Portable x-ray fluorescence for bone lead measurement: Current approaches and future directions.

PURPOSE OF REVIEW: Legacy lead exposures persist as a widespread problem. Blood lead is traditionally used for lead exposure surveillance; however, bone lead proves to be a cheaper, more accessible, and more revealing tool for surveillance that can be measured using portable x-ray fluorescence techniques. We outline how this approach excels for bone lead measurements. RECENT FINDINGS: Portable XRF offers quick, non-invasive in vivo quantification of bone lead. Compared to traditional KXRF systems, pXRF is limited to cortical bone but allows for quicker and similar results. Current methodologies of lead exposure need re-evaluation as lead-related disease burden and trends are dependent on both cumulative and acute impacts. We examined the evolution of XRF techniques for measuring bone lead, comparing current methods with previous ones. We assessed their accuracy, identified limitations, and discussed potential advances in future techniques. Legacy lead exposures call for a revitalization of lead surveillance methods, and pXRF measurement of bone lead offers such a solution.

Lead exposure across the life course and age at death.

BACKGROUND: Lead (Pb) exposure has been associated with an increased risk of all-cause mortality, even at low levels. Little is known about how the timing of Pb exposure throughout life may influence these relationships. Quantifying the amount of Pb present in various tissues of the body provides measurements of exposure from different periods of life. These include bone, tooth enamel, which is the hard outer layer of the crown, and tooth cementum, which is the calcified connective tissue covering the tooth root. The purpose of the study was to examine Pb exposure at multiple periods throughout life, including childhood (enamel), adulthood (cementum), and later life (bone), and to estimate their associations with age at death. METHODS: 208 skeleton donors (born 1910-1960) from an ongoing case-control study were included in this study. Pb was measured in tibia (shin), bone using X-Ray Florescence and in teeth using Laser-Ablation Inductively Coupled Plasma Mass Spectroscopy. After excluding unusually high measurements (>2sd), this resulted in a final sample of 111 with all exposure measures. Correlations across measures were determined using partial Spearman correlations. Associations between Pb exposure and age at death were estimated using Multivariable Linear Regression. RESULTS: Pb measures across exposure periods were all significantly correlated, with the highest correlation between cementum and tibia measures (r = 0.61). Donors were largely female (63.0 %), White (97.3 %), and attended some college (49.5 %). Single exposure models found that higher tooth cementum Pb (-1.27; 95 % CI: -2.48, -0.06) and tibia bone Pb (-0.91; 95 % CI: -1.67, -0.15) were significantly associated with an earlier age at death. When considered simultaneously, only cementum Pb remained significant (-1.51; 95 % CI: -2.92, -0.11). Secondary analyses suggest that the outer cementum Pb may be especially associated with an earlier age at death. CONCLUSION: Results suggest that higher Pb exposure is associated with an earlier age at death, with adulthood as the life period of most relevance. Additional studies using Pb exposure measures from different life stages should be conducted.

Firearm-Related Lead Exposure and Child Lead Levels in the United States, 2012-2018.

OBJECTIVE: To determine if firearm ownership is positively related to elevated child lead levels at a state-level, even when accounting for other sources of lead. STUDY DESIGN: For this cross-sectional ecological study, we investigated whether household firearm ownership rates (a proxy for firearm-related lead exposure) was associated with the prevalence of elevated child blood lead levels in 44 US States between 2012 and 2018. To account for potential confounding, we adjusted for other known lead exposures, poverty rate, population density, race, and calendar year. To address missing data, we used multiple imputation by chained equations. RESULTS: Prevalence of elevated child blood lead positively correlated with household firearm ownership and established predictors of lead exposure. In fully adjusted negative binomial regression models, child blood lead was positively associated with household firearm ownership and older housing; each IQR (14%) increase in household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (prevalence ratio: 1.41, 95% CI: 1.11-1.79). CONCLUSION: These data provide state-level evidence that firearms may be an important source of child lead exposure. More research is needed to substantiate this relationship and identify modifiable pathways of exposure at the individual level.

Benchtop x-ray fluorescence to quantify elemental content in nails non-destructively.

Metals continue to impose health issues among world populations. A non-invasive alternative biomarker for assessment of metals and other elements has been explored in other studies using toenail samples. Some benefits of using toenails as biomarkers over blood samples include cost efficiency, ease of collection, and a longer biological half-life within samples. The objective of this study was to employ desktop XRF for the purpose of measuring metal concentrations in human nail samples, thus conducting a non-destructive assessment. These benefits paired with comparable accuracy in exposure detection could prove toenail samples to be a preferred biomarker for many studies. Current elemental quantification techniques in toenail samples could be improved. The standard practice for measuring metal exposure in toenails, inductively coupled plasma mass spectrometry (ICP-MS), has a counterpart in x-ray fluorescence. While maintaining similar quantification capabilities, x-ray fluorescence could provide decreased cost, preservation of samples, and ease of operation. Portable XRF machines have been tested for measuring toenail samples, but they have drastically increased detection limits in comparison to ICP-MS. New benchtop XRF systems should give comparable detection limits to ICP-MS. This study compares the benchtop XRF measurements of lead (Pb), copper (Cu), iron (Fe), and Selenium (Se) levels to that of ICP-MS measurements of toenail samples and calculates estimated detection limits for 23 other elements. We found strong correlations for the toenail lead (R2 = 0.92), copper (R2 = 0.95), selenium (R2 = 0.60), and iron (R2 = 0.77) comparison between desktop XRF and ICP-MS measurements. Median minimum detection limits over the 23 elements were found to be 0.2 µg/g using a 7.5-min measurement. Benchtop XRF provides a lower detection limit than previously studied portable XRF machines, which gives it the capability of accurately detecting almost any desired element in nail samples. Benchtop XRF provides a non-destructive alternative to ICP-MS in surveillance of nail samples.

Who tests for lead and why? A 10-year analysis of blood lead screening, follow-up and CNS outcomes in a statewide US healthcare system.

OBJECTIVES: This study aims to determine (1) which providers in US healthcare systems order lead tests, why and at what frequency and (2) whether current patient population lead levels are predictive of clinical outcomes. METHODS: Retrospective medical record study of all blood lead tests in the Medical University of South Carolina healthcare system 2012-2016 and consequent evidence of central nervous system (CNS)-related disease across a potential 10-year window (2012-2022). RESULTS: Across 4 years, 9726 lead tests resulted for 7181 patients (49.0% female; 0-94 years), representing 0.2% of the hospital population. Most tests were for young (76.6%≤age 3) and non-Hispanic black (47.2%) and Hispanic (26.7%) patients. A wide variety of providers ordered tests; however, most were ordered by paediatrics, psychiatry, internal medicine and neurology. Lead levels ranged from ≤2.0 µg/dL (80.8%) to ≥10 µg/dL (0.8%; max 36 µg/dL). 201 children (3.1%) had initial lead levels over the reference value for case management at the time (5.0 µg/dL). Many high level children did not receive follow-up testing in the system (36.3%) and those that did often failed to see levels fall below 5.0 µg/dL (80.1%). Non-Hispanic black and Hispanic patients were more likely to see lead levels stay high or go up over time. Over follow-up, children with high lead levels were more likely to receive new attention-deficit/hyperactivity disorder and conduct disorder diagnoses and new psychiatric medications. No significant associations were found between lead test results and new CNS diagnoses or medications among adults. CONCLUSIONS: Hospital lead testing covers a small portion of patients but includes a wide range of ages, presentations and provider specialities. Lack of lead decline among many paediatric patients suggests there is room to improve provider guidance around when to test and follow-up.

First report of some rare earth elements and trace elements in sands from different islands located in the Marine Natural Monument Archipelago Cayos Cochinos, Caribbean Sea.

Rare earth elements (REEs) are a group of chemicals widely used in emerging technologies today, and are often labeled as potential environmental contaminants. The Cayos Cochinos Archipelago is a protected area of Honduras, Central America, with intertidal and supratidal sands, making it a prime candidate for pollution research. In December 2022, sand samples from the Cayos Cochinos area was collected and analyzed by X-ray fluorescence to determine the levels of REEs and some less-studied trace elements (TEs). Based on the findings, REEs mean contents (µg g-1 d.w.) fluctuated between 2.96 for Y to 667.1 for Nd, while TEs ranged from 10.37 for Th to 3896.2 for Sr. Also, the results showed significantly higher levels of La, Pr, Y, Sr, Ba, and Th in the supratidal zone than in the intertidal zone. The data are useful as a basis for understanding the presence of chemical elements in near-shore marine areas and subsequently help identify sustainable practices that will reduce the impacts of these chemicals.

Lead exposure of mainland Australia's top avian predator.

Lead (Pb) toxicity, through ingestion of lead ammunition in carcasses, is a threat to scavenging birds worldwide, but has received little attention in Australia. We analyzed lead exposure in the wedge-tailed eagle (Aquila audax), the largest raptor species found in mainland Australia and a facultative scavenger. Eagle carcasses were collected opportunistically throughout south-eastern mainland Australia between 1996 and 2022. Lead concentrations were measured in bone samples from 62 animals via portable X-ray fluorescence (XRF). Lead was detected (concentration >1 ppm) in 84% (n = 52) of the bone samples. The mean lead concentration of birds in which lead was detected was 9.10 ppm (±SE 1.66). Bone lead concentrations were elevated (10-20 ppm) in 12.9% of samples, and severe (>20 ppm) in 4.8% of samples. These proportions are moderately higher than equivalent data for the same species from the island of Tasmania, and are comparable to data from threatened eagle species from other continents. Lead exposure at these levels is likely to have negative impacts on wedge-tailed eagles at the level of the individual and perhaps at a population level. Our results suggest that studies of lead exposure in other Australian avian scavenger species are warranted.

The United States Navy and Employees with Cancer: The Time for Change Is Now.

ABSTRACT: The US Navy, including the US Marine Corps and Naval Nuclear Propulsion Program (NNPP), has a robust radiological protection and monitoring program meeting (and typically exceeding, in the name of conservatism) federal law requirements. The program covers the variety of ways in which the Navy produces and uses ionizing radiation and radioactive sources: in medicine, nuclear ship propulsion and repair, industrial and aircraft radiography, and myriad other unique uses in carrying out its vital mission. In executing these programs, thousands of people across the world are employed as active-duty Sailors and Marines, government civilians, and government contractors. These workers include physicians, reactor operators, radiation safety officers, and nuclear repair workers, to name but a few. The health protection standards for these workers are promulgated in the publicly available Navy Medicine P-5055 Radiation Health Protection Manual (NAVMED P-5055), published February 2011 with Change 2 published December 2022, and are applicable to Navy and Marine Corps and NNPP radiation protection programs. The NAVMED P-5055 outlines the individual medical requirements for those qualified and able to receive exposure to ionizing radiation as part of their duties and requires that "Radiation workers receive focused medical examinations to establish whether or not cancer is present which would medically disqualify a person from receiving occupational radiation exposure." Additionally, without scientific or medical basis, the NAVMED P-5055 requires disqualifying those employees who have a history of cancer, cancer therapy, radiation therapy including radiopharmaceuticals received for therapeutic purposes, or bone marrow suppression from drawing dosimetry, entering radiation areas, or handling radioactive material. This policy, which exists regardless of lifetime occupational radiation dose or projected future radiation dose, applies to all cancers except adequately treated basal cell carcinoma. The policy is not supported by relevant scientific and medical literature; does not align with reasonable professional ethical standards; does not conform to US Navy radiological training, which stipulates the assumed increased risk of developing cancer from Navy and Marine Corps and NNPP occupational radiation exposure is small; and removes critical leadership and mentoring capability from the workforce unnecessarily. This article discusses in detail (1) this policy and its ramifications to the Navy and Marine Corps and NNPP workforce and (2) recommendations, benefits, and impacts for the Navy and Marine Corps and NNPP to remove this policy and still maintain a robust radiation protection program.

Bone lead variability in bone repository skeletal samples measured with portable x-ray fluorescence.

Bone lead serves as a better, more accessible biomarker to many communities experiencing chronic exposure to lead. A new method using low energy x-ray fluorescence in a handheld device (portable XRF) allows us to measure this chronic biomarker in only a few minutes. However, many unknowns remain about this biomarker measured using a new low energy x-ray technique. The low energy of the new method was theorized to measure a slightly different portion of the bone than previous techniques, which could influence measurements at different bone sites and types. We tested how bone measurements varied across five bone sites: mid-tibial shaft, proximal tibia, distal tibia (ankle), ilium, and cranium. We found bone lead measurements are not significantly different between skeletal elements when measured using a portable XRF. On average, bone lead in the repository samples was measured to be 21.6 ± 21.3 µg/g with an XRF detection limit of 2.1 ± 0.5 µg/g. Cumulative lead exposure can be effectively measured using the portable XRF on a variety of bone types, but the tibia should be preferentially measured to compare between studies and individuals.

Firearm-related lead exposure and pediatric lead levels in Massachusetts: A decade of evidence (2010-2019).

The US has more firearms than any other country in the world and uses lead ammunition almost exclusively. Lead exposure is a significant public health concern and children are at the greatest risk given their exposure to take-home lead. Firearm-related take-home lead exposure may be one of the greatest influences on elevated pediatric blood lead levels. For this ecological and spatial investigation of the relationship between firearm licensure rates as a proxy for firearm-related lead exposure and prevalence of children with blood lead levels ≥5 µg/dL in 351 cities/towns in Massachusetts, we used 10 years of data (2010-2019). We examined this relationship against other known contributors to pediatric lead exposure including old housing stock (lead paint/dust), occupations, and lead in water. Pediatric blood lead levels were positively correlated with licensure, poverty, and certain occupations and negatively correlated with lead in water and police or firefighter employment. Firearm licensure was a major significant predictor of pediatric blood lead alone (ß = 0.13; 95% CI, 0.10, 0.17) and across all regression models. The final model predicted over half the variation in pediatric blood lead (Adjusted R2 = 0.51). Negative binomial analysis found cities/towns with more firearms had higher pediatric blood lead levels (highest quartile fully adjusted prevalence ratio ((aPR) = 1.18; 95% CI, 1.09, 1.30) with a significant increase in pediatric blood lead per increase in firearms (p < 0.001). There were no significant spatial effects, suggesting that although there could be other factors impacting elevated pediatric blood lead, they are unlikely to influence spatial associations. Our paper provides compelling evidence of a potential and dangerous link between lead ammunition and child blood lead levels and is the first to do so using multiple years' worth of data. More research is required to substantiate this relationship on the individual-level and into prevention/mitigation.

Expanding the use of portable XRF to monitor lead exposure in an Australian duck species two decades after a ban on lead shot.

There is growing worldwide recognition of the threat posed by toxic lead for wildlife and humans. Lead toxicity from ammunition has been shown to be a threat to waterbirds across the globe. Lead shot was banned for all waterfowl hunting in Victoria, Australia, in 2002. However, no assessments of lead exposure in Australian waterfowl have been published since the 1990s. Our aim was to estimate contemporary lead exposure via measuring bone lead concentrations in a harvested dabbling duck, the Pacific black duck (Anas superciliosa). We collected wings from 77 Pacific black ducks, spanning 2018 (n = 30) and 2021 (n = 47), from nine sites with long-term histories of regular waterfowl hunting. We sought to validate portable X-ray fluorescence (XRF) for this purpose by taking a piece of humerus bone from each bird, and measuring lead concentration (mg/kg), first via non-destructive XRF and then via destructive inductively coupled plasma mass spectrometry (ICP-MS) and validated the relationship via regression analysis. Portable XRF bone lead measurement demonstrated a strong correlation with ICP-MS results using root-transformed regression (R2 = 0.85). Greater than 92 % of ducks had only background lead exposure (<10 mg/kg). When compared to historical studies in the same species at similar field sites from the 1990s, lead exposure levels were considerably lower, with mean lead concentrations ∼2-fold lower (3.7 c.f. 7.7 mg/kg), and the frequency of birds with severe lead exposure (>20 mg/kg) ∼3-fold lower (2.6 c.f. 7.5 %). Our results confirm that portable XRF is a useful option for measurement of bone lead in Australasian waterbird species. Our findings also demonstrate that a ban on the use of lead shot around 20 years ago has been associated with a substantial reduction in lead exposure in at least one species of waterfowl.

Firearm licensure, lead levels and suicides in Massachusetts.

Nationally, between 2011 and 2019, suicide was the second leading cause of injury death, and about half of all suicides were firearm related. An overlooked factor connecting firearms and suicide is lead exposure. Lead bullets and primers are used throughout the US and pose danger to adults and children. Most (not all) studies link lead to mental illness, while others link lead with suicide. Research has linked lead and firearm violence, but rarely examined the relationship among firearms, lead exposure, and suicide. We collected data for cities/towns in Massachusetts between 2011 and 2019 regarding the number of firearm licenses, suicides, prevalence of blood lead levels, and covariates. We hypothesized that; 1) towns with higher levels of licensure will have higher levels of firearm suicides but licensure will have little relationship with non-firearm suicide; 2) towns with higher levels of licensures would have higher rates of lead exposure; 3) higher lead levels would be associated with higher rates of suicide by all methods. Individuals living in towns with higher rates of licensure were significantly more likely to die in firearm suicides and all suicide types. They were not more or less likely to die from non-firearm suicides. Lead was a predictor of all suicide types. Our study appears to be the first to show the established firearm suicide relationships holds within municipalities in a single state. We provide evidence concerning the link between lead exposure and suicide, particularly from firearms, and provide a glimpse into the relationship between firearm prevalence and elevated blood lead levels.

Chromium distribution in an oropharyngeal aspiration model for hexavalent chromium in rats.

Hexavalent chromium [Cr(VI)] is a well-known and widespread environmental contaminant associated with a variety of adverse health effects, in particular lung cancer. The primary route of exposure in humans is through inhalation. Particulate forms of Cr(VI) are the most potent but in vivo studies are difficult. Intratracheal instillation requires highly trained surgical procedures which also limits the number of repeated exposures possible and thus requires high doses. Inhalation studies can deliver lower more chronic doses but are expensive and generate dangerous aerosols. We evaluated an oropharyngeal aspiration exposure route for zinc chromate particles in Wistar rats. Animals were treated once per week for 90 days. We found chromium accumulated in the lungs, blood, and reproductive tissues of all treated animals. Additionally, we found inflammatory indicators in the lung were elevated and circulating lymphocytes had increased chromosomal damage. These results show oropharyngeal aspiration provides a practicable exposure route for chronic and sub-chronic exposures of Cr(VI) particles.

In vivo quantification of strontium in bone among adults using portable x-ray fluorescence.

BACKGROUND AND OBJECTIVE: Bone strontium (Sr) is a reliable biomarker for studying related bone health outcomes and the effectiveness of Sr supplements in osteoporosis disease treatment. In this study, we evaluated the sensitivity of portable x-ray fluorescence (XRF) technology for in vivo bone Sr quantification among adults. MATERIALS AND METHODS: Sr-doped bone-equivalent phantoms were used for system calibration. Using the portable XRF, we measured bone Sr levels in vivo in mid-tibia bone in 76 adults, 38-95 years of age, living in Indiana, US; we also analyzed bone data of 29 adults, 53-82 years of age, living in Shanghai, China. The same portable XRF device and system settings were used in measuring their mid-tibia bone. We compared bone Sr concentrations by sex, age, and recruitment site. We also used multiple linear regression model to estimate the association of age with bone Sr concentration, adjusting for sex and recruitment site. RESULTS: The uncertainty of in vivo individual measurement increased with higher soft tissue thickness overlying bone, and it ranged from 1.0 ug/g dry bone (ppm) to 2.4 ppm with thickness ranging from 2 to 7 mm, with a measurement time of 5 min. Geometric mean (95% confidence interval (CI)) of the bone Sr concentration was 79.1 (70.1, 89.3) ppm. After adjustment for recruitment site and sex, an increase in five years of age was associated with a 8.9% (95% CI: 2.5%, 15.6%) increase in geometric mean bone Sr concentration. DISCUSSION AND CONCLUSION: Sr concentrations were consistently well above detection limits of the portable XRF, and exhibited an expected increase with age. These data suggest that the portable XRF can be a valuable technology to quantify Sr concentration in bone, and in the study of Sr-related health outcomes among adults, such as bone mineral density (BMD) and bone fracture risk.

Lead and other toxic metals in plastic play foods: Results from testing citizen science, lead detection tools in childcare settings.

A method development pilot study examining citizen science tools for assessing lead in childcare settings identified plastic food toys as an unexpected potential source of lead and arsenic. Collaborating researchers at three universities sought to develop a low cost, replicable approach for use in childcare centers to identify lead. Through graduate Environmental Health courses at Northeastern and Boston Universities, 197 Plastic Food Toys (PFTs) used in a childcare center were tested for lead using a portable X-Ray fluorescence (XRF) instrument and a colorimetric wipe method for detecting surface lead. The XRF identified concerning levels of lead and co-occurring arsenic in PFTs. The XRF analysis found 8.63% (17/197) of PFTs from the childcare center contained more than 100.00 ppm of lead, the U.S. Consumer Protection Safety Commission's (CPSC) upper regulatory threshold for lead in childrens' products. However, wipes did not detect removable surface lead. Lead concentrations ranged from 6.14 ppm to 11,999.00 ppm with a median of 40.00 ppm. Additionally, 7.10% of all PFTs tested had detectable levels of arsenic which ranged from 9.30 ppm to 1134.42 ppm and had a median value of 113.20 ppm. Arsenic concentrations in 6.60% of PFTs' exceeded the US voluntary standard for arsenic in children's products of 25.00 ppm (adopted from the EU standard). These findings prompted further sampling of similar newly-purchased PFTs. None of the newly-purchased PFTs tested positive for lead or arsenic (0/87). Several other elements were also identified, particularly in the used PFTs. Because these food-like toys are frequently put in children's mouths, we recommend further investigation of PFTs in circulation via citizen science combining the wipe and XRF method as they provide immediate data to participants. Additionally, CPSC should consider a systematic recall of some used PFTs to prevent exposure disparities by socio-economic status and increased surveillance for other toxic metals in new PFTs.

Study Protocol: Interactive Dynamics of Coral Reef Fisheries and the Nutrition Transition in Kiribati.

The Kiribati 2019 Integrated Household Income and Expenditure Survey (Integrated HIES) embeds novel ecological and human health research into an ongoing social and economic survey infrastructure implemented by the Pacific Community in partnership with national governments. This study seeks to describe the health status of a large, nationally representative sample of a geographically and socially diverse I-Kiribati population through multiple clinical measurements and detailed socio-economic surveys, while also conducting supporting food systems research on ecological, social, and institutional drivers of change. The specific hypotheses within this research relate to access to seafood and the potential nutritional and health benefits of these foods. We conducted this research in 21 of the 23 inhabited islands of Kiribati, excluding the two inhabited islands-Kanton Islands in the Phoenix Islands group with a population of 41 persons (2020 census) and Banaba Island in the Gilbert Islands group with a population of 333 persons (2020 census)-and focusing exclusively on the remaining islands in the Gilbert and Line Islands groups. Within this sample, we focused our intensive human health and ecological research in 10 of the 21 selected islands to examine the relationship between ecological conditions, resource governance, food system dynamics, and dietary patterns. Ultimately, this research has created a baseline for future Integrated HIES assessments to simultaneously monitor change in ecological, social, economic, and human health conditions and how they co-vary over time.

Risk-Factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy.

OBJECTIVES: Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated a risk-factor based questionnaire to detect elevated blood lead levels in pregnancy. METHODS: We performed a secondary analysis of a cohort of parturients enrolled to evaluate the association of lead with hypertensive disorders of pregnancy. We included participants in this analysis if they had a singleton pregnancy ≥ 34 weeks' gestation with blood lead levels recorded. Participants completed a lead risk factor survey modified for pregnancy. We defined elevated blood lead as ≥ 2 µg/dL, as this was the clinically reportable level. RESULTS: Of 102 participants enrolled in the cohort, 92 had blood lead measured as part of the study. The vast majority (78%) had 1 or more risk factor for elevated lead using the questionnaire yet none had clinical blood lead testing during routine visits. Only two participants (2.2%) had elevated blood lead levels. The questionnaire had high sensitivity but poor specificity for predicting detectable lead levels (sensitivity 100%, specificity 22%). CONCLUSIONS FOR PRACTICE: Prenatal risk-factor based lead screening appears underutilized in practice and does not adequately discriminate between those with and without elevated blood levels. Given the complexity of the risk factor-based approach and underutilization, the benefit and cost-effectiveness of universal lead testing should be further explored.

Validation of in vivo toenail measurements of manganese and mercury using a portable X-ray fluorescence device.

BACKGROUND AND OBJECTIVE: Toenail metal concentrations can be used as an effective biomarker for exposure to environmental toxicants. Typically toenail clippings are measured ex vivo using inductively coupled plasma mass spectrometry (ICP-MS). X-ray fluorescence (XRF) toenail metal measurements done on intact toenails in vivo could be used as an alternative to alleviate some of the disadvantages of ICP-MS. In this study, we assessed the ability to use XRF to measure toenail metal concentrations in real-time without having to clip the toenails (i.e., in vivo) in two occupational settings for exposure assessment of manganese and mercury. MATERIALS AND METHODS: The portable XRF method used a 3-min in vivo measurement of toenails prior to clipping and was assessed against ICP-MS measurement of toenail clippings taken immediately after the XRF measurement and work history for a group of welders (n = 16) assessed for manganese exposure and nail salon workers (n = 10) assessed for mercury exposure. RESULTS AND CONCLUSIONS: We identified that in vivo XRF metal measurements were able to discern exposure to manganese in welders and mercury in nail salon workers. We identified significant positive correlations between ICP-MS of clippings and in vivo XRF measures of both toenail manganese (R = 0.59, p = 0.02) and mercury (R = 0.74, p < 0.001), as well as between in vivo XRF toenail manganese and work history among the welders (R = 0.55, p = 0.03). We identified in vivo XRF detection limits to be 0.5 µg/g for mercury and 2.6 µg/g for manganese. Further work should elucidate differences in the timing of exposure using the in vivo XRF method over toenail clippings and modification of measurement time and x-ray setting to further decrease the detection limit. In vivo portable, XRF measurements can be used to effectively measure toenail Mn and Hg in occupational participants in real-time during study visits and at a fraction of the cost.