Contribution of Biological and EPR Dosimetry to the Medical Management Support of Acute Radiation Health Effects

In this review, we discuss the value of biological dosimetry and electron paramagnetic resonance (EPR) spectroscopy in the medical management support of acute radiation syndrome (ARS). Medical management of an ionizing radiation scenario requires significant information. For optimal medical aid, this information has to be rapidly (< 3 days) delivered to the health-care provider. Clinical symptoms may initially enable physicians to predict ARS and initiate respective medical treatment. However, in most cases at least further verification through knowledge on radiation exposure details is necessary. This can be assessed by retrospective dosimetry techniques, if it is not directly registered by personal dosimeters. The characteristics and potential of biological dosimetry and electron paramagnetic resonance (EPR) dosimetry using human-derived specimen are presented here. Both methods are discussed in a clinical perspective regarding ARS diagnostics. The presented techniques can be used in parallel to increase screening capacity in the case of mass casualties, as both can detect the critical dose of 2 Gy (whole body single dose), where hospitalization will be considered. Hereby, biological dosimetry based on the analysis of molecular biomarkers, especially gene expression analysis, but also in vivo EPR represent very promising screening tools for rapid triage dosimetry in early-phase diagnostics. Both methods enable high sample throughput and potential for point-of-care diagnosis. In cases of higher exposure or in small-scale radiological incidents, the techniques can be used complementarily to understand important details of the exposure. Hereby, biological dosimetry can be employed to estimate the whole body dose, while EPR dosimetry on nails, bone or teeth can be used to determine partial body doses. A comprehensive assessment will support optimization of further medical treatment. Ultimately, multipath approaches are always recommended. By tapping the full potential of all diagnostic and dosimetric methods, effective treatment of patients can be supported upon exposure to radiation.