Assessment of radiation damage-the need for a multiparametric and integrative approach with the help of both clinical and biological dosimetry.

Accidental exposure to ionizing radiation leads to damage on different levels of the biological organization of an organism. Depending on exposure conditions, such as the nature of radiation, time and affected organs and organ systems, the clinical endpoint of radiation damage and the resulting acute and chronic radiation syndromes may vary to a great extent. Exposure situations range from purely localized radiation scenarios and partial-body exposures to whole-body exposures. Therefore, clinical pictures vary from localized radiation injuries up to the extreme situation of radiation-induced multi-organ involvement and failure requiring immediate, intensive, and interdisciplinary medical treatment. These totally different and complex clinical situations not only appear most different in clinical diagnostic and therapeutic aspects, but also, due to different levels of underlying biological damage, biological indicators of effects may vary to a wide extent. This fact means that an exact assessment of the extent of radiation damage within individual patients can only be performed when taking into consideration clinical as well as different biological indicators. Among the clinical indicators, routine laboratory parameters such as blood counts and the documentation of clinical signs and symptoms (using such methods as the METREPOL system) are the key parameters, but dicentric assay, the gold standard for biological dosimetry, and other methods under development, such as the gamma-H2AX focus assay or gene expression analysis of radiosensitive genes, must also be taken into account. Each method provides best results in different situations, or, in other words, there are methods that work better in a specific exposure condition or at a given time of examination (e.g., time after exposure) than others. Some methods show results immediately; others require days to weeks until results are available for clinical decision-making. Therefore, to provide the best basis for triage and planning and to provide medical treatment after accidental radiation exposure, different and independent diagnostic procedures integrating all clinical aspects as well as different biological indicators have to be applied. This multiparametric approach has been suggested after recent radiation accidents but needs to be adopted and standardized worldwide. A new integrative concept is shown and discussed.