{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:06:39Z","timestamp":1790636799931,"version":"4.1.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"14","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U19AI091173"],"award-info":[{"award-number":["U19AI091173"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Following large-scale radiation events, an overwhelming number of people will potentially need mitigators or treatment for radiation-induced injuries. This necessitates having methods to triage people based on their dose and its likely distribution, so life-saving treatment is directed only to people who can benefit from such care. Using estimates of victims following an improvised nuclear device striking a major city, we illustrate a two-tier approach to triage. At the second tier, after first removing most who would not benefit from care, biodosimetry should provide accurate dose estimates and determine whether the dose was heterogeneous. We illustrate the value of using in vivo electron paramagnetic resonance nail biodosimetry to rapidly assess dose and determine its heterogeneity using independent measurements of nails from the hands and feet. Having previously established its feasibility, we review the benefits and challenges of potential improvements of this method that would make it particularly suitable for tier 2 triage. Improvements, guided by a user-centered approach to design and development, include expanding its capability to make simultaneous, independent measurements and improving its precision and universality.<\/jats:p>","DOI":"10.1093\/rpd\/ncad022","type":"journal-article","created":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T07:47:23Z","timestamp":1695023243000},"page":"1539-1550","source":"Crossref","is-referenced-by-count":10,"title":["Benefits and challenges of <i>in vivo<\/i> EPR nail biodosimetry in a second tier of medical triage in response to a large radiation event"],"prefix":"10.1093","volume":"199","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4035-3084","authenticated-orcid":false,"given":"Ann Barry","family":"Flood","sequence":"first","affiliation":[{"name":"Dartmouth College Radiology Department, Geisel School of Medicine at Dartmouth, , Hanover, NH , USA"},{"name":"Clin-EPR, LLC , Lyme, NH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W","family":"Sidabras","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin Department of Biophysics, , Milwaukee, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9211-2805","authenticated-orcid":false,"given":"Steven G","family":"Swarts","sequence":"additional","affiliation":[{"name":"University of Florida Department of Radiation Oncology, , Gainesville, FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W","family":"Buehler","sequence":"additional","affiliation":[{"name":"University of Maryland Department of Pathology, , Baltimore, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Schreiber","sequence":"additional","affiliation":[{"name":"Clin-EPR, LLC , Lyme, NH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleg","family":"Grinberg","sequence":"additional","affiliation":[{"name":"Clin-EPR, LLC , Lyme, NH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold M","family":"Swartz","sequence":"additional","affiliation":[{"name":"Dartmouth College Radiology Department, Geisel School of Medicine at Dartmouth, , Hanover, NH , USA"},{"name":"Clin-EPR, LLC , Lyme, NH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"issue":"5","key":"2023091807454283600_ref1","doi-asserted-by":"crossref","DOI":"10.1667\/RADE-21-00198.1","article-title":"NIH policies and regulatory pathways to U.S. FDA licensure: strategies to inform advancement of radiation medical countermeasures and biodosimetry devices","volume":"197","author":"Satyamitra","year":"2022","journal-title":"Radiat. Res."},{"key":"2023091807454283600_ref2","volume-title":"Planning Guidance for Response to a Nuclear Detonation, Third Edition","author":"Federal Emergency Management Agency","year":"2022"},{"key":"2023091807454283600_ref3","article-title":"Estimation of radiation-induced health hazards from a \u201cdirty bomb\u201d attack with radiocesium under different assault and rescue conditions","volume":"8","author":"Rump","year":"2021","journal-title":"Mil. Med. Res."},{"issue":"Suppl 1","key":"2023091807454283600_ref4","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1001\/dmp.2011.17","article-title":"Radiation injury after a nuclear detonation: medical consequences and the need for scarce resources allocation","volume":"5","author":"DiCarlo","year":"2011","journal-title":"Disaster Med. Public Health Prep."},{"issue":"5","key":"2023091807454283600_ref5","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1080\/09553002.2021.2000659","article-title":"What if a major radiation incident happened during a pandemic? Considerations of the impact on biodosimetry","volume":"98","author":"Swartz","year":"2022","journal-title":"Int. J. Radiat. Biol."},{"issue":"1\u20134","key":"2023091807454283600_ref6","article-title":"Advances in a framework to compare bio-dosimetry methods for triage in large-scale radiation events","volume":"159","author":"Flood","year":"2014","journal-title":"Radiat. Prot. Dosimetry"},{"issue":"9","key":"2023091807454283600_ref7","doi-asserted-by":"crossref","DOI":"10.1016\/j.radmeas.2011.02.019","article-title":"A framework for comparative evaluation of dosimetric methods to triage a large population following a radiological event","volume":"46","author":"Flood","year":"2011","journal-title":"Radiat. Meas."},{"issue":"3","key":"2023091807454283600_ref8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1051\/radiopro\/2022022","article-title":"Complementary lessons learned from testing strategies used for radiation emergencies and COVID-19: a white paper from the International Association of Biological and Electron Paramagnetic Resonance (EPR) Radiation Dosimetry (IABERD)","volume":"57","author":"Swartz","year":"2022","journal-title":"Radioprotection"},{"key":"2023091807454283600_ref9","volume-title":"Preparing for the aftermath of a nuclear detonation; an analytic framework for disaster management LLNL-CONF-664395","author":"Buddemeier","year":"2014"},{"key":"2023091807454283600_ref10","volume-title":"Summit: Improvised Nuclear Device (IND) Response Planning Workshop","author":"Greater New York Hospital Association"},{"issue":"1","key":"2023091807454283600_ref11","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1667\/RR2610.1","article-title":"Development and licensure of medical countermeasures for platelet regeneration after radiation exposure","volume":"176","author":"DiCarlo","year":"2011","journal-title":"Radiat. Res."},{"issue":"1","key":"2023091807454283600_ref12","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00723-021-01444-w","article-title":"Radiation medical countermeasures and use of EPR biodosimetry to facilitate effectiveness of applied clinical procedures","volume":"53","author":"Singh","year":"2022","journal-title":"Appl. Magn. Reson."},{"issue":"1","key":"2023091807454283600_ref13","doi-asserted-by":"crossref","first-page":"e0001","DOI":"10.1667\/RROL01.1","article-title":"Medical countermeasures for platelet regeneration after radiation exposure. Report of a workshop and guided discussion sponsored by the National Institute of Allergy and Infectious Diseases, Bethesda, MD, March 22\u201323, 2010","volume":"176","author":"DiCarlo","year":"2011","journal-title":"Radiat. Res."},{"issue":"1","key":"2023091807454283600_ref14","doi-asserted-by":"crossref","DOI":"10.1097\/HP.0000000000001244","article-title":"Scientific and logistical considerations when screening for radiation risks by using biodosimetry based on biological effects of radiation rather than dose: the need for prior measurements of homogeneity and distribution of dose","volume":"119","author":"Swartz","year":"2020","journal-title":"Health Phys."},{"issue":"12","key":"2023091807454283600_ref15","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.7326\/0003-4819-140-12-200406150-00015","article-title":"Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group","volume":"140","author":"Waselenko","year":"2004","journal-title":"Ann. Intern. Med."},{"issue":"9","key":"2023091807454283600_ref16","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1089\/ars.2013.5635","article-title":"Hematopoietic stem cell injury induced by ionizing radiation","volume":"20","author":"Shao","year":"2014","journal-title":"Antioxid. Redox Signal."},{"issue":"1","key":"2023091807454283600_ref17","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1182\/asheducation-2003.1.473","article-title":"The hematologist and radiation casualties","volume":"2003","author":"Dainiak","year":"2003","journal-title":"Hematology Am. Soc. Hematol. Educ. Program"},{"issue":"6","key":"2023091807454283600_ref18","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0301-472X(02)00802-0","article-title":"Hematologic consequences of exposure to ionizing radiation","volume":"30","author":"Dainiak","year":"2002","journal-title":"Exp. Hematol."},{"issue":"1","key":"2023091807454283600_ref19","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.cyto.2014.08.003","article-title":"Colony-stimulating factors for the treatment of the hematopoietic component of the acute radiation syndrome (H-ARS): a review","volume":"71","author":"Singh","year":"2015","journal-title":"Cytokine"},{"key":"2023091807454283600_ref20","doi-asserted-by":"crossref","DOI":"10.1093\/rpd\/ncad009","article-title":"EPR biodosimetry: challenges and opportunities","author":"Swartz","year":"2023","journal-title":"Radiat. Prot. Dosimetry"},{"issue":"2","key":"2023091807454283600_ref21","doi-asserted-by":"crossref","DOI":"10.1007\/s00411-014-0522-0","article-title":"Overview of the principles and practice of biodosimetry","volume":"53","author":"Swartz","year":"2014","journal-title":"Radiat. Environ. Biophys."},{"issue":"9","key":"2023091807454283600_ref22","doi-asserted-by":"crossref","DOI":"10.1016\/j.radmeas.2011.03.011","article-title":"Overview of biodosimetry for management of unplanned exposures to ionizing radiation","volume":"46","author":"Swartz","year":"2011","journal-title":"Radiat. Meas."},{"issue":"1","key":"2023091807454283600_ref23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s00723-021-01458-4","article-title":"EPR dosimetry in human fingernails: investigation of the origin of the endogenous signal and implications for estimating dose from nail signals","volume":"53","author":"Tkatchenko","year":"2022","journal-title":"Appl. Magn. Reson."},{"key":"2023091807454283600_ref24","first-page":"46","volume-title":"4 Electron Paramagnetic Resonance Dosimetry","year":"2019"},{"issue":"10","key":"2023091807454283600_ref25","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/0883-2889(89)90005-1","article-title":"A portable spectrometer for ESR microscopy, dosimetry and dating","volume":"40","author":"Ikeya","year":"1989","journal-title":"Int. J. Radiat. Appl. Instrum. Part A: Appl. Radiat. Isotopes"},{"issue":"10","key":"2023091807454283600_ref26","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/0883-2889(89)90004-X","article-title":"Frequency-sweep ESR spectrometer for dosimetry and dating","volume":"40","author":"Hara","year":"1989","journal-title":"Int. J. Radiat. Appl. Instrum. Part A: Appl. Radiat. Isotopes"},{"key":"2023091807454283600_ref27","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1143\/JJAP.29.871","article-title":"An electron spin resonance system for in-vivo human tooth dosimetry","volume":"29","author":"Ishii","year":"1990","journal-title":"Japanese J. Appl. Phys."},{"issue":"9\u201310","key":"2023091807454283600_ref28","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1007\/s00723-020-01259-1","article-title":"Dielectric-backed aperture resonators for X-band depth-limited in vivo epr nail dosimetry","volume":"51","author":"Grinberg","year":"2020","journal-title":"Appl. Magn. Reson."},{"issue":"1","key":"2023091807454283600_ref29","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1038\/s41598-021-82462-3","article-title":"The design of X-band EPR cavity with narrow detection aperture for in vivo fingernail dosimetry after accidental exposure to ionizing radiation","volume":"11","author":"Guo","year":"2021","journal-title":"Sci. Rep."},{"issue":"4","key":"2023091807454283600_ref30","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1002\/mrm.1910030412","article-title":"Counter rotating current local coils for high-resolution magnetic resonance imaging","volume":"3","author":"Froncisz","year":"1986","journal-title":"Magn. Reson. Med."},{"issue":"1","key":"2023091807454283600_ref31","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s00723-021-01352-z","article-title":"Dispersion EPR: considerations for low-frequency experiments","volume":"53","author":"Hyde","year":"2022","journal-title":"Appl. Magn. Reson."},{"issue":"10","key":"2023091807454283600_ref32","doi-asserted-by":"crossref","first-page":"104707","DOI":"10.1063\/1.4898179","article-title":"A microwave resonator for limiting depth sensitivity for electron paramagnetic resonance spectroscopy of surfaces","volume":"85","author":"Sidabras","year":"2014","journal-title":"Rev. Sci. Instrum."},{"issue":"1","key":"2023091807454283600_ref33","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/HP.0000000000000874","article-title":"Developments in biodosimetry methods for triage with a focus on x-band electron paramagnetic resonance in vivo fingernail dosimetry","volume":"115","author":"Swarts","year":"2018","journal-title":"Health Phys."},{"issue":"6","key":"2023091807454283600_ref34","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/mrm.10302","article-title":"Mapping of the B1 field distribution of a surface coil resonator using EPR imaging","volume":"48","author":"He","year":"2002","journal-title":"Magn. Reson. Med."},{"issue":"5","key":"2023091807454283600_ref35","doi-asserted-by":"crossref","first-page":"N27","DOI":"10.1088\/0957-0233\/18\/5\/N03","article-title":"Automatic matching control circuit based on phase-sensitive detection for in vivo CW-EPR spectroscopy","volume":"18","author":"Hirata","year":"2007","journal-title":"Measure Sci. Tech."},{"issue":"1","key":"2023091807454283600_ref36","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/mrm.10487","article-title":"Control characteristics of an automatic matching control system for in vivo EPR spectroscopy","volume":"50","author":"Hirata","year":"2003","journal-title":"Magn. Reson. Med."},{"issue":"1","key":"2023091807454283600_ref37","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s00723-021-01413-3","article-title":"RF\/microwave resonators for preclinical and clinical EPR applications: current status and challenges","volume":"53","author":"Hirata","year":"2022","journal-title":"Appl. Magn. Reson."},{"issue":"3","key":"2023091807454283600_ref38","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.apergo.2010.09.005","article-title":"Methodological issues in product evaluation: the influence of testing environment and task scenario","volume":"42","author":"Sauer","year":"2011","journal-title":"Appl. Ergon."},{"key":"2023091807454283600_ref39","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/978-3-319-91287-5_37","article-title":"Guidance to transfer \u2018bench-ready\u2019 medical technology into usual clinical practice: case study \u2013 sensors and spectrometer used in EPR oximetry","volume":"1072","author":"Flood","year":"2018","journal-title":"Adv. Exp. Med. Biol."},{"issue":"1","key":"2023091807454283600_ref40","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1472-6947-11-15","article-title":"The role of the user within the medical device design and development process: medical device manufacturers\u2019 perspectives","volume":"11","author":"Money","year":"2011","journal-title":"BMC Med. Inform. Decis. Mak."},{"key":"2023091807454283600_ref41","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.apergo.2013.05.009","article-title":"Integration of human factors and ergonomics during medical device design and development: It\u2019s all about communication","volume":"45","author":"Vincent","year":"2014","journal-title":"Appl. Ergon."}],"container-title":["Radiation Protection Dosimetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/rpd\/article-pdf\/199\/14\/1539\/51652838\/ncad022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rpd\/article-pdf\/199\/14\/1539\/51652838\/ncad022.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T07:47:42Z","timestamp":1695023262000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/rpd\/article\/199\/14\/1539\/7274395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":41,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,9,18]]},"published-print":{"date-parts":[[2023,9,18]]}},"URL":"https:\/\/doi.org\/10.1093\/rpd\/ncad022","relation":{},"ISSN":["0144-8420","1742-3406"],"issn-type":[{"value":"0144-8420","type":"print"},{"value":"1742-3406","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,9]]},"published":{"date-parts":[[2023,9]]}}}