Papers by Alicja Jaworska
TMT Handbook: guidelines for treatment and long-term follow up of people exposed to radiation after a malevolent act [abstract]
MULTIBIODOSE: multi-disciplinary biodosimetric tools to manage high scale radiological casualties

Radiation and Environmental Biophysics, 2020
This work presents an overview of the applications of retrospective dosimetry techniques in case ... more This work presents an overview of the applications of retrospective dosimetry techniques in case of incorporation of radionuclides. The fact that internal exposures are characterized by a spatially inhomogeneous irradiation of the body, which is potentially prolonged over large periods and variable over time, is particularly problematic for biological and electron paramagnetic resonance (EPR) dosimetry methods when compared with external exposures. The paper gives initially specific information about internal dosimetry methods, the most common cytogenetic techniques used in biological dosimetry and EPR dosimetry applied to tooth enamel. Based on real-case scenarios, dose estimates obtained from bioassay data as well as with biological and/or EPR dosimetry are compared and critically discussed. In most of the scenarios presented, concomitant external exposures were responsible for the greater portion of the received dose. As no assay is available which can discriminate between radiat...

Realism and usefulness of multispecies experiment designs with regard to application in radioecology: a review
Science of The Total Environment
Multispecies experiments like microcosms and mesocosms are widely used in many fields of research... more Multispecies experiments like microcosms and mesocosms are widely used in many fields of research but not in radioecology. In radioecology, size limitations are important as large experimental volumes involve problems with waste (radionuclides), or shielding, absorption and available space in gamma fields (often within a climate chamber). We have therefore performed a literature review (ISI Web of Science, n = 406) of the design and properties of multispecies effect studies <100 L in size and with three or more mentioned taxa in other research fields to assess their suitability to radioecology. Studies with more mentioned taxa assess structural ecosystem parameters more often than studies with fewer mentioned taxa, while the opposite trend is seen for indirect effects/interactions. Studies of indirect effects benefit from more replicates and longer experiments. Almost all studies assess some ecosystem level parameter but only a quarter take a holistic approach assessing both structural and functional as well as indirect effects. We find that most cosms are custom-made systems, rather than standardised designs. Unmanipulated cosms consist of excised portions of the natural environment with a higher number of mentioned taxa, high ecological complexity and high realism, but have a relatively low replicability. In contrast, standardised cosms with fewer mentioned taxa have less ecological complexity but much higher replicability. This literature review shows that smaller cosm sizes have similar ecological complexity (e.g. number of taxa and trophic levels) and experimental duration as larger sized cosms, allowing for ecologically-relevant investigations, despite their small size. We encourage multispecies radioecology studies, preferably with environmental relevant doses and sufficient detail on dosimetry.

A survey on emergency thyroid monitoring strategies and capacities in Europe and comparison with international recommendations
Radiation Measurements
Abstract There are ongoing social debates about the risks and benefits of using nuclear reactors ... more Abstract There are ongoing social debates about the risks and benefits of using nuclear reactors to generate electricity. Radiation accidents can occur for different reasons and even be caused deliberately as a result of terrorist actions, and these may affect from a few to thousands of people. After a major release of radioactive iodine as a result of a nuclear accident, large number of potentially affected people may require rapid assessments to determine the degree of thyroid contamination, especially children and young people given that their thyroid is a highly radiosensitive organ and particularly vulnerable to the carcinogenic action of ionising radiation. To date, there is no internationally agreed protocol for measuring 131I in the thyroid of affected persons, especially in children. To address this problem, the Child and Adult Thyroid Monitoring After Reactor Accident (CAThyMARA) project ( https://www.eu-neris.net/projects/operra/operra-cathymara.html ) focused on post-accidental 131I measurements in the thyroid, giving special attention to children and involved 15 institutions from 12 European countries. One of the Work Packages of the project had the objective to overview existing national plans and means for thyroid monitoring and to review international recommendations about radioiodine monitoring in the thyroid in case of a large scale nuclear accident. To achieve this objective, a questionnaire-based survey was carried out from May to October 2016. The survey results were based on the analysis of the answers of 31 institutions in 18 European countries, which included a wide range of questions related to emergency plan strategies, monitoring strategies for radioiodine in thyroid, dose assessment, etc. In addition, the peer-review literature in this area was reviewed and summarised. The results of the survey together with the current international recommendations about radioiodine monitoring in thyroid could provide important information on existing gaps, which can be used to develop new or update existing guidelines on thyroid monitoring after a nuclear accident.

As a continuation to the NKS-funded BIODOS project, the BIOPEX project has aimed at testing and v... more As a continuation to the NKS-funded BIODOS project, the BIOPEX project has aimed at testing and validation of the newly established dose calibration curve for PCC rings, a specific chromosome aberration for use in biodosimetry in large casualty emergency preparedness. The testing of the PCC ring technique was performed by direct comparison to the conventional dicentric assay, both conducted with a triage approach that gives a crude dose estimate through analysis of a relatively small number of cells. Altogether 62 blood samples were analysed, each irradiated with an individual dose using γ-rays, and representing casualties in a simulated radiation accident resulting in a broad spectrum of whole body and partial body doses, ranging from zero dose up to a lethal whole body dose of 13 Gy. The results indicated that both triage assays were capable of discerning non-exposed cases and that in the uniform irradiations, the dose estimates based on data from both assays were fairly consistent with the given dose. However, differences were observed depending on the dose level. At doses about 5 Gy and below, dicentric scoring resulted in more accurate wholebody dose estimates than PCC rings. At very high doses, PCC rings appeared to give more accurate dose estimates than dicentrics. The discrepancies are mainly caused by shortcomings in the respective dose calibration curves. In non-uniform irradiations, the PCC ring assay was slightly better in the approximation of the partial body dose than dicentrics, but neither assay enabled accurate estimation of either dose or fraction of cells irradiated. The irradiated fraction of cells for the casualties in this scenario was apparently too small (10-40%) to be distinguished with the triage approach applied in the current study. With respect to the technical aspects, scoring of the PCC rings is easier and therefore somewhat faster but may be more sensitive to quality aspects. In conclusion, the study demonstrated that the PCC ring assay is suitable for use as a biodosimeter, especially for estimation of very high doses.
Jodprofylakse ved strålingsulykker

Premature chromosome condensation (PCC) assay for dose assessment in large radiological accidents
The study was undertaken to establish a dose calibration curve for a practical PCC ring assay and... more The study was undertaken to establish a dose calibration curve for a practical PCC ring assay and to apply it in a simulated mass casualty accident. The PCC assay was validated against the conventional dicentric assay. A linear relationship was established for PCC rings after (60)Co gamma irradiation with doses up to 20 Gy. In the simulated accident experiment, 62 blood samples were analyzed with both the PCC ring assay and the conventional dicentric assay, applying a triage approach. Samples received various uniform and non-uniform (10-40% partial-body) irradiations up to doses of 13 Gy. The results indicated that both assays yielded good dose estimates for the whole-body exposure scenario, although in the lower-dose range (0-6 Gy) dicentric scoring resulted in more accurate whole-body estimates, whereas PCC rings were better in the high-dose range (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;6 Gy). Neither assay was successful in identifying partial-body exposures, most likely due to the low numbers of cells scored in the triage mode. In conclusion, the study confirmed that the PCC ring assay is suitable for use as a biodosimeter after whole-body exposure to high doses of radiation. However, there are limitations for its use in the triage of people exposed to high, partial-body doses.
Lessons from past radiation accidents: Critical review of methods addressed to individual dose assessment of potentially exposed people and integration with medical assessment
Environment International

A New Handbook on Triage, Monitoring and Treatment of People Following Malevolent Use of Radiation
Health Physics, 2010
Through the Euratom 6 Framework Programme, the European Commission is co-sponsoring the specific ... more Through the Euratom 6 Framework Programme, the European Commission is co-sponsoring the specific targeted research project &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Triage, Monitoring and Treatment-Handbook for management of the public in the event of malevolent use of radiation&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (TMT Handbook). The main aim of the project is to produce a handbook for the effective and timely triage, monitoring, and treatment of people exposed to radiation following a malevolent act. The World Health Organization contributed to this project with development of guidelines on medical and public health response. A training course based on the TMT Handbook was developed. It will help to enhance national capacity for planning and response to acts involving the malevolent use of radiation. The course will also provide a platform to identify common challenges and discuss opportunities for harmonizing response strategies throughout the European Union. Focusing on its medical and public health response aspects, this paper introduces the TMT Handbook and its potential applicability not only as practical guidance for end-users but also as a useful tool for education and training.

RENEB – Running the European Network of biological dosimetry and physical retrospective dosimetry
International Journal of Radiation Biology, 2016
A European network was initiated in 2012 by 23 partners from 16 European countries with the aim t... more A European network was initiated in 2012 by 23 partners from 16 European countries with the aim to significantly increase individualized dose reconstruction in case of large-scale radiological emergency scenarios. The network was built on three complementary pillars: (1) an operational basis with seven biological and physical dosimetric assays in ready-to-use mode, (2) a basis for education, training and quality assurance, and (3) a basis for further network development regarding new techniques and members. Techniques for individual dose estimation based on biological samples and/or inert personalized devices as mobile phones or smart phones were optimized to support rapid categorization of many potential victims according to the received dose to the blood or personal devices. Communication and cross-border collaboration were also standardized. To assure long-term sustainability of the network, cooperation with national and international emergency preparedness organizations was initiated and links to radiation protection and research platforms have been developed. A legal framework, based on a Memorandum of Understanding, was established and signed by 27 organizations by the end of 2015. RENEB is a European Network of biological and physical-retrospective dosimetry, with the capacity and capability to perform large-scale rapid individualized dose estimation. Specialized to handle large numbers of samples, RENEB is able to contribute to radiological emergency preparedness and wider large-scale research projects.

Uncertainty of fast biological radiation dose assessment for emergency response scenarios
International Journal of Radiation Biology, 2016
Reliable dose estimation is an important factor in appropriate dosimetric triage categorization o... more Reliable dose estimation is an important factor in appropriate dosimetric triage categorization of exposed individuals to support radiation emergency response. Following work done under the EU FP7 MULTIBIODOSE and RENEB projects, formal methods for defining uncertainties on biological dose estimates are compared using simulated and real data from recent exercises. The results demonstrate that a Bayesian method of uncertainty assessment is the most appropriate, even in the absence of detailed prior information. The relative accuracy and relevance of techniques for calculating uncertainty and combining assay results to produce single dose and uncertainty estimates is further discussed. Finally, it is demonstrated that whatever uncertainty estimation method is employed, ignoring the uncertainty on fast dose assessments can have an important impact on rapid biodosimetric categorization.

RENEB accident simulation exercise
International Journal of Radiation Biology, 2016
The RENEB accident exercise was carried out in order to train the RENEB participants in coordinat... more The RENEB accident exercise was carried out in order to train the RENEB participants in coordinating and managing potentially large data sets that would be generated in case of a major radiological event. Each participant was offered the possibility to activate the network by sending an alerting email about a simulated radiation emergency. The same participant had to collect, compile and report capacity, triage categorization and exposure scenario results obtained from all other participants. The exercise was performed over 27 weeks and involved the network consisting of 28 institutes: 21 RENEB members, four candidates and three non-RENEB partners. The duration of a single exercise never exceeded 10 days, while the response from the assisting laboratories never came later than within half a day. During each week of the exercise, around 4500 samples were reported by all service laboratories (SL) to be examined and 54 scenarios were coherently estimated by all laboratories (the standard deviation from the mean of all SL answers for a given scenario category and a set of data was not larger than 3 patient codes). Each participant received training in both the role of a reference laboratory (activating the network) and of a service laboratory (responding to an activation request). The procedures in the case of radiological event were successfully established and tested.
The Effect of Paraquat on the Radiosensitivity of Melanoma Cells: the Role of Superoxide Dismutase & CATALASE
The activities of reactive oxygen species scavenging enzymes, superoxide dismutases (SODs) and ca... more The activities of reactive oxygen species scavenging enzymes, superoxide dismutases (SODs) and catalase (in cells of two melanomas (mouse B16 and human SK23) and in Chinese hamster ovary (CHO) cells were examined. Melanoma cells are relatively depleted in activities of superoxide dismutases and catalase as compared to CHO cells. Short equitoxic (500 microM for CHO and B16 cells and 5 microM for SK23 cells) paraquat treatment (15 min before the X-irradiation, 45 min in postirradiation period--the total time of treatment was 1 h) caused an increase in radiation resistance, measured as colony forming ability, in two of the three lines examined. It is proposed that PQ may exert its radioprotective effect by induction of antioxidant enzymes.
Radiation Research, Dec 1, 2007
[Prenatal diagnosis of genetic defects--analysis of 300 cases]
Ginekologia polska

Radiation sensitivity and the status of some radiation sensitivity markers in relatively sensitive lymphoid cells
Radiatsionnaia biologiia, radioecologiia / Rossiĭskaia akademiia nauk
The most commonly used indicators of ionizing radiation exposure are cytogenetic measures and sur... more The most commonly used indicators of ionizing radiation exposure are cytogenetic measures and survival parameters. All these methods have their advantages, disadvantages and uncertainties, such that better biological estimators of the absorbed dose, especially in the low dose range, are being sought. In this study we analyzed apoptosis and several proteins involved in the regulation of apoptosis as possible indicators of irradiation after relatively small doses (0.1-2 Gy) of X-rays. The studies were carried out in seven lymphoid cell lines: two mouse lymphoma L5178Y, the human pre-B cell leukemia Reh, and four human Epstein-Barr virus-transformed lymphoid cell lines (two apparently normal and two Ataxia-telangiectasia (AT)). We detected apoptosis with the in situ terminal deoxynucleotidyl transferase assay and flow cytometry, and measured the expression of several apoptotic-regulatory proteins (Bcl-2, Bax, Bclx, NF kappa B) with Western blotting. The cytokinesis-block micronucleus a...

Annali dell'Istituto superiore di sanità, 2009
Management of radiation mass casualty exposure that may occur as a result of nuclear or radiation... more Management of radiation mass casualty exposure that may occur as a result of nuclear or radiation accident will depend on the type of accident, and of the knowledge about the actual radiation exposure situation for those who might be involved. Management of the public after an accident in a nuclear or radiation installation will follow existing specific emergency plans, and will take advantage of existing radiation monitoring systems. In other radiation mass casualty exposures, whenever accidental or malevolent use of radiation, there will be a requirement to employ screening programs for indentifying and sorting out exposed people (radiological triage), who will need medical treatment and/or other assistance like decontamination and individual dose assessment. In the later stage after the accident the monitoring for dose assessment purposes for those who will need medical or public health assistance will be required. Demand for dose assessment for large groups of individuals may cr...

A method for biological assessment of radiation dose for specific application in emergency prepar... more A method for biological assessment of radiation dose for specific application in emergency preparedness was developed. Premature chromosome condensation (PCC) was investigated to provide a potentially faster means of analysis and the ability to assess higher doses than with the dicentric assay which is routinely applied in biodosimetry today. A review of existing methods was made, followed by experiments determine optimal assay conditions, and evaluations to determination of optimal conditions and the most appropriate endpoints for analyses. Twelve different experimental conditions were examined with four different evaluation approaches. Aspects during optimization such as practicality, speed, and reliability were considered. The conclusion from these studies was a PCC protocol utilizing okadaic acid for induction of PCC cells in stimulated lymphocytes but without the use of colcemid for metaphase arrest with the subsequent evaluation of ring chromosomes. Well-defined criteria were established for evaluation of PCC cells and ring chromosome aberrations. An inter-calibration was made by comparing assessment of ring chromosomes between all three laboratories. Agreement was made to count only rings with observable open spaces or large, obvious rings without open spaces. The finally a dose response curve for the PCC method was prepared and a comparison of the PCC method to the traditional dicentric assay in triage mode was made. The triage method requires a minimal number of evaluations so that categorization of high, medium and low doses may be made in an emergency situation where large numbers of people should be evaluated. The comparison of the PCC method with the dicentric assay triage method indicated that the PCC assay performed superior to the dicentric assay for evaluation of samples at higher doses, however, the dicentric assay appeared to provide more accurate dose assessment at lower doses.
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Papers by Alicja Jaworska