Assessment of Radiation Injury (Biodosimetry)

WHAT WE DO

After a suspected radiation injury, it is vital to determine the extent of actual injury to determine treatment or disposition. The goals of the Biodosimetry Program are to develop rapid, precise methods to assess the severity of radiation injury as early as possible after the event. These methods will aid in the triage of personnel during a radiological scenario. They will guide treatment decisions, and aid in monitoring recovery from injury and effectiveness of treatments.

The gold standard for biodosimetry has been cytogenetics (analysis of chromosomal abnormalities), including dicentric assays. To increase throughput during mass casualty scenarios, AFRRI has been working on identifying novel biomarkers amenable to accelerated analysis of noninvasive samples.

To increase precision, multiparameter assessment has been a recent focus of AFRRI’s program, together with development of prognostic algorithms using these data. AFRRI has been working with corporate partners to devise deployable platforms incorporating both detection processes and software. Software developed by AFRRI staff has been deployed to DOD websites to aid in assessment of radiation injury severity by integrating a variety of medical data available to health workers in the field.

BIODOSIMETRY TOOLS

Some AFRRI information products are available to qualified users from the Defense Technical Information Center. "AD" numbers that appear after titles are assigned by DTIC for its use in locating documents.

MEDICAL DATA FORMS

AFRRI Adult/Pediatric Field Medical Record (AFRRI Form 330)—Provides a convenient one-page form for gathering emergency medical information in the field. Applicable to both adult and pediatric cases.

AFRRI Biodosimetry Worksheet (AFRRI Form 331)—Provides a place for recording the facts about a case of radiation exposure, including the source and type of radiation, the extent of exposure, and the nature of the resulting injuries. Applicable to both adult and pediatric cases.

AFRRI Radiocesium Worksheet (AFRRI Form 335)—Flowchart details steps for screening patients suspected of having been or confirmed to have been exposed to radiocesium during a radiation dispersal device (RDD) event.

 

BAT—BIODOSIMETRY ASSESSMENT TOOL VERSION 1.06

A computer-based software diagnostic tool for use by health-care providers early after a radiation incident. Assists providers in identifying individuals with significant radiation exposures and in making appropriate treatment decisions. BAT is NOT a substitute for treatment decisions by physicians and other trained health-care professionals.

East Tools

Exposure and Symptom Triage (EAST) tools are designed to aid first responders in the triage of patients involved in a mass-casualty incident involving radiation. The use of these worksheets is to be utilized after a primary trauma triage and life-treats have been addressed and to aid in the decision-making process for administering the FDA-approved drugs for hematopoietic acute radiation syndrome (H-ARS), which need to be administered  early (24-48 hrs) after exposure. It is intended that the H-ARS EAST worksheet is used first followed by the gastrointestinal acute radiation syndrome (GI-ARS) EAST worksheet. USUHS/AFFRRI/PMB has modified the worksheets to be annotatable and to streamline the use of the  EAST H- and GI-ARS worksheets.  Exposure and Symptom Triage (EAST) tools are designed to aid first responders in the triage of patients involved in a mass-casualty incident involving radiation. The use of these worksheets is to be utilized after a primary trauma triage and life-treats have been addressed and to aid in the decision-making process for administering the FDA-approved drugs for hematopoietic acute radiation syndrome (H-ARS), which need to be administered  early (24-48 hrs) after exposure. It is intended that the H-ARS EAST worksheet is used first followed by the gastrointestinal acute radiation syndrome (GI-ARS) EAST worksheet. USUHS/AFFRRI/PMB has modified the worksheets to be annotatable and to streamline the use of the  EAST H- and GI-ARS worksheets.

  • Hick JL, Bader JL, Coleman CN, Ansari AJ, Chang A, Salame-Alfie A, Hanfling D, Koerner JF. Proposed "Exposure And Symptom Triage" (EAST) Tool to Assess Radiation Exposure After a Nuclear Detonation. Disaster Med Public Health Prep. 2018 Jun;12(3):386-395. doi: 10.1017/dmp.2017.86. Epub 2017 Jul 31. PMID: 29911522.  https://pubmed.ncbi.nlm.nih.gov/29911522/
  • Kenchegowda D, Bolduc DL, Kurada L, Blakely WF. Severity scoring systems for radiation-induced GI injury - prioritization for use of GI-ARS medical countermeasures. Int J Radiat Biol. 2023;99(7):1037-1045. doi: 10.1080/09553002.2023.2210669. Epub 2023 May 24. PMID: 37172305. https://pubmed.ncbi.nlm.nih.gov/37172305/

Program Information

Previous patient data files: BAT version 0.7.5 saved patient files to a different location than the current version of BAT available on this website. If you are upgrading from the 0.7.5 release, you will need to move the files from the old install directory to the new Biodose_AFRRI folder. When you start the newly installed version of BAT, you will get a warning message. Follow the directions (the old and new location folders will be listed) on this warning message. Remember to delete the original (old) “data” folder after you have moved the files. If you do not know how to move the files, or do not have sufficient access to remove the old “data” folder, please consult with your system administrator.

Windows Color Scheme setting: If you have changed your Windows Color Scheme to one of the preset ones (e.g., silver or olive green) or modified the colors using the Advanced option, some of the screen colors will not display properly—most noticeable on BAT's splash screen. The numbered columns in the following two tables will appear as black rather than numbered: the “Therapy” table on screen 10 and the “Wound” table on screen 12. This issue only affects the look of the BAT program, not the calculations. To return your Windows Color Scheme to the Default setting (blue): right click anywhere on the desktop then select Properties > Appearance > Color Scheme > Default (blue). For additional help, please consult with your system administrator.

Print Screen: Every screen in BAT gives the option to print the currently displayed screen via a “Print this screen” button or through the toolbar. The program uses your computer's print screen drivers, which may differ from user to user. As a result, some information may be lost between the screen as displayed and the printed sheet (such as the information of the lymphocyte kinetics screens). To print exactly what is seen on your screen, use CRTL+PrtSc and paste the resulting image into a document. For more information on this method, please consult your system administrator.

For questions about using the BAT software, contact AFRRI BAT project managers.

Privacy statement and disclaimer

  • The Armed Forces Radiobiology Research Institute (AFRRI) and the United States Government are not responsible for any damage that occurs as a result of the use of this program. Users assume all responsibility for the results of the program's use.
  • All information obtained by the use of this program is confidential under the Privacy Act of 1974. Misuse of this information violates the Privacy Act of 1974 and is subject to the penalties thereof.
  • The WinFRAT program is NOT a substitute for treatment decisions by physicians and other trained healthcare professionals. AFRRI, DoD, and the United States Government do not assume responsibility for use (or misuse) of the WinFRAT program by anyone other than federal healthcare providers acting within the scope of their duties.

Features and Request

  • Runs on Windows XP, Vista, or 7.
  • Uses templates to collect, integrate, and archive data obtained from patients accidentally exposed to ionizing radiation.
  • Includes an interactive human body map to easily indicate location of radioactivity detected by an appropriate device.
  • Delivers diagnostic information (clinical signs and symptoms, physical dosimetry, etc.).
  • Generates diagnostic indices for the development of a multiparameter dose assessment.
  • Assesses clinical parameters useful for casualty management.
  • Displays concise, relevant patient diagnostic information.
  • Archives information for further use in radiation protection management.
  • Read the BAT Brochure for more information
  • Request BAT v 1.06 or WinFRAT v 0.7.6.0

WINFRAT—FIRST-RESPONDERS RADIOLOGICAL ASSESSMENT TRIAGE (FOR WINDOWS) VERSION 0.7.6.0 BETA

Enables first responders to triage suspected radiation casualties based on the initial, or prodromal, features listed in the Emergency Radiation Medicine Response - AFRRI Pocket Guide

Development status—Prototype release version 0.7.6.0 beta

Program Information

WinFRAT users: First-responders Radiological Assessment Triage for Windows (WinFRAT) is to be used by any person who has the responsibility to assess and record medical information from a suspected radiation event.

Hardware and operating system requirements: First-responders Radiological Assessment Triage for Windows (WinFRAT) runs on Windows XP SP3, Vista, or 7, with .NET Framework 3.5 SP1, with a minimum of a Pentium 200 with 1 MB of RAM and 10 MB of free disk space. No endorsement is implied nor should be inferred from reference to any commercial products.

Distribution: Distribution is limited to individuals from countries allied to the U.S. and to individuals from non-allied countries that are not currently defined by the Department of State as Terrorist Countries, subject to review and approval by the Department of Defense. U.S. Government users may request and obtain the current WinFRAT software and future upgrades.

Features and Request

  • Provide, with minimum text entry, signs and symptoms, blood lymphocyte counts, and dosimetry data.
  • Assess the multiparameter triage dose or the exposure without an assigned dose or indicate no evidence of overexposure.
  • Provide dose-specific messages addressing reliability and diagnostic information, hospitalization estimations, and mortality projections.
  • Read the WinFRAT Brochure for more information
  • Request BAT v 1.06 or WinFRAT v 0.7.6.0

COMBINED INJURY: RADIATION WITH OTHER INJURIES

After a nuclear detonation, a high percentage of radiation casualties will have combined injuries: radiation exposure combined with wounds, burns or other trauma. Research at AFRRI and elsewhere has shown a powerful synergy between radiation and other injuries in causing deleterious biological effects, including enhanced ARS, delayed wound healing and increased mortality. Pharmacological countermeasures that are effective against radiation injury alone are not always effective against combined injury. AFRRI is discovering mechanisms of, and developing promising candidates for combined injury.

INTERNAL CONTAMINATION AND METAL TOXICITY

AFRRI’s earlier work on the biological effects of depleted uranium injury has evolved into a broad program on internal contamination with radionuclides and heavy metals. Metal alloys proposed as replacements for depleted uranium have been subjected to toxicological analysis. Research conducted at AFRRI has led to changes in DOD policy for medical management of depleted uranium and reconsideration of deployment of other specific alloys. To address internal contamination with radionuclides, AFRRI is exploring novel materials designed to remove radionuclides from the body (decorporation agents). AFRRI is also investigating the long-term health effects of depleted uranium, including the basic molecular mechanisms of these effects.

LOW DOSE, DOSE RATE AND LATE EFFECTS

In radiological scenarios, many individuals may be subjected to ionizing radiation at low doses or low dose rates. These exposures may result from fallout fields, radiological dispersal devices (“dirty bombs”), nuclear accidents or space travel. The primary concern from such exposures is not Acute Radiation Syndrome (ARS), but late effects such as cancer. The molecular mechanisms leading to these effects are different from those causing acute effects, and the mechanisms are being investigated at AFRRI. A better understanding of low dose and dose rate effects will lead to improved radiation protection guidance and will suggest targets for pharmacological countermeasures. AFRRI has been investigating countermeasure candidates that prevent radiation-induced leukemia.