Perspectives of IABERD on biodosimetry strategies for a large-scale nuclear event

<b>Purpose:</b> Performing biodosimetry assessment for several hundreds of thousands of individuals in the aftermath of large scale radiological/nuclear incidents will be technically challenging. The purpose of this review is to provide logistical planning to determine when, how and which biodosimetry tools can be used for providing useful information to mediate an effective triage and for guiding the medical management of exposed victims of such an event. <b>Conclusions:</b> This review highlighted the potential capabilities of various types of biodosimetry tools in advanced development to handle the needs of different triage stages for a large-scale nuclear detonation event. While each was reviewed independently, the consensus was that complex exposure scenarios require a multiparametric approach where biomarkers/biodosimeters can be used alternatively or targeted for subgroups, e.g. with combined injury or by type of radiation, for rapid assessment and confirmation of exposure dose for exposed individuals. Further studies and exercises are required to validate the capability of using the biodosimetry tools, both individually and in combination, under the likely logistical constraints of a nuclear detonation, both to guide development of processes such as high-throughput platforms and field-deployable mechanisms that can best address the volume and needs of the affected population.