Pilot website to support international collaboration for dose assessments in a radiation emergency

Nuclear terrorism has emerged as a significant threat which could require timely medical interventions to reduce potential radiation casualties. Early dose assessments are critical since optimal care depends on knowing a victim's radiation dose. The dicentric chromosome aberration assay is considered the "gold standard" to estimate the radiation dose because the yield of dicentrics correlates positively with the absorbed dose. Dicentrics have a low background frequency, are independent of age and gender and are relatively easy to identify. This diagnostic test for radiation exposure, however, is labor intensive and any single or small group of laboratories could easily be overwhelmed by a mass casualty event. One solution to this potential problem is to link the global WHO BioDoseNet members via the Internet so multiple laboratories could work cooperatively to screen specimens for dicentric chromosomes and generate timely dose estimates. Inter-laboratory comparison studies have shown that analysis of electronic chromosome images viewed on the computer monitor produces scoring accuracy equivalent to viewing live images in the microscope. This functional equivalence was demonstrated during a comparative study involving five laboratories constructing ⁶⁰Co gamma ray calibration curves and was further confirmed when comparing results of blind dose estimates submitted by each laboratory. It has been further validated in two recent WHO BioDoseNet trial exercises where 20 metaphase images were shared by e-mail and 50 images were shared on a test website created for this purpose. The Internet-based exercise demonstrated a high level of concordance among 20 expert scorers who evaluated the same 50 metaphase spreads selected to exhibit no, low, moderate and severe radiation damage. Nineteen of 20 scorers produced dicentric equivalent counts within the 95% confidence limits of the mean. The Chi-squared test showed strong evidence of homogeneity in the data (p = 0.999). Altogether, data obtained from these studies support the conclusion that Internet-based scoring is likely to overcome the "bottleneck" in workflow, reduce turn-a-round time for dose estimates and ultimately strengthen surge capacity. Use of the Internet for biodosimetry would obviously leverage the human and equipment resources throughout the world. As part of radiation emergency planning, we conclude that a global IT network/infrastructure is needed to serve the needs of an expanding biodosimetry community and should be given high priority to meet the growing threat of radiological and nuclear terrorism.