Chelation Modeling of a Plutonium-238 Inhalation Incident Treated with Delayed DTPA.

This work describes an analysis, using a previously established chelation model, of the bioassay data collected from a worker who received delayed chelation therapy following a plutonium-238 inhalation. The details of the case have already been described in two publications. The individual was treated with Ca-DTPA via multiple intravenous injections and then nebulizations beginning several months after the intake and continuing for four years. The exact date and circumstances of the intake are unknown. However, interviews with the worker suggested that the intake occurred via inhalation of a soluble plutonium compound. The worker provided daily urine and fecal bioassay samples throughout the chelation treatment protocol, including samples collected before, during, and after the administration of Ca-DTPA. Unlike the previous two publications presenting this case, the current analysis explicitly models the combined biokinetics of the plutonium-DTPA chelate. Using the previously established chelation model, it was possible to fit the data through optimizing only the intake (day and magnitude), solubility, and absorbed fraction of nebulized Ca-DTPA. This work supports the hypothesis that the efficacy of the delayed chelation treatment observed in this case results mainly from chelation of cell-internalized plutonium by Ca-DTPA (intracellular chelation). It also demonstrates the validity of the previously established chelation model. As the bioassay data were modified to ensure data anonymization, the calculation of the "true" committed effective dose was not possible. However, the treatment-induced dose inhibition (in percentage) was calculated.

Chelation Model Validation: Modeling of a Plutonium-238 Inhalation Incident Treated with DTPA at Los Alamos National Laboratory.

ABSTRACT: Accidental inhalation of plutonium at the workplace is a non-negligible risk, even when rigorous safety standards are in place. The intake and retention of plutonium in the human body may be a source of concern. Thus, if there is a suspicion of a significant intake of plutonium, medical countermeasures such as chelation treatment may be administered to the worker. The present work aimed to interpret the bioassay data of a worker involved in an inhalation incident due to a glovebox breach at Los Alamos National Laboratory's plutonium facility. The worker was treated with intravenous injections of calcium salts of diethylenetriaminepentaacetic acid (DTPA) in an attempt to reduce the amount of plutonium from the body and therefore reduce the internal radiation dose. It is well known in the internal dosimetry field that the administration of chelation treatment poses additional challenges to the dose assessment. Hence, a recently developed chelation model was used for the modeling of the bioassay data. The objectives of this work are to describe the incident, model the chelation-affected and non-affected bioassay data, estimate the plutonium intake, and assess the internal radiation dose.

Use of Nasal Swab Activity to Estimate Intake in Internal Dosimetry.

ABSTRACT: In addition to a review of theoretical analyses, this work presents an empirical study of nasal swab data from the Los Alamos National Laboratory (LANL) database correlated with intake obtained from plutonium internal dosimetry calculations. As a result of this work, several "intake-versus-nasal-swab" models were derived. We advocate quantitative use of nasal swab measurements in dose assessment calculations and discuss ways that this can be done. The best description of the LANL plutonium internal dose database is arguably intake = A + Bx, where A = 2.7 Bq, B = 3.8, and x = summed nasal swab activity. The geometric standard deviation was found to be 8.2. This relationship, obtained using plutonium data, should apply also for other radionuclides.

Dose Assessment Following a 238 Pu Inhalation Incident at Los Alamos National Laboratory.

ABSTRACT: A glovebox breach at the plutonium facility at Los Alamos National Laboratory potentially exposed 15 individuals to 238 Pu aerosols. One of the individuals (P0) received two 1-g intravenous DTPA treatments, one on the day of the intake and another the following day. Several urine samples were collected from the individuals involved in the incident. Particle size analysis on the PPE and solubility analysis of the particles on a filter sample were conducted in vitro. The applicability of the results from the in vitro studies for dose assessment was questionable because of the effect of the cloth mask the workers were wearing for COVID-related protection. Based on several considerations, including the effect of cloth masks on the "effective" particle size inhaled and the analysis of fecal-to-urine ratio, the default Type M 1 µm AMAD model was used to estimate intakes and doses. Using the urinary excretion data collected after 100 d post last chelation treatment, the committed effective dose, E(50), for P0 was calculated to be 5.2 mSv. For all others, the bioassay data were consistent with no intakes or very small intakes [corresponding to E(50) less than 0.1 mSv].

Alternate Analysis of an In Vitro Solubility Study on the Lung Dissolution Rate of 238PuO2 Material Involved in the 2020 Incident at Los Alamos National Laboratory.

ABSTRACT: This work presents an alternate analysis of an in vitro solubility study on the lung dissolution rate of 238PuO2 material involved in a recent inhalation incident at Los Alamos National Laboratory (LANL). The original dataset used in this work was retrieved from a recently published report. The present work shows an analysis of the same dataset by modeling the dissolution in separate time intervals rather than modeling the cumulative dissolution.

Plutonium Systemic Biokinetic Model for Rats.

A baseline compartmental model (relative to modeling decorporation) of the distribution and retention of plutonium (Pu) in the rat for a systemic intake is derived. The model is derived from data obtained from a study designed to evaluate the behavior of plutonium in the first 28 days after incorporation. The model is based on a recently published model of americium (Am) in rats, which incorporated a pharmacokinetic (PK)-front-end modeling approach, which was used to specify transfer to and from the extracellular fluids (ECF) in the various tissues in terms of vascular flow and volumes of ECF. In the americium model, the approach was "cell-membrane limited," meaning that rapid diffusion of americium occurred throughout all the extracellular fluids (i.e., the blood plasma and interstitial fluids), while back-end rates representing transport into and out of the cells were determined empirically. However, this approach was inconsistent with the plutonium dataset. A good fit to the data is obtained by incorporating aspects of the Durbin et al. model structure, with plutonium in plasma separated into "free" and "bound" components. Free plutonium uses a cell-membrane-limited front end as for americium. Bound plutonium uses a capillary-wall-limited front end, where transfer rates from blood plasma into the interstitial fluids are relatively slow, and must be determined either empirically or from a priori knowledge. As in the Durbin et al. model, both free and bound plutonium are available for deposition in bone. In addition, our model has some bound plutonium associated with uptake to the gastrointestinal (GI) tract. Uncertainties in transfer rates were investigated using Markov Chain Monte Carlo (MCMC). It is anticipated that this model structure of plutonium will also be useful in interpreting comparable data from decorporation studies done in experimental animals.

Development of a New Chelation Model: Bioassay Data Interpretation and Dose Assessment after Plutonium Intake via Wound and Treatment with DTPA.

The administration of chelation therapy to treat significant intakes of actinides, such as plutonium, affects the actinide's normal biokinetics. In particular, it enhances the actinide's rate of excretion, such that the standard biokinetic models cannot be applied directly to the chelation-affected bioassay data in order to estimate the intake and assess the radiation dose. The present study proposes a new chelation model that can be applied to the chelation-affected bioassay data after plutonium intake via wound and treatment with DTPA. In the proposed model, chelation is assumed to occur in the blood, liver, and parts of the skeleton. Ten datasets, consisting of measurements of C-DTPA, Pu, and Pu involving humans given radiolabeled DTPA and humans occupationally exposed to plutonium via wound and treated with chelation therapy, were used for model development. The combined dataset consisted of daily and cumulative excretion (urine and feces), wound counts, measurements of excised tissue, blood, and post-mortem tissue analyses of liver and skeleton. The combined data were simultaneously fit using the chelation model linked with a plutonium systemic model, which was linked to an ad hoc wound model. The proposed chelation model was used for dose assessment of the wound cases used in this study.

IMPROVED EMPIRICAL LIKELIHOOD FUNCTION BASED ON NORMALIZATION-DEPENDENT REPLICATE MEASUREMENTS.

Based on $n$ replicate measurements that require known normalization factors and assuming an underlying normal distribution for individual measurements but with unknown standard deviation, a combined likelihood function is derived that takes the form of a Student's $t$-distribution with $\nu = n-1$ degrees of freedom and $t=(\psi -\overline{Y})/s$, where $\psi $ is the true value of the measurement quantity calculated from the forward model, and $\overline{Y}$ and $s$ are average and standard error of the mean obtained from the $n$ measurements defined with weighting proportional to the inverse of the normalization factor squared. Assuming an underlying triangle distribution rather than a normal distribution does not produce a large change for six replicates. Examples of replicate data from an animal study and sequential occupational urine and fecal monitoring are given. The use of the empirical likelihood function in data modeling is discussed.

Americium Systemic Biokinetic Model for Rats.

In this work, a baseline compartmental model of the distribution and retention of americium in the rat for a systemic intake was derived. The model was derived from data obtained from a study designed to evaluate the behavior of americium in the first 28 days after incorporation. A pharmacokinetic (PK)-front-end modeling approach was used to specify transfer to and from the extracellular fluids (ECF) in the various tissues in terms of vascular flow and volumes of ECF. Back-end rates representing transport into and out of the cells were determined empirically. Uncertainties in transfer rates were investigated using Markov chain Monte Carlo (MCMC). The combination of PK-front-end model and the back-end model structure used allowed for extrapolation to the earliest times with small uncertainty. This approach clearly demonstrated the rapid transfer of material from ECF to liver and bone. This model provides a baseline for modeling the action of decorporation agents, such as DTPA.

Bayesian Analysis of Plutonium Bioassay Data at Los Alamos National Laboratory.

The main concern of operational internal dosimetry is to detect intakes and estimate doses to the worker from a series of bioassay measurements. Although several methods are available, the inverse problem of internal dosimetry-i.e., determination of time, amount, and types of intake given a set of bioassay data-is well suited to a Bayesian approach. This paper summarizes the Bayesian methodology used at Los Alamos National Laboratory to detect intakes and estimate doses from plutonium bioassay measurements. Some advantages and disadvantages of the method are also discussed. The successful application of Bayesian methods for several years at Los Alamos National Laboratory, which monitors thousands of workers annually for plutonium, indicates that the methods can be extended to other facilities.

Second-order Kinetics of DTPA and Plutonium in Rat Plasma.

In 2008, Serandour et al. reported on their in vitro experiment involving rat plasma samples obtained after an intravenous intake of plutonium citrate. Different amounts of DTPA were added to the plasma samples and the percentage of low-molecular-weight plutonium measured. Only when the DTPA dosage was three orders of magnitude greater than the recommended 30 µmol/kg was 100% of the plutonium apparently in the form of chelate. These data were modeled assuming three competing chemical reactions with other molecules that bind with plutonium. Here, time-dependent second-order kinetics of these reactions are calculated, intended eventually to become part of a complete biokinetic model of DTPA action on actinides in laboratory animals or humans. The probability distribution of the ratio of stability constants for the reactants was calculated using Markov Chain Monte Carlo. These calculations substantiate that the inclusion of more reactions is needed in order to be in agreement with known stability constants.

The Role Of Extracellular Fluid in Biokinetic Modeling.

The pharmacokinetic equations of Pierson et al. describing the behavior of bromide in rat provide a general approach to the modeling of extracellular fluid (ECF). The movement of material into ECF spaces is rapid and is completely characterized by tissue volumes and vascular flow rates to and from a tissue, the volumes of the tissue, and the ECF associated with the tissue. Early-time measurements are needed to characterize ECF. Measurements of DTPA disappearance from plasma by Wedeking et al. are discussed as an example of such measurements. In any biokinetic model, the fastest transfer rates are not determinable with the usual datasets, and if determined empirically, these rates will have very large and highly correlated uncertainties, so particular values of these rates, even though the model fits the available data, are not significant. A pharmacokinetic front-end provides values for these fast rates. An example of such a front-end for a 200-g rat is given.

Characterisation of non-constant background in counting measurements.

A 'moving-target' method for characterising background in a counting measurement in which the instantaneous background count rate is a function of time, rather than being fixed, is proposed. This model treats the average Poisson mean in observation period P as coming from a gamma distribution with parameters αP and ßP. This model is applied to a large dataset of replicate observations, consisting of 242 (234)U method blank measurements collected over a 2-y period. Point estimates of the model parameters are determined by comparing the mean and variance of the observed data and by maximising the likelihood function. Posterior distributions of the parameters are obtained by Markov Chain Monte Carlo. Assuming time-invariant fluctuations of the background count rate, the variation of the instantaneous count rate is described by a correlation function, which can be interpreted as describing how rapidly the background changes with time, or how likely the background is to change between measurements. An 'exponential-correlation' model of background time dependence is proposed, with parameters α, ß and correlation time τ. Once determined, these parameters fully describe the distribution of background, just as NB and TB in the fixed-target model.

Software for empirical building of biokinetic models for normal and decorporation-affected data.

This paper describes software ("RATDOSE") developed to analyze data from animal experiments investigating the efficacy of chelating agents. An empirical model building approach is used where, starting from the simplest model structures, one minimizes χ(2) by varying transfer rates in the model. Model complexity is increased as needed until the minimum attained value of χ(2) per data point decreases to about 1. This approach requires careful treatment of data uncertainties and independent checks of data self-consistency. The biokinetic models can include second-order kinetics to describe the chelation chemical reaction. The radiation dose to the animal is also calculated using S quantities specific for the animal, although the tissue weighting factors used to calculate the effective dose are those for the human.

Three plutonium chelation cases at Los Alamos National Laboratory.

Chelation treatments with dosages of 1 g of either Ca-DTPA (Trisodium calcium diethylenetriaminepentaacetate) or Zn-DTPA (Trisodium zinc diethylenetriaminepentaacetate) were undertaken at Los Alamos Occupational Medicine in three recent cases of wounds contaminated with metallic forms of Pu. All cases were finger punctures, and each chelation injection contained the same dosage of DTPA. One subject was treated only once, while the other two received multiple injections. Additional measurements of wound, urine, and excised tissues were taken for one of the cases. These additional measurements served to improve the estimate of the efficacy of the chelation treatment. The efficacy of the chelation treatments was compared for the three cases. Results were interpreted using models, and useful heuristics for estimating the intake amount and final committed doses were presented. In spite of significant differences in the treatments and in the estimated intake amounts and doses amongst the three cases, a difference of four orders of magnitude was observed between the highest excretion data point and the values observed at about 100 d for all cases. Differences between efficacies of Zn-DTPA and Ca-DTPA could not be observed in this study. An efficacy factor of about 50 was observed for a chelation treatment, which was administered at about 1.5 y after the incident, though the corresponding averted dose was very small (LA-UR 09-02934).

Poisson mixture model for measurements using counting.

Starting with the basic Poisson statistical model of a counting measurement process, 'extraPoisson' variance or 'overdispersion' are included by assuming that the Poisson parameter representing the mean number of counts itself comes from another distribution. The Poisson parameter is assumed to be given by the quantity of interest in the inference process multiplied by a lognormally distributed normalising coefficient plus an additional lognormal background that might be correlated with the normalising coefficient (shared uncertainty). The example of lognormal environmental background in uranium urine data is discussed. An additional uncorrelated background is also included. The uncorrelated background is estimated from a background count measurement using Bayesian arguments. The rather complex formulas are validated using Monte Carlo. An analytical expression is obtained for the probability distribution of gross counts coming from the uncorrelated background, which allows straightforward calculation of a classical decision level in the form of a gross-count alarm point with a desired false-positive rate. The main purpose of this paper is to derive formulas for exact likelihood calculations in the case of various kinds of backgrounds.

Uncertainties of Mayak urine data.

A method of parameterising the likelihood functions representing the uncertainty of Mayak plutonium urine bioassay measurements is described. The Poisson-lognormal model is assumed and data from 63 cases (1,087 urine measurements in all) are used to empirically determine the lognormal normalisation uncertainty, given the measurement uncertainties obtained from count quantities. An outlier-insensitive procedure is used to fit the cumulative probability distribution of scaled deviations in order to determine the normalisation uncertainty. The natural logarithm of the geometric standard deviation of the total normalisation uncertainty is found to be 0.34 including a measurement component estimated to be 0.2.

Capstone depleted uranium aerosol biokinetics, concentrations, and doses.

One of the principal goals of the Capstone Depleted Uranium (DU) Aerosol Study was to quantify and characterize DU aerosols generated inside armored vehicles by perforation with a DU penetrator. This study consequently produced a database in which the DU aerosol source terms were specified both physically and chemically for a variety of penetrator-impact geometries and conditions. These source terms were used to calculate radiation doses and uranium concentrations for various scenarios as part of the Capstone Human Health Risk Assessment (HHRA). This paper describes the scenario-related biokinetics of uranium, and summarizes intakes, chemical concentrations to the organs, and E(50) and HT(50) for organs and tissues based on exposure scenarios for personnel in vehicles at the time of perforation as well as for first responders. For a given exposure scenario (duration time and breathing rates), the range of DU intakes among the target vehicles and shots was not large, about a factor of 10, with the lowest being for a ventilated operational Abrams tank and the highest being for an unventilated Abrams with DU penetrator perforating DU armor. The ranges of committed effective doses were more scenario-dependent than were intakes. For example, the largest range, a factor of 20, was shown for scenario A, a 1 min exposure, whereas, the range was only a factor of two for the first-responder scenario (E). In general, the committed effective doses were found to be in the tens of mSv. The risks ascribed to these doses are discussed separately.

Methods used to calculate doses resulting from inhalation of Capstone depleted uranium aerosols.

The methods used to calculate radiological and toxicological doses to hypothetical persons inside either a U.S. Army Abrams tank or Bradley Fighting Vehicle that has been perforated by depleted uranium munitions are described. Data from time- and particle-size-resolved measurements of depleted uranium aerosol as well as particle-size-resolved measurements of aerosol solubility in lung fluids for aerosol produced in the breathing zones of the hypothetical occupants were used. The aerosol was approximated as a mixture of nine monodisperse (single particle size) components corresponding to particle size increments measured by the eight stages plus the backup filter of the cascade impactors used. A Markov Chain Monte Carlo Bayesian analysis technique was employed, which straightforwardly calculates the uncertainties in doses. Extensive quality control checking of the various computer codes used is described.

Variability and uncertainty of biokinetic model parameters: the discrete empirical Bayes approximation.

In the Bayesian approach to internal dosimetry, uncertainty and variability of biokinetic model parameters need to be taken into account. The discrete empirical Bayes approximation replaces integration over biokinetic model parameters by discrete summation in the evaluation of Bayesian posterior averages using Bayes theorem. The discrete choices of parameters are taken as best-fit point determinations of model parameters for a study subpopulation with extensive data. A simple heuristic model is constructed to numerically and theoretically study this approximation. The heuristic example is the measurement of heights of a group of people, say from a photograph where measurement uncertainty is significant. A comparison is made of posterior mean and standard deviation of height after a measurement, (i) using the exact prior describing the distribution of true height in the population and (ii) using the approximate discrete empirical Bayes prior obtained from measurements of some study subpopulation.