽  
Neelam Chhillar
Keyword(s):  
Radiation Dose ◽  
Gamma Radiation ◽  
Radiation Injury ◽  
Acute Radiation ◽  
Dose Assessment ◽  
Whole Body ◽  
Dependent Manner ◽  
Acute Radiation Injury ◽  
Radiation Induced ◽  
Dose Dependent

AbstractObjectiveResearchers have been evaluating several approaches to assess acute radiation injury/toxicity markers owing to radiation exposure. Keeping in mind this background, we assumed that whole-body irradiation in single fraction in graded doses can affect the antioxidant profile in skin that could be used as an acute radiation injury/toxicity marker.MethodsSprague-Dawley rats were treated with CO-60 gamma radiation (dose: 1-5 Gy; dose rate: 0.85 Gy/minute). Skin samples were collected (before and after radiation up to 72 hours) and analyzed for glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), and lipid peroxidation (LPx).ResultsIntra-group comparison showed significant differences in GSH, GPx, SOD, and CAT, and they declined in a dose-dependent manner from 1 to 5 Gy (P value&lt;0.01, r value: 0.3-0.5). LPx value increased (P value&lt;0.01, r value: 0.3-0.5) as the dose increased, except in 1 Gy (P value&gt;0.05).ConclusionsThis study suggests that skin antioxidants were sensitive toward radiation even at a low radiation dose, which can be used as a predictor of radiation injury and altered in a dose-dependent manner. These biochemical parameters may have wider application in the evaluation of radiation-induced skin injury and dose assessment. (Disaster Med Public Health Preparedness. 2019;13:197–202).

scholarly journals Wound Trauma Exacerbates Acute, but not Delayed, Effects of Radiation in Rats: Mitigation by Lisinopril

2020 ◽  
Vol 21 (11) ◽  
pp. 3908
Author(s):  
Meetha Medhora ◽  
Tracy Gasperetti ◽  
Ashley Schamerhorn ◽  
Feng Gao ◽  
Jayashree Narayanan ◽  
...  
Keyword(s):  
Wound Healing ◽  
Radiation Exposure ◽  
Molecular Mechanisms ◽  
Skin Wound ◽  
Acute Radiation ◽  
X Rays ◽  
Delayed Effects ◽  
Post Irradiation ◽  
Effects Of Radiation ◽  
Combined Injuries

The goal of this study is to understand and mitigate the effects of wounds on acute radiation syndrome (ARS) and delayed effects of acute radiation exposure (DEARE), for preparedness against a radiological attack or accident. Combined injuries from concomitant trauma and radiation are likely in these scenarios. Either exacerbation or mitigation of radiation damage by wound trauma has been previously reported in preclinical studies. Female WAG/RijCmcr rats received 13 Gy X-rays, with partial-body shielding of one leg. Within 2 h, irradiated rats and non-irradiated controls were given full-thickness skin wounds with or without lisinopril, started orally 7 days after irradiation. Morbidity, skin wound area, breathing interval and blood urea nitrogen were measured up to 160 days post-irradiation to independently evaluate wound trauma and DEARE. Wounding exacerbated morbidity in irradiated rats between 5 and 14 days post-irradiation (during the ARS phase), and irradiation delayed wound healing. Wounding did not alter delayed morbidities from radiation pneumonitis or nephropathy after 30 days post-irradiation. Lisinopril did not mitigate wound healing, but markedly decreased morbidity during DEARE from 31 through 160 days. The results derived from this unique model of combined injuries suggest different molecular mechanisms of injury and healing of ARS and DEARE after radiation exposure.

Influence of Drinking Water Quality on the Current of Acute Radiation Disease in Mice

2021 ◽  
Vol 66 (6) ◽  
pp. 34-38
Author(s):  
T. Bichkova ◽  
I. Andrianova ◽  
O. Nikitenko ◽  
N. Stavrakova ◽  
I. Parfenova ◽  
...  
Keyword(s):  
Drinking Water ◽  
Radiation Injury ◽  
Tap Water ◽  
Lethal Dose ◽  
Acute Radiation ◽  
Rank Test ◽  
X Rays ◽  
X Ray ◽  
Acute Radiation Injury ◽  
Modifying Effect

Purpose: Assessing the role of various factors in the formation of radioresistance is an important branch of radiobiology. The quality of drinking water, as it turned out, can significantly affect radioresistance. Against the background of studying the antiradiation properties of various types of water, differing in mineral and isotopic composition, the problem of the influence of tap water on the course of radiation injury remained underestimated. This circumstance determined the purpose of the work: to evaluate the modifying effect of tap water on the course of acute radiation sickness after X-ray irradiation of mice at an average lethal dose. Material and methods: Female ICR (CD-1) mice were irradiated with an average lethal dose once – 6.5 Gy of X-ray irradiation. After irradiation, half of the mice received tap water as drinking water, and the other half received artificially mineralized drinking water. Results: Keeping animals on tap water significantly reduced the survival rate of mice both with a single dose (log-rank test p=0.02, χ2=5.38) compared with animals receiving artificially mineralized distilled water. In addition, in the group of mice that received tap water, an increase in the rate of death of mice and a lower preservation of the group mass of animals during the development of acute radiation injury was noted. Conclusion: Tap water, used as drinking water, increases the damaging effect of radiation when X-rays are irradiated in mice.

scholarly journals Extrapolation and Justification of Nplate Dosing to Improve Overall Survival in Acute Radiation Syndrome

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 15-16
Author(s):  
Sameer Doshi ◽  
Zachary Jones ◽  
Ari Pritchard-Bell ◽  
Joseph Park ◽  
Per Olsson Gisleskog
Keyword(s):  
Overall Survival ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Survival Benefit ◽  
Radiation Effects ◽  
Acute Radiation ◽  
Platelet Response ◽  
Acute Radiation Syndrome ◽  
Pkpd Model ◽  
Post Radiation

Background: Acute Radiation Syndrome (ARS) is an acute illness caused by exposure to a high dose of penetrating radiation over a short period of time. Hematopoietic subsyndrome of ARS (HS-ARS) is characterized by dose dependent bone marrow depression leading to lymphopenia, neutropenia, thrombocytopenia, and anemia. Death due to HS-ARS from infection or excessive bleeding usually occurs within 2 to 3 weeks. Duration of thrombocytopenia is a predictor of overall survival (OS) in irradiated animal models, suggesting that a treatment for thrombocytopenia may increase survival in humans with HS-ARS. Romiplostim, a thrombopoietin receptor agonist, treatment resulted in prevention of severe thrombocytopenia and increased OS in irradiated animals. As human clinical trials for HS-ARS are not feasible or ethical, a romiplostim pharmacokinetic/pharmacodynamic (PKPD)-OS model for irradiated humans was developed. The model, informed by PKPD data in healthy/irradiated rhesus monkeys (RM) and healthy volunteers (HV), was subsequently used to predict the survival benefit of romiplostim relative to placebo in humans with HS-ARS. Methods: A PKPD model of romiplostim exposure-platelet response in healthy RM was developed and updated with radiation parameters to estimate the radiation effects on thrombopoiesis, on PKPD of romiplostim, and on differences in platelet response due to sex and body weight (Pritchard-Bell, ACoP11, 2020). A parametric time-to-event model relating platelet time course to OS in irradiated RM with/without romiplostim treatment was developed to quantify the impact of platelet response on OS (Jones, ACoP11, 2020). To extrapolate radiation effects to humans, romiplostim PKPD radiation parameters and radiation effects estimated from irradiated RM were applied to a romiplostim HV PKPD model. The extrapolated irradiated human PKPD model and irradiated RM OS model were combined and calibrated against published historical mortality data of humans exposed to acute radiation (Scott BR 1990). Following calibration, the extrapolated irradiated human PKPD and OS models were used to conduct simulations of OS in irradiated humans receiving romiplostim or placebo treatment. Relative survival benefit (RSB) of romiplostim, proportion of romiplostim treated humans surviving relative to placebo treated humans post radiation exposure, was summarized for various romiplostim doses (1 [initiation dose per label], 3, or 10 µg/kg [maximum dose per label]) and treatment scenarios (time after irradiation, adult vs pediatric) based on simulations of 10,000 humans/scenario randomized 1:1 to receive romiplostim or placebo. Results: An HV PKPD model of thrombopoiesis was updated to incorporate radiation specific scaling factors estimated from irradiated RM on romiplostim pharmacokinetic parameters and platelet lifespan, nonlinear inhibitory effect of radiation dose on megakaryocyte production, treatment effect of romiplostim on platelet lifespan, radiation sensitivity and radiation intensity. The extrapolated PKPD model for irradiated humans combined with the OS model from irradiated RM was calibrated with a scaling factor of 1.24 on radiation parameters to result in 50% survival 60 days post radiation exposure for humans exposed to a 3.07 Gy radiation dose (1 Gy/hr over 3.07 hr) consistent with published data. The calibrated OS model was used to simulate OS following romiplostim treatment 24 hours post irradiation and predicted 75% (RSB: 1.5), 80% (RSB: 1.6), and 87% (RSB: 1.7) survival on day 60, for romiplostim doses of at 1, 3, and 10 µg/kg, respectively compared to 50% survival for placebo. Percent survival was &gt;75% when 10 µg/kg romiplostim was administered 24, 48, or 72 hours post irradiation and when administered to pediatric sub-groups (0-2, &gt;2-6, &gt;6-12, &gt;12-18). Conclusions: A PKPD model of romiplostim exposure-response in irradiated humans was used to predict platelet response in humans with HS-ARS with/without treatment with romiplostim and was combined with an OS model to simulate 60-day survival in humans with HS-ARS. Simulations demonstrated the robust survival benefit of a single 10 µg/kg romiplostim dose compared with placebo in both adult and pediatric humans with HS-ARS following an acute radiation event. Selection of a romiplostim dose for treatment of HS-ARS is pending review of the irradiated RM studies and subsequent modeling and simulation analyses by the FDA. Disclosures Doshi: Amgen Inc: Current Employment. Jones:Amgen Inc: Current Employment. Pritchard-Bell:Amgen Inc: Current Employment. Park:Amgen Inc: Current Employment. Olsson Gisleskog:POG Pharmacometrics Ltd: Current Employment.

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