Biodosimetry in interventional radiology: cutaneous-based immunoassay for anticipating risks of dermatitis.

OBJECTIVES: Interventional radiology procedures expose individuals to ionizing radiation. However, existing dosimetry methods do not provide the dose effectively absorbed to the skin, and do not consider the patient's individual response to irradiation. To resolve this lack of dosimetry data, we developed a new external irradiation biodosimetry device, DosiKit, based on the dose-dependent relationship between irradiation dose and radiation-induced H2AX protein phosphorylation in hair follicles. This new biological method was tested in Clermont-Ferrand University Hospital to evaluate the assay performances in the medical field and to estimate DosiKit sensitivity threshold. METHODS: DosiKit was tested over 95 patients treated with neuroradiological interventions. For each intervention, lithium fluoride thermoluminescent dosimeters (TLD) were used to measure total dose received at each hair collection point (lateral and occipital skull areas), and conventional indirect dosimetry parameters were collected with a Dosimetry Archiving and Communication System (DACS). RESULTS: Quantitative measurement of radiation-induced H2AX protein phosphorylation was performed on 174 hair samples before and after the radiation exposure and 105 samples showed a notable induction of gammaH2AX protein after the radiological procedure. According to a statistical analysis, the threshold sensitivity of the DosiKit immunoassay was estimated around 700 mGy. CONCLUSIONS: With this study, we showed that DosiKit provides a useful way for mapping the actually absorbed doses, allowing to identify patients overexposed in interventional radiology procedures, and thus for anticipating risk of developing dermatitis. KEY POINTS: • DosiKit is a new external irradiation biodosimetry device, based on the dose-dependent relationship between irradiation dose and radiation-induced H2AX protein phosphorylation in hair follicles. • DosiKit was tested over 95 patients treated with neuroradiological interventions. • The threshold sensitivity of the DosiKit immunoassay was estimated around 700 mGy and DosiKit provides a useful way for mapping the actually absorbed doses.

DosiKit, a New Immunoassay for Fast Radiation Biodosimetry of Hair and Blood Samples.

DosiKit is a field radiation biodosimetry immunoassay for fast triage of individuals exposed to external total-body or partial-body irradiation (TBI or PBI). Assay proof-of-concept based on γ-H2AX analysis of human blood samples has been previously described as a promising tool for rapid assessment of TBI. Here, we report on the performance of the assay for PBI based on an analysis of hair follicles irradiated with a 137Cs gamma-ray source, at doses ranging from 0 to 20 Gy and dose rates ranging from ∼0.8 to ∼3 Gy/min. First, we show that the DosiKit protocol allows extraction and analysis of hair follicle proteins. Next, we show that irradiated hair follicles trigger a DNA damage response by inducing dose-dependent γ-H2AX expression. Since γ-H2AX expression strongly decreases 2 to 4 h postirradiation, due to DNA repair, we hypothesized that an antibody targeting the S*/T*Q domains, phosphorylated by ATM for DNA repair activation (pSQTQ), would extend the postirradiation dosimetry time window. DosiKit analysis of pSQTQ in ex vivo irradiated cynomolgus monkey skin explants shows that these sequences are phosphorylated in a dose-dependent manner up to 8 h postirradiation, and that statistically different ranges of external radiation exposure can be distinguished (0-2 Gy, 5-10 Gy, 20 Gy). Since the DosiKit protocol is intended to be used on both blood and hair samples, we also show that SQTQ sequences are phosphorylated dose-dependently in human blood, allowing samples to be classified into three radiation dose ranges (0-0.1 Gy, 0.5-3 Gy and 5-8 Gy). In conclusion, radiation biodosimetry can be performed on both blood and hair samples up to 8 h after exposure using the DosiKit protocol, allowing the concomitant characterization of TBI and PBI for fast and efficient radiological crisis management.

DosiKit, a New Portable Immunoassay for Fast External Irradiation Biodosimetry.

DosiKit is a new field-radiation biodosimetry immunoassay for rapid triage of individuals exposed to external total-body irradiation. Here, we report on the validation of this immunoassay in human blood cell extracts 0.5 h after in vitro exposure to 137Cs gamma rays, using γ-H2AX analysis. First, calibration curves were established for five donors at doses ranging from 0 to 10 Gy and dose rates ranging from ∼0.8 to ∼3 Gy/min. The calibration curves, together with a γ-H2AX peptide scale, enabled the definition of inter-experimental correction factors. Using previously calculated correction factors, blind dose estimations were performed at 0.5 h postirradiation, and DosiKit performance was compared against concomitant dicentric chromosome assay (DCA), the current gold standard for external irradiation biodosimetry. A prototype was then assembled and field tested. We show that, despite significant inter-individual variations, DosiKit can estimate total-body irradiation doses from 0.5 to 10 Gy with a strong linear dose-dependent signal and can be used to classify potentially exposed individuals into three dose ranges: below 2 Gy, between 2 and 5 Gy and above 5 Gy. The entire protocol can be performed in 45 min, from sampling to dose estimation, with a new patient triaged every 10 min. While DCA enables precise measurement of doses below 5 Gy, it is a long and difficult method. In contrast, DosiKit is a quick test that can be performed directly in the field by operational staff with minimal training, and is relevant for early field triage and identification of individuals most likely to experience acute radiation syndrome. These findings suggest that DosiKit and DCA are complementary and should be combined for triage in a mass scale event. While the proof-of-concept reported here validates the use of DosiKit at 0.5 h postirradiation, further studies are needed to calibrate and evaluate the performance of the DosiKit assay at longer times after irradiation.