Improvements, New Methods, and Plans for the …...Robert L. Jones, PhD Inorganic and Radiation Analytical Toxicology Branch June 2018 APHL 2018 Meeting CDC’S Rapid Radionuclide

Robert L. Jones, PhD

Inorganic and Radiation Analytical Toxicology Branch

June 2018

APHL 2018 Meeting

CDC’S Rapid Radionuclide Screen –Improvements, New Methods, and Plans

for the Future

Division of Laboratory SciencesNational Center for Environmental Health

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The Boston Marathon 2013

What if,

It had been an Radiological

Dispersion Device (RDD)

(“Dirty Bomb”)?

Presenter

Presentation Notes

What we need is lab capicity to link EPI to lab to analyze the most critical first 100 samples form the exposed population (out of possible thousands) and do that on 10-50 mL of sample in 12-36 hours.

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Was it a Widespread Dispersal?

Reproduced with permission from Dr. Michael Brown, LANL

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Examples of Mass ScreeningRadiat ion Specific

• 1986 Chernobyl, Incident – >300,000 screened

• 1987 Goiania, Incident - ~112,000 screened

• 1999 Japan, Tokaimura Incident – >74,600 screened

• 2011 Japan, Fukushima incident – >244,000 screened

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Examples of Radiat ion Poisonings(“Micro RDDs” )

• 1957 Frankfurt, Germany Thallium-204• 1990 Canada, Tritium (H-)3• 1994-1995 Taiwan, Phosphorus-32• 1995 NIH, Phosphorus-32• 1995 MIT, Phosphorus-32• 1996 Long Island, NY, Radium-226• 1999 U. of CA, Phosphorus-32• 2009 India, Tritium (H-3)• 2006 London, Polonium-210

Joseph Sorcic, Master’s Thesis, Colorado State Univ., 2010

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Bioassay: Key Issue Detect ion of Internal Contaminat ion

Radionuclides Urine bioassaydetection

Primary radiat iondetect ion

Uranium (235U, 238U), Thorium yesStront ium, Plutonium (238Pu, 239Pu) yes

Americium, Californium, Neptunium, yes

Phosphorus, Curium, Polonium yes

Cesium, Cobalt (57Co, 60Co), Radium yes

Iodine (125I, 131I),Technet ium-99m yes

Selenium, Molybdenum, Iridium yes

alpha and beta

Gammarays

Internal radiation screening via hand held detectors or portals is applicable only for gamma emitting radionuclides.

Radionuclides of concern can be found at:www-pub.iaea.org/MTCD/publications/PDF/Pub1309_web.pdfwww.energy.gov/media/RDDRPTF14MAYa.pdfc

The “Grand Rounds” presentation and slides can be found at:www.cdc.gov/about/grand-rounds/archives/2010/03-March.htm

Presenter

Presentation Notes

Shown here is a listing of the radionuclides of concern from an emergency response point of view. Because ALL of these radionuclides can be detected by a urine bioassay methods versus a limited set of radionuclides via other methods, our laboratory efforts have focused on developing the rapid urine bioassays. They include both the traditional radiation counting technologies, alpha, beta and gamma spectroscopy and liquid scintillation counting, as well as, state-of-the-art mass spectrometry analytical methods. This allows for the most efficient and rapid detection based on the type of radioactive decay. Due to the sensitivity of these urine bioassays, exposure can be evaluated, in most cases, days or weeks after an initial exposure event.

250 -3000 samples per day10-20 samples per daySample throughput

70 mL1 -2 LSample Size Requirement

yesminimalScalable for “Surge Capacity”

yesnoCLIA Compliant Methods

22 + “fission products”(14 current)

Limited to contract with Bioassay lab

Number of radionuclides with validated clinical methods

“spot” collection24 hour collectionSample Requirements

Less than 24 hoursAbout 3-6 daysTime to first analytical results for 40 samples

New “Rapid” methods: CDC

“Traditional” Radionuclidemethods

Rapid Radionuclide Bioassay analytical methods: traditional versus new methods

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The Clinical Decision Guide (CDG),

The Clinical Decision Guide (CDG), a new operational quantity, is defined here to provide a measure that physicians can use when considering the need for medical treatment for internally-deposited radionuclides or as a screening level indicating the need for a more detailed investigation of tissue-specific absorbed doses over different time periods. For radionuclides other than isotopes of iodine, the CDG is the maximum, once-in-a lifetime intake of a radionuclide that represents:

NCRP Report 161: Management of Persons Contaminated with Radionuclides: Handbook

Clinical Decision Guide (Adult)Nuclide Route

Class/chem AMAD

ALI(Bq)

CDG(Bq) (Bq/d) (Bq/ml) (Bq/L)

Co-60 Inhalation M 1 um 7.40E+06 1.23E+05 8.54E+01 8.54E+04

Co-60 Inhalation M 5 um 3.50E+07 7.00E+05 4.86E+02 4.86E+05

Sr-90 Inhalation F 1 um 1.48E+05 3.41E+03 2.37E+00 2.37E+03

Sr-90 Inhalation F 5 um 8.30E+06 5.64E+05 3.92E+02 3.92E+05

Sr-90 Ingestion n/a n/a 1.11E+06 4.96E+04 3.45E+01 3.45E+04

Sr-90 Ingestion n/a n/a 8.90E+06 4.98E+05 3.46E+02 3.46E+05

Cs-137 Inhalation F 1 um 7.40E+06 4.21E+04 2.92E+01 2.92E+04

Cs-137 Inhalation F 5 um 5.80E+07 1.28E+06 8.86E+02 8.86E+05

Cs-137 Ingestion n/a n/a 3.70E+06 8.35E+04 5.80E+01 5.80E+04

Cs-137 Ingestion n/a n/a 2.80E+07 1.26E+06 8.78E+02 8.78E+05

Pu-239 Inhalation M 1 um 2.22E+02 3.61E-02 2.51E-05 2.51E-02

Pu-239 Inhalation M 5 um 7.60E+03 1.60E+00 1.11E-03 1.11E+00Adult, 1 day Post exposure

CDC’s Urine Radionuclide Screen

Gamma SpectroscopyQuantificat ion

Urine “Spot” Sample

Alpha/Beta Radionuclide Screen/Quantificat ion Alpha (Long Lived) ICP-MS Screen

Mass SpectrometryQuantificat ion

High Resolut ion Mass Spectrometry Quantificat ion

Alpha SpectroscopyQuantificat ion

Gamma Radionuclide Screen

Six analytical technologies needed to enable the analysis of the priority radionuclides

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NaI Gross Gamma Emitters in Urine

60Co137Cs57Co

99mTc

201Tl

Medical Diagnostic Radionuclide

Medical Diagnostic Radionuclide

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Custom Sodium Iodide (NaI) Well Detector systems for Gamma Screen

Manual system

Dual Shield system

Single Shield system

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CDC Radiat ion Lab UpdatesICP-MS Act inide Screen for:Am-241 U-238Np-237 Pu-239Am-241

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HPLC-ICP-MS Act inide Urine Screen

Actinides: 200 pg/ml in sample using a TRU resin HPLC column

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Alpha detectors

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CDC Radiat ion Lab Updates

Alpha Spec for:Po-210Pu-238Cf-252Cm-244

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Liquid Scint illat ion Count ing for:Gross Alpha/Beta Screen

Sr-90P-32H-3

Liquid Scint illat ion Counting

Quantulus GCT 6220

Tri-Carb 3110 TR

Quantulus 1220 Ultra Low Level

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HPGe for:Cs-137 Tc-99mCo-60 Mo-99I-131 Ir-192I-125 Se-75

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HPGe detector

Robotic sample changer, 100 sample tray

ICP-MS

ICP-MS ICP-QQQ-MS

HR-ICP-MS

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CDC Radiat ion Lab UpdatesICP-QQQ-MS for:

Ra-226

ICP-MS for: HR-ICP-MS for:U-238 U-238 U-234U-235 U-235 U-236

Pu-239 Np-237Am-241

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CDC Radiat ion Lab Future WorkRefining and enhancing some methods

Sr-90, Pu-239, H-3, P-32

Np-237 via HR-ICP-MS and Q-ICP-MSRa-226 via ICP-MS-QQQ Se-75, I-131 & I-125 via Gamma Spec. (HPGe)Po-210, Cf-252 & Cm-242 via Alpha Spec.

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CDC Radiat ion Lab Future WorkEliminat ing the use of vacuum boxes

Vacuum Box: 24 samples (manual)

Sample Prep Station: 60 samples (automated)

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Laboratory Goals and Needs for Effect ive Response

CDC• Develop rapid CLIA-compliant analyt ical

methods for 22 priority radionuclides, and increase sample throughput

State and local • Establish Laboratory Response

Network-Radiologic– Participation: 10 or more state

and/or DOE laboratories– Training and technology transfer– Performance evaluation

Presenter

Presentation Notes

The primary needs for an effective public health response to a national radiological or nuclear incident are: To develop the analytical methods to identify and quantify the remaining 15 radionuclides of concern and increase sample throughput through automation. Presently, the state public health laboratories that analyze radionuclides in the states have no rapid analytical methods for clinical samples according to recent surveys by the Association of Public Health Laboratories and the Conference of Radiation Control Program Directors. Consequently, they would be unable to assist in a national radiological incident with clinical sample surge capacity. Therefore, to develop this surge capacity there is a need to establish a Laboratory Response Network – Radiological (LRN-R) including 10 or more state public health laboratories. This would include training, technology transfer and on-going performance evaluation. In conclusion, CDC has developed screening and quantitative methods for assessing human radionuclide contaminations. We have the science-based plans for developing the remaining analytical methods. There is currently no other such capability in the nation. The next speaker is Dr. John Halpin.

CDC Web site for Radiat ion Emergency Preparedness and Response:

Sample collect ion, and shipping info

http://emergency.cdc.gov/radiat ion/resourcelibrary/lab.asp 26

Urine Collect ion and Processingemergency.cdc.gov/radiat ion/pdf/UrineCollect ionFlowChart.pdf

Urine Shipping Instruct ionsemergency.cdc.gov/radiat ion/pdf/ShippingInstruct ionsFlowChart.pdf

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Summary• Radiat ion Laboratory Methods (bioassay): rapidly identify and

quantify specific radionuclides in people potent ially contaminated in a radiological or nuclear event.

• Provides t imely and crit ical information for effect ive medical management and follow-up of individuals by assessing risk for contamination by radionuclides.

• Provides information for populat ion monitoring (populat ions and populat ion sub-groups) by determining the level of internal contamination/exposure.

• Provides “negative” results for people, who think that they may be contaminated but are not truly contaminated, thereby relieving the stress on the public health system and medical infrastructure.

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Acknowledgements Kathleen Caldwell, PhD Olga Piraner, PhD Ge Xiao, PhD Jon Button, PhD Carl Verdon, PhD Youngzhong Liu, PhD Supriyadi Sadi, Phd

Shannon Sullivan, MS Rebecca Hunt, MS Kameswara Voleti, PhD David Saunders, PhD

Los Alamos National Labs Sandia National Labs Savannah River National Labs Argonne National Labs FDA, EPA, NIST, BOD, DOE

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Quest ions

and

Discussions

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov

For more information please contactCenters for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov

“The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy. Use of trade names is for

identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the U.S. Department of Health and Human Services.”

National Center for Environmental HealthDivision of Laboratory Science

Thank you

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mailto:[email protected]

http://www.cdc.gov/

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ContactRobert L. Jones, PhD

Centers for Disease Control and Prevention4770 Buford Hwy

Mailstop F-50Atlanta, GA 30341-3724

[email protected]

“The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not

be construed to represent any agency determination or policy.

Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the

U.S. Department of Health and Human Services.”

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Backup Slides

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• Radiation Exposure: A person is “exposed” to radioactive materials through – gamma irritation (e.g. Improvised Nuclear Device (IND) blast) – “exposure” to alpha, beta or gamma radiation from external or

internal contamination (RDD or IND fallout).

• Radiation Contaminat ion: A person is “contaminated” internally with radioact ive materials via inhalation, ingestion or penetrating injury.

Both “exposure” and “contamination” result in an exposure dose.

Radiat ion Diagnost ics

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Radiat ion Diagnost icsTool Effect iveness vs. Type of Incident

Type of Incident Exposure (Biodosimetry)

Contaminat ion (Bioassay)

Improvised Nuclear Device (IND)

Effect ive (shine) Effect ive (fallout)

Nuclear Power Plant (NPP) Limited Effect ive (fallout)

Radiation DispersalDevice (RDD)

Limited Effect ive

Radiation ExposureDevice (RED)

Effect ive Not useful

Biodosimetry determines a “past” radiation dose from an “exposure” incident. (HHS/BARDA Diagnostic test Development)

Bioassay determines “past, current and future” radiation doses from a “contamination” incident. (CDC Diagnostic test Development)

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Concerned Cit izen Mult iplier• 1987 Goiania – 137Cs – 50 treated / 112,000 screened

= 2240 “concerned cit izen mult iplier” (CCM)

• 1995-1996 U.S. Methyl parathion – 16,000 CCM

• 2001-2002 U.S. Anthrax (clinical) – 30 casualties or

infected / 250,000 tests = 8,500 CCM

• 2005 NV Mercury exposure – 1 contaminated /280

tested = 280 CCM

• 2006 London - 210Po –1 casualty / 800 tested = 800

CCM

Documents

Improvements, New Methods, and Plans for the …...Robert L. Jones, PhD Inorganic and Radiation Analytical Toxicology Branch June 2018 APHL 2018 Meeting CDC’S Rapid Radionuclide