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Author Notes:

For correspondence contact: Arif N. Ali, 1365 Clifton Road NE, Atlanta, GA 30322, or email at aali24@emory.edu.

Disclaimer: A. S. Camarata and A. N. Ali are members of the U.S. Navy and the Air National Guard, respectively.

The views expressed in this presentation are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Air Force, Air National Guard, Department of Defense, or the United States government.

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Research Funding:

This work was fund in part by the Pilot Project Program from the Dart-Dose CMCR’s NIAID grant, U19-AI091173 (H. Swartz) and Winship Cancer Center’s NCI P30 grant, 2P30CA138292-04 (W. Curran).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Technology
  • Environmental Sciences
  • Public, Environmental & Occupational Health
  • Nuclear Science & Technology
  • Radiology, Nuclear Medicine & Medical Imaging
  • Environmental Sciences & Ecology
  • atomic bomb survivors
  • dose assessment
  • emergencies
  • radiological
  • emergency planning
  • MEDICAL-MANAGEMENT
  • NUCLEAR TERRORISM
  • RADIOBIOLOGY
  • CASUALTIES
  • TIME

Emesis as a Screening Diagnostic for Low Dose Rate (LDR) Total Body Radiation Exposure

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Journal Title:

Health Physics

Volume:

Volume 110, Number 4

Publisher:

, Pages 391-394

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Current radiation disaster manuals list the time-toemesis (TE) as the key triage indicator of radiation dose. The data used to support TE recommendations were derived primarily from nearly instantaneous, high dose-rate exposures as part of variable condition accident databases. To date, there has not been a systematic differentiation between triage dose estimates associated with high and low dose rate (LDR) exposures, even though it is likely that after a nuclear detonation or radiologic disaster, many surviving casualtieswould have received a significant portion of their total exposure from fallout (LDR exposure) rather than from the initial nuclear detonation or criticality event (high dose rate exposure). This commentary discusses the issues surrounding the use of emesis as a screening diagnostic for radiation dose after LDR exposure. As part of this discussion, previously published clinical data on emesis after LDRtotal body irradiation (TBI) is statistically re-analyzed as an illustration of the complexity of the issue and confounding factors. This previously published data includes 107 patients who underwent TBI up to 10.5 Gy in a single fraction delivered over several hours at 0.02 to 0.04 Gy min-1. Estimates based on these data for the sensitivity of emesis as a screening diagnostic for the low dose rate radiation exposure range from 57.1% to 76.6%, and the estimates for specificity range from 87.5% to 99.4%. Though the original data contain multiple confounding factors, the evidence regarding sensitivity suggests that emesis appears to be quite poor as a medical screening diagnostic for LDR exposures.

Copyright information:

© 2016 Health Physics Society.

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