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PLOS One logoLink to PLOS One
. 2020 Apr 24;15(4):e0232008. doi: 10.1371/journal.pone.0232008

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

Peter K Rogan 1,2,*, Eliseos J Mucaki 1, Ruipeng Lu 3, Ben C Shirley 2, Edward Waller 4, Joan H M Knoll 2,3
Editor: Gayle E Woloschak5
PMCID: PMC7182271  PMID: 32330192

Abstract

Background

Accurate radiation dose estimates are critical for determining eligibility for therapies by timely triaging of exposed individuals after large-scale radiation events. However, the universal assessment of a large population subjected to a nuclear spill incident or detonation is not feasible. Even with high-throughput dosimetry analysis, test volumes far exceed the capacities of first responders to measure radiation exposures directly, or to acquire and process samples for follow-on biodosimetry testing.

Aim

To significantly reduce data acquisition and processing requirements for triaging of treatment-eligible exposures in population-scale radiation incidents.

Methods

Physical radiation plumes modelled nuclear detonation scenarios of simulated exposures at 22 US locations. Models assumed only location of the epicenter and historical, prevailing wind directions/speeds. The spatial boundaries of graduated radiation exposures were determined by targeted, multistep geostatistical analysis of small population samples. Initially, locations proximate to these sites were randomly sampled (generally 0.1% of population). Empirical Bayesian kriging established radiation dose contour levels circumscribing these sites. Densification of each plume identified critical locations for additional sampling. After repeated kriging and densification, overlapping grids between each pair of contours of successive plumes were compared based on their diagonal Bray-Curtis distances and root-mean-square deviations, which provided criteria (<10% difference) to discontinue sampling.

Results/Conclusions

We modeled 30 scenarios, including 22 urban/high-density and 2 rural/low-density scenarios under various weather conditions. Multiple (3–10) rounds of sampling and kriging were required for the dosimetry maps to converge, requiring between 58 and 347 samples for different scenarios. On average, 70±10% of locations where populations are expected to receive an exposure ≥2Gy were identified. Under sub-optimal sampling conditions, the number of iterations and samples were increased, and accuracy was reduced. Geostatistical mapping limits the number of required dose assessments, the time required, and radiation exposure to first responders. Geostatistical analysis will expedite triaging of acute radiation exposure in population-scale nuclear events.

Introduction

In a large-scale nuclear event or accident, many will be exposed to varying levels of radiation, some of whom would require immediate treatment. Various approaches have been used to triage or estimate radiation exposure including: direct measures of physical radiation levels, expedited medical assessment (for the prodromal signs and symptoms of exposure), and measurements of surrogate effects of radiation through hematological bioindicator analysis (e.g. cytogenetic analysis of chromosomes) [1]. Individuals at risk for acute radiation syndrome, e.g. those receiving ≥ 2Gy exposure, should be rapidly identified by these approaches to determine eligibility for therapy [2].

Physical dose can be inferred from the prodromal response of absorbed radiation, which include erythema, headache, fever, lethargy, tachycardia, nausea and vomiting [1, 3]. Meanwhile, biological exposure to ionizing radiation can be assessed using dicentric chromosomes (DCs), as their frequency correlates with the radiation dose in a linear quadratic manner [4, 5]. Recent advancements in automated DC analysis have reduced the time required to accurately determine biological radiation exposures [610]). Nevertheless, sample preparation steps continue to introduce latency in the overall procedure, precluding comprehensive assessment of large populations. Anticipated test volumes would be significant enough to require dosimetry testing that is orders of magnitude faster than what is currently available [11]. Absolute lymphocyte depletion is a strong indicator of absorbed dose, but requires repeated sampling of a patient over several hours to days after exposure [12]. For this reason, management of acute radiation exposures has often relied upon physical dosimetry as a surrogate for biological exposures. Confounding factors may affect testing results. These include the possibility of discordant physical radiation measurements and estimated biodosimetry exposures [13, 14], and other causes of indirect predictors of exposure such as time-to-emesis (such as head trauma, or comorbid infections), thereby reducing accuracy of diagnoses [15]. More importantly, dose assessment of a large population would likely overwhelm available first responders and prevent timely triage assessment. One approach to alleviating the need to individually triage the entire population would be to survey radiation levels at a subset of locations and derive a radiation map by geostatistical analysis. This survey may involve either location-based physical dosimetry, where high-risk individuals are identified based on their proximity to fixed radiation detectors or by geospatially targeted biodosimetry. We demonstrate that combining surveys (of consistent methodology) with the geolocations of these measurements can reduce sampling requirements in population-scale radiation scenarios and would be expected to decrease total radiation exposures of first responders.

Geostatistical analysis uses regression or kriging methods to interpolate environmental measurements across a range of spatial coordinates [16]. Kriging interpolates the value of unsampled locations by computing weight linear estimates at these locations using neighboring data [17]. The mining industry application of kriging to estimate the contiguous distribution of mineral deposits from limited number of samples [18, 19] motivated us in this study to apply kriging for geographic extrapolation of absorbed radiation from a fraction of potentially exposed individuals or sampling locations. There are two variants of classical kriging, depending on whether the mean of the set of exposures is stationary (Simple Kriging) or not (Ordinary and Universal kriging) [17]. Empirical Bayesian Kriging (EBK) differs from classical kriging by using restricted maximum likelihood (REML) and accounts for measurement uncertainty, while other kriging methods use weighted least squares [20].

Our objective was to implement a geostatistical approach that accurately estimates the radiation exposures on a population-scale, based on the sampling of a subset of individuals or locations at software-guided coordinates. To validate this approach, we conducted simulated analyses of multiple population-scale nuclear detonation scenarios, using simulated dose plumes generated by HPAC (Hazard Prediction and Assessment Capability) software as ground truth estimates of exposures [21]. HPAC models the transport and dispersion of chemical, biological, radiological and nuclear releases into the atmosphere based on historical weather patterns and predicts the effects of those hazards on civilian and military populations [21]. The question this paper addresses is whether the radiation plumes derived by HPAC can be reconstructed with iterative kriging using a relatively small number of samples consistently analyzed by the same dosimetry method.

Methods

Overview

Nuclear detonation scenarios created by HPAC were derived for 22 North American cities and surrounding regions. Initially, locations within likely fallout areas were sampled from the potentially affected population. In each real-world scenario, a set of randomly sampled locations downwind of the event epicenter are initially selected. In each scenario, we assume the epicenter location (“ground zero”), wind direction, intensity, and weather conditions. In this paper, we refer to these locations as samples, regardless of whether the radiation is quantified from either physical emissions or by quantifying absorbed biological effects. We assume that all measurements used to derive the plume are consistently obtained by the same approach. The contours of the HPAC radiation plumes were used to specify the dose levels and random locations downwind of the epicentre. In HPAC, the contours are created from the points at locations specifying the contour threshold, in which exposure levels are known. Simulated dosimetry measurements were created from these samples and used to populate geostatistical-derived radiation maps. In the simulation, we assume that map locations between the contour boundaries exhibit the same radiation levels of the outer boundary. This introduces a source of systematic error into dose estimation, since it is likely that that the actual exposures at these locations should be interpolated between the neighboring contours that circumscribe the specific sample location. Samples were then simulated, initially at randomly selected locations, and which were then used to further refine the radiation exposure plume. After the initial set of samples were analyzed and an initial draft plume was computed by kriging, subsequent sampling locations were specified by densification. Densification is the geostatistical procedure that targets and localizes an additional small cohort of sampling locations to mitigate uncertainty in environmental measurements. These kriging and densification processes are repeated for a limited number of iterations until the coverage area and the radiation level contours of the inferred plume stabilizes (i.e. additional sampling in the affected area does not significantly alter the geographic coverage of the plume or the estimates of absorbed radiation dose). Comparisons between independent replicates of the same scenarios using different, randomized, initial sample distributions evaluated the reliability of this approach. A detailed sequential protocol is available (http://dx.doi.org/10.17504/protocols.io.ba4nigve; "Protocol for Geostatistical Determination of Radiation Dosimetry Maps of Population-Scale Exposures").

Acquisition and processing of United States (US) census data for geostatistical analysis

The sizes of populations impacted by simulated nuclear events in each scenario were based on 2017 US Census Data of affected counties and subdivisions. US state and sub-division boundary files (in KML [Keyhole Markup Language] format) were retrieved from the US census bureau (https://www2.census.gov/geo/tiger/GENZ2016/shp/). Population data were downloaded from the US Census (“Incorporated Places and Minor Civil Divisions Datasets: Subcounty Resident Population Estimates: April 1, 2010 to July 1, 2017”), supplemented with additional population data from the American Fact Finder and Home Town Locator (both updated July 1, 2018).

Geostatistical analysis was implemented with the ArcGIS Runtime SDK (Software Development Kit) for Java and the ArcPy package. Geostatistical mapping was performed with customized Python scripts calling the ArcGIS software toolkit (ESRI, Redlands, California, United States). For import into the ArcGIS environment, the US state sub-division boundary files were first split by sub-division name and imported to ArcMap using the ‘KMLtoLayer’ tool. Exceptions handled states with multiple sub-divisions that share the same name, so that ArcMap did not also select unintended sub-divisions found outside of the radiation plume. Sub-division names with spaces or dashes were also modified by concatenating them prior to ‘KMLtoLayer’ conversion to avoid their unintended truncation.

Derivation of ground-truth HPAC radiation plumes

Radiological release scenarios were derived for 24 different US locations (in 22 cities) by the University of Ontario Institute of Technology (UOIT) Health Physics and Environmental Safety Research Group. Radiation plumes were simulated using HPAC v4.04 (developed by the Defense Threat Reduction Agency [DTRA]), which models the dispersion of radiation (as well as chemical and biological releases) assuming only the location of the epicenter, historical prevailing wind direction and speeds, and weather conditions. A typical ground truth plume comprised 4000 sample locations, each coincident with the contour boundaries for each radiation level. The majority of the nuclear incident scenarios did not include precipitation, except for New York and Washington D.C., where rain and snow were compared with normal plume conditions. The HPAC data are represented as a series of high-density data points at geospatial coordinates which define the shape of each radiation contour level of the plume. Topological exposure contours were computed in increments of 0.5Gy, across the 0.0–7.0Gy range, with 1.0Gy intervals shown. Contours were plotted on top of a US city map layer generated by the Humanitarian OpenStreetMap project (https://export.hotosm.org/en/v3/).

Radiation plume reconstruction with iterative kriging and densification

The HPAC-generated plume for each scenario was visualized with the ArcMap software toolkit. The plume location was used to estimate affected population size. The US census-defined sub-divisions, which overlap and/or surround the plume of interest, were determined from overlap with their respective latitude and longitude boundaries. A Python script was written to select data points (or ‘samples’) at random locations within each Census sub-division using the ArcMap tool, ‘CreateRandomPoints_management’. These random samples, which corresponded to 0.1% of the population of each sub-division overlapping and surrounding the HPAC plume, simulated the locations for dose assessment. Randomization of samples was bootstrapped a minimum of 10 times per scenario to evaluate whether this procedure impacted the final plume derived by simulated physical or cytogenetic dosimetry. Results were exported using the ArcMap ‘ExportXYv_stats’ tool, then assigned radiation level values corresponding to the adjacent outer HPAC contour by a script comparing each sample with its location within the HPAC plume. The number of random samples generated for each scenario, and how many of those overlapped the HPAC plume, is available in S1 Table. Only a subset of the random samples shown overlapped the HPAC-derived plume; all remaining samples were considered to be unirradiated. The resulting output was then re-uploaded into ArcMap to perform kriging and densification.

We used kriging, a geostatistical interpolation technique which computes the spatial autocorrelation between data points (unlike deterministic interpolation techniques) to map predicted radiation levels by sampling around the epicentre of the event and surrounding region. Various kriging methods, available through the ArcMap extension “Geostatistical Analyst”, were evaluated for this study: Ordinary, Simple, Universal, and Empirical Bayesian kriging (EBK; each kriging method described in the S1 Methods). To determine which type of kriging generated the most accurate plume, random points representing 1% of the population of the Boston (N = 617,594) and Cambridge (N = 105,162) subdivisions were generated by ArcMap, of which 223 points overlapped the Boston HPAC plume (predicted dose >0Gy). While no plume could be derived from Simple kriging, the methods of Ordinary, Universal and EBK were successful (S1 Fig). Ultimately, EBK was used for all further analyses featured in this manuscript, as the plume generated best represented the expected HPAC plume (with a 57% overlap to HPAC plume vs. 35% overlap for Ordinary and Universal) and has the advantage of taking uncertainty measurements into account (S1 Fig). The presence of unirradiated data points adjacent to the plume was found to be crucial for accurate kriging, since these points served as boundaries for kriging. A high number of unirradiated (0Gy) samples can depress the range of the plume; therefore, these locations were restricted to the subdivisions immediately surrounding the irradiated region. The number of unirradiated samples for each scenario replicate is listed in S1 Table. We envision that testing could be greatly reduced by initially measuring background or low level physical radiation in population scale events by aerial surveys or targeted multiplex dosimetry. Dose reconstruction has been extensively modeled over varied geographical, topological and weather scenarios [21]. In an actual event, environmental physical measurements at these locations without detectable radiation could substitute for dosimetry at this boundary, in order to focus attention on sampling within irradiated regions [22].

The “Densify Sampling Network” tool of the Geostatistical toolbox indicates lower confidence regions in the kriging-derived map, i.e. regions with highest variance specifying radiation dose [17]. We applied this tool to limit results to regions that would most likely exceed a pre-defined radiation level threshold. In practice, the locations selected by densification would be used to direct first responders to new locations for subsequent rounds of data acquisition in order to improve the accuracy of the kriging-derived map. Using 2Gy as the critical threshold (selection criterion QUARTILE_THRESHOLD_UPPER option), densification on one plume identified a maximum of 200 new sampling locations. We assume that locations within the 0Gy envelope surrounding the plume do not have to be sampled in subsequent kriging iterations. Densification is a compute intensive step, requiring approximately 1 hour on a desktop with an Intel i7-4770 processor [3.4Ghz] and 16GB of RAM. Note that reducing the number of requested sampling locations decreases overall processing time. The Densify Sampling Network tool would sometimes select a sample at the same latitude and longitude between iterations. Furthermore, many densification-selected samples did not overlap the HPAC plume. As a consequence, the process often did not always yield 200 unique samples with values exceeding 0Gy. New sample data were assigned radiation values based upon their locations within the HPAC-generated plume, and kriging was performed on these and the original samples to generate another iteration of the inferred plume.

Simulated analyses of population-scale, nuclear radiation scenarios

A geostatistical workflow managed iterative computation of the inferred radiation plume in population-scale radiation events when processing new samples (Fig 1). The purpose of simulating analyses of the radiation exposures was to determine accuracy for distinguishing clinically relevant exposure levels, and the number of irradiated individuals or locations necessary to measure dose. This was based on an initial random set of location-based data points representing sample measurements and locations collected by first responders, followed by measurements at additional locations which were assigned by densification and kriging.

Fig 1. The workflow for handling a population-scale radiation event.

Fig 1

First responders collect dose measurements and coordinates of the tested individuals or locations. Measurements are then collected and mapped. A dose plume is generated, and densification is used to select locations with lower confidence radiation estimates for follow-on sampling. These steps are repeated until output plume dosimetry levels converge. The resultant plume can be used to differentiate locations associated with significant exposures (≥2Gy) from those below this or other thresholds.

EBK with default values for optional parameters was selected to predict the dose value which each location received (Fig 1), which generated a dosimetry-based radiation plume establishing the spatial boundaries of graduated exposure doses. Two consecutive plumes were quantitatively compared with a heat map matrix with overlapping radiation levels. Each row or column respectively corresponded to a dose range in the current or previous plume, and the dose ranges were sorted in the ascending order downward or rightward. Each cell indicates the average overlap percentage between two dose ranges in terms of area. Therefore, two identical plumes resulted in an identical identity matrix. The dissimilarity between the two consecutive plumes was quantified by the diagonal Bray-Curtis dissimilarity (BCD) and root-mean-square deviation (RMSD) between the heat map matrix and the identity matrix. Lower BCD and RMSD values indicate better fit [23, 24]. For this study, BCD is computed as:

BCD=i=1n|Aideal,iAcomputed,i|i=1n(Aideal,i+Acomputed,i) (1)

where n represents the 8 topological contours of the plumes (<1Gy, 1-2Gy, 2-3Gy, 3-4Gy, 4-5Gy, 5-6Gy, 6-7Gy, >7Gy), Acomputed is the percent area overlap of a particular contour of each plume, and Aideal represents an identical overlap between the plumes (Aideal = 1). RMSD is computed as:

RMSD=1ni=1n(Aideal,iAcomputed,i)2 (2)

The diagonal values of the heat matrix represent the overlap of each radiation dose range (the topological contours) between compared plumes (see center heat matrices in Fig 2). The converging BCD and RMSD thresholds of 1/19 and 0.1 (respectively) were computed as equivalent to heat maps with a 90% overlap across each radiation dose level. This 90% stringency of overlap between consecutive iterations of geostatistical analysis was selected as a compromise to limit the number of samples while building a strong approximation of each HPAC plume (which themselves vary in shape and size). This has been a threshold indicated in prior geostatistical studies [25, 26]. The iterative workflow was discontinued when either metric dropped below the threshold.

Fig 2.

Fig 2

The simulated analysis of the no-precipitation scenarios of urban New York [Replicate #4] (A) and Albany [Replicate #1] (B). Each of the three left-most maps (first row) display sample locations and EBK-derived dosimetry plumes after several rounds of densification (iterations; note gradual improvement of plume from left to right), while the right-most map displays the HPAC plume. Plume colours (from red to purple) indicate the dose ranges of the region (from <1Gy [100cGy] to ≥7Gy [700 cGy]). The total number of samples exceeding 0Gy in each iteration are indicated (in parentheses). The matrices (second row) are used to compare two plumes at each dose range, where each value indicates the area overlap (background grey level is proportional to the percent overlap) of two regions of plume pair. The right-most matrix compares the final derived plume to the HPAC plume. Below the matrices, the diagonal BCD and RMSD values between successive iterations represented by each heat matrix are indicated. The green or red colors indicate that these two metrics exceeded or did not meet the threshold for convergence of the procedure, respectively. Subsequent iterations gradually improved the computed radiation dosimetry plume, with each adding a small number of new samples. Based on the census data, the converged plumes localized 80.3% and 75% of the locations (weighted for population density) for treatment-eligible radiation exposures in these scenarios.

The geostatistical workflow was used to analyze three replicates of each scenario, with each replicate initiated with a different set of random sample locations within the plume. After each iteration of kriging and densification, the resultant plumes were compared with the preceding versions (and the HPAC-based map) and presented using heat maps indicating overlap between different radiation levels. Variation between radiation levels at the same locations in successive plumes determined whether the distribution of the initially sampled locations affected the resulting maps. BCD and RMSD were computed when comparing derived plumes to both the HPAC plume (S1 Table) and all other replicates for the same scenario (S2 Table). Since the HPAC plume cannot be directly compared with the converged dosimetry plume because their data formats are incompatible, EBK was performed on all joint vertices associated with the mapped dosimetry results. This produced a topographic map that best approximated the HPAC plume. The percentage of individuals with ≤2Gy exposures that were correctly localized, assuming a uniform population distribution within each subdivision, was determined by converting the area overlap ratio with population. Area overlap is converted to estimated population affected by multiplying the area of plume overlap by the total population contained within a subdivision, divided by the area of said subdivision.

We further evaluated the proposed geostatistical approach by testing the method under 2 suboptimal sampling conditions. We mimicked improper sampling due to an inaccurate specification of wind direction for the Albany NY scenario by providing samples which partially deviated from the affected census sub-divisions (e.g. undersampling the region overlapping the plume while oversampling a non-irradiated region; S1 Table). The angle was determined by finding the distance of mean latitude or longitude of all random points and computing an angle against the direction of the HPAC plume. To simulate variation in the precision of the radiation dose measurements, we applied random dose errors to HPAC generated radiation doses (to a maximum value of either ± 0.5Gy or ± 1.0Gy) to all initial and densification-selected samples. A representative subset of the previously analyzed radiation release scenarios was assessed for both plume accuracy and for the numbers of kriging/densification iterations and samples required for convergence by iterative kriging and densification (S3 Table). These included Birmingham AL (Replicate #2), Boston MA (Replicate #1), Chicago IL (Replicate #1), Columbia SC (Replicate #1), and Columbus OH (Replicate #1 and 2).

Results

Development of simulated radiation plumes

We simulated the analysis of 28 population-scale, 10 megaton yield nuclear detonation scenarios with dosimetry data for radiation exposures corresponding to HPAC-derived dose estimates. These results were used to derive plumes of absorbed radiation exposures. The simulations included 22 in urban/high-density populated regions of the United States, and 2 rural/low-density scenarios. The process of kriging and densification was repeated until the difference between the current and previous plume reached a minimum threshold (Fig 2). The number of samples with radiation exposure used to generate the final iteration of a plume would vary between different scenarios (ranging from 58 and 347 samples within the irradiated plume; starting from an initial sample set representing 0.1% of the population; Table 1). For less densely populated regions, initial sampling was also performed at higher population densities (0.2 and 1.0%). The number of samples necessary to reach this stopping point was sometimes variable between replicates, and this variability was inversely proportional to the overall population density of the region (from the US census). Cities with a high population density (>10,000 per square mile) had a 16.0% average coefficient of variation (CV) of the number of samples necessary to reach convergence, whereas the scenarios within low-density regions (<10,000 per square mile) had an average CV of 21.4% (see S4 Table for all CVs). In general, more samples would lead to a plume which better resembles the HPAC result (Table 1). There are exceptions where equivalent accuracy is obtained with fewer overall points (e.g. Buffalo NY; Table 1) which implies that the spatial distribution of initial set of random samples can also influence the accuracy of the converged plume.

Table 1. Simulated analyses of population-scale nuclear radiation scenarios on 22 cities.

Scenario Replicate: No. of Iterations2 No. of Samples (>0Gy) Accuracy (%)
City Population Density1 Special Conditions ≥ 2Gy ≥ 3Gy
Albany, NY Urban None 1 3 106 75.0 83.2
2 4 119 78.4 84.5
3 5 186 76.1 82.7
Alexandria, VA Urban None 1 4 137 57.8 83.3
2 3 129 56.0 81.2
3 3 127 52.8 79.3
Baltimore, MD Urban None 1 4 111 75.0 80.2
2 4 115 75.9 83.9
3 3 111 76.2 77.0
Birmingham, AL Urban None 1 4 98 67.8 43.6
2 4 101 69.6 39.7
3 4 87 71.9 49.3
Boston, MA Urban None 1 5 166 67.7 84.7
2 3 132 59.2 85.3
3 3 143 63.4 83.3
Buffalo, NY Urban None 1 6 111 66.8 84.3
2 6 222 64.6 77.7
3 4 138 62.5 82.0
Burlington, VT Urban None 1 4 177 90.2 88.6
2 5 205 90.3 85.1
3 7 205 90.7 88.1
Camden, NJ Urban None 1 5 136 71.1 54.9
2 5 142 70.8 62.2
3 8 180 71.6 62.6
Charleston, SC Urban None 1 4 66 60.5 67.8
2 4 66 58.5 73.7
3 4 94 70.7 65.8
Charlotte, NC Urban None 1 5 133 67.5 72.2
2 4 77 60.9 76.9
3 7 114 65.6 76.5
Chicago, IL Urban None 1 4 63 78.7 54.8
2 4 59 70.7 37.9
3 4 62 78.2 54.4
Cincinnati, OH Urban None 1 6 139 73.2 72.0
2 8 144 72.5 64.8
3 9 288 69.6 70.3
Cleveland, OH Urban None 1 5 130 72.0 77.2
2 4 128 73.2 78.8
3 4 143 72.2 77.7
Columbia, SC Urban None 1 5 126 66.0 26.7
2 4 72 30.1 3.9
3 4 75 60.5 30.4
4 4 78 55.6 2.6
5 3 79 27.6 0.0
  • 0.2% population3

6 6 218 65.1 48.2
7 3 114 58.1 52.9
1% population3,4 8 7 1409 69.8 72.7
Columbus, OH Urban None 1 4 74 66.5 74.1
2 4 137 44.1 19.0
3 6 123 74.7 73.8
4 8 130 67.9 71.1
5 5 103 66.5 72.2
0.2% population3 6 4 378 68.8 78.6
Des Moines, IA Urban None 1 4 240 74.7 63.5
2 5 282 70.2 60.8
3 4 271 77.0 62.7
Detroit, MI Urban None 1 4 117 80.3 74.3
2 5 132 76.2 74.6
3 4 123 79.2 77.7
Evansville, IN Urban None 1 3 76 67.8 45.1
2 5 68 63.4 39.1
3 5 58 70.6 47.0
Grand Rapids, MI Urban None 1 9 199 72.9 73.8
2 4 168 74.5 74.7
3 6 156 73.7 75.5
New York, NY Rural None 1 8 131 68.8 63.7
2 10 181 69.0 66.8
3 5 101 64.9 72.1
Urban None 1 3 308 80.3 83.4
2 3 347 81.4 82.1
3 3 332 81.0 80.5
4 3 332 80.8 80.5
Rain 1 3 265 72.3 86.4
Snow 1 3 275 74.3 87.4
Philadelphia, PA Urban None 1 4 79 79.2 75.0
2 7 91 75.5 63.5
3 5 79 74.9 68.5
Washington D.C. Rural None 1 3 120 74.7 74.8
2 4 148 73.6 73.7
3 7 142 73.1 71.5
Urban None 1 5 237 68.2 82.6
2 3 190 66.9 82.2
3 3 193 66.9 79.5
Rain 1 5 237 68.2 82.6
Snow 1 3 131 82.0 83.7

1 ‘Urban’ and ‘Rural’ indicate whether the HPAC plume was placed in a region of high or low population density, respectively. For example, while both Washington DC scenarios have the same point of origin within Washington sub-division, the low-density scenario encompasses a region southwest of the city including Arlington National Cemetery.

2 The number of iterations (kriging and densification steps) required to reach stopping criteria for this replicate.

3 Plumes derived with increased initial sampling rate (representing 0.2% or 1.0% of the population of each subdivision) under normal weather conditions.

4 The densification threshold for the 1.0% Columbia SC replicate was increased to allow for >200 samples.

Success in reconstructing simulated plumes from dosimetry data was based on the accuracy of predicting irradiated samples ≥ 2Gy (as defined by the HPAC plume). This radiation level threshold was selected based on US government recommendations for eligibility of clinical treatment of Acute Radiation Syndrome by cytokine therapies [27]. Results are reported based on the accuracy in distinguishing samples exposed to this threshold or higher from false positives or negatives. In these simulations, we have determined that false positive samples (i.e. ≤ 2Gy account for [on average] 0.5─2% of those estimated to be exposed at ≥2Gy. On average, the accuracy of the simulated plumes to predict exposures above this threshold (relative to the HPAC radiation plume) was 69.8%, ranging from 52.8% (Alexandria VA) to 90.7% (Burlington VT). The accuracy range for replicates from the same geographic region was also consistent, i.e. within 10% difference between replicates.

Two of the 28 scenarios exhibited outlier replicates, in which accuracy was impacted by the random sampling procedure and local population densities (Columbia SC replicate #2 [30.1%] and Columbus OH replicate #2 [44.1%]; Table 1 and S1 Table). Additional replicates were analyzed for these scenarios. While both additional replicate sets for the Columbus OH scenario closely resembled the first replicate (67–68% accuracy), one of the Columbia SC replicates continued to perform poorly (27.6% [replicate #5]). Further investigation suggested that this result might not correlate with the number of initial sampled locations within the irradiated region (12–16 samples exceeding 0Gy). Rather, it was apparent that the initial sets of sample data for these particular replicates exhibited sparse coverage over large regions of the HPAC radiation plume. Including subsequent densification steps did not always identify additional sample locations that resulted in a contiguous 2Gy plume similar to the entire HPAC plume. This issue was addressed by increasing the population fraction that was initially sampled. By combining the initial samples of the two underperforming Columbia SC replicates (#2 and #5; now representing 0.2% of the population rather than 0.1%), a plume was generated with accuracy equivalent to the best performing Columbia replicate (65.1% accuracy in 6 iterations [replicate #6]; Table 1). An independently selected random set of samples representing 0.2% of the population led to a comparable (albeit slightly lower) accuracy rate using fewer kriging and densification cycles (58.1% in 3 iterations [replicate #7]). A further increase in sampling rate to 1.0% of the population improved performance relative to the best Columbia SC replicate (+3.8% more accurate; replicate #8). Thus, in scenarios with low population densities, the population fraction sampled will need to be increased to construct a contiguous dosimetry map that resembles the actual radiation plume.

In rare cases, low population scenarios would fail to yield a plume in the initial step, regardless of kriging method used. When this occurred, the iteration methods could not progress to the following densification steps, and plume development was halted. The numbers of samples which overlapped the HPAC plume were found to be extremely low in these cases, ranging from 0–2 samples in total. There are instances in which 2 irradiated samples were adequate to progress plume development (e.g. Cincinnati urban sampling #2 [Table 1]). In these cases, a greater number of iterations were required for plume development to fulfill the established stopping criteria (N = 8 iterations for the Cincinnati example). Therefore, while the minimum number of irradiated samples can be extremely low, development of accurate dosimetry plumes in such cases could require unacceptable levels of exposure for first responders.

We also compared coverage of derived plumes at a higher radiation level (≥ 3Gy), since these were expected to be more compact than the ≥ 2Gy contour, more densely populated, and more likely to result in severe clinical symptoms. Based on the degree of overlap between the derived and HPAC plumes (Table 1), 19 of 28 scenarios were more accurate at the ≥ 3Gy contour than at ≥ 2Gy level for at least one replicate (greater accuracy was seen for all replicates of 13 scenarios). In particular, the Alexandria VA, Boston MA and Buffalo NY cases respectively exhibited an average of +25.7%, +21.0% and +16.7% higher accuracies at the 3Gy threshold. In several instances, the performance of replicates of the same scenario varied (e.g. Charleston SC replicates #2 (+15.2%) and #3 (-4.9%) in comparison with the 2Gy threshold). Derivation of plumes for the Charleston scenario has been challenging due to differences in population density for different initial sampling locations, for example, replicate #5. However, this issue was mitigated by sampling at higher densities (replicates #6–8), for example, the 1.0% population density replicate, in which the 3Gy contour accuracy exceeded that of the 2Gy contour (+2.9%).

Distinct initial sampling locations produced similar plumes for the same scenarios

In each case, determination of the distribution of radiation exposure in each scenario began with an initial set of sampling locations within the region of the simulated radiation release scenario. The majority of these locations did not overlap with the HPAC plume and have therefore been modelled as unirradiated samples. As a result, the initial number of irradiated samples can vary significantly among different scenarios, based on the population of the region and overall plume size. Thus, the number of iterations of densification required to maximize the accuracy of the simulated dose plumes varied significantly between replicates (between 3 and 10 iterations per replicate; Table 1).

The initial sets of samples were randomly assigned locations within each census sub-division by ArcMap. We first determined whether this process affected accurate derivation of the plume as a consequence of the variable locations of these initial conditions. Replicate dissimilarity was quantified as BCD and RMSD (S2 Table) to determine the extent to which this source of variation could impact the accuracy of the derived radiation plumes. The BCD between plume replicates were less than 0.3 (or a >70% similarity between them [23]) for nearly all scenarios (S2 Table). New York NY and Cincinnati OH show > 90% similarity (by BCD) across all replicates, while Albany NY, Boston MA, Birmingham AL, Camden NJ, Cleveland OH, Detroit MI, Grand Rapids MI, Philadelphia PA and Washington D.C. (urban scenario) have at least two replicates with a >90% similarity to each other.

Increasing stringency of overlap between consecutive iterations of radiation plumes

To expedite dose estimation for triage management of a nuclear incident, sampling was discontinued when the estimated populations in areas covered consecutive plume iterations were within 90% of each other based on similarity. We investigated whether further cycles of geostatistical processing would stabilize or improve the derived plumes relative to the HPAC standard. We therefore mandated a more stringent threshold for consistent coverage of iterative plumes, i.e. from 90% to 99%, and determined whether the additional iterations would more closely resemble the gold standard for one replicate of each scenario (S5 Table). On average, an additional 3–4 iterations were necessary to reach this threshold, with an average of 65 additional sampling locations. In 3 scenarios, the plumes improved significantly: rural New York (+9.6%); Alexandria VA (+7.7%); and Columbus OH (+5.1%). In the rural New York scenario, the 1Gy and 2Gy contours are significantly expanded with the inclusion of additional data points (S2 Fig). However, altering the stopping criteria did not significantly improve plume accuracy in most replicates tested (+1.2% improvement, on average). Frequently, the plume would prematurely stabilize once densification failed to reveal new sampling locations. The addition of further iterations did not always improve accuracy at the 2Gy threshold. For example, addition of 43 new unique sampling locations slightly reduced the accuracy (-2.5%) of one Boston MA replicate (S5 Table). While the 2Gy contour in this instance did expand geographically, new 1.0 and 1.5Gy samples introduced by densification made the 2Gy contour discontinuous, explaining the reduction in accuracy (S3 Fig). Contours at higher radiation levels for this plume were unaffected, and were contiguous, however.

Impact of weather effects on derived plumes

The effects of adverse and normal weather conditions (i.e. no precipitation, rain and snow) were compared for both urban and rural New York and Washington DC scenarios (Table 1 and S1 Table). The HPAC software was used to simulate the effects of rain and snow conditions in these scenarios at the same nuclear yields. The resulting HPAC plumes closely resembled the morphology, extent, and wind vector of the no precipitation scenario. At the >2Gy threshold, both final New York plumes with precipitation exhibited less accurate geographic coverage (72% rain and 74% snow) than under normal conditions (76–81% without weather effects; S2 Table). By contrast, the Washington D.C. urban snow scenario significantly outperformed both no precipitation and rain scenarios (82% accuracy versus 66–68% for all other weather conditions; S2 Table). These plumes were found to have a 70–76% similarity to the HPAC plume (by BCD), similar to that of the same scenarios in the absence of weather effects (S1 Table). In these nuclear event scenarios, adverse weather events did not confound or impact the accuracy of population scale geographic dosimetry using the same approach described for normal weather conditions.

Inferred radiation exposures under suboptimal sampling conditions

If the information about wind direction and location of the epicenter of a nuclear event is limited and/or inaccurate, it might be expected to lead to improper sampling. Initial samples for the Albany NY scenario were used as input, undersampling the Albany sub-division (which overlaps much of the plume) while oversampling its neighboring sub-division, Colonie, which is due north of the epicentre of the simulated nuclear event. The bearing angle of the Albany NY scenario is N 51.9º W. For the initial sample data, the populations representing Albany and Colonie were shifted from equal 0.1% proportions of their respective populations to unequal distributions of either 0.05:0.2% or 0.01:1.0%. The 0.05:0.2% ratio simulates a wind measurement error of 29.1º north (or N 22.8º W) relative to the actual wind direction that produced the HPAC plume. The 0.01:1.0% ratio corresponds to a deviation of 40.9º north (or N 11.0º W). Despite this initial sampling error, inferred radiation plumes comparable to the correct plume were obtained. The accuracies of the >2Gy threshold maps were, respectively, 74.2% for the 0.05:0.2% population ratio and 74.5% for the 0.01:1.0% ratio, which compares well with the correctly sampled initial map of 75.0–78.4%. Reconstruction of the geostatistical dosimetry map required 4 iterations with sampling error, which was only one more cycle of densification-sample procurement and kriging than the map generated from the original (correctly sampled) Albany scenario. This demonstrates the robustness of the densification step to select relevant sample points at subsequent iterations of kriging and densification that result in a correct dosimetry map. It appears that, in some scenarios, reconstruction of the original HPAC map can largely succeed and achieve convergence with fewer irradiated samples, at the expense of a single additional sampling cycle (e.g. iteration).

The original set of simulations presented do not account for error in dose estimates, which can vary considerably based on the methodology used [28]. The impact of random variation on measured dose was examined by deriving plumes with modified sample exposures with added or subtracted random errors. Random errors in radiation exposure (either ±0.5Gy or ±1.0Gy) were applied to both the initial samples and those obtained from subsequent densification steps. Maximum deviations were designed to represent confidence values in physical and/or biodosimetry methods, including physical dose estimation error [29], dicentric chromosome analysis (DCA; ±0.5Gy) or cytokinesis-blocked micronucleus assays (±1.0Gy), which exhibit higher variance in estimating dose compared to DCA [28, 30, 31]. The introduction of such measurement errors led to plumes that were generally less accurate, required a greater number of samples, and additional iterations of kriging and densification to achieve convergence (S3 Table). The degree of error in this analysis was also correlated with decreased accuracy and increased processing time (±0.5Gy error-derived plumes were more accurate than ±1.0Gy error-derived plumes in nearly all scenarios; S3 Table). We also note that dose modifications (±1.0Gy) for the Columbia SC scenario #1 completely failed to achieve complete plume coverage, and as a consequence, did not successfully derive a plume with accurate radiation exposure levels >2Gy.

Discussion

A large-scale nuclear detonation or radiation accident would be expected to place excessive demands on first responders to rapidly identify those individuals with significant exposures. We describe a geostatistical method of localizing significant exposures based on a significantly reduced number of tested samples or dose measurements. Overall, plumes from 28 distinct scenarios simulating absorbed radiation identified 70±10% of locations where the population are expected to receive ≥2Gy of radiation exposure (and thus are eligible for cytokine therapy), each based on between 58 and 347 samples (median of 131; excluding scenarios sampled initially at >0.1% of the population). Although initial sampling represented 0.1% of the population of the region, very few of these samples would have been exposed to radiation. The relatively high fidelity of the radiation dosimetry maps is attributable to the reconstruction of the radiation plume using geostatistical analysis of limited acquisition of additional samples at key locations within the areas of high radiation exposure. After a nuclear incident, processing all individuals for dose assessment has been acknowledged to be labor intensive, and would likely be a major bottleneck in identifying those who require immediate treatment [32].

The distribution of initial sampling seemed to have a significant impact on the overall accuracy of the modeled plume, especially in regions of low population density. In the Columbus OH and Columbia SC scenarios, one of three replicates exhibited significantly lower resemblance to the HPAC plume than the others. Performing additional replicates resulted in a second poorly performing Columbia replicate. In each replicate, a similar number of initial samples were found to be within the HPAC plume and did not correspond to the observed performance differences. Visually, the poor performance of these replicates was apparently due to a lack of coverage of large segments of the HPAC plume due to undersampling of regions of low population density, thereby making the subsequent densification steps ineffective. This was addressed by increasing the fraction of the population that was initially sampled. Thus, implementation of an initial sampling strategy that takes population density into account (e.g. maintaining an even distribution of samples) would increase the likelihood of deriving an accurate plume with fewer iterations. Additional densification steps with different settings (i.e. setting a lower radiation level threshold) could also lead to a more representative sample distribution and final distribution, however this also increases processing time (~1 hour per iteration). In a real-world scenario, secondary sampling locations assigned by densification would be supervised, which would direct the software towards derivation of a complete and accurate plume. Indeed, we found that manually adding two new sample locations to the unrepresented region corrected the poor results obtained for the Columbia SC scenario replicate after two additional cycles of kriging and densification.

The HPAC source and geostatistically-derived plumes are based on very distinct sample distributions. HPAC data are highly deterministic, with samples being densely arrayed at each respective contour boundary, whereas iterative kriging and densification distributes these sample locations throughout these regions. Kriging computes and derived plume contours from distributed sample data, but the sample locations themselves rarely coincide with HPAC contours. At lower radiation exposures, kriging tends to produce contours that do not fully overlap the corresponding HPAC-defined plume boundaries. These regions of the derived plume do not exceed the 2Gy threshold (e.g. S3 Fig, middle plume). In this case, a discontinuity at the ≥2 Gy contour is eliminated at ≥1.9Gy, where 83% of the plume area overlapped or was within 0.1Gy of the ≥ 2Gy threshold. This indicates that the derived plumes can generally approximate the HPAC plume, regardless of the accuracy at the ≥ 2 Gy threshold. Additional improvements may rely on manual selection of sampling locations at or close to locations circumscribing the ≥ 2 Gy threshold.

One limitation of this study is the static nature of the derived dosimetry plume presented here, that is, it is based on sampling at a single time point immediately following the nuclear incident. Radiation dispersion and decay are known to have significant effects for hours after an event [33]. Physical dosimeters deposited by radio-controlled drones, for example, at locations specified by geostatistics could provide continuous radiation levels for accurate dynamic modelling of plume evolution. Alternatively, these data could be captured and transmitted by first responders through the RadResponder Network ([34] https://www.radresponder.net/). Furthermore, since our sampling methods are based on population census data over geographic county subdivisions, they do not have sufficient granularity to model how population densities vary over the time continuum (for example, the population of Manhattan, New York City doubles during daytime hours [2013 Census estimate]). This study does not correct for the cumulative exposure, which would be particularly relevant to the individuals sheltering in radiation-contaminated areas, who may have been sampled for the creation of dosimetry maps. Finally, neither the HPAC version available for this study, nor our geostatistical models account for shielding by infrastructure, such as shadowing, which computes the degree to which radiation is prevented from reaching certain locations by the urban environment [35]. While these factors will impact the predicted accuracies of derived dosimetry maps, these effects will also have to be accounted for in ground truth models, such as HPAC, before they could be addressed in geostatistical interpolation.

This approach made several reasonable assumptions that are necessary to perform the simulation, but these also affected the accuracy of the derived radiation plumes. Currently, the radiation levels determined by dosimetry are expected to approximate full exposures and do not account for partial body exposures. These simulations were intentionally designed to avoid a circular argument that geostatistical estimation of radiation plumes were based solely on the original dose estimates; thus, the values used did not specify the same radiation dose as an interpolated value at that location (which would be expected to reconstruct the same dose). Consequently, the contours of the derived plume, while closely resembling the original HPAC thresholds, are nevertheless different. This may be the likely explanation for why the derived plume does not encompass all individuals expected to be exposed to ≥2Gy of ionizing radiation in these scenarios. We also assumed that estimated doses would be sufficiently accurate to derive the radiation maps derived from those estimates.

Biodosimetry estimates absorbed radiation exposures, whereas physical dosimetry measures environmental emissions. Physical dosimetry is more rapid and can map changing radiation plume locations dynamically. However, unfiltered radiation emissions are prone to false positive readouts, for example in aerial physical dosimetry counterterrorism surveys [29] due to common environmental sources of radiation. Uncorrected, such data will introduce errors and distort geostatistically derived plumes. Mitigation may be possible by specifying the locations of radiation detectors by iterative kriging and densification. Nevertheless, biodosimetry at specified locations may provide results that might be useful for assessing treatment-eligibility in instances of borderline clinical exposures.

Simulations with increased dose estimation errors showed that the amounts of time, numbers of samples, and field excursions to procure samples would be increased in order to infer approximate exposure levels by geographic interpolation. These error sources were also responsible for the failure to derive contiguous dosimetry maps, especially in less densely populated regions. Sampling estimates are also based on the number of individuals or locations with detectable exposures. Samples outside of the plume region where radiation was not detectable were assumed to be unexposed. Nevertheless, in an actual event, some of the samples obtained might be unirradiated, which could therefore increase the number of tested samples necessary for derivation of an accurate plume.

The approach described here suggests the feasibility of quantifying radiation exposures at untested locations using either bio- or physical dosimetry. The benefits of geostatistical biodosimetry would be minimal, however, if it were possible to acquire, process and analyze large numbers of samples quickly. Processing and analysis of samples from all known or suspected irradiated individuals for biodosimetry is too labor intensive, a significant bottleneck in identifying treatment-eligible exposures [32]. While rapid interpretation of cytogenetic biodosimetry data is feasible [36], sample acquisition and data generation exceed the capacities of small teams of first responders and individual testing laboratories [37]. The proposed approach may partially overcome capacity resource limitations of first responders and biodosimetry laboratories to provide data for triage assessment of entire populations. Laboratory contexts, where sample preparation, imaging and DCA can be highly automated and multiplexed may have sufficient throughput [10, 35, 38]. Field sampling, laboratory and computational resources could be amplified through simultaneous deployment of multiple dedicated teams. With high performance computing and parallel processing [36], it should be possible to model multiple sample data sources concurrently, and then combine these into more robust geostatistical models. It may also be possible to independently verify exposures by multi-parameter co-kriging [17], for example, with laboratory measurements of white blood cell counts in the same samples- such measurements would be expected to be inversely related to radiation dose. Timely and accurate triage assessment will be needed to inform health professionals about individuals at high-risk for Acute Radiation Syndrome, preferably during the prodromal phase. The radiation dose maps generated by the proposed method can potentially contribute to expediting such decisions.

Supporting information

S1 Fig. Kriging methods using random points representing 1% of Boston population.

These plumes were generated with random points representing 1% of the Boston (N = 617,594) and Cambridge (N = 105,162) populations, the two subdivisions overlapping the Boston HPAC plume (no precipitation). These points were assigned dose values based on their location relative to the HPAC plume (N = 223 with dose > 0Gy). The following kriging methods were then applied to these data: Ordinary, Simple, Universal and Empirical Bayesian kriging (EBK). A contiguous plume could not be derived from Simple kriging. In these, and in other similar tests, the plume generated using EBK best resembled the plume produced by HPAC.

(TIF)

S2 Fig. Rural New York scenario at a 90% and 99% stringency of overlap between consecutive iterations of geostatistical analysis.

These plumes represent the radiation levels of the rural New York nuclear incident scenario. The first two plumes were derived using the geostatistical method using two iteration stopping criteria: a 90% (left plume) and a 99% (middle plume) stringency of overlap threshold between consecutive iterations. When compared to the HPAC plume (right plume), we found that increasing the stringency of overlap resulted in an additional 73 sampling locations selected by densification, which consequently significantly increased the size and similarity of the derived plume, most notably at the 1Gy and 2Gy contours.

(TIF)

S3 Fig. Boston MA scenario at a 90% and 99% stringency of overlap between consecutive iterations of geostatistical analysis.

These plumes represent the radiation levels of the Boston MA nuclear incident scenario. The first two plumes were derived using the geostatistical method using two different stopping criteria: a 90% (left plume) and a 99% (middle plume) stringency of overlap between consecutive iterations. Right-most plume is HPAC. We find that the increased sampling of this scenario (43 additional sampling locations) led to the development of a gap in the 2Gy threshold, which resulted in a slight decrease in plume accuracy at the 2Gy threshold.

(TIF)

S1 Table. Comparison between derived and HPAC plumes in terms of area and population.

(XLSX)

S2 Table. Comparison between scenario replicates in terms of area.

(XLSX)

S3 Table. Radiation scenarios with dose measurement error.

(DOCX)

S4 Table. Samples required for plume convergence is inversely related to population density.

(DOCX)

S5 Table. Plume derivation with an increased (>99%) stringency of overlap between consecutive iterations of geostatistical analysis.

(DOCX)

S1 Methods

(DOCX)

Acknowledgments

We are grateful to the SOSCIP Smart Computing for Innovation Consortium (J.H.M.K., P.K.R.), Natural Sciences and Engineering Research Council of Canada (Engage Program; E.W., P.K.R), Ontario Centres of Excellence (Talent Edge Postdoctoral Fellowship Program; J.H.M.K., P.K.R.), and CytoGnomix (P.K.R., B.C.S, J.H.M.K) for support. We are grateful to Dr. Ruth C Wilkins (Health Canada) for valuable comments on this manuscript.

Data Availability

Data and Software from this study are available in the Zenodo repository: https://doi.org/10.5281/zenodo.3572574. The data includes modified U.S. state and sub-division boundary files [in KML format], as well as the geographic coordinates and dose values (World Geodetic System [WGS] 1984) which define each HPAC and geostatistical-derived plume for all scenarios described. The programs include custom scripts used to preprocess the data for use with ArcMap GIS software.

Funding Statement

We are grateful to the SOSCIP Smart Computing for Innovation Consortium (J.H.M.K., P.K.R.), Natural Sciences and Engineering Research Council of Canada (Engage Program; E.W., P.K.R), Ontario Centres of Excellence (Talent Edge Postdoctoral Fellowship Program; J.H.M.K., P.K.R.), CytoGnomix (P.K.R.) for support of this project. We are grateful to Dr. Ruth C Wilkins (Health Canada) for valuable comments on this manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

  • 1.Mickelson AB, Department TBI US Army Medical. Medical Consequences of Radiological and Nuclear Weapons. Government Printing Office; 2013. [Google Scholar]
  • 2.Coleman CN, Weinstock DM, Casagrande R, Hick JL, Bader JL, Chang F, et al. Triage and treatment tools for use in a scarce resources-crisis standards of care setting after a nuclear detonation. Disaster Med Public Health Prep. 2011. March;5 Suppl 1:S111–121. [DOI] [PubMed] [Google Scholar]
  • 3.Anno GH, Baum SJ, Withers HR, Young RW. Symptomatology of acute radiation effects in humans after exposure to doses of 0.5–30 Gy. Health Phys. 1989. June;56(6):821–38. 10.1097/00004032-198906000-00001 [DOI] [PubMed] [Google Scholar]
  • 4.Bauchinger M. Cytogenetic Effects in Human Lymphocytes as a Dosimetry System In: Eisert WG, Mendelsohn ML, editors. Biological Dosimetry. Springer; Berlin Heidelberg; 1984. p. 15–24. [Google Scholar]
  • 5.Lloyd DC, Edwards AA, Prosser JS. Chromosome Aberrations Induced in Human Lymphocytes by In Vitro Acute X and Gamma Radiation. Radiat Prot Dosimetry. 1986. June 1;15(2):83–8. [Google Scholar]
  • 6.Rogan PK, Li Y, Wickramasinghe A, Subasinghe A, Caminsky N, Khan W, et al. Automating dicentric chromosome detection from cytogenetic biodosimetry data. Radiat Prot Dosimetry. 2014. June;159(1–4):95–104. 10.1093/rpd/ncu133 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Li Y, Knoll JH, Wilkins RC, Flegal FN, Rogan PK. Automated discrimination of dicentric and monocentric chromosomes by machine learning-based image processing. Microsc Res Tech. 2016. May;79(5):393–402. 10.1002/jemt.22642 [DOI] [PubMed] [Google Scholar]
  • 8.Rogan PK, Li Y, Wilkins RC, Flegal FN, Knoll JHM. Radiation Dose Estimation by Automated Cytogenetic Biodosimetry. Radiat Prot Dosimetry. 2016. December;172(1–3):207–17. 10.1093/rpd/ncw161 [DOI] [PubMed] [Google Scholar]
  • 9.Shirley B, Li Y, Knoll JHM, Rogan PK. Expedited Radiation Biodosimetry by Automated Dicentric Chromosome Identification (ADCI) and Dose Estimation. J Vis Exp JoVE. 2017. 04;(127). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Li Y, Shirley BC, Wilkins RC, Norton F, Knoll JHM, Rogan PK. RADIATION DOSE ESTIMATION BY COMPLETELY AUTOMATED INTERPRETATION OF THE DICENTRIC CHROMOSOME ASSAY. Radiat Prot Dosimetry. 2019. January 9. [Epub ahead of print] [DOI] [PubMed] [Google Scholar]
  • 11.Wilkins RC, Carr Z, Lloyd DC. An update of the WHO Biodosenet: Developments since its Inception. Radiat Prot Dosimetry. 2016. December;172(1–3):47–57. 10.1093/rpd/ncw154 [DOI] [PubMed] [Google Scholar]
  • 12.Fliedner TM. Nuclear terrorism: the role of hematology in coping with its health consequences. Curr Opin Hematol. 2006. November;13(6):436–44. 10.1097/01.moh.0000245696.77758.e6 [DOI] [PubMed] [Google Scholar]
  • 13.Simon SL, Bailey SM, Beck HL, Boice JD, Bouville A, Brill AB, et al. Estimation of Radiation Doses to U.S. Military Test Participants from Nuclear Testing: A Comparison of Historical Film-Badge Measurements, Dose Reconstruction and Retrospective Biodosimetry. Radiat Res. 2019. February;191(4):297–310. 10.1667/RR15247.1 [DOI] [PubMed] [Google Scholar]
  • 14.Kubelka D, Fučić A, Milković-Kraus S. The value of cytogenetic monitoring versus film dosimetry in the hot zone of a nuclear power plant. Mutat Res Lett. 1992. November 1;283(3):169–72. [DOI] [PubMed] [Google Scholar]
  • 15.Demidenko E, Williams BB, Swartz HM. Radiation Dose Prediction Using Data on Time to Emesis in the Case of Nuclear Terrorism. Radiat Res. 2009. March;171(3):310–9. 10.1667/RR1552.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Jenness S, Dooley J, Aguilar-Manjarrez J, Riva CM. African Water Resource Database. GIS-based tools for aquatic resource management. CIFA Tech. Pap. No. 33. Rome, FAO. 2006.
  • 17.Leuangthong O, Khan KD, Deutsch CV. Solved Problems in Geostatistics. Wiley-Interscience; 2008. p.85–101. [Google Scholar]
  • 18.Krige DG. A statistical approach to some mine valuation and allied problems on the Witwatersrand [Thesis (M. Sc. Engineering)]. University of the Witwatersrand. 1951. http://wiredspace.wits.ac.za/handle/10539/17975
  • 19.Sichel HS. New methods in the statistical evaluation of mine sampling data. In: Transactions of the Institution for Mining and Metallurgy. London; 1952. p. 261–88.
  • 20.Krivoruchko K. Empirical Bayesian Kriging Implemented in ArcGIS Geostatistical Analyst. Environmental Systems Research Institute; 2012. p. 6–10. [Google Scholar]
  • 21.Waller E, Millage K, Blakely WF, Ross JA, Mercier JR, Sandgren DJ, et al. Overview of hazard assessment and emergency planning software of use to RN first responders. Health Phys. 2009. August;97(2):145–56. 10.1097/01.HP.0000348464.78396.23 [DOI] [PubMed] [Google Scholar]
  • 22.National Council on Radiation Protection and Measurements. NCRP Report No. 165—Responding to a radiological or nuclear terrorism incident: a guide for decision makers. Bethesda, MD: 2010.
  • 23.Greenacre M, Primicerio R. Multivariate Analysis of Ecological Data. Fundacion BBVA; 2014. [Google Scholar]
  • 24.Lu R, Rogan PK. Transcription factor binding site clusters identify target genes with similar tissue-wide expression and buffer against mutations. F1000Research. 2019. April 8;7:1933. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Sales M, de Bruin S, Herold M, Kyriakidis P, Souza C Jr. A spatiotemporal geostatistical hurdle model approach for short-term deforestation prediction. Spat Stat. 2017. August 1;21:304–18. [Google Scholar]
  • 26.Rushworth AM, Peterson EE, Ver Hoef JM, Bowman AW. Validation and comparison of geostatistical and spline models for spatial stream networks. Environmetrics. 2015. August;26(5):327–38. 10.1002/env.2340 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.DiCarlo AL, Maher C, Hick JL, Hanfling D, Dainiak N, Chao N, et al. Radiation Injury After a Nuclear Detonation: Medical Consequences and the Need for Scarce Resources Allocation. Disaster Med Public Health Prep. 2011. March;5(0 1):S32–44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Ainsbury EA, Higueras M, Puig P, Einbeck J, Samaga D, Barquinero JF, et al. Uncertainty of fast biological radiation dose assessment for emergency response scenarios. Int J Radiat Biol. 2017;93(1):127–35. 10.1080/09553002.2016.1227106 [DOI] [PubMed] [Google Scholar]
  • 29.Karam PA. Radiation in Daily Life. 2017 Aug 28 [cited 19 February 2020]. In: American Nuclear Society Nuclear Cafe [Internet]. La Grange Park, Illinois U.S.A. [about 5 screens]. Available from: http://ansnuclearcafe.org/2017/08/28/radiation-in-daily-life/#sthash.pSWLh6N3.LL8ZnwjV.dpbs
  • 30.Kang C-M, Yun HJ, Kim H, Kim CS. Strong Correlation among Three Biodosimetry Techniques Following Exposures to Ionizing Radiation. Genome Integr. 2016. December 30;7:11 10.4103/2041-9414.197168 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Pajic J, Rakic B, Jovicic D, Milovanovic A. Construction of dose response calibration curves for dicentrics and micronuclei for X radiation in a Serbian population. Mutat Res Toxicol Environ Mutagen. 2014. October 1;773:23–8. [DOI] [PubMed] [Google Scholar]
  • 32.Maznyk NA, Wilkins RC, Carr Z, Lloyd DC. The capacity, capabilities and needs of the WHO biodosenet member laboratories. Radiat Prot Dosimetry. 2012. October 1;151(4):611–20. 10.1093/rpd/ncs156 [DOI] [PubMed] [Google Scholar]
  • 33.Kearny CH. Nuclear war survival skills. NWS Research Bureau; 1979. [Google Scholar]
  • 34.Levy A. The Nuclear Threat and U.S. Preparedness: Radiation Monitoring. Journal of American Physicians and Surgeons. 2016;21(3):88–90. [Google Scholar]
  • 35.Buddemeier B. Reducing the Consequences of a Nuclear Detonation: Recent Research. National Academy of Engineering: The Bridge. 2010. 40:2 p28–38. [Google Scholar]
  • 36.Rogan PK, Lu R, Mucaki E, Ali S, Shirley B, Li Y, et al. Automated Cytogenetic Biodosimetry at Population-Scale. bioRxiv. 2019. July 30;718973. [Google Scholar]
  • 37.Coleman CN, Bader JL, Koerner JF, Hrdina C, Cliffer KD, Hick JL, et al. Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE). Disaster Med Public Health Prep. 2019. June 17;1–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Dainiak N, Albanese J, Kaushik M, Balajee AS, Romanyukha A, Sharp TJ, et al. CONCEPTS OF OPERATIONS FOR A US DOSIMETRY AND BIODOSIMETRY NETWORK. Radiat Prot Dosimetry. 2019. [Epub ahead of print] [DOI] [PubMed] [Google Scholar]

Decision Letter 0

Gayle E Woloschak

11 Nov 2019

PONE-D-19-22325

Meeting cytogenetic biodosimetry capacity requirements of population-scale radiation exposures with geostatistical sampling

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Reviewer #2: Yes

**********

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Reviewer #2: Yes

**********

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Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: This manuscript has two main elements – one good and one bad. First, the methodology of geostatistical sampling and guidance of future, iterative sampling is logical and well-described. It could have great utility in a scenario of limited data acquisition and processing to replace universal assessment (impossible) with a plan to most rapidly and efficiently acquire the necessary limited data to refine (and confirm) a priori models. However, the application of this approach to the second element – biodosimetry via cytogenetic assessment of dicentric chromosomes – appears to be without merit or value. Also, it is unnecessary. For all the work, the authors have simulated biodosimetry data from physical dose values, with the assumption that the latter is the ground truth. Essentially, this means they could have removed the entire aspect of biodosimetry and simply applied the geostatistical sampling approach to the question of where to focus a limited number of physical dose assessments so as to confirm/modify predicted models of the radiation plume. So they have basically made a circular argument to go from physical dose to biological dose to arrive at agreement with models of physical dose. A second major problem with the application to biodosimetry deals with the re-iterative process. Identification of sites/individuals for subsequent sampling works when the sampling is not a bottleneck – both in terms of capacity (number that can be processed at any time) and throughput (time for generation of the next set of data). The first is obvious and pointed out by the authors – with examples of 160 to 400 samples being presented as possible realistic goal for a “round” of assessments. From this, one-two rounds of testing would be required to provide the necessary samples (Table 1). But, one does not know at start where to sample for each iteration. And one cannot start subsequent sampling until the initial model is produced. With a turn-around time of 1.5 weeks, a model requiring 3-4 iterations would be worthless in terms of timely provision of information on how to triage and who to treat. Even if all bottlenecks are not consecutive, one still has minimum of a week from sampling to a data point (culturing, preparing metaphase cells, and imaging) before the next round can start. Further, if the situation of dose accumulation is not static – which the authors admit it is not – then the data from samples collected in subsequent iterations may not really extend the data in the first iteration. This makes the whole application unfeasible. In contrast, sticking to physical dose assessments, the turn-around time between iterations might be only one day and thus a feasible approach to rapid and efficient real dose-mapping to confirm models.

There is also a problem with the language used in several places. While the whole concept is one of limited sampling to aid in prediction modeling, there are statements that imply universal assessment of all potentially irradiated individuals. Last sentence of first paragraph on page 17 states that a capacity of 400 samples “should be sufficient to diagnose most or all individuals with symptoms of Acute Radiation Syndrome”. First, this has nothing to do with diagnosis, only assignment of a biological dose (>2 Gy) that carries with it a potential for ARS. And with actual symptoms of ARS (a diagnosis) one probably needs nothing further to initiate treatment. Further, the final prediction of biological dose locations (contours) at best will confirm a physical dose map derived from either actual dose measurements or the HPAC models. But what if it doesn’t? Either because there is not a one-to-one correlation between biological dose and physical dose (again, the authors acknowledge this) or because the model is not applicable. And the more “discrepancies” one has in the first iteration, the harder it will be to arrive at the final mapping.

In the end, the use of geostatistical sampling, at least when applied to limited biodosimetry data, is unlikely to be “one of the only practical solutions in a radiation mass casualty to quickly and accurately triage large populations for therapeutic decisions”. It will not be quick – in time to initiate treatment for those who might potentially benefit. And there will be no way to determine how accurate it is.

Reviewer #2: This is an interesting exercise on an attempt to map radiation plumes and fallout to determine a sample of individuals to test for radiation exposure in the case of a nuclear event. There are several concerns around this manuscript.

1. it is not clear how much better this will be compared to simple dosimeters that are commonly found in cities. mapping this mathematically does not appear to add much to the data that is possible to be collected by physical biodosimetry.

2. the major concern is that the radiation doses in a large city will be inhomogeneous due to partial shielding. How does this algorithm account for such events?

**********

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PLoS One. 2020 Apr 24;15(4):e0232008. doi: 10.1371/journal.pone.0232008.r002

Author response to Decision Letter 0


13 Dec 2019

Gayle E. Woloschak, PhD

Academic Editor

PLOS ONE

Dear Dr. Woloschak:

Thank you for allow us to revise our manuscript for PLoS ONE. We appreciate your consideration of the revised manuscript. We are grateful for the insightful comments by the Referees, which we have address in the revision and respond to below.

Please note that we have added one author, Ben C. Shirley, who has contributed software development expertise to this work.

Kind regards,

Peter K. Rogan, Ph.D. (on behalf of all of the authors)

University of Western Ontario

Responses to Academic Editor

Style requirements: The manuscript is compliant with journal requirements

Financial disclosure: The funders had no role in the design, collection of data, publication or preparation of the manuscript. This is now explicitly stated:

“The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

(please add this text to the original text)

Competing interests:

The text has been revised to:

“Peter K. Rogan and Joan H. Knoll are founders and Ben Shirley is an employee of CytoGnomix, which partially supported this research. Cytognomix holds relevant patents and relevant patent applications. This does not alter our adherence to PLOS ONE policies on sharing data and materials.”

(please replace original text with the above)

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Response to Reviewers

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Since Reviewer #1 did not indicate specific issues, we are unable to address their response.

________________________________________

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction…

Reviewer #1: No

Reviewer #2: Yes

In response to reviewer #1, we have uploaded the HPAC derived data and our scenario sample locations with inferred radiation levels for each scenario to a Zenodo.archive (https://doi.org/10.5281/zenodo.3572574). The address of this archive is also indicated in the manuscript.

________________________________________

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:

A) This manuscript has two main elements – one good and one bad. First, the methodology of geostatistical sampling and guidance of future, iterative sampling is logical and well-described. It could have great utility in a scenario of limited data acquisition and processing to replace universal assessment (impossible) with a plan to most rapidly and efficiently acquire the necessary limited data to refine (and confirm) a priori models. However, the application of this approach to the second element – biodosimetry via cytogenetic assessment of dicentric chromosomes – appears to be without merit or value. Also, it is unnecessary. For all the work, the authors have simulated biodosimetry data from physical dose values, with the assumption that the latter is the ground truth. Essentially, this means they could have removed the entire aspect of biodosimetry and simply applied the geostatistical sampling approach to the question of where to focus a limited number of physical dose assessments so as to confirm/modify predicted models of the radiation plume. So they have basically made a circular argument to go from physical dose to biological dose to arrive at agreement with models of physical dose.

We have modified the text of the manuscript in order to generalize the source of radiation measurement to either physical or biodosimetry methods. While the method was conceptualized with biodosimetry in mind, the method would still be useful to reduce physical sampling requirements in population-scale radiation scenarios and would be expected to decrease total radiation exposures of first responders. We have generalized the text to avoid specifying a particular dosimetry method (e.g. “cytogenetic biodosimetry” changed to “dosimetry”). As this transition required numerous edits (too many to describe here), we have provided select examples of where the text has been modified to include physical dose measurement:

1) Abstract (Background section):

“Even with high-throughput dosimetry analysis, test volumes far exceed the capacities of first responders to measure radiation exposures directly, or to acquire and process samples for follow-on biodosimetry testing.”

2) Abstract (Results/Conclusions section): “Geostatistical mapping limits the number of individuals requiring laboratory testing, the time required, and radiation exposure to first responders.”

This has been modified to (see bolded text):

“Geostatistical mapping limits the number of individuals requiring dose assessment, the time required, and radiation exposure to first responders.”

3) Introduction (Paragraph 4, page 4): “The question this paper addresses is whether the radiation plumes derived by HPAC can be reconstructed with kriging using a relatively small number of samples analyzed by physical or biodosimetry methods.”

4) Results (Paragraph 1, page 11): “We simulated the analysis of 28 population-scale, 10 megaton yield nuclear detonation scenarios with ADCI-HT using cytogenetic biodosimetry data…”

This has been modified to:

“We simulated the analysis of 28 population-scale, 10 megaton yield nuclear detonation scenarios with dosimetry data…”

5) We have also greatly modified the Introduction paragraph describing dosimetry methods to expand information regarding physical dose methods. Example:

Introduction (Paragraph 2, page 3): “Physical dose can be inferred from the prodromal response of absorbed radiation, which include erythema, headache, fever, lethargy, tachycardia, nausea and vomiting (1,3).”

However, results from biodosimetry can be achieved in a clinically relevant time frame. The estimates given in the manuscript were simply examples based on certain assumptions about laboratory capacity. With laboratory scale-up and parallelization (e.g. commercial cytogenetic laboratories with highly automated sample preparation and redundant microscope imaging systems), the time to determine and report absorbed radiation would be reduced significantly, e.g. 3-4 days. This approach has been suggested as part of the U.S. Concept of Operations in a nuclear incident, which is now cited in this article as reference 36. We previously suggested this possibility at a BARDA TechWatch presentation in 2012 and provided relevant data to these authors (who presented it at the most recent EPR Biodose conference in Munich, 2018). As the text has been modified to include physical dosimetry methods, the majority of text discussing cytogenetic biodosimetry has been moved to the latter part of the Discussion (pages 18-20).

We carefully describe the assignment of dose values in the simulation to demonstrate that the results presented are not the result of cyclical reasoning. The HPAC plume is considered the “ground truth” dose estimate, however the actual portable data generated and exported by the HPAC software is confined to the values at the contours that make up the plume itself. Locations between the geospatial coordinates given by the contours are not provided by HPAC. For more accurate dose estimation, these values should be interpolated between adjacent contours. To avoid a circular reasoning argument we have not performed such interpolation, rather we use the dose estimate of the outer contour adjacent to sampled locations (regardless of whether they intersect the contour or not), that is, we introduce a source of systematic error to avoid the circular argument. The data collected by first responders after kriging and densification should reflect the actual dose at the site sampled. When we then compare the derived plume with the HPAC plume, we are comparing the dose that was derived from the corresponding interval separated by contours with what is expected from geostatistical estimation of dose. The goal was to demonstrate that this approximation method provides actionable information about exposures based on the sampling procedure, and that we can reconstruct the plume from a small fraction of the samples that were used to generate it (<10%). Biological dose estimation for large scale events with geolocation data equivalent to HPAC models has not been previously reported. Without such a map, it is not possible to directly compare bio- with physical dose estimates for a large-scale incident. We therefore simulate the biological dose by sampling the HPAC map at many fewer locations that HPAC uses to derive plume contours.

B) A second major problem with the application to biodosimetry deals with the re-iterative process. Identification of sites/individuals for subsequent sampling works when the sampling is not a bottleneck – both in terms of capacity (number that can be processed at any time) and throughput (time for generation of the next set of data). The first is obvious and pointed out by the authors – with examples of 160 to 400 samples being presented as possible realistic goal for a “round” of assessments. From this, one-two rounds of testing would be required to provide the necessary samples (Table 1). But, one does not know at start where to sample for each iteration. And one cannot start subsequent sampling until the initial model is produced. With a turn-around time of 1.5 weeks, a model requiring 3-4 iterations would be worthless in terms of timely provision of information on how to triage and who to treat. Even if all bottlenecks are not consecutive, one still has minimum of a week from sampling to a data point (culturing, preparing metaphase cells, and imaging) before the next round can start. Further, if the situation of dose accumulation is not static – which the authors admit it is not – then the data from samples collected in subsequent iterations may not really extend the data in the first iteration. This makes the whole application unfeasible. In contrast, sticking to physical dose assessments, the turn-around time between iterations might be only one day and thus a feasible approach to rapid and efficient real dose-mapping to confirm models.

We have added text to address where first-responders could perform initial sampling (Methods section, first paragraph, page 4):

“Initially, locations within likely fallout areas were sampled from the potentially affected population. In a real-world scenario, initial randomly sampled locations would be selected based on approximate wind direction and location of the epicenter (“ground zero”).”

We have also made significant changes throughout the text in order to generalize the potential sources of radiation measurements to include physical dose. The methodology proposed in this manuscript should be feasible regardless of the dosimetry method used to derive it. For any radiation metric, the proposed approach should benefit first responders by reducing sampling requirements, and consequently their exposure to radiation.

Regarding your comments about cytogenetic biodosimetry turnaround time, please see our comment in part (A).

C) There is also a problem with the language used in several places. While the whole concept is one of limited sampling to aid in prediction modeling, there are statements that imply universal assessment of all potentially irradiated individuals. Last sentence of first paragraph on page 17 states that a capacity of 400 samples “should be sufficient to diagnose most or all individuals with symptoms of Acute Radiation Syndrome”. First, this has nothing to do with diagnosis, only assignment of a biological dose (>2 Gy) that carries with it a potential for ARS. And with actual symptoms of ARS (a diagnosis) one probably needs nothing further to initiate treatment.

Thank you for your suggestion. We have corrected any text that describes Acute Radiation Syndrome (ARS) to make it clear that a >2Gy dose only indicates the potential risk of ARS and is not a diagnosis of ARS. For example, the sentence you indicated on page 17 (now on page 19) is now written as follows:

“Timely and accurate assessment will be needed to inform health professionals about individuals at high-risk for Acute Radiation Syndrome, preferably during the prodromal phase.”

Another example where we discussing a method to expedite identification of those at risk for ARS, not diagnosis of ARS:

Introduction (paragraph 1, page 3): “Individuals at risk for acute radiation syndrome, e.g. those receiving ≥ 2Gy exposure, should be rapidly identified by these approaches to determine eligibility for therapy (2).”

D) Further, the final prediction of biological dose locations (contours) at best will confirm a physical dose map derived from either actual dose measurements or the HPAC models. But what if it doesn’t? Either because there is not a one-to-one correlation between biological dose and physical dose (again, the authors acknowledge this) or because the model is not applicable. And the more “discrepancies” one has in the first iteration, the harder it will be to arrive at the final mapping.

The manuscript already addresses this issue. We have explicitly introduced the possibility that the deviation could involve physical vs biodosimetry dose estimation:

Results (final paragraph, page 16): “Maximum deviations were designed to represent confidence values in physical and/or biodosimetry methods, including dicentric analysis (DCA; ±0.5Gy) or cytokinesis-blocked micronucleus assays (±1.0Gy), which exhibit higher variance in estimating dose compared to DCA (28–30). The introduction of such measurement errors led to plumes that were generally less accurate, required a greater number of samples, and additional iterations of kriging and densification to achieve convergence (S2 Table). The degree of error in this analysis was also correlated with decreased accuracy and increased processing time (±0.5Gy error-derived plumes were more accurate than ±1.0Gy error-derived plumes in nearly all scenarios; S2 Table).”

Note that while an increase in dosimetry error both increases sampling requirements and modestly decreases overall accuracy, the method will still ultimately derive a plume regardless.

E) In the end, the use of geostatistical sampling, at least when applied to limited biodosimetry data, is unlikely to be “one of the only practical solutions in a radiation mass casualty to quickly and accurately triage large populations for therapeutic decisions”. It will not be quick – in time to initiate treatment for those who might potentially benefit. And there will be no way to determine how accurate it is.

We have altered this statement:

Discussion (paragraph 7; page 20): “Geostatistical sampling may provide a practical solution to quickly triage these exposures in large populations.”

There are promising approaches to expedite the preparation of samples and data acquisition steps (Dainiak et al. 2019; Ref. #36) so that triage biodosimetry could be carried out sufficiently quickly to benefit many of those requiring treatment. Furthermore, we have broadened the scope of the paper to include reconstruction of physical radiation plumes from geostatistically sampled subsets of locations or individuals. Reconstruction of the plume could be carried out within a few minutes if the radiation detectors are placed at geolocations specified by kriging and densification.

Reviewer #2:

This is an interesting exercise on an attempt to map radiation plumes and fallout to determine a sample of individuals to test for radiation exposure in the case of a nuclear event. There are several concerns around this manuscript.

1. it is not clear how much better this will be compared to simple dosimeters that are commonly found in cities. mapping this mathematically does not appear to add much to the data that is possible to be collected by physical biodosimetry.

In the Introduction, we cite previous studies that illustrate inaccuracies when comparing results of physical dosimetry and cytogenetic biodosimetry for the same individuals from the same exposure. Such discrepancies have implications for medical emergency management:

Introduction (Paragraph 2, page 3): “Confounding factors may affect testing results. These include the possibility of discordant physical radiation measurements and estimated biodosimetry exposures (13,14), and other causes of indirect predictors of exposure such as time-to-emesis (such as head trauma, or comorbid infections), thereby reducing accuracy of diagnoses (15).”

The manuscript has been modified to put a greater emphasis on the benefits of this method for reconstructing exposures over affected geographic areas for any type of dosimetry, including physical dosimetry (see our response to Reviewer #1 [A]). Despite physical dosimetry being much faster compared to cytogenetic biodosimetry, determining the physical dose of all individuals in a large city is still infeasible. In the early stages of a nuclear event, collecting data would be difficult for first responders. In this situation, the proposed approach would allow for the development of an accurate radiation plume with only limited sampling while decreasing exposure of first responders by minimizing time in irradiated areas.

2. the major concern is that the radiation doses in a large city will be inhomogeneous due to partial shielding. How does this algorithm account for such events?

The third paragraph of the Discussion describes the limitations of our method. Here, we discuss how shielding (or “shadowing”) by infrastructure is not accounted for, and how these concessions may limit the overall accuracy of our method.

Results (Paragraph 3, page 18): “Finally, neither the HPAC version available for this study, nor our geostatistical models account for shielding by infrastructure, such as shadowing, which computes the degree to which radiation is prevented from reaching certain locations by the urban environment (34). These concessions may limit the overall accuracy of radiation measurements that we are using as the ground truth.”

Attachment

Submitted filename: Response to Reviewers.docx

Decision Letter 1

Gayle E Woloschak

30 Dec 2019

PONE-D-19-22325R1

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

PLOS ONE

Dear Dr. Rogan:

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please address the concerns raised by the reviewers.  One suggested major revisions.

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Kind regards,

Gayle E. Woloschak, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

One reviewer accepted the work, the other suggested major revisions. Please address as many concerns as possible.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: While substantial improvements have been made, there is still a remaining problem that will mislead a naïve reader. That is the continued emphasis on ”individuals” that implies more than is warranted. While the authors have made the necessary modifications to replace the biological dosimetry with physical dose measurement, there is still text that implies assessment of individuals (i.e., biological dosimetry) rather than locations (physical dosimetry). Although the simulated measurements based on location can be weighted for population density, it still does not provide information at the individual level.

An example of the focus on individuals is a phrase that is repeated in the Abstract (Results) and the first paragraph of the Discussion:

On average, 71±9% of those with ≥2Gy exposures were accurately localized.

plumes from 28 distinct scenarios simulating absorbed radiation identified 71±9% of individuals with ≥2Gy exposures

A better phrasing would be “71±9% of those locations where the population might be expected to receive an exposure greater than 2 Gy were identified.”

There is also a problem with how the central data in Table 1 are interpreted. As stated on page 13, “Success” was based on accuracy of predicting irradiated samples greater than 2 Gy. The authors took the final iteration values and stated an average accuracy of 70.6%. But this is after omitting an outlier for Columbia (or replacing with a further re-iteration attempt – it is not clear which). There was also an intermediate outlier for Columbus but the final value was in range and was apparently used. No mention is made of Charleston where the final value exceeds the 10% threshold of difference from either of the first two values. Most importantly, the average accuracy from the final values after the process is no different from the average accuracy computed using the first iteration values. Just as many locations had a decrease from first to final iteration as had an increase. And excluding the 10% increase for Charleston the maximum “improvement” was 4% while the maximum loss of accuracy was 5%. So, what is the value of this iterative process? While it may have the potential to refine predicted dose maps, it clearly does not provide better results for “success” based on the accuracy values.

Finally, despite the shift from biodosimetry to physical dose sampling, there is still the underlying implication that this process may be applied to “a relatively small number of samples analyzed by physical or biodosimetry methods” (last sentence of Introduction). Similarly, on page 20, “Population-scale radiation exposure identification can be achieved through a combination of high-throughput dicentric chromosome identification software and GIS-based software analysis, and the test volume is likely to be feasible for a large dosimetry lab.” Any aspect that relies on an iterative process using cytogenetic data is patently not feasible for triage purposes when there is a minimum 1 week turn-around time. One might use the reiterative process on physical dose mapping to select locations where selected individuals are then assessed by biodosimetry – but this is not the take-away message from the manuscript as written.

Reviewer #2: all concerns addressed - no further comments

**********

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PLoS One. 2020 Apr 24;15(4):e0232008. doi: 10.1371/journal.pone.0232008.r004

Author response to Decision Letter 1


10 Jan 2020

Academic Editor Comments

We would appreciate receiving your revised manuscript by Feb 13 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Author Response (Cover letter)

Dear Dr. Woloschak:

Thank you for allowing us to once again revise our manuscript for PLoS ONE. We have thoughtfully considered the comments made by the first referee, and we have responded to each point in a separate letter provided below. As you recommended, we have also included a detailed protocol for generation and comparison of radiation dosimetry maps using the method described in the paper and uploaded this protocol to protocols.io (http://dx.doi.org/10.17504/protocols.io.ba4nigve). This protocol has been named "Protocol for Geostatistical Determination of Radiation Dosimetry Maps of Population-Scale Exposures".

The first referee expresses their specific point of view regarding the protocols and guidelines for application of physical dosimetry vs biological dosimetry methods and relegates biological dosimetry to a secondary role. Recent advances in these techniques, in particular interpretation of data, have demonstrated that timely and useful information can inform clinical decisions. We never intended our manuscript to be a discourse on benefits vs. drawbacks of performing different types of dosimetry. Discussion of preference between physical and bio-dosimetry methods is not relevant to the scientific validity of the work, which is one of the reasons why we submitted our manuscript to PLoS ONE.

The point of our manuscript is to introduce a new method of deriving accurate radiation plumes requiring far fewer direct measurements than previously thought necessary. While plumes can be derived with the geostatistical approach described in our manuscript using any dosimetry method, it has particular implications for biodosimetry, which has been previously dismissed by many (including this reviewer) as too slow to be used to guide management of radiation-caused illness. Rather, maps derived from biological radiation measurements that significantly exceeding the recognized threshold of 2Gy are likely precise enough to begin treatment prior to obtaining the final plume.

Putting the issue of the benefits or drawbacks of performing different types of dosimetry aside, we hope that you find our responses to the first reviewer’s comments acceptable; and that you consider our manuscript for publication in PLoS ONE.

Kind regards,

Peter K. Rogan, Ph.D. (on behalf of all of the authors)

Reviewer comments (Author Responses follow each comment)

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

________________________________________

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

RESPONSE

Reviewer #1 has misunderstood the results by confusing the “iterative” process of kriging and densification with the analysis of 3 completely independent replicates of scenarios initiated using different random seed conditions (see Section 6.3 below). We have submitted a detailed protocol to the protocols.io website that demonstrates this iterative process. We have also uploaded the sample data for each replicate of each scenario, along with project-related software that are used with ArcMap to perform the geostatistical analyses to the public repository, Zenodo. Reviewer #1 is invited to review these resources and reproduce our findings prior to drawing conclusions regarding their adequacy.

________________________________________

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

RESPONSE

There is no factual basis for this conclusion by Reviewer #1. We emphatically deny that we have removed or selectively altered any data presented in this study. In fact, the reviewer’s conclusion appears to have been based on a misinterpretation of the results obtained for the Columbia SC scenario (see Section 6.3 below) alone. The statistical analyses for all 24 scenarios have been performed appropriately and rigorously, according to accepted methods in geostatistical analyses.

As mentioned in our previous response, we have uploaded the HPAC-derived data and our scenario sample locations with inferred radiation levels for each scenario to a Zenodo archive (https://doi.org/10.5281/zenodo.3572574). In addition to this, we also include a detailed protocol for generation and comparison of radiation dosimetry maps using the method described in the paper and uploaded this protocol to protocols.io (dx.doi.org/10.17504/protocols.io.ba4nigve). The protocol contain links to data and programs in the Zenodo archive, however these links will not be live until the archive is formally published. This will occur should the paper be acceptable for publication by PLoS ONE.

________________________________________

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

________________________________________

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

RESPONSE

We do not understand this conclusion by reviewer 2, who has recommended acceptance of the manuscript. Elaboration is requested.

________________________________________

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:

1. While substantial improvements have been made, there is still a remaining problem that will mislead a naïve reader. That is the continued emphasis on ”individuals” that implies more than is warranted. While the authors have made the necessary modifications to replace the biological dosimetry with physical dose measurement, there is still text that implies assessment of individuals (i.e., biological dosimetry) rather than locations (physical dosimetry). Although the simulated measurements based on location can be weighted for population density, it still does not provide information at the individual level.

RESPONSE

The method described in this manuscript would allow for the derivation of a radiation plume using any (consistent) type of radiological measurement. This includes the physical measurement of radiation of a location, but this also includes biological dosimetry of individuals, which is what we are referring to here. The Introduction describes how first responders and medical personnel have qualitatively inferred exposures based upon presentation of symptoms, aside from simply obtaining direct measurements via Geiger counters:

“Physical dose can be inferred from the prodromal response of absorbed radiation, which include erythema, headache, fever, lethargy, tachycardia, nausea and vomiting (1,3).”

To eliminate any confusion, we have added text to the method which indicates that “sample” can refer to any radiological measurement type:

Methods: “…we refer to these locations as samples, regardless of whether the radiation is quantified from either physical emissions or from absorbed biological effects. We assume that all measurements used to derive the plume are consistently obtained by the same approach.”

Biodosimetry of individuals can provide actual exposure measurements, whereas physical dosimeters measure environmental radiation emission levels. While physical dosimetry measurement is more rapid than biodosimetry, there are limitations in applying unfiltered data to derivation of radiation plumes. There are well known false positive readouts obtained through aerial physical dosimetry counterterrorism surveys (Karam PA, “Radiation in Daily Life,” ANS Nuclear Cafe website; Aug. 28, 2017):

http://ansnuclearcafe.org/2017/08/28/radiation-in-daily-life/#sthash.pSWLh6N3.dpbs)

Common environmental sources of radiation, such as large deposits of granite (i.e. headstones in cemeteries), as well as medical and construction sites (i.e. radiation from poorly maintained X-Ray machines), can lead to false positive spikes in physical radiation unrelated to the nuclear incident that we are attempting to model using multiple measurements dispersed across the landscape. If used, these data could distort a plume derived by geostatistical analysis. These factors would be somewhat mitigated by depositing physical detectors at ground locations specified by this iterative densification, as suggested in the paper. Nevertheless, it would appear that there are certain advantages of performing biodosimetry on individuals at specified locations, as an alternative to surveying locations themselves for radioactive emissions.

2. An example of the focus on individuals is a phrase that is repeated in the Abstract (Results) and the first paragraph of the Discussion:

On average, 71±9% of those with ≥2Gy exposures were accurately localized.

plumes from 28 distinct scenarios simulating absorbed radiation identified 71±9% of individuals with ≥2Gy exposures

A better phrasing would be “71±9% of those locations where the population might be expected to receive an exposure greater than 2 Gy were identified.”

RESPONSE

The value of 71±9% accuracy has been corrected (to 70±10%) in the latest version of the manuscript. As the paper states, each scenario initially consisted of three replicates, however we did perform additional replicates for 2 of the scenarios which exhibited larger inter-replicate variation in performance. An additional 2 replicates for these scenarios were included close to the completion of the manuscript. Inclusion of these additional replicates (Columbia SC replicates #4 and 5, and the Columbus OH replicates #4 and 5) resulted in a minor adjustment to the accuracy calculation, which was not statistically different from the results based on 3 replicates. The omission of the additional replicates from the accuracy calculation was inadvertent.

We appreciate the reviewer’s suggestion, and have made said change to the manuscript, with slight adjustments:

Abstract: “On average, 70±10% of locations where populations are expected to receive an exposure ≥2Gy were identified.”

Discussion: “Overall, plumes from 28 distinct scenarios simulating absorbed radiation identified 70±10% of locations where the population are expected to receive ≥2Gy of radiation exposure (and thus are eligible for cytokine therapy), …”

Furthermore, the overall accuracy of 70.6% has been adjusted to 69.8%.

3. There is also a problem with how the central data in Table 1 are interpreted. As stated on page 13, “Success” was based on accuracy of predicting irradiated samples greater than 2 Gy. The authors took the final iteration values and stated an average accuracy of 70.6%. But this is after omitting an outlier for Columbia (or replacing with a further re-iteration attempt – it is not clear which).

There was also an intermediate outlier for Columbus but the final value was in range and was apparently used. No mention is made of Charleston where the final value exceeds the 10% threshold of difference from either of the first two values. Most importantly, the average accuracy from the final values after the process is no different from the average accuracy computed using the first iteration values. Just as many locations had a decrease from first to final iteration as had an increase. And excluding the 10% increase for Charleston the maximum “improvement” was 4% while the maximum loss of accuracy was 5%. So, what is the value of this iterative process? While it may have the potential to refine predicted dose maps, it clearly does not provide better results for “success” based on the accuracy values.

RESPONSE

This was a misunderstanding by the reviewer, since outliers were not excluded at any time in any computation. The final accuracy for each of the replicates (replicate #1, 2 and 3) were included in the computation of the overall accuracy of the project. As previously mentioned, inclusion of replicates #4 and 5 for Columbia SC and Columbus OH slightly decreased this value (from 70.6% to 69.8%).

There also appears to have been a fundamental misunderstanding of the results presented in Table 1. In contrast to the assertion by the reviewer, replicates shown in Table 1 are not a step-by-step description of the progression of our iterative process. Instead, they each represent independently-derived plumes (each consisting of multiple iterations of kriging and densification) differing only in their starting set of random determined sample locations. The replicates are arbitrarily labeled as numbers 1,2 and 3. These replicates are not presented in any particular order.

From the Methods:

“Comparisons between independent replicates of the same scenarios using different, randomized, initial sample distributions evaluated the reliability of this approach.”

“The geostatisical workflow was used to analyze three replicates of each scenario, with each replicate initiated with a different set of random sample locations within the plume.”

The plumes derived from the initial set of points alone are less accurate than the final plume. In low population-density or sparsely sampled regions, the HPAC and derived plumes show limited overlap of the same contours resulting in poor accuracy for defining the 2Gy threshold. Neither example in Figure 2 exhibits this issue because of the relatively higher sampling densities in these scenarios. Reduction in the off-diagonal cell values over consecutive iterations in the tables below the plume maps illustrates the improvement in the model. We do not believe that it would be as informative to the reader to compute accuracy metrics between iterations, and generally only present accuracy at the end of the procedure (except for the new Columbia SC replicate shown below).

Nevertheless, we address the reviewer’s critique of our results for the Columbia SC scenario by performing this analysis for a new, previously unreported replicate. The following results are now reported as an example of the procedure (at https://www.protocols.io/) described in the Methods of our manuscript.

We find:

• Accuracy of plume from initial set of random samples only: 0% accuracy (the entire plume is <2Gy; image of plume in Section 4 of the online protocol) [N=8 samples > 0 Gy]

• Accuracy after 1 Iteration: 21.1% accuracy (image of plume in Section 5 of the online protocol) [N=55 samples > 0 Gy]

• Accuracy after 3 Iterations: 46.0% accuracy [N=79 samples > 0 Gy]

• Accuracy after 5 Iterations: 68.4% accuracy (final derived plume; image of plume in Section 6 of the online protocol) [N=136 samples > 0 Gy]

As this was a source of confusion, we have added a new comment in the footnote to Table 1 for the “No. of Iterations” column:

“2 The number of iterations (kriging and densification steps) required to reach stopping criteria for this replicate.”

Additionally, in places in the manuscript where we discuss the iterative process, we have added text to make it clear that we are referring to iterations of kriging and densification. For example:

Methods (new text bolded): “These kriging and densification processes are repeated for a limited number of iterations until the coverage area and the radiation level contours of the inferred plume stabilizes”

4. Finally, despite the shift from biodosimetry to physical dose sampling, there is still the underlying implication that this process may be applied to “a relatively small number of samples analyzed by physical or biodosimetry methods” (last sentence of Introduction). Similarly, on page 20, “Population-scale radiation exposure identification can be achieved through a combination of high-throughput dicentric chromosome identification software and GIS-based software analysis, and the test volume is likely to be feasible for a large dosimetry lab.” Any aspect that relies on an iterative process using cytogenetic data is patently not feasible for triage purposes when there is a minimum 1 week turn-around time. One might use the reiterative process on physical dose mapping to select locations where selected individuals are then assessed by biodosimetry – but this is not the take-away message from the manuscript as written.

RESPONSE

We have not “shifted the emphasis” of this paper to sampling by physical dosimetry. Rather, we have expanded our approach to include sample data originating from either physical- or bio-dosimetry. The approach we describe can be performed using either type of data.

Biological dosimetry would still be feasible to generate meaningful plumes, leading to sufficiently timed treatment. The 1.5-week scenario that we describe in the Discussion accounted for all iterations of the plume development process and assumed that a single or two typical biodosimetry laboratories would perform the sample processing and analysis. The revised manuscript cited a recent Concept of Operations study (Daniak et al. 2019) that envisions engagement by large commercial cytogenetic operations with substantial automation of these processes. We have attempted to make this clearer in the text (new text bolded):

“The expected throughput of cytogenetic biodosimetry of a typical small city scenario (~160 samples) is less than 1 week (for all iterations per scenario, cumulatively), assuming…”

While sample culturing introduces an initial 48-hour lag, the period afterwards would be quite rapid due to A) automated sample preparation, B) multiplexed imaging of samples in parallel, C) automated dicentric chromosome detection and radiation dose estimation, and D) kriging and densification. Additional samples can be collected during some of these analysis steps. We envision a continuous process, not a segmented one as the reviewer has suggested.

Geographic regions close to the epicentre receiving high levels of radiation exposures (> 3Gy) will be evident early in the process. It should not be necessary to wait until the final iteration is completed to apply this information in clinical decision making. We have not investigated this possibility in detail in the current manuscript, however we plan to examine this possibility in future studies. If proven, it may be feasible to consider eligibility for therapy using the plume derived after the first iteration of geostatistical analysis. While the 2Gy contour may not be well defined after a single iteration, we note that locations where absorbed radiation exposures are highest generally cover the similar geographic contours in subsequent plumes. Individuals in imminent need of treatment would benefit sooner, while management of those with lower, clinically relevant radiation exposure would be deferred until the plume is better defined.

It is not our intent to evaluate or compare physical versus biological dosimetry methods in this study. The purpose was to introduce a geostatistical method to deriving radiological plumes from any measurement source. Biodosimetry covers many techniques, however our work has primary focused on advancing the state-of-the-art of the dicentric chromosome assay (see https://adciwiki.cytognomix.com/doku.php?id=main:references). The Discussion of this paper therefore describes the impact of the geostatistical approach on this assay. Other, more rapid biodosimetry assays could also be used to derive a plume based on absorbed radiation, however the dose estimates obtained with these techniques have lower confidence. We also present results addressing the impacts of less accurate measurements on derived radiation plumes, whether they are derived from biological or physical dosimetry data.

Attachment

Submitted filename: Response to Reviewers 2.docx

Decision Letter 2

Gayle E Woloschak

28 Jan 2020

PONE-D-19-22325R2

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

PLOS ONE

Dear Dr. Rogan--

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

One reviewer noted minor revisions, but believes the work is very important as a contribution to the field.  The other reviewer has selected rejection even though in the most recent decision selected acceptance.  Please attempt to address concerns of BOTH reviewers, I will attempt to work through the reviewer who changed opinions on the work so drastically.

We would appreciate receiving your revised manuscript by Mar 13 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Gayle E. Woloschak, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

One reviewer has indicated that minor revisions are needed. One reviewer has rejected the work, but previously accepted it. Please address as many concerns as you can and I will attempt to wade through the issues of reviewers changing their opinions on the work.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: No

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript is definitely getting better; however, there remain problematic issues that relate to the potential for a causal reader to be misled as to what was done and what the results mean.

The Abstract is now an appropriate description of what was done. A minor suggestion is to move the first sentence of the Methods to before the current third sentence (Initially …). This would emphasize that this is a modelling exercise and that exposures or boundaries were not actually determined.

One remaining issue in the manuscript body is in the overlap or inappropriate implied equivalence of “individuals” and “locations”. The authors should confirm (by searching for the words) that when talking about measurements or sampling or results that location is applied to physical dosimetry and individual is restricted to biodosimetry. Some of these may just be residual from prior versions but need to be corrected. This would then allow the appropriate inference by the reader that locations are fixed and may accurately reflect physical dose levels at or in proximity to that location. This then leads to a reasonable assumption that interpolation between two locations (by additional sampling) is likely to refine dose boundaries. The same cannot be said for individuals. A value for a third individual, sampled at a location between the locations where two initial individuals were assessed by biodosimetry, would not a priori be expected to provide an intermediate biodosimetry value. This could be due to heterogeneity in inherent radiosensitivity of the population, movement by the individual, comorbidities, or any of the reasons that the authors allude to. This also leads into the need to be precise as to what measurements are reasonable to utilize for the kriging process and the re-iterative process. That is, one can reasonably postulate additional physical dosimetry sampling over a few days to refine dose boundaries that then can be used to perform biodosimetry on a selected set of individuals. But with the time restraints of biodosimetry it is not practical to consider more than one sampling as contributing to the triaging process. But current wording might suggest otherwise. As an example, at the bottom of page 3, there is the following:

“One approach to alleviating the need to triage all potentially exposed individuals would be to survey a subset of individuals combined with their respective locations by geostatistical analysis. We demonstrate that combining such surveys with the geolocations of these measurements can reduce sampling requirements in population-scale radiation scenarios and would be expected to decrease total radiation exposures of first responders.”

The term “combining” might be interpreted as using the two dosimetry methods reiteratively. Also “surveys” of individuals might be mis-interpreted as multiple surveys (i.e., biodosimetry) in the same general vicinity to aid in the kriging, rather than a single targeted survey of individuals in a location selected by the physical dosimetry kriging.

Last sentence before Methods: “kriging using a relatively small number of samples analyzed by physical or biodosimetry methods.” Biodosimetry needs to be removed, but the sentence can be extended to state using kriging of physical dosimetry to aid in selection of individuals for biodosimetry.

Page 5: “Densification is the geostatistical procedure that targets and localizes an additional small cohort of irradiated individuals (1) to mitigate uncertainty in environmental measurement. These kriging and densification processes are repeated for a limited number of iterations until the coverage area and the radiation level contours of the inferred plume stabilizes (i.e. sampling of additional individuals (2)”. (1) it identifies a location, not any individuals who might be there. (2) Locations will be sampled reiteratively, not individuals.

Page 7, para 2: “To map predicted radiation levels based on the distribution of dose-estimated patients around the prediction location” It is locations sampled by physical dosimetry that have a distribution – not patients.

Figure legend 2; last sentence “% of the individuals eligible for cytokine treatment” – locations (weighted for population density) where treatments of individuals might be necessary.

Page 15; para 2; sentence 1: “subset of irradiated individuals”. Subset of locations - there is no a priori assumption about irradiation of individuals. Sentence 2: unirradiated individuals. Sentence 3: irradiated individuals.

Page 16; para 2; sentence 1: “incorrect sampling of potentially exposed individuals”.

Page 16; para 2; last sentence: “fewer irradiated individuals”.

Page 16, bottom; Page 17 top: The inclusion of variation for biodosimetry, especially for specific methods, is irrelevant (and misleading) – the simulations and the kriging are based solely on physical dosimetry.

Page 19; para 3: This discussion is useful but misses the point. If one can only practically process 160 individuals by biodosimetry (the time frame does not permit going back for a second sample), then one must focus on those most likely to be shown to irradiated (> 2 Gy). And one must have this subset within a few days at most (allowing how many rounds of physical dosimetry for kriging?). Beyond that, one is too late to initiate cytokine therapy with any expectation of success. Also unaddressed is whether the proposed biodosimetry techniques are effective for assessing cumulative chronic doses (over a few weeks) – or whether they have all been developed using a specific (24 hr?) time point of sampling after a single acute radiation exposure. If that is the case, then even 3-4 days for physical dosimetry kriging may not be beneficial

A final major issue that is subject to misinterpretation by an audience that is not familiar with the radiation countermeasures/response field is contained in the last sentence of Figure legend 1. ”The individuals residing in this part are eligible to be treated by cytokine therapies.” This implies that treatment (with potentially deleterious effects) would be administered to individuals on the basis of either a physical dosimetry measurement map that includes their location or even a biodosimetry assessment of a neighbor – but not themselves. This is most likely to be the case. Or if the authors, believe that it would be, they should provide a citation for the strategy.

In all, the authors present what could be a valuable aide in directing triage and treatment of selected individuals in the aftermath of a nuclear scenario. But it must be presented reasonably and without the potential to confuse and mislead a readership that will be predominately be unfamiliar with any radiation dosimetry methods or with the strategies likely to be employed in such a situation.

Reviewer #2: The authors use geospatial modeling in an attempt to decrease the need for radiation dosimetry in the setting of a large scale disaster. They modeled 30 scenarios, including 22 urban/high-density and 2 rural/low-density scenarios under various weather conditions. Multiple (3-10) rounds of sampling and kriging were required for the dosimetry maps to converge, requiring between 73 and 417 samples for different scenarios. On average, 70±10% of locations where populations are expected to receive an exposure ≥2Gy were identified.

They conclude that geostatistical mapping limits the number of individuals requiring dose assessment, the time required, and radiation exposure to first responders. Geostatistical analysis will expedite triaging of acute radiation exposure in population-scale nuclear events.

This manuscript is a highly mathematical approach to a major problem in a mass casualty event concerning radiation exposure. The major hurdle with this reviewer is that this approach does not really solve the problem. Based on their data from table 1, the range is so variable that this reviewer does not see the value of this approach. For example, the accuracy is as low as in the 20% range making this approach inferior to a coin toss. The best case scenario is in the low 80% range. I am not clear that this provides much more information since it’s not clear what the responders would approach the other 20% that did receive a higher dose.

Lastly, a major difficulty is partial body shielding which would make this approach even more difficult to interprete.

**********

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Submitted filename: The authors use geospatial modeling in an attempt to decrease the need for radiation dosimetry in the setting of a large scale disaster.docx

PLoS One. 2020 Apr 24;15(4):e0232008. doi: 10.1371/journal.pone.0232008.r006

Author response to Decision Letter 2


26 Feb 2020

Summary of New Data Analyses added to Version 3 of the manuscript (for Editor and Reviewers):

1. We computed the accuracy of the derived plumes at the 3Gy radiation level. We hypothesized that because regions more distant from the epicentre of the nuclear event were less densely populated and less compact at the 2 Gy contour compared to the 3 Gy contour in some scenarios that the performance of the proposed method might improve at the higher radiation threshold. Plumes at the 3Gy level were similar to the HPAC plume in many scenarios (see Table 1, rightmost column), and this is described in the Results.

2. The initial conditions for stopping our procedure (>90% concordance between areas of consecutive plumes) were specified for rapid computation of an initial radiation plume map in a triage situation. We determined whether these convergence criteria were optimal using a higher stringency of overlap between the plumes of consecutive iterations of geostatistical analysis (>99% concordance) for one replicate in each scenario. The accuracy for some scenarios improved significantly (supplementary table S4, Figures S2 and S3), and this is summarized in the Results.

3. We estimated the magnitude of 2 Gy plume error by varying the contour threshold of the derived plume until the differences between the HPAC and derived plumes were minimized. Based on Reviewer #2 comments, a significant amount of the error reported for each scenario replicate is relatively close to the desired threshold. For example, 63% of Boston MA replicate #3 is accurate at the 2Gy contour, but 86% of the missing plume area occurs within 1.7-2.0 Gy exposure level. This is now described in the Discussion.

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

________________________________________

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: No

Response:

We note that Reviewer #2 has changed their decision from Yes in the previous two revisions of the manuscript. Based on Reviewer #2 comments in this most recent review, we assume this is due to the accuracy values presented in the manuscript, which have now changed since the initial draft of the manuscript. The particular replicates that the Reviewer has commented on consist of small numbers of samples in two scenarios with low density populations predominantly in rural areas. We have addressed this by performing additional simulations with increased initial population densities (0.2, 1.0%) and adding additional iterations of kriging and densification. Both of these have improved the final accuracies for these replicates.

________________________________________

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

________________________________________

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

________________________________________

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

Response:

Documentation of specific errors as requested by PLOS ONE has not been provided by Reviewer #2.

Based on the evidence after multiple rounds of review, reviewer #2 clearly understands the main points addressed in the manuscript, that is, the paper is written in an intelligible fashion. After multiple revisions, this Reviewer has not listed any errors in our grammar, spelling or clarity of presentation.

________________________________________

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:

1. This manuscript is definitely getting better; however, there remain problematic issues that relate to the potential for a causal reader to be misled as to what was done and what the results mean.

Response:

On multiple occasions, this Reviewer has indicated that we have mislead or have the potential to mislead the casual reader regarding terminology related to the types and methods of processing samples. We do not share this view. Nevertheless, have modified our manuscript to be agnostic about the type of dosimetry that can be used with the method we propose. We sincerely believe that this latest revision alleviates any remaining issues that led to their perception. We discuss this in greater detail in several of the responses below.

2. The Abstract is now an appropriate description of what was done. A minor suggestion is to move the first sentence of the Methods to before the current third sentence (Initially …). This would emphasize that this is a modelling exercise and that exposures or boundaries were not actually determined.

Response:

We agree to your suggestion and have changed the Abstract accordingly.

“Methods: Physical radiation plumes modelled nuclear detonation scenarios of simulated exposures at 22 US locations. Models assumed only location of the epicenter and historical, prevailing wind directions/speeds. The spatial boundaries of graduated radiation exposures were determined by targeted, multistep geostatistical analysis of small population samples...”

3A. One remaining issue in the manuscript body is in the overlap or inappropriate implied equivalence of “individuals” and “locations”. The authors should confirm (by searching for the words) that when talking about measurements or sampling or results that location is applied to physical dosimetry and individual is restricted to biodosimetry. Some of these may just be residual from prior versions but need to be corrected. This would then allow the appropriate inference by the reader that locations are fixed and may accurately reflect physical dose levels at or in proximity to that location. This then leads to a reasonable assumption that interpolation between two locations (by additional sampling) is likely to refine dose boundaries.

Response:

The changes made to the manuscript in our previous revision were to generalize the text so that it could apply to any type of dosimetry method, as long as all measurements in a dosimetry map were obtained using the same method. We state that we are simulating “physical or cytogenetic dosimetry”, as dosimetry data from either method would result in an accurate plume. We have gone through the manuscript again in an attempt to further generalize the text to avoid any confusion about our presentation. Most uses of the term “individuals” have been changed to “samples.” In the Methods section, we define the term “samples” to refer either emissions measured by physical radiation detectors at the time of the nuclear incident or to radiation levels absorbed by biological samples. Since there could be differences between the radiation levels obtained by different methods, we indicate that the dosimetry maps are assumed to be consistently derived by the same method.

The proposed geostatistical method can only be used with dosimetry at known physical locations. This is feasible by design of physical detectors containing GIS devices. In the case of biological samples, the random access memory of cellular telephones carried by individuals should still retain of the last known locations, even in the event of an electromagnetic storm that affects network function. Only biological samples remaining at a fixed location after the nuclear incident would be eligible for geostatistical analysis. The advantages and drawbacks of different dosimetry methods (see next section) do not negate the core claim of this manuscript that the geostatistical method proposed would reduce the required sampling to develop a sufficiently accurate plume for triage purposes.

Table 1 indicates the number of unique samples used to derive our plume. We would like to point out that the number of samples in this table has been decreased significantly. This was due to identical samples being counted as unique if separate densification steps had selected the same location more than once. This was corrected, which reduced the number of samples (from a range of “73 - 417” to “58 – 347”).

3B. The same cannot be said for individuals. A value for a third individual, sampled at a location between the locations where two initial individuals were assessed by biodosimetry, would not a priori be expected to provide an intermediate biodosimetry value. This could be due to heterogeneity in inherent radiosensitivity of the population, movement by the individual, comorbidities, or any of the reasons that the authors allude to. This also leads into the need to be precise as to what measurements are reasonable to utilize for the kriging process and the re-iterative process. That is, one can reasonably postulate additional physical dosimetry sampling over a few days to refine dose boundaries that then can be used to perform biodosimetry on a selected set of individuals. But with the time restraints of biodosimetry it is not practical to consider more than one sampling as contributing to the triaging process. But current wording might suggest otherwise. As an example, at the bottom of page 3, there is the following:

“One approach to alleviating the need to triage all potentially exposed individuals would be to survey a subset of individuals combined with their respective locations by geostatistical analysis. We demonstrate that combining such surveys with the geolocations of these measurements can reduce sampling requirements in population-scale radiation scenarios and would be expected to decrease total radiation exposures of first responders.”

The term “combining” might be interpreted as using the two dosimetry methods reiteratively. Also “surveys” of individuals might be mis-interpreted as multiple surveys (i.e., biodosimetry) in the same general vicinity to aid in the kriging, rather than a single targeted survey of individuals in a location selected by the physical dosimetry kriging.

Response:

Each dosimetry method has advantages and drawbacks but determining the best type of dosimetry method to be used is not (and has never been) the purpose of this study. The objective of the paper is to find a way to accurately map radiation with limited sampling. Our approach could accelerate treatment decisions in a way that has not been previously considered.

There are no optimal dosimetry methods. Applications of biodosimetry may be limited due to the total time required to obtain results, but it does not diminish the value of those results. Complete reliance on physical dosimetry may be concerning, since it does not measure the amount of radiation that has been absorbed and may also be prone to false positives. From the revised Discussion:

“Biodosimetry estimates absorbed exposures, whereas physical dosimeters measure environmental emissions. Physical dosimetry is more rapid and can map changing radiation plume locations dynamically. However, unfiltered radiation emissions are prone to false positive readouts, for example in aerial physical dosimetry counterterrorism surveys (Karam, 2017) due to common environmental sources of radiation. Uncorrected, such data will introduce errors and distort geostatistical-derived plumes. Mitigation may be possible by specifying the locations of radiation detectors by iterative kriging and densification. Nevertheless, biodosimetry at specified locations may provide results that might be useful in assessing treatment eligibility, especially in instances of borderline clinical exposures.”

We specify in the Methods section that sampling of consecutive iterations should use the same approach at each stage of refinement to derive an accurate plume. Our intent is to generalize the text in the manuscript to be agnostic to the dosimetry method used to derive a plume. Changes to the paragraph rectify this as well.

“One approach to alleviating the need to triage all potentially exposed samples would be to survey a subset of samples and their respective locations by geostatistical analysis. This survey may involve location-based physical dosimetry, where high-risk individuals are tagged based on their proximity to nearby detectors. We demonstrate that combining surveys using uniform methodologies with the geolocations of these measurements can reduce sampling requirements in population-scale radiation scenarios. This would also be anticipated to decrease overall radiation exposures to first responders.”

4. Last sentence of Introduction: “kriging using a relatively small number of samples analyzed by physical or biodosimetry methods.” Biodosimetry needs to be removed, but the sentence can be extended to state using kriging of physical dosimetry to aid in selection of individuals for biodosimetry.

Response:

As previously mentioned, we have decided to simplify the text so that the text does not specify the dosimetry method used, as a plume can be derived with any type of dosimetry method as long as it is consistent. We have therefore changed the last sentence of the Introduction to the following:

“The question this paper addresses is whether the radiation plumes derived by HPAC can be reconstructed with iterative kriging using a relatively small number of samples consistently analyzed by the same dosimetry method.”

5. Page 5: “Densification is the geostatistical procedure that targets and localizes an additional small cohort of irradiated individuals (1) to mitigate uncertainty in environmental measurement. These kriging and densification processes are repeated for a limited number of iterations until the coverage area and the radiation level contours of the inferred plume stabilizes (i.e. sampling of additional individuals (2)”. (1) it identifies a location, not any individuals who might be there. (2) Locations will be sampled reiteratively, not individuals.

Response:

. The text has been generalized in the following manner:

- For issue (1): We have changed “irradiated individuals” to “sampling locations”.

- For issue (2): We change “sampling of additional individuals” to “additional sampling”.

This text is now:

“Densification is the geostatistical procedure that targets and localizes an additional small cohort of sampling locations to mitigate uncertainty in environmental measurements. These kriging and densification processes are repeated for a limited number of iterations until the coverage area and the radiation level contours of the inferred plume stabilizes (i.e. additional sampling in the affected area does not significantly alter the geographic coverage of the plume or the estimates of absorbed radiation dose).”

6. Page 7, para 2: “To map predicted radiation levels based on the distribution of dose-estimated patients around the prediction location” It is locations sampled by physical dosimetry that have a distribution – not patients.

Response:

To generalize this sentence, we have changed “patients” to “samples” as this includes physical dose measurements. The sentence now reads as follows:

“To map predicted radiation levels based on the distribution of samples across the location of interest, …”

7. Figure legend 2; last sentence “% of the individuals eligible for cytokine treatment” – locations (weighted for population density) where treatments of individuals might be necessary.

Response:

As suggested, we have edited the sentence to state that we are computing a dose estimate for a location (weighted by population density), rather than for individuals specifically:

“… the converged plumes localized 80.3% and 75% of the locations (weighted for population density) for treatment-eligible radiation exposures in these scenarios. “

8. Page 15; para 2; sentence 1: “subset of irradiated individuals”. Subset of locations - there is no a priori assumption about irradiation of individuals. Sentence 2: unirradiated individuals. Sentence 3: irradiated individuals.

Response:

As previously mentioned, this does not preclude the proposed method from being used to derive radiation plumes based on biologically-determined dose, regardless of assumptions about processing time (see our response to point 11 below). As a compromise, rather than using the word “locations”, we have used the word “samples”, or have modified the sentence to remove the segment which used the word entirely.

9. Page 16; para 2; sentence 1: “incorrect sampling of potentially exposed individuals”. Page 16; para 2; last sentence: “fewer irradiated individuals”.

Response:

Both suggestions pertain to a paragraph discussing dosimetry measurement error. We have modified the first sentence of this paragraph to eliminate the text referring to exposed individuals:

“…it might be expected to lead to improper sampling.”

For the final sentence of the paragraph, we eliminated the word “individuals” and replaced it with “samples”.

10. Page 16, bottom; Page 17 top: The inclusion of variation for biodosimetry, especially for specific methods, is irrelevant (and misleading) – the simulations and the kriging are based solely on physical dosimetry.

Response:

In response to this reviewer’s previous comments, we revised the text to be agnostic to the type of dosimetry method used to obtain the data. As we have indicated (and cited), physical dosimetry is also prone to systematic sources of radiation measurement error. This justifies inclusion of the examples given in the text. We do not agree with the reviewer’s claim that inclusion of variation in radiation measurements is irrelevant and misleading. Indeed, the examples provided illustrate the robustness of the proposed methods to different sources of systematic error. The section on inferred radiation exposures under sub-optimal sampling conditions remains relevant, and we argue, is a strength of our approach. We have therefore included “physical dose estimation error” as an example of possible sources for variation in radiation dose measurements.

“Maximum deviations were designed to represent confidence values in physical and/or biodosimetry methods, including physical dose estimation error (29), dicentric analysis…”

11. Page 19; para 3: This discussion is useful but misses the point. If one can only practically process 160 individuals by biodosimetry (the time frame does not permit going back for a second sample),

Response:

The reviewer appears to assume that First Responses to a nuclear incident regarding sample acquisition and laboratory processing samples will be limited in scope and resources. However, in our previous response to this reviewer, we suggested that field, laboratory and computational resources could be amplified through parallel deployment of multiple dedicated teams and automation. Indeed, we cited a recent, peer-reviewed Concept of Operations article in Radiation Protection Dosimetry that recommended large scale processing and multiple procurement mechanisms. We suggest that the reviewer consider such alternatives, which could overcome the capacity and time limitations that s/he envisions in a large scale nuclear incident.

11. (continued) then one must focus on those most likely to be shown to irradiated (> 2 Gy). And one must have this subset within a few days at most (allowing how many rounds of physical dosimetry for kriging?). Beyond that, one is too late to initiate cytokine therapy with any expectation of success.

Response:

Our paper does not model how long dosimetry testing and measurement will require or what type of testing (physical or biological) will be performed. The reviewer’s assumptions about what would be feasible to accomplish within a 3 day time frame seem to be predicated on a single field team sampling exposed individuals or placing radiation detectors followed by sequential geostatistical analysis. With high performance computing and parallel processing, it should be possible to model different data sources at the same time, and then combine these into more robust geostatistical models. It is really beyond the scope of this first publication on the subject (nor do we have the resources to perform at this time) large scale modeling of multi-source data processing and geostatistical analysis. Nevertheless, we stand by the main conclusions of the paper, that strategic sampling guided by geostatistical methods of a relatively small fraction of irradiated “samples” can be used to compute exposures for much larger populations.

11. (continued) Also unaddressed is whether the proposed biodosimetry techniques are effective for assessing cumulative chronic doses (over a few weeks) – or whether they have all been developed using a specific (24 hr?) time point of sampling after a single acute radiation exposure. If that is the case, then even 3-4 days for physical dosimetry kriging may not be beneficial

Response:

We state that biodosimetry does not address dynamic changes in radiation levels which have cumulative effects. Physical dosimetry can provide dynamic measurements of emitted radiation, but does not measure how much radiation is absorbed. In any case, distinctions about intermediate or long term exposures are not relevant in a triage situation where the existing testing capacity may not be sufficient to process every individual or sample that would be desirable to create a dense dosimetry plume map.

12. A final major issue that is subject to misinterpretation by an audience that is not familiar with the radiation countermeasures/response field is contained in the last sentence of Figure legend 1. ”The individuals residing in this part are eligible to be treated by cytokine therapies.” This implies that treatment (with potentially deleterious effects) would be administered to individuals on the basis of either a physical dosimetry measurement map that includes their location or even a biodosimetry assessment of a neighbor – but not themselves. This is most likely to be the case. Or if the authors, believe that it would be, they should provide a citation for the strategy.

Response:

We concur that the derived map would not be used – by itself - as the sole basis of managing treatment. The described method is designed to triage and identify individuals who may benefit from treatment in situations, based on limited sampling of irradiated individuals in the affected geographic regions. The Introduction of the paper describes multiple clinical criteria that contribute to the diagnosis of Acute Radiation Syndrome, and nothing in the paper disputes any of these criteria. Besides symptoms, laboratory testing would contribute valuable confirmation of these symptoms (especially if they were mild or non-specific due to presence of other confounding diagnoses) may treatment, which may include cytokine therapies.

To avoid any confusion or misinterpretation, we have decided to delete this sentence entirely from the Figure 1 legend, as it is unrelated to the content of Figure 1. Furthermore, the significance of the >2Gy threshold has been stated elsewhere in the manuscript.

13. In all, the authors present what could be a valuable aide in directing triage and treatment of selected individuals in the aftermath of a nuclear scenario. But it must be presented reasonably and without the potential to confuse and mislead a readership that will be predominately be unfamiliar with any radiation dosimetry methods or with the strategies likely to be employed in such a situation.

Response

We modified the paper according to the reviewer’s recommendations to avoid endorsement of any particular dosimetry method. We believe that those deciding what strategy to employ after a nuclear incident should not be bound by previous dogma about which types of dosimetry to perform and when. Further research in this area could address optimization of geostatistical analysis when multiple dosimetry data types are collected.

However, the purpose of this study was to introduce this approach and demonstrate using simulations that it could provide a means of inferring radiation across the landscape given a limited set of assumptions (epicentre, wind vector, and weather), and fewer radiation measurements. For us to provide a complete TR7-level solution at this stage would be beyond the scope of this paper.

Reviewer #2:

The authors use geospatial modeling in an attempt to decrease the need for radiation dosimetry in the setting of a large scale disaster. They modeled 30 scenarios, including 22 urban/high-density and 2 rural/low-density scenarios under various weather conditions. Multiple (3-10) rounds of sampling and kriging were required for the dosimetry maps to converge, requiring between 73 and 417 samples for different scenarios. On average, 70±10% of locations where populations are expected to receive an exposure ≥2Gy were identified. They conclude that geostatistical mapping limits the number of individuals requiring dose assessment, the time required, and radiation exposure to first responders. Geostatistical analysis will expedite triaging of acute radiation exposure in population-scale nuclear events.

This manuscript is a highly mathematical approach to a major problem in a mass casualty event concerning radiation exposure. The major hurdle with this reviewer is that this approach does not really solve the problem. Based on their data from table 1, the range is so variable that this reviewer does not see the value of this approach. For example, the accuracy is as low as in the 20% range making this approach inferior to a coin toss. The best case scenario is in the low 80% range. I am not clear that this provides much more information since it’s not clear what the responders would approach the other 20% that did receive a higher dose.

Response:

We reject the notion our “mathematical approach“ should be expected to completely identify every single individual with clinically relevant radiation exposure levels. We anticipate that it will be primarily applied in triage situations soon after a nuclear incident, with the primary focus of providing guidance for an orderly and efficient response in the early stages of in a large scale nuclear incident.

The reviewer misstated the performance of our best case scenario which was actually 90.7% overlap of the Burlington VT HPAC plume at the 2Gy plume contour. The current version of the manuscript now demonstrates that the accuracy of overlap between plumes –where it counts- at higher radiation levels (3 Gy) is higher for most of the scenarios that we present. Nearly all of the contours are contiguous and non-intersecting, that is 3 Gy exposures which are miscalled are still interpreted as >2 Gy. Although incorrectly determined high level exposures are slightly underestimated, such individuals will still be brought to clinical attention.

To the best of our knowledge, this is the first report of this approach for triaging radiation exposed individuals for sample measurement. While it may not be perfect, we present a novel, useful and scientifically valid solution to a longstanding problem. Perfection is likely unachievable. Indeed, as we describe, physical radiation measurements and biodosimetry testing also contribute systematic error, and therefore even the most comprehensive saturation testing protocols will be susceptible to such errors.

We have revised and ensured that this paper meets the criteria for publication in PLoS ONE. Specifically, the simulations we performed have been conducted rigorously, with appropriate replication, and we have presented a wide variety of scenarios to explore the strengths and weaknesses of the proposed approach. The data presented in the manuscript support the conclusions drawn and are not overstated. Methods and data have been deposited in publicly available resources. In fairness, we ask the Reviewer to consider the publication criteria that the journal has established in assessing our contribution.

We have been honest and transparent about sources and impacts of error in radiation measurements and limitations of the approach for computing accurate low level radiation exposures. For example, the census data that is publicly available is not as granular as the data that the US Census Bureau actually collects. Thus, when we compute the number of samples that would be impacted by a radiation plume, this requires us to compute the population density for the minimal reported geographic region, which is usually a county subdivision. This averages impact over a geographic area and affects the accuracy of our estimates. Small overlapping segments of subdivisions are particularly prone to these types of errors. Also, we show that the reported accuracy does depend on the fraction of the total population that is initially sampled, and that sparsely populated regions are more prone to lower levels of accuracy (see below).

While the majority of scenarios gave results consistent with the HPAC plume, there were 2 exceptions. We have performed additional work that provides an explanation of the particular Columbia SC and Columbus OH anomalous replicates which did not reproduce the HPAC plume (Results, 3rd paragraph, Discussion 2nd paragraph). Initial sampling for these replicates exhibited sparse coverage over large regions of the HPAC plume. Densification steps did not select locations for further sampling. Scenarios with low population density appear to be susceptible to this problem. We demonstrate that it can be mitigated by either increasing sampling density, or by strategically selecting sampling locations within this region.

From the Discussion:

“In a real-world scenario, secondary sampling locations assigned by densification would be supervised, which would direct the software towards derivation of a complete and accurate plume. Indeed, we found that manually adding two new sample locations to the unrepresented region corrected the poor results obtained for the Columbia SC scenario replicate after two additional cycles of kriging and densification. “

Lastly, a major difficulty is partial body shielding which would make this approach even more difficult to interpreted.

Response:

Reviewer #2 had previously mentioned shielding during the first round of revisions:

“The major concern is that the radiation doses in a large city will be inhomogeneous due to partial shielding. How does this algorithm account for such events?”

To which we responded:

The Discussion describes the limitations of our method. Here, we discuss how shielding (or “shadowing”) by infrastructure is not accounted for, and how these concessions may limit the overall accuracy of our method.

Results (Paragraph 3, page 18): “Finally, neither the HPAC version available for this study, nor our geostatistical models account for shielding by infrastructure, such as shadowing, which computes the degree to which radiation is prevented from reaching certain locations by the urban environment (35). While these factors will impact the predicted accuracies of derived dosimetry maps, these effects will also have to be accounted for in ground truth models, such as HPAC, before they could be addressed in geostatistical interpolation.”

During the second round of revisions, it seemed that this response had satisfied the reviewer:

“Reviewer #2: all concerns addressed - no further comments”

In the future, obstacles that occlude diffusion of radioactive particles could be factored into the derived plume. Samples from city neighborhoods with densely arrayed, tall building infrastructure may be partially shielded, resulting in lower actual exposures to ionizing radiation. However, we did not and still do not have access to these calculations to test this possibility, since these algorithms and software, to the best of our knowledge, are not publicly available.

Attachment

Submitted filename: Response-to-Reviewers.Third-Revision Final.docx

Decision Letter 3

Gayle E Woloschak

12 Mar 2020

PONE-D-19-22325R3

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

PLOS ONE

Dear Dr, Rogan:

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Additional minor comments have been suggested by one reviewer.  Please address these in a revision.

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Gayle E. Woloschak, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

One reviewer has suggested some minor edits for the work in the comments below.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Partly

Reviewer #2: Yes

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Reviewer #1: N/A

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: Yes

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6. Review Comments to the Author

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Reviewer #1: Still a few instances where the term “individuals” is inaccurate or misleading. These are easily corrected without changing the meaning of the sentence.

Page 2; para 4; line 6-7: “limits the number of individuals requiring dose assessment”. Suggest re-wording as “limits the number of required dose assessments”

Page 4; para 3; line 2-3: “subset of radiation exposed individuals or locations”.

Page 6; para 3; line 8: “locations of either radiation-exposed individuals or physical radiation detectors”. The problem here is not specifically with individuals but with the conclusion that they are all radiation-exposed (which assumes knowledge prior to testing). Moreover, it is acknowledged that most physical dosimetry readings will be zero. For simplicity, can the phrases be replaced with “subset of individuals or locations” and “locations for dose assessment”, respectively? The phrase is also used on page 18 (last line) but is not so critical there.

Page 21; para 2; line 8-9: “the number of tested individuals necessary for derivation of an accurate plume” Replace individuals with samples.

Lastly, there is an apparent discrepancy which even if the statements are correct could confuse the reader. On page 6; para 3; line 6 it is stated that “random samples, which corresponded to 0.1% of the population of each sub-division”. On the next page (para 2; line 6) there is a similar statement “random points representing 1% of the population of the … subdivisions”. Should it be 0.1% in both places? That would make the value of 223/617 more reasonable than 223/6175. If the text is correct, a few additional words of explanation might be helpful. 0.1% is also used on page 18

Because there have been modifications to the data and how they are presented, I re-examined the tables (table 1 plus supplementary) for clarity and consistency.

Page 6; para 2; line 11-12: “(topological contours range from 1.0-7.0Gy in intervals of 0.5Gy).” From Figure 2 it appears that the intervals are 1 Gy.

Page 7; para 1; line 5-6: “The number of random samples generated for each scenario, and how many of those overlapped the HPAC plume, is available in S1A Table”. It would be helpful to place here the statement in the next paragraph that “overlapped” equates to samples >0Gy.

Page 10; para 1; line 1 (Figure 2 legend): “The total number of samples in one iteration is indicated (in parentheses)”. It seems that the numbers shown are not total samples but rather samples >0 Gy.

Page 11; para 2; line 7: The potential for confusion mentioned in the above item is repeated here. The phrase used of “irradiated samples” is imprecise. No samples were irradiated; rather, what is meant here is samples with a dose greater than 0 Gy. The potential for confusion is enhanced when in Table 1 the column header is simply “No. of Samples” without reference to these being greater than 0 Gy. The same appears in Table S2.

Page 15; para 3; line 3: “majority of these locations did not overlap with the HPAC plume and have therefore been modelled as unirradiated samples.” Majority is an understatement. From table S1A, the lowest frequency of values generated as 0 Gy was 94.5%. But in some regions (Chicago) it can be 99%. Which would seem to suggest that in these scenarios the first iteration might provide the outer boundaries (for any dose) but would provide little in the way of interior contour structure. The situation is even worse when one starts with a low number in addition to low frequency. For Cincinnati, with 2 points with dose (0.5%), how can any contour be derived? The result seems to be that a larger number of iterations is then required to derive the final plume. But then this doesn’t hold true, with 6 and 8 iterations required when starting with two points, yet 9 iterations when starting with 9 dose points. On the other hand, Chicago consistently required only 4 iterations (and a low number of samples) to reach the final plume [Or is this something trivial such as all the wind blows east and it is easy to model doses in the lake where there is no population?]. A critical aspect – in a disaster scenario – would be the number of iterations (and the time) required to arrive at a final plume. Is there any analysis that could assist in identifying factors (other than initial sampling size) that could be used to reduce the number of iterations?

Considering the two comments above, it would seem that a useful set of data would be the actual numbers of both samples with dose and samples without dose that are added at each iteration step. In other words, how does one go from 2 and 393 (first step for replicate 1 for Cincinnati) to 139 and ??what is the total number of samples with zero dose that end of being selected?? One would expect that with each iteration there are proportionally more samples with dose and fewer without dose. But the “improvement” at each step, and the total number of samples that have to be assessed in a real-word scenario are critical aspects of the potential utility of this approach. As it is, the reader is unable to evaluate the overall requirements. I might argue that this information is more meaningful that the replicates in Table 1 (which could be presented in a supplemental table).

Figure 2A: The numbers shown for Samples at first and final iteration (assuming >0Gy), BCD and RMSD for final vs HPAC plume do not agree with values provided in Table 1 and S1A. For B (Albany), only the sample number in first iteration (12) agrees with table S1A and Table 1.

In summary, this paper has the most value if it is clear to the naïve reader what was done and how the strategy might be used to advantage. And for a reader knowledgeable in the field who wants to examine the process in detail, there must be sufficient accurate and consistent data to allow that.

Reviewer #2: no further comments - all addressed

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PLoS One. 2020 Apr 24;15(4):e0232008. doi: 10.1371/journal.pone.0232008.r008

Author response to Decision Letter 3


29 Mar 2020

Reviewer #1: Still a few instances where the term “individuals” is inaccurate or misleading. These are easily corrected without changing the meaning of the sentence.

Page 2; para 4; line 6-7: “limits the number of individuals requiring dose assessment”. Suggest re-wording as “limits the number of required dose assessments”

RESPONSE

The change has been incorporated.

Page 4; para 3; line 2-3: “subset of radiation exposed individuals or locations”.

Page 6; para 3; line 8: “locations of either radiation-exposed individuals or physical radiation detectors”. The problem here is not specifically with individuals but with the conclusion that they are all radiation-exposed (which assumes knowledge prior to testing). Moreover, it is acknowledged that most physical dosimetry readings will be zero. For simplicity, can the phrases be replaced with “subset of individuals or locations” and “locations for dose assessment”, respectively?

RESPONSE

These changes have been incorporated to both locations of the manuscript.

The phrase is also used on page 18 (last line) but is not so critical there.

RESPONSE

The last line of this paragraph has been changed to the following:

“After a nuclear incident, processing all individuals for dose assessment has been acknowledged to be labor intensive, and would likely be a major bottleneck in identifying those who require immediate treatment (32). “

Page 21; para 2; line 8-9: “the number of tested individuals necessary for derivation of an accurate plume” Replace individuals with samples.

RESPONSE

The suggested change has been incorporated.

Lastly, there is an apparent discrepancy which even if the statements are correct could confuse the reader. On page 6; para 3; line 6 it is stated that “random samples, which corresponded to 0.1% of the population of each sub-division”. On the next page (para 2; line 6) there is a similar statement “random points representing 1% of the population of the … subdivisions”. Should it be 0.1% in both places?

RESPONSE

No. The 1% sampling rate on page 7 was only used to compare the results of the different kriging approaches. Once the EBK was determined to be the best approach, initial sampling was performed at 0.1% of the population as indicated on page 6. We have clarified the text on page 7 to make the reasons for sampling at 1% clearer to the reader.

That would make the value of 223/617 more reasonable than 223/6175. If the text is correct, a few additional words of explanation might be helpful. 0.1% is also used on page 18

*RESPONSE

The default initial sampling rate for all scenarios was 0.1% of the population. However, Table 1 also shows the results at higher initial sampling rates tested for the Columbia SC (0.2% and 1.0%) and Columbus OH (0.2% only) scenarios, which significantly improved the performance of the method in these cases. As explained in the manuscript, these regions exhibited strong inhomogeneity in population densities, especially in regions of the plume that were more remotely located from the epicentre of the event. We believe this is clearly explained in our previous response to this reviewer and in the manuscript itself.

Because there have been modifications to the data and how they are presented, I re-examined the tables (table 1 plus supplementary) for clarity and consistency.

Page 6; para 2; line 11-12: “(topological contours range from 1.0-7.0Gy in intervals of 0.5Gy).” From Figure 2 it appears that the intervals are 1 Gy.

*RESPONSE

In this paragraph, we are describing the raw HPAC data, which indeed consists of contours at intervals of 0.5Gy. For clarity, however, we set ArcMap to only display the contours at 1.0Gy, as displaying all contours (N=13 total) made the plumes difficult to interpret visually.

We want to make it clear that this decision has absolutely no impact on the overall accuracy of the derived plumes. When assigning our simulated sampling locations a radiation value based on its location relative to the HPAC plume, this included all contours (including 1.5Gy, 2.5Gy, etc).

Page 7; para 1; line 5-6: “The number of random samples generated for each scenario, and how many of those overlapped the HPAC plume, is available in S1A Table”. It would be helpful to place here the statement in the next paragraph that “overlapped” equates to samples >0Gy.

RESPONSE

The suggested change has been incorporated.

Page 10; para 1; line 1 (Figure 2 legend): “The total number of samples in one iteration is indicated (in parentheses)”. It seems that the numbers shown are not total samples but rather samples >0 Gy.

*RESPONSE

As requested, this is now indicated in the figure legend.

Please note that this was already clear, as previous text had already addressed this issue:

p.7 (para 2) “of which 223 points overlapped the Boston HPAC plume (predicted dose >0Gy” and “A high number of unirradiated (0Gy) samples can depress the range of the plume; therefore, these locations were restricted to the subdivisions immediately surrounding the irradiated region.”

p.8 (para 1) “As a consequence, the process often did not always yield 200 unique samples with values exceeding 0Gy”

Page 11; para 2; line 7: The potential for confusion mentioned in the above item is repeated here. The phrase used of “irradiated samples” is imprecise. No samples were irradiated; rather, what is meant here is samples with a dose greater than 0 Gy.

RESPONSE

The change has been incorporated.

The potential for confusion is enhanced when in Table 1 the column header is simply “No. of Samples” without reference to these being greater than 0 Gy. The same appears in Table S2.

*RESPONSE

Tables 1 and S2 are first referenced on page 11. The limitation of samples to those >0Gy is described on pages 7 and 8 (see response to above comment). Although the predicate statements are sufficiently clear regarding the results shown in these Tables, we have incorporated the change requested by the reviewer.

Page 15; para 3; line 3: “majority of these locations did not overlap with the HPAC plume and have therefore been modelled as unirradiated samples.” Majority is an understatement. From table S1A, the lowest frequency of values generated as 0 Gy was 94.5%. But in some regions (Chicago) it can be 99%. Which would seem to suggest that in these scenarios the first iteration might provide the outer boundaries (for any dose) but would provide little in the way of interior contour structure.

*RESPONSE

This lack of definition of the plume in the first iteration is evident from the Albany example in Figure 2 in the manuscript. It is important to recall that the only assumptions are the location of the epicentre and the approximate wind vector, so there is no expectation that it will be accurate at this stage. The subsequent steps identify the map locations with lowest confidence (highest variance) radiation estimates to define the locations for sampling in the next round of densification. See text below which address how these locations are chosen (page 8).

Furthermore, please note that our method uses ArcMap software to select initial random points evenly across a subdivision. In some scenarios, the plume only encompasses a small portion of the total sub-division area (e.g. the Boston MA scenario), which is why some scenarios have a high proportion of 0Gy samples. In a real-world scenario, sampling could be limited to a considerably smaller area based on preliminary information (e.g. wind direction). This is why when discussing testing unirradiated samples in the Methods, we mention that aerial survey could help target initial sampling regions:

“We envision that testing could be greatly reduced by initially measuring background or low level physical radiation in population scale events by aerial surveys….”

p. 7 of Methods. This statement has been included in the past several revisions of the manuscript but has been updated to improve clarity.

The situation is even worse when one starts with a low number in addition to low frequency. For Cincinnati, with 2 points with dose (0.5%), how can any contour be derived?

*RESPONSE

This is actually one of the strengths of the geostatistical approach. So long as there are at least two samples with exposure >0 Gy, densification can derive the locations of additional samples in subsequent iterations.

“There are instances in which 2 irradiated samples were adequate to progress plume development (e.g. Cincinnati urban sampling #2 [Table 1]).

We also demonstrate this by intentionally mis-specifying the wind vector in the section titled “Inferred Radiation Exposures Under Suboptimal Sampling Conditions” on page 17:

“The 0.05:0.2% ratio simulates a wind measurement error of 29.1º north (or N 22.8º W) relative to the actual wind direction of the HPAC plume. The 0.01:1.0% corresponds to a deviation of 40.9º north (or N 11.0º W). Despite this initial sampling error, inferred radiation plumes comparable to the correct plume were obtained.”

In a previous revision of this article, the reviewer requested that we eliminate this section of the manuscript. The reviewer seems to misunderstand this aspect of geostatistical dosimetry, but it clearly demonstrates that a plume can be defined even if only a small number of initial locations with dose estimates > 0 Gy have been identified within the derived plume.

The result seems to be that a larger number of iterations is then required to derive the final plume.

RESPONSE

Usually this generalization is correct, but not in all instances, see below.

But then this doesn’t hold true, with 6 and 8 iterations required when starting with two points, yet 9 iterations when starting with 9 dose points. On the other hand, Chicago consistently required only 4 iterations (and a low number of samples) to reach the final plume [Or is this something trivial such as all the wind blows east and it is easy to model doses in the lake where there is no population?].

RESPONSE

The distribution of samples is derived from the population density which is inhomogeneous in almost all scenarios (New York urban scenario, being an exception). Sampling in the proposed method is highly dependent on population density. Lake Michigan is never sampled because the US census doesn’t count any individuals in this location. This is a reasonable assumption whether physical- or bio-dosimetry is performed.

The number of iterations required can vary in different replicates because different initial random locations are selected often in distinct county subdivisions with distinct population densities. Replicates have the same number of initial samples selected in the same subdivisions. However, where these samples overlap the HPAC plume, their locations can differ, which appears to have a significant impact on the final derived plumes.

A critical aspect – in a disaster scenario – would be the number of iterations (and the time) required to arrive at a final plume. Is there any analysis that could assist in identifying factors (other than initial sampling size) that could be used to reduce the number of iterations?

*RESPONSE

The number of iterations required depends on many factors, but most critically, the stopping criteria for convergence of the process. We used 90% overlap between consecutive plume iterations because the process described here was intended for triage purposes. Subsequent more stringent criteria (99% overlap) shown in the previous version of this manuscript required more iterations, but was also more comprehensive relative to the HPAC plume.

Sampling strategies would be more precise with more granular street-level US Census data. We would not be limited to selecting sampling locations based on average population densities across county subdivisions, which themselves, can be quite inhomogeneous. This is not possible with publicly available data sources. This would optimize the selection of sampling locations across the topographic map of the final plume.

Considering the two comments above, it would seem that a useful set of data would be the actual numbers of both samples with dose and samples without dose that are added at each iteration step.

RESPONSE

We are comfortable with using the 0Gy measurements obtained by the US Department of Energy Aerial Surveys that would be used in the geostatistical analysis that defines the outer limits of the radiation plume. There is an excess of such measurements in these models, in order to focus the statistical analysis on defining the plume in regions where radiation (absorbed or emitted) is evident.

Our Zenodo archive now contains a file named “Progression-of-New-Densification-Selected-Sampling-Locations-For-All-Scenarios.xslx” which provides a categorical breakdown of how many unique densification-selected sampling locations occur within the irradiated region (i.e. overlap the HPAC plume) for each iteration of all scenario replicates. This Excel file is found within the archive “Intermediate-Derived-Plumes.Data-Points.zip”.

In other words, how does one go from 2 and 393 (first step for replicate 1 for Cincinnati) to 139

*RESPONSE

This is addressed on page 8 (text bolded):

The “Densify Sampling Network” tool of the Geostatistical toolbox indicates lower confidence regions in the kriging-derived map, i.e. regions with highest variance specifying radiation dose [17]. We applied this tool to limit results to regions that would most likely exceed a pre-defined radiation level threshold. In practice, the locations selected by densification would be used to direct first responders to new locations for subsequent rounds of data acquisition in order to improve the accuracy of the kriging-derived map. Using 2Gy as the critical threshold (selection criterion QUARTILE_THRESHOLD_UPPER option), densification on one plume identified a maximum of 200 new sampling locations. Densification is a compute intensive step, requiring approximately 1 hour on a desktop with an Intel i7-4770 processor [3.4Ghz] and 16GB of RAM. Note that reducing the number of requested sampling locations decreases overall processing time. The Densify Sampling Network tool would sometimes select a sample at the same latitude and longitude between iterations. Furthermore, many densification-selected samples did not overlap the HPAC plume. As a consequence, the process often did not always yield 200 unique samples with values exceeding 0Gy. New sample data were assigned radiation values based upon their locations within the HPAC-generated plume, and kriging was performed on these and the original samples to generate another iteration of the inferred plume.

We have previously addressed this particular issue during second revision of this manuscript. Our response to this reviewer’s comments e included a step-by-step breakdown of the derivation of a previously unreported replicate for the Columbus OH scenario.

“We find:

• Accuracy of plume from initial set of random samples only: 0% accuracy (the entire plume is <2Gy; image of plume in Section 4 of the online protocol) [N=8 samples > 0 Gy]

• Accuracy after 1 Iteration: 21.1% accuracy (image of plume in Section 5 of the online protocol) [N=55 samples > 0 Gy]

• Accuracy after 3 Iterations: 46.0% accuracy [N=79 samples > 0 Gy]

• Accuracy after 5 Iterations: 68.4% accuracy (final derived plume; image of plume in Section 6 of the online protocol) [N=136 samples > 0 Gy]”

and ??what is the total number of samples with zero dose that end of being selected??

*RESPONSE

Densification-directed sampling locations may indeed be located in regions outside of the HPAC plume. The fraction of densification-selected samples depends on many factors, including the stage of plume development, as densification selects points based on the quality of the plume it is given. However, selected sampling locations that are outside of the plume region could be ignored by our proposed method. Since the first revision of the manuscript, we included the following statement (which has been altered over the course of our revisions):

(p.7, para. 2) “We envision that testing could be greatly reduced by initially measuring background or low level physical radiation in population scale events by aerial surveys or targeted multiplex dosimetry. “

For clarity, we now also state the following in the paragraph describing densification:

(p.8, para 2) “We assume that locations within the 0 Gy envelope surrounding the plume do not have to be sampled in subsequent kriging iterations.”

One would expect that with each iteration there are proportionally more samples with dose and fewer without dose.

*RESPONSE

Anecdotally, we find that the highest ratio of irradiated/unirradiated samples are selected during the second densification (third iteration). The first densification step often includes locations in unirradiated regions (especially in low-density scenarios). The first densification is based on kriging following the initial sampling, and often produces a low definition plume. The plume from the following iteration is significantly improved because of the inclusion of more irradiated samples. We noticed that subsequent densification steps are prone to selecting the same locations as prior densification steps (as described in the Methods), meaning that the proportion of novel samples is reduced compared to earlier steps. Also, the locations of these novel samples tended to occur beyond the irradiated regions.

We have found that the fraction of irradiated to unirradiated sampling locations varies among scenarios and individual replicates for the same scenarios. Initial densification steps for scenarios in regions in high-density populations (e.g. urban New York and Washington D.C. scenarios) and were much more likely to select sampling locations in irradiated regions, while scenarios within regions of low population density (Charleston SC and Des Moines IA) had a greater proportion of locations selected in irradiated regions in later densification steps.

We also find that this fraction can be influenced by differences between replicates for the same scenario. Replicates differ by consisting of an entirely different set of initial sampling locations (each location randomly selected by ArcMap software). For example, the first densification step for Albany NY scenario replicate #3 selected nearly 4 times as many sampling locations with dose compared to replicate #2 (N=67, 26 and 101 irradiated sampling locations selected by the first densification step for Albany NY replicate #1, 2 and 3).

Nevertheless, we are concerned about broad generalizations, because of the considerable variability in the locations and exposures of samples obtained through densification within different replicates of the same scenario and in different scenarios. Rather, the focus in this manuscript is to determine whether the scenarios converge to fulfill the criteria for discontinuation of the process and how many samples and iterations were required to meet these criteria.

But the “improvement” at each step, and the total number of samples that have to be assessed in a real-word scenario are critical aspects of the potential utility of this approach.

*RESPONSE

The total number of samples required at each step is shown in Figure 2. Superfluous sampling of unirradiated locations or individuals does not occur: the number of samples indicated in the figure is the actual number sampled. The incremental sampling reflects the difference between the numbers of samples at each successive iteration. For example, in panel B, 67 additional samples are evaluated in the 2nd iteration that were not included during the 1st iteration. The 3rd iteration requires 27 additional samples that were not available during the 1st and 2nd iterations. The level of effort required means that it should be feasible for first responders to procure these samples. With protective shielding and geospatial targeting, the limited amount of sampling would minimize their duration of their overall exposure to radiation.

As it is, the reader is unable to evaluate the overall requirements.

*RESPONSE

Based on the following, we disagree with the reviewer’s assessment that we have not provided sufficient details on our methods and results for the scenarios we have analyzed. The details of our procedure are provided – as requested by the editor during the second round of review – at Protocols.IO: (http://dx.doi.org/10.17504/protocols.io.ba4nigve; "Protocol for Geostatistical Determination of Radiation Dosimetry Maps of Population-Scale Exposures").

We have also included an extensive Zenodo archive of data and programs since the first revision of this manuscript (labeled for Peer Review Only, as it would only be published on Zenodo if the paper is determined to be accepted for publication). This information is cited in the above protocol and can be used to reconstruct our work including: 1) modified U.S. state and sub-division boundary files [in KML format], which can be imported into ArcMap using its KMLtoLayer function. These files have been modified to prevent sub-division naming issues that we encountered when importing boundary data into ArcMap; 2) contain HPAC plume coordinate (WGS1984) and dose (in cGy) values for all scenarios discussed in the manuscript. We provide "processed" and "unprocessed" HPAC plume data files. The "unprocessed" HPAC plume data are provided in its original XML format, which cannot be imported into ArcMap directly. The "processed" HPAC plumes are provided in tab-delimited X,Y,Z format (Latitude, Longitude, and Dose). We have also added a "0 cGy" contour in the "processed" plumes; 3) geostatistically-derived plume coordinate (WGS1984) and dose (in cGy) values for all scenarios discussed in the manuscript. Data is in comma-delimited format (Latitude, Longitude, and Dose).4) We have updated this component of the archive to include the sample locations and estimated doses for all iterations for each scenario as requested by the reviewer. Sample data consist of a set of coordinates generated at random locations within each Census sub-division using the ArcMap tool, ‘CreateRandomPoints_management’, and subsequent points generated by densification (the geostatistical procedure that targets and localizes an additional small cohort of irradiated individuals to mitigate uncertainty in environmental measurements.

I might argue that this information is more meaningful that the replicates in Table 1 (which could be presented in a supplemental table).

RESPONSE

The journal requires that findings be replicated as a condition of publication. Furthermore, since initial sampling is within county subdivisions performed at randomized locations, replication of each scenario is essential to determine if the results are reproducible. When replicates did not provide consistent levels of accuracy relative to the HPAC plume, we demonstrated that both increased sampling densities and the more stringent overlap between the plumes improved the performance of the procedure.

The information requested by the reviewer is quite lengthy and is not suitable for presentation as a Supplemental Table. As indicated above, locations and doses for each sample of every replicate of every scenario have been incorporated in the Zenodo archive along with the other data that we generated.

Figure 2A: The numbers shown for Samples at first and final iteration (assuming >0Gy), BCD and RMSD for final vs HPAC plume do not agree with values provided in Table 1 and S1A. For B (Albany), only the sample number in first iteration (12) agrees with table S1A and Table 1.

RESPONSE

We investigated this issue. The New York (Urban) scenario in Figure 2 was derived before we began to prepare this manuscript. This replicate had been reported at the International Congress of Radiation Research in fall 2019, but was not previously described in the manuscript, which was based on an independent analysis. Details about the replicate in Figure 2 have now been added to both Table 1 and Supplementary Table S1A (and designated replicate #4), and the figure legend has been updated.

The Albany NY example present in Figure 2B is indeed Albany replicate #1 in Tables 1 and S1A. The BCD and RMSD were simply incorrectly transcribed for the Albany NY replicate from the original source analysis presented in S1A. We have corrected these statistics in Figure 2B. Also, as we indicated in the previous version of the manuscript, the “Number of Samples” column in Table 1 was updated to correct for duplicate locations computed from different densification steps for the same replicate. This issue persisted in Figure 2 but has been corrected.

In summary, this paper has the most value if it is clear to the naïve reader what was done and how the strategy might be used to advantage. And for a reader knowledgeable in the field who wants to examine the process in detail, there must be sufficient accurate and consistent data to allow that.

RESPONSE

We have more than adequately demonstrated the advantages of the proposed approach for deriving a dosimetry map from sparse sampling of the area impacted by a radiation plume. We also provide a detailed online step-by-step protocol requested by the journal, which the reviewer has failed to acknowledge. Following this protocol will allow a reader knowledgeable in the field to examine the process in detail and reconstruct our results.

The reviewer’s goal of testing the proposed method in real world scenarios is unrealistic. Our results can only be as accurate as the underlying population density data used to guide sampling. As stated previously, publicly available US census data is of lower geographic resolution than would be desirable for accurate sampling. Furthermore, the HPAC software that was available to us is not the current version provided by DTRA to US Government agencies. This software lacks many features, for example, it was not capable of incorporating the radiation shielding effects of buildings and infrastructure in urban environments, an issue that has been raised by this reviewer previously. These resources would be necessary in order to examine the process in detail at a sufficient accuracy and consistency to satisfy this reviewer. Nevertheless, the results we have achieved without these resources convincingly demonstrate that the procedures we developed are useful, because they closely approximate the HPAC plumes for all of the simulated scenarios that we analyzed.

Decision Letter 4

Gayle E Woloschak

7 Apr 2020

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

PONE-D-19-22325R4

Dear Dr.Rogan:

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Section Editor

PLOS ONE

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Reviewer #1: Yes

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Acceptance letter

Gayle E Woloschak

13 Apr 2020

PONE-D-19-22325R4

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

Dear Dr. Rogan:

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Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Fig. Kriging methods using random points representing 1% of Boston population.

    These plumes were generated with random points representing 1% of the Boston (N = 617,594) and Cambridge (N = 105,162) populations, the two subdivisions overlapping the Boston HPAC plume (no precipitation). These points were assigned dose values based on their location relative to the HPAC plume (N = 223 with dose > 0Gy). The following kriging methods were then applied to these data: Ordinary, Simple, Universal and Empirical Bayesian kriging (EBK). A contiguous plume could not be derived from Simple kriging. In these, and in other similar tests, the plume generated using EBK best resembled the plume produced by HPAC.

    (TIF)

    S2 Fig. Rural New York scenario at a 90% and 99% stringency of overlap between consecutive iterations of geostatistical analysis.

    These plumes represent the radiation levels of the rural New York nuclear incident scenario. The first two plumes were derived using the geostatistical method using two iteration stopping criteria: a 90% (left plume) and a 99% (middle plume) stringency of overlap threshold between consecutive iterations. When compared to the HPAC plume (right plume), we found that increasing the stringency of overlap resulted in an additional 73 sampling locations selected by densification, which consequently significantly increased the size and similarity of the derived plume, most notably at the 1Gy and 2Gy contours.

    (TIF)

    S3 Fig. Boston MA scenario at a 90% and 99% stringency of overlap between consecutive iterations of geostatistical analysis.

    These plumes represent the radiation levels of the Boston MA nuclear incident scenario. The first two plumes were derived using the geostatistical method using two different stopping criteria: a 90% (left plume) and a 99% (middle plume) stringency of overlap between consecutive iterations. Right-most plume is HPAC. We find that the increased sampling of this scenario (43 additional sampling locations) led to the development of a gap in the 2Gy threshold, which resulted in a slight decrease in plume accuracy at the 2Gy threshold.

    (TIF)

    S1 Table. Comparison between derived and HPAC plumes in terms of area and population.

    (XLSX)

    S2 Table. Comparison between scenario replicates in terms of area.

    (XLSX)

    S3 Table. Radiation scenarios with dose measurement error.

    (DOCX)

    S4 Table. Samples required for plume convergence is inversely related to population density.

    (DOCX)

    S5 Table. Plume derivation with an increased (>99%) stringency of overlap between consecutive iterations of geostatistical analysis.

    (DOCX)

    S1 Methods

    (DOCX)

    Attachment

    Submitted filename: Response to Reviewers.docx

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    Submitted filename: Response to Reviewers 2.docx

    Attachment

    Submitted filename: The authors use geospatial modeling in an attempt to decrease the need for radiation dosimetry in the setting of a large scale disaster.docx

    Attachment

    Submitted filename: Response-to-Reviewers.Third-Revision Final.docx

    Data Availability Statement

    Data and Software from this study are available in the Zenodo repository: https://doi.org/10.5281/zenodo.3572574. The data includes modified U.S. state and sub-division boundary files [in KML format], as well as the geographic coordinates and dose values (World Geodetic System [WGS] 1984) which define each HPAC and geostatistical-derived plume for all scenarios described. The programs include custom scripts used to preprocess the data for use with ArcMap GIS software.


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