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A multi-modal scanning system to digitize CBRNE emergency response scenes

A handheld system developed to digitize a contextual understanding of the scene at a chemical, biological, radiological, nuclear and/or explosives (CBRNE) events is described. The system uses LiDAR and cameras to create a colorized 3D model of the environment, which helps domain experts that are supporting responders in the field. To generate the digitized model, a responder scans any suspicious objects and the surroundings by carrying the system through the scene. The scanning system provides a real-time user interface to inform the user about scanning progress and to indicate any areas that may have been missed either by the LiDAR sensors or the cameras. Currently, the collected data are post-processed on a different device, building a colorized triangular mesh of the encountered scene, with the intention of moving this pipeline to the scanner at a later point. The mesh is sufficiently compressed to be sent over a reduced bandwidth connection to a remote analyst. Furthermore, the system tracks fiducial markers attached to diagnostic equipment that is placed around the suspicious object. The resulting tracking information can be transmitted to remote analysts to further facilitate their supporting efforts. The paper will discuss the system's design, software components, the user interface used for scanning a scene, the necessary procedures for calibration of the sensors, and the processing steps of the resulting data. The discussion will close by evaluating the system's performance on 11 scenes.

Prins, Nicholas↗

Radiological Recovery Logistics Tool - 20161

Argonne is building and testing a tool, the Radiological Recovery Logistics Tool (RRLT), that can be used during the response and recovery from a radiological or nuclear incident to effectively allocate appropriate commercial and public works equipment to mitigate, remove, and contain radiological contamination. The requirements for this tool - as well as development of the resulting software - is overseen by a steering committee of stakeholders from DHS's National Urban Security Technology Laboratory (NUSTL), the Federal Emergency Management Agency (FEMA), and the Environmental Protection Agency (EPA). One essential requirement is for RRLT to support the efficient and appropriate allocation of resources for a radiological response. Subsequent discussions between ANL and stakeholders have solidified the nature of this support to include identification of the types of resources to be allocated. The study reported in this paper has both factored fundamental concepts and connections out of this identification process and created a Knowledge Base detailing support goals, response scenarios, and efficacy information on dozens of equipment types. In short, RRLT will dynamically apply these findings to situational conditions surrounding contamination incidents. RRLT's Domain, the model of elements, ideas and relationships with which the tool will work, draws concepts from technical reports and stakeholder vocabularies to connect response goals and scenarios to types of equipment that offer utility towards those goals in those scenarios. RRLT's Knowledge Base will contain details on dozens of equipment types and facilitate the operator's discovery and consumption of these details most pertinent to a dynamically selected subset of goals. The core of its Domain Model is based on a report authored by this team. This report [1] contains a comprehensive list of proposed equipment to accomplish various missions or scenarios that might arise after a large-scale radiological contamination incident in an urban environment or critical infrastructure. The report divides potential response and recovery efforts into five support goals: Survey and monitoring of the contaminated area; Mitigation of received dose to first responders: Decontamination (gross and final) of buildings, vehicles, roadways, parks, and other surfaces: Waste management of solid waste generated during recovery operations: and Containment of wastewater and other waste generated during the response and recovery phases. RRLT's development is driven by use cases. A use case is an intention with which a user approaches the software. Use cases are grouped into delivery increments to schedule development, testing, and presentation to stakeholders. This model partitions the system into seven increments: User Arrival and Authentication, Search and Navigation, Equipment Recommendation, Plan Management, Content Management, and Expanded Access. Once a user 15 authenticated, RRLT will present the user with a dashboard that allows them to explore or search RRLT's content. The dashboard will also include a 'Plan' panel for collecting decisions and relevant observations about an incident at hand to facilitate development of an equipment list. RRLT will offer three general modes of access to items in the knowledge base: - Keyword search for direct discovery of items, - Navigation along predetermined paths from recovery goal towards equipment types, and - Interactive guidance towards equipment types by an autonomous software agent: the Equipment Recommendation Wizard. This presentation will detail progress in the development of the RRLT and also discuss opportunities for those interested in providing feedback on its content and functionality. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Logistics simulation of a remediation effort for a hypothetical radiological contamination scenario

To mitigate the effects following a large-scale nuclear or radiological material release in an urban environment and to expedite recovery, the Integrated Wash-Aid Treatment Emergency Reuse System (IWATERS) was developed. IWATERS consists of three operations: washing contaminated surfaces with an ionic wash solution, collecting, and treating the contaminated wash solution on-site to remove contaminants, and reusing the treated solution throughout operations to preserve the clean water resource. This study develops a framework to simulate the logistics of IWATERS deployment, thereby gaining an understanding of the timeline for decontamination operations. For this purpose, the Analysis of Mobility Platform and GoldSim were leveraged for a hypothetical contamination scenario covering 65,200 m 2 of an urban center. The framework reveals that remediation progress is limited by several resources, notably the availability of vermiculite, a reactive clay that is required to treat the contaminated wash solution. Further, this study also presents how the simulation approach can be used to characterize alternatives to reduce the influence of limited resources on operational progress. Overall, this work lays the foundation for evaluating different decontamination methods through detailed logistics simulation, i.e., by refining simulation assumptions and expanding the range of scenarios the simulation can depict.

98 NUCLEAR DISARMAMENT, SAFEGUARDS, AND PHYSICAL P↗

Emergency Radiation Dose Rate Monitoring During Prolonged Armed Conflict

The 2022 Russian full-scale invasion of Ukraine has introduced unprecedented challenges for the nuclear power generation and radiological safety communities, including occupation and disturbance of highly-contaminated areas, occupation of a nuclear power plant, and strikes near and within boundaries of nuclear sites. The war has necessitated the implementation of a supplementary dose rate sensor network to provide resilient measurement data for public protection and leadership awareness. This paper discusses the implementation of such a system, the factors determining what equipment is best suited for the purpose, and practical factors regarding deployment of the system and data management. The crucial factors for operating a supplementary dose rate sensing network are backup power and communications options for dose rate sensors to make the network resilient to the effects of military operations. The most important implementation factor is to plan for extended operations beyond those typically considered for emergency response given the unpredictable nature of warfare.

resilience↗

Providing Housing, Food and Medical Support for 25,000 Katrina Evacuees with 12 Hours Notice: The Harris County Medical Support of the Superdome Evacuees

Hurricane Katrina was responsible for trapping 25,000 people in the New Orleans Superdome and isolating many others throughout Louisiana and Mississippi. The transport of these evacuees to the Reliant Park (Houston, Texas) used 500 buses each containing about 55 people. Processing the arriving evacuees included addressing their health status and medical needs as follows: an initial triage at disembarkation, a secondary triage in the Reliant Astrodome and Center, and definitive clinical care in the Reliant Arena "Katrina" Clinic. Baylor College of Medicine (BCM) physicians boarded buses and identified the sickest for emergency transport to Harris County Hospital District (HCHD) hospitals. BCM departments represented included pediatrics, family and community medicine, internal medicine, radiology, obstetrics and gynecology, orthopedics, surgery, and psychiatry. Astrodome and Center triage was managed by BCM physicians and staffed by HCHD Nurses and volunteers from Texas and beyond. The Reliant Astrodome, Center and Arena reached peak headcounts of 15,000,4500, and 2500, respectively Most evacuees visiting the triage sites in the Astrodome and Center were treated using "over-the-counter" medications with the remaining being transported to the "Katrina" clinic. The clinic was equipped with a lab, pharmacy, digital X-ray, and ultrasound machines in addition to electronic patient records created using 80 computer terminals. The Katrina clinic saw more than 15,000 patients during 15 days of operations (2,000 on the first full day), administered 10,000 tetanus shots, and filled thousands of prescriptions. At the peak of operations, the clinic saw 150 patients/hour with 25 physicians scheduled for each 12-hour shift. Approximately 900 people were transported to hospital emergency rooms. Within 3 weeks of arriving at the Reliant Park facilities, more than 90% of the families found permanent housing, enrolled children in schools, and found work. Using data obtained from manual and electronic medical records, this presentation will document the major milestones and lessons learned from this extraordinary project to help the Katrina evacuees.

Hamilton, Douglas↗

The Industry's Long-term, Yet Near-term, Issues: The Need for Radiation Protection Professionals - 20266

Since the discovery of X-rays and radioactivity, the civil use of nuclear technology has thrived for more than a half-century and has matured to be safer and more efficient. A balance between radiological and non-radiological knowledge and experience has been gained and retained through the years. Nevertheless, a slowly developing gap has emerged during the past few decades. National and international data show a declining trend in the existence of health physics programs and associated enrollment and training, which directly impact the pipeline of radiation professionals (i.e., educators, technicians, researchers, and regulators). This decline can be attributed to many factors including the lack of scientific inquisitiveness, declining funding, and the perception that existing protocols are sufficiently protective. Decommissioning and dismantling nuclear facilities is a complex and multi-phased process that generates large quantities of various levels of radioactive waste. With multiple facilities reaching their end of operational life, and others being shut down for economic reasons, the current pipeline for radiation protection experts cannot meet the future's need. Consequently, international organizations have proposed a variety of programs to transfer knowledge of radiation protection principles and practice. While many change-oriented efforts to counteract this trend aim to promote mobility, this is just a partial solution to the actual issue: long-term availability. This paper suggests multidisciplinary collaborations with modern technologies as a path forward to educate young professionals on the diversity of radiation-related applications to retain expert knowledge and foster innovation. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Comparison of Projections for a Short-Term Release, CAP88 vs NARAC

The purpose of this study was to compare the projected dose using different plume models, evaluating a short duration release of tritium to the 16 compliance sectors and 4 additional points of interest using local meteorology. This report is written as guidance to the decision makers when reviewing this specific Gaussian plume model intended for radiological dose assessment and regulatory compliance, called CAP88 1 , as compared to a more-complex model designed for emergency response. The emergency response model, NARAC 2 , can be used to supplement the CAP88 compliance model evaluations, since NARAC is intended for use in situations where releases are shorter in duration and have increased complexity in terrain and meteorology.

54 ENVIRONMENTAL SCIENCES↗

International Radiological/Nuclear Training for Emergency Response - Major Public Events Virtual Workshop: Nuclear Security Planning and Operations (Day 3) [Slides]

This module will provide a basic overview of radiological/nuclear search operations, including the application of radiological detection instrumentation and best practices for operational tactics, techniques and procedures. This module will introduce basic radiological/nuclear search operations and include the following: (1) A review of the principles of optimizing detection, (2) An understanding of radiation hazards and alarms, and (3) An examination of nuclear security measures best practices for buildings and stadium complexes, large areas, roadways and parking areas, and pedestrian and vehicle entrance portals.

61 RADIATION PROTECTION AND DOSIMETRY↗

IRAD-MPE Radiation Source Recovery (Day 4) [Slides]

The objective of this module is to review emergency response radiation detection equipment, operational and safety procedures, and best practices for planning that are required to conduct a successful radiological source recovery operation.

61 RADIATION PROTECTION AND DOSIMETRY↗

Tool for Developing Integrated Strategies for Decontamination and Waste Management - 20291

Management of waste from chemical, biological, and radiological incidents is complicated by the fact that decontamination decisions have a profound impact on the characteristics of resulting waste streams. Wide-area biological and radiological incidents could produce massive quantities of waste that may need to be treated on-site and sent for subsequent disposal as non-contaminated materials, or else be directly disposed of as contaminated materials. The EPA has developed the Waste Estimation Support Tool (WEST) for characterizing and quantifying biological and radiological waste that may be generated from decontamination efforts. This paper focuses on the WEST's uses for radiological incidents. WEST combines Geographic Information System (GIS)-based analysis of externally-supplied plume data, infrastructure databases derived from the Federal Emergency Management Agency's (FEMA's) Hazus tool [1], and satellite imagery surface recognition algorithms to combine the composition and square footage of the buildings in the plume with estimates of the materials between the buildings in the plume. The resulting GIS data files are then imported into a Microsoft Access database application, where they are combined with information about the nature and concentration of contaminants, and then subjected to decontamination strategies for different contaminated surfaces. The tool provides estimates of the type and quantities of potential wastes resulting from simulated decontamination and/or demolition activities and includes estimates of the remaining contamination levels including residual contamination contained within each waste stream. Estimates are presented at several levels of detail, allowing users to obtain needed data at the desired resolution. These include estimates for the total affected area, estimates by contamination zone, estimates by decontamination method(s), and estimates by building type (occupancy classification). EPA is currently developing the next version of WEST which will include several substantial enhancements. The most significant improvement for the next version of WEST will include the ability for users to develop contamination scenarios and waste estimates based on previously developed, readily available, and geographically specific infrastructure data. Instead of using WEST's default infrastructure data based on FEMA's Hazus tool, users will be able to import their own building data specific to the geographically affected area. This capability may substantially decrease uncertainties in the resulting waste estimates because the results will be based on actual building data (numbers of each type, square footage, building height, etc.). Two other significant enhancements will be the ability to generate waste estimates for vehicles and biomass. In addition to building debris and building decontamination waste, vehicles and biomass will likely constitute a significant percentage of the total waste which may result from wide area contamination events. This presentation will present the most recent version of WEST, which includes such considerations as affected biomass (e.g., trees), vehicles, and the ability to replace the default Hazus infrastructure databases with custom infrastructure databases. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Probabilistic predictions and uncertainty estimation for radiological and nuclear effects modeling

Better characterization of meteorological uncertainty is needed to predict the effects of radiological and nuclear releases in the atmosphere. Multi-physics ensembles of atmospheric simulations can estimate uncertainty of physical processes, but they are often limited for computational reasons. Because weather uncertainty is important for emergency response applications, but the conventional way of running multi-physics ensembles is infeasible, we have developed new machine learning-based methods that quickly estimate and identify key sources of meteorological uncertainty. Machine learning accelerates the analysis of weather uncertainty by iteratively learning about model physics options that affect plume predictions. We have demonstrated the power of machine learning by creating a large multi-physics weather and dispersion ensemble dataset containing 1,200 simulations for two hypothetical radiological release scenarios. By training on less than 10% of the ensemble, we can quickly and accurately predict different outcomes, including the mass of radiological material deposited and spatial distribution and extent of contaminated areas.

54 ENVIRONMENTAL SCIENCES↗

NASA Utilization of Space Nuclear Systems for Robotic and Human Exploration Missions: Response to EO 13972: Promoting Small Nuclear Reactors for National Defense and Space Exploration

Space Nuclear Systems (SNS) technology development offers a wide range of capabilities to support NASA’s current and future missions. Executive Order (EO) 13972, “Promoting Small Modular Reactors for National Defense and Space Exploration” [1], issued 5 January 2021, directs NASA to define requirements for NASA utilization of nuclear energy systems for human and robotic exploration missions through 2040 and analyze the costs and benefits of such requirements.” Although it is premature to define requirements and cost for future exploration missions that have not yet been formulated, this report describes planned objectives and missions by 2040 that are enabled or enhanced by nuclear systems while taking into account a number of unique considerations for nuclear energy in the space environment. Nuclear energy systems are enabling for space missions and critical capabilities where conventional forms of energy production are impractical or impossible due to mass constraints, mission duration, or distance from the Sun. Space nuclear technologies available or in development for use by 2040 utilize radioisotope decay or nuclear fission and fall into three categories: heat, power, and propulsion. Current applications utilize radioisotope power systems that provide consistent and reliable performance in the sub-kilowatt power range. More advanced SNS can enable new mission objectives where high energy density solutions are critical, or where access to solar solutions is prohibitive. Higher power radioisotope and fission systems are under development within NASA for a wide variety of human exploration and science mission applications. Planned missions designed to use radioisotope systems include Dragonfly, a rotorcraft that will explore the surface of Titan, and Persephone, a mission concept for a Pluto orbiter. Nuclear fission systems have the key advantage of providing significantly higher power, lower mass solutions from tens to even thousands of kilowatts. Fission power is enabling to a sustained human presence on the Moon and developing a robust lunar economy. Fission propulsion is enabling for missions within and beyond cis-lunar space. This report examines NASA-envisioned mission applications and associated performance needs for SNS over the next twenty years leading to 2040 along with the unique technical considerations posed by space nuclear technology development. This includes engineering and operational logistics for ground handling, thermal management, survival of the space environment, operational safety, power requirements, and service longevity. Safety to the public, the NASA work force, and agency assets remains a top priority for NASA and particular attention is given to this aspect in the design, hardware assembly, ground operation, launch, and mission operation of an SNS. NASA relies on the Department of Energy as nuclear authority and its legacy of rigorous safety procedures as standards for ground development, test, transportation, and launch site operation. The principal concern is preventing unintended radiological release to the public or environment. Radioisotope system experience has established processes, including ground operation, transportation, and launch, that are considered directly applicable to emerging fission systems; however, fission systems have unique design needs that impact the safety and performance requirements. High efficiency power conversion from both fission and radioisotope systems requires high operating temperatures necessitating both passive and active thermal management to maintain safe and nominal operating conditions. Effective cooling and waste heat rejection have special considerations for space applications, whether in zero-g or reduced gravity. Fluid and heat transfer within the reactor system is not anticipated to be impacted by reduced or zero-g environments. Cryogenic working fluids and propellant supplies utilized in some space nuclear applications will need low mass, high capacity cryocoolers to meet the long-term storage and near zero-boiloff needs. Integrated, high power density SNS capable of being packaged in a single vehicle is a key consideration for NASA. Due to concerns for complexity and reliability, in space reactor assembly and reactor refueling are not current design considerations. Expanding into a new era for space exploration depends on mass-efficient, high-energy solutions to power deep-space vehicles, operate in harsh environments, and increase mission flexibility. NASA nuclear technology investments are targeting power for surface operations and propulsion for fast-transit, deep-space missions, all with the ability to reliably operate without the need for repair or refueling. NASA’s goals, enabled by nuclear technologies, provide for exciting advances in scientific objectives and human exploration, ushering in a new space age that enables a human presence on bodies beyond our Earth.

nuclear↗

A full-ring variable-aperture cadmium zinc telluride system for whole-body single photon emission computed tomography: realistic simulations with phantoms

Single photon emission computed tomography (SPECT) is an imaging modality that has demonstrated its utility in a number of clinical indications. Despite this progress, a high sensitivity, high spatial resolution, multi-tracer SPECT with a large field of view suitable for whole-body imaging of a broad range of radiotracers for theranostics is not available. Purpose We have designed a cadmium zinc telluride (CZT) variable-aperture full-ring SPECT scanner instrumented with a broad-energy tungsten collimator intended to fill this technological gap. The final purpose is to provide a multi-tracer solution for brain and whole-body imaging. Our static SPECT scanner breaks the paradigm of the standard dual- and triple-head rotational SPECT systems, utilizing a larger detector area in each scan increasing the sensitivity. We provide a demonstration of the performance of our design using a realistic model of our detector with simulated body-sized 99mTc phantoms. Methods We developed a realistic model of our detector by using a combination of a Geant4 Monte Carlo simulation and a CZT detector response model based on a finite element model. Our approach models the characteristic low-energy tail effect in CZT that noticeably affects the sensitivity and the quality of the scatter correction in CZT detectors. We implement a modified dual energy window scatter correction adapted to include the CZT low-energy tail effect. A dedicated correction is also developed to eliminate the undesirable truncation observed in images given the presence of detector edges and gaps between detectors, due to the non-rotational nature of our device. Corrections for the attenuation, detector response and the presence of collimators are also included. The images are reconstructed using the maximum-likelihood expectation-maximization algorithm implemented in the reconstruction open software STIR. Detector and reconstruction performance are characterized with a Derenzo phantom and a body-sized National Electrical Manufacturers Association (NEMA) Image Quality (IQ) phantom containing 99mTc. Results Our SPECT design can resolve 6.4mm rods in a Derenzo phantom and obtain a good image contrast with the IQ phantom. Explicit testing of the gap and edge correction is provided, showing an excellent performance in eliminating the image truncation artifacts. Our modified scatter correction shows no overestimation of the contrast-recovery ratio for our realistic CZT detector model, as opposed to the cases without correction and with a standard dual-energy window scatter correction. Conclusions In this paper, we further demonstrate the performance of our design for whole-body imaging purposes. This adds to our previous demonstration of improved qualitative and quantitative 99mTc imaging for brain perfusion and 123I imaging for dopamine transport with respect to state-of-the-art NaI dual-head cameras. We show that our design performs similarly to the VERITON SPECT from Spectrum Dynamics, a commercial full-ring CZT SPECT camera, with the potential advantage of the broader energy range of application given by our custom-design tungsten collimators. Here, our device combines high sensitivity and image resolution with a broad-energy imaging application for the purpose of clinical imaging and theranostics of emerging radionuclides.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

[18F]Tosyl fluoride as a versatile [18F]fluoride source for the preparation of 18F-labeled radiopharmaceuticals

Abstract Positron emission tomography (PET) is an in vivo imaging technology that utilizes positron-emitting radioisotope-labeled compounds as PET radiotracers that are commonly used in clinic and in various research areas, including oncology, cardiology, and neurology. Fluorine-18 is the most widely used PET-radionuclide and commonly produced by proton bombardment of 18 O-enriched water in a cyclotron. The [ 18 F]fluoride thus obtained generally requires processing by azeotropic drying in order to completely remove H 2 O before it can be used for nucleophilic radiofluorination. In general, the drying step is important in facilitating the radiofluorination reactions and the preparation of 18 F-labeled PET radiotracers. In this communication, we have demonstrated the feasibility of using [ 18 F]tosyl fluoride ([ 18 F]TsF) as a versatile [ 18 F]fluoride source for radiofluorination to bypass the azeotropic drying step, and we have developed a continuous flow solid-phase radiosynthesis strategy to generate [ 18 F]TsF in a form that is excellent for radiofluorination. [ 18 F]TsF shows high reactivity in radiofluorination and provides the features suitable for preparing PET radiotracers on a small scale and exploring novel radiolabeling technologies. Thus, using [ 18 F]TsF as a [ 18 F]fluoride source is a promising strategy that facilitates radiofluorination and provides a convenient and efficient solution for the preparation of 18 F-labeled radiopharmaceuticals that is well matched to the emerging trends in PET imaging technologies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Technical analysis of filter testing at the U.S. Department of Energy Filter Test Facility

The U.S. Department of Energy (DOE) technical standard DOE-STD-3020-2015 requires verification testing at the Filter Test Facility (FTF) of high-efficiency particulate air (HEPA) filters to be installed in nuclear facility (Hazard Category 1, 2, 3, and radiological facilities) confinement ventilation systems, or to be installed in habitability systems (e.g., filters for protection of workers required to act for the control and mitigation of emergency situations). Filters in these applications perform a safety function in accident situations, are designated as important to safety, or are necessary for habitability systems. Different FTFs have operated for decades, and results of tests are available to examine the need for and benefits of continued execution of 100 percent QA verification testing. The objective of this study and resulting report was to assess the need for 100 percent QA testing at the current FTF in Maryland, based on an examination of a database of test results from 2013 to August 2020. Filters that require independent testing per DOE-STD-3020-2015 to be installed in nuclear facilities are sent to the FTF before being shipped to the facilities. The FTF examines the documentation (e.g., certificates of compliance, results of particle penetration and airflow resistance testing by the manufacturers, labels affixed to filters and packages, and other requirements specified in purchase orders by the nuclear facility operators), implements visual inspections of the physical state of the filters, and checks the dimensions of frames. Filters that meet the documentation and visual inspection requirements are subjected to particle penetration and airflow resistance testing. In case of rejections, the filters are shipped back to the manufacturers, at the cost of the manufacturers, for replacement. Filters that pass all tests are shipped to the nuclear facilities.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Nuclear Emergency Support Team Public Health and Safety [Slides]

RAP is the nation’s premier first-response resource for advising Federal, state, local and tribal decision-makers on steps to take to evaluate and minimize the hazards of a radiological or nuclear incident. RAP support ranges from giving technical information or advice over the telephone to sending highly trained personnel with state-of-the-art equipment to the incident site where team members help identify, characterize and minimize any radiological or nuclear hazards.

98 NUCLEAR DISARMAMENT, SAFEGUARDS, AND PHYSICAL P↗

Diagnostic, Prognostic, and Therapeutic Use of Radiopharmaceuticals in the Context of SARS-CoV-2

The coronavirus disease 2019 (COVID-19) outbreak has devastated the healthcare systems and economies of over 200 countries in just a few months. The etiological agent of COVID-19, SARS-CoV-2, is a highly contagious virus that can be transmitted by asymptomatic and symptomatic carriers alike. While in vitro testing techniques have allowed for population-wide screening, prognostic tools are required to assess the disease severity and therapeutic response, contributing to improve the patient clinical outcomes. Moreover, no specific antiviral against COVID-19 exists at the time of publication, severely limiting treatment against the infection. Hence, there is an urgent clinical need for innovative therapeutic strategies that may contribute to manage the COVID-19 outbreak and prevent future pandemics. In this work, we critically examine recent diagnostic, prognostic, and therapeutic advancements for COVID-19 in the field of radiopharmaceuticals. First, we summarize the gold standard techniques used to diagnose COVID-19, including in vitro assays and imaging techniques, and then discuss how radionuclide-based nuclear imaging provides complementary information for prognosis and treatment management of infected patients. Second, we introduce new emerging types of radiotherapies that employ radioimmunoconjugates, which have shown selective cytotoxic response in oncological studies, and critically analyze how these compounds could be used as therapeutic agents against SARS-CoV-2. Finally, this Perspective further discusses the emerging applications of radionuclides to study the behavior of pulmonary SARS-CoV-2 aerosol particles.

62 RADIOLOGY AND NUCLEAR MEDICINE↗