Flood Ann Barry, Nicolalde Roberto J, Demidenko Eugene, Williams Benjamin B, Shapiro Alla, Wiley Albert L, Swartz Harold M
Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 USA.
Radiat Meas. 2011 Sep 1;46(9):916-922. doi: 10.1016/j.radmeas.2011.02.019.
To prepare for a possible major radiation disaster involving large numbers of potentially exposed people, it is important to be able to rapidly and accurately triage people for treatment or not, factoring in the likely conditions and available resources. To date, planners have had to create guidelines for triage based on methods for estimating dose that are clinically available and which use evidence extrapolated from unrelated conditions. Current guidelines consequently focus on measuring clinical symptoms (e.g., time-to-vomiting), which may not be subject to the same verification of standard methods and validation processes required for governmental approval processes of new and modified procedures. Biodosimeters under development have not yet been formally approved for this use. Neither set of methods has been tested in settings involving large-scale populations at risk for exposure. OBJECTIVE: To propose a framework for comparative evaluation of methods for such triage and to evaluate biodosimetric methods that are currently recommended and new methods as they are developed. METHODS: We adapt the NIH model of scientific evaluations and sciences needed for effective translational research to apply to biodosimetry for triaging very large populations following a radiation event. We detail criteria for translating basic science about dosimetry into effective multi-stage triage of large populations and illustrate it by analyzing 3 current guidelines and 3 advanced methods for biodosimetry. CONCLUSIONS: This framework for evaluating dosimetry in large populations is a useful technique to compare the strengths and weaknesses of different dosimetry methods. It can help policy-makers and planners not only to compare the methods' strengths and weaknesses for their intended use but also to develop an integrated approach to maximize their effectiveness. It also reveals weaknesses in methods that would benefit from further research and evaluation.
为应对可能涉及大量潜在受照人员的重大辐射灾难，能够根据可能的病情和可用资源，迅速、准确地对人员进行治疗与否的分类至关重要。迄今为止，规划者不得不基于临床上可用的剂量估算方法，并利用从无关病症推断出的证据来制定分类指南。因此，现行指南侧重于测量临床症状（例如呕吐时间），而这些症状可能无法像新程序和修订程序的政府审批流程所要求的标准方法那样，接受相同的验证和确认过程。正在研发的生物剂量计尚未获得正式批准用于此用途。这两种方法都未在涉及大量有暴露风险人群的环境中进行过测试。
提出一个对此类分类方法进行比较评估的框架，并评估目前推荐的生物剂量测定方法以及新开发的方法。
我们采用美国国立卫生研究院（NIH）有效转化研究所需的科学评估和科学模型，将其应用于辐射事件后对大量人群进行分类的生物剂量测定。我们详细阐述了将剂量测定的基础科学转化为对大量人群进行有效多阶段分类的标准，并通过分析3份现行指南和3种先进的生物剂量测定方法进行说明。
这个用于评估大量人群剂量测定的框架是一种有用的技术，可用于比较不同剂量测定方法的优缺点。它不仅可以帮助政策制定者和规划者比较这些方法在预期用途中的优缺点，还可以制定一种综合方法以最大限度地提高其有效性。它还揭示了那些需要进一步研究和评估的方法中的弱点。
