Comparing the effectiveness of biodosimetry methods for triage in a large-scale radiation event: how feasible is their throughput and capacity to respond?

Following a major radiation event, such as a 10 kiloton nuclear device detonated by terrorists in a large urban area, several thousand people can be expected to have been exposed to clinically significant levels of ionizing radiation such that their survival depends on receiving mitigators or treatment for acute radiation syndrome (ARS). However, the likely population potentially exposed is several times greater; indeed, the US federal government estimates that the population needing dose estimated by biodosimetry in such a scenario will be one million. Therefore, the goal of biodosimetry is to reliably, accurately and quickly identify the two or three thousand individuals actually exposed to 2 gray or higher (the threshold for potentially dying from ARS) from among the estimated one million people potentially at risk but who may in fact have received no or only low levels of exposure. For this analysis, six biodosimetry methods that are currently recommended or are in advanced development for triaging individuals in this scenario are compared regarding their feasibility to provide dose estimates for one million individuals within a few days. The times when sampling is valid (relative to the exposure-event) and the time needed to process the sample to delivering the result to the triage decision maker are drawn from peer reviewed literature. The throughput, i.e., the capability to process one million people within ten days, is simulated for each method. The resulting rates of sampling and the capacity needed (e.g., the number of laboratories and people needed to accomplish this throughput) are compared for each method. These comparisons help assess the feasibility of each biodosimetry method to accomplish the intended goal in this scenario. We also examine the impact of questioning some of the assumptions made in the simulation, e.g., whether waiting for 10 days to begin treatment or mitigators can still be life-saving for subgroups like the physically injured