A comprehensive review of dose limits, triage systems and measurement tools for consequence management of nuclear and radiological emergencies.

ABSTRACT

During a radiological or nuclear emergency, occupational workers, members of the public, and emergency responders may be exposed to radionuclides, whether external or internal, through inhalation, ingestion, or wounds. In the case of internalized radiation exposure, prompt assessment of contamination is necessary to inform subsequent medical interventions. This review assembles the constituent considerations for managing nuclear and radiological incidents, focused on a parallel analysis of the evolution of radiation dose limits - notably in the emergency preparedness and response realm - alongside a discussion of triage systems and in vivo radionuclide detection tools. The review maps the development of international and national standards and regulations concerning radiation dose limits, illuminating how past incidents and accumulated knowledge have informed present emergency preparedness and response practices, specifically for internalized radiation. Additionally, the objectives and levels of radiation triage systems are explored in-depth, along with a global survey of practices and protocols. Finally, this review also focuses on in vivo detection systems and their capacities for radionuclide identification, prioritizing internalized gamma-emitting isotopes due to their broader relevance. Collectively, this study comprehensively addresses the intricacies of triage management following radiation emergencies, emphasizing the imperative for enhanced standardization and continued research in this critical domain.