Tibia lead levels and methodological uncertainty in 12-year-old children

Factors influencing uncertainties of in vivo bone lead measurement using a (109)Cd K X-ray fluorescence clover leaf geometry detector system

A (109)Cd K X-ray fluorescence (KXRF) measurement system consisting of four detectors in clover-leaf geometry is a non-invasive, low-radiation-dose method of measuring bone lead concentration. Its high precision in estimating the bone lead content makes it a promising tool for the determination of the low levels of lead currently found in the general population. After developing the clover-leaf geometry system, the system was used for the first time in a major survey in 2008 to measure the lead levels of 497 smelter employees (an occupationally exposed group with high lead levels). Since the delivered effective dose of the bone lead system in clover-leaf geometry is small (on the order of nSv), the technique can be used to measure the bone lead of sensitive populations such as the elderly and children. This detector system was used from 2009 to 2011, in a pilot study that measured the bone lead concentration of 263 environmentally exposed individuals (termed the EG group) residing in Toronto, Ontario, Canada. In this paper, the factors that influence uncertainties in lead content in tibia (cortical bone) and calcaneus (trabecular bone) are discussed based on gender, age, and body mass index (BMI) by using analysis of variance (ANOVA) and multiple linear regression models. Results from the two study groups (the EG group versus the occupationally exposed smelter employees) are compared where appropriate (i.e. for males older than 20). Results from univariate analyses showed that females have higher tibia uncertainty compared to males. We observed significant differences for both calcaneus and tibia uncertainty measures (p < 0.0005) among different age groups, where the uncertainties were highest in the lowest age group (<11 years). Lastly, and perhaps most significantly, we found that the product of source activity and measurement time influenced the precision of measurements greatly, and that this factor alone could account for the higher uncertainties observed for the male cohort of the EG group versus the smelter employees.

Blood lead in the 21st Century: The sub-microgram challenge

In the US the dominant sources of lead through much of the 20th Century (eg, vehicular emissions, plumbing, household paint) have been significantly diminished. The reductions in adult and pediatric average blood lead levels in the US have been extraordinary. Progress continues: the US Environmental Protection Agency recently developed a new air standard for lead. In the 21st Century, the average blood lead level in a society may be seen as a marker of the status of their public's health. However, the threat of lead exposure remains a significant public health problem among subpopulation groups in the US and in many less developed countries. This paper examines some of the specific issues involved in the reduction of blood lead in a post-industrial era. These involve the control of the remaining exogenous primary sources, both general (eg, industrial emissions) and specific (eg, at-risk occupations), exogenous secondary sources (eg, contaminated urban soils, legacy lead-based paints), an endogenous source (ie, cumulative body lead burden) and emergent sources.

Uncertainty calculations for the measurement of in vivo bone lead by x-ray fluorescence

In order to quantify the bone lead concentration from an in vivo x-ray fluorescence measurement, typically two estimates of the lead concentration are determined by comparing the normalized x-ray peak amplitudes from the Kalpha(1) and Kbeta(1) features to those of the calibration phantoms. In each case, the normalization consists of taking the ratio of the x-ray peak amplitude to the amplitude of the coherently scattered photon peak in the spectrum. These two Pb concentration estimates are then used to determine the weighted mean lead concentration of that sample. In calculating the uncertainties of these measurements, it is important to include any covariance terms where appropriate. When determining the uncertainty of the lead concentrations from each x-ray peak, the standard approach does not include covariance between the x-ray peaks and the coherently scattered feature. These spectral features originate from two distinct physical processes, and therefore no covariance between these features can exist. Through experimental and simulated data, we confirm that there is no observed covariance between the detected Pb x-ray peaks and the coherently scattered photon signal, as expected. This is in direct contrast to recent work published by Brito (2006 Phys. Med. Biol. 51 6125-39). There is, however, covariance introduced in the calculation of the weighted mean lead concentration due to the common coherent normalization. This must be accounted for in calculating the uncertainty of the weighted mean lead concentration, as is currently the case. We propose here an alternative approach to calculating the weighted mean lead concentration in such a way as to eliminate the covariance introduced by the common coherent normalization. It should be emphasized that this alternative approach will only apply in situations in which the calibration line intercept is not included in the calculation of the Pb concentration from the spectral data: when the source of the intercept is well characterized and known to come from trace contamination by Pb in the plaster of Paris calibration standards. In our approach, the coherent normalization is only applied to one parameter and we no longer take a weighted mean of correlated quantities. Our proposed alternative calculation has essentially no effect on the calculated error of the mean lead concentration, indicating that the existing method of accounting for this covariance is sufficient.

Monte Carlo simulations of in vivo K-shell X-ray fluorescence bone lead measurement and implications for radiation dosimetry

In order to improve measurement precision and decrease minimum detectable limit, recent applications of K-shell X-ray fluorescence (KXRF) bone lead measurement have used shorter source-to-sample (S-S) distances (approximately 0.5 cm) than the traditionally standard values ranging between 2.0 and 3.0 cm. This alteration will have an effect on subject radiation dose. This paper reports a comprehensive Monte Carlo study performed to investigate the radiation energy deposition values delivered to the leg of model human subjects of various ages. The simulations were run for models approximating 1-year, 5-year, and adult subjects, assuming lead concentrations of 10 microg/g in bone and tracing 500 million photons in each simulation. Trials were performed over a range of S-S distances, from 0.5 to 6.0 cm. The energy deposition due to photoelectric and Compton processes occurring in bone and soft tissue are presented. For each subject age, the Monte Carlo analysis demonstrates that the amount of energy deposited in the bone is increased as the sample is moved closer to the source (from 3.0 to 0.5 cm). The amount of energy deposited in the bone was found to increase by approximately 91% (1-year old), 66% (5-year old), and 41% (adult). The amount of energy deposited to the leg sample as a whole increased by approximately 43% (1-year old), 32% (5-year old), and 21% (adult). Results are used to estimate the changes in the amount of dose received by subjects of different ages.

Lead exposure in children: prevention, detection, and management

Fatal lead encephalopathy has disappeared and blood lead concentrations have decreased in US children, but approximately 25% still live in housing with deteriorated lead-based paint and are at risk of lead exposure with resulting cognitive impairment and other sequelae. Evidence continues to accrue that commonly encountered blood lead concentrations, even those less than 10 microg/dL, may impair cognition, and there is no threshold yet identified for this effect. Most US children are at sufficient risk that they should have their blood lead concentration measured at least once. There is now evidence-based guidance available for managing children with increased lead exposure. Housing stabilization and repair can interrupt exposure in most cases. The focus in childhood lead-poisoning policy, however, should shift from case identification and management to primary prevention, with a goal of safe housing for all children.

In vivo K-shell X-ray fluorescence bone lead measurements in young adults

The (109)Cd K-shell X-ray fluorescence (XRF) technique was used to measure in vivo tibia lead concentrations of 34 young adults living in the state of Vermont (USA) and the province of New Brunswick (Canada). The subjects ranged in age from 18 to 35 years, and had no known history of elevated lead exposure. Measurement parameters were varied, using the same XRF system for both populations. Tibia lead concentrations were low for both groups, with mean values of 0.7 microg lead g(-1) bone mineral (Vermont) and 0.5 microg g(-1)(New Brunswick). No individual measurement exceeded 7 microg g(-1). Mean uncertainty values obtained for the Vermont and New Brunswick subjects were 4.1 microg g(-1) and 2.6 microg g(-1), respectively. Improved measurement uncertainty in the New Brunswick group was attributed to the use of a reduced source-to-skin distance (approximately 5 mm) and a longer measurement time (3600 seconds) using a weaker radioisotope source (< or =0.42 GBq). Measurement uncertainty tended to increase with body mass index. For a given body mass index, female subjects returned a measurement uncertainty approximately 1 microg g(-1) greater than males.

A Prospective Study of Prenatal and Childhood Lead Exposure and Erythropoietin Production

We test the hypothesis that chronic lead (Pb) exposure may be associated with an inability to maintain an adequate serum erythropoietin (EPO) concentration. From a longitudinal study of Pb exposure and infant and childhood development, we measured blood Pb (BPb) and serum EPO concentrations serially at ages 4.5, 6.5, 9.5, and 12 and tibia (cortical) Pb concentration at age 12. Pb-exposed children aged 4.5 and 6.5 produced increased concentrations of EPO to maintain normal Hgb concentrations. EPO production declined between ages 4.5 and 6.5. At ages 9.5 and 12, further diminution of the association was found. No association was found between tibia Pb and EPO. The continued decline in the slope of the relationship between EPO and BPb with age, after adjustment for hemoglobin, implies a gradually decreasing capacity to produce EPO.

Combined Exchange Transfusion and Chelation Therapy for Neonatal Lead Poisoning

OBJECTIVE

To describe the results of combined exchange transfusion and chelation therapy in a neonate with an elevated blood lead level (BLL).

CASE SUMMARY

A 34-year-old Latina woman with a long history of pica (eating glazed pottery) gave birth to a healthy-appearing girl at 40 weeks of gestation. The mother's preconception BLL was 117 μg/dL and remained elevated throughout pregnancy. At parturition, the mother's BLL was 87 μg/dL and the infant's cord BLL was 100 μg/dL. The infant underwent single-volume exchange transfusion within 12 hours of birth. BLL was 28 μg/dL following the exchange, and a 5-day course of chelation with dimercaprol and CaNa2 ethylenediamine tetraacetic acid was initiated at 36 hours of life. The infant's BLL was 37 μg/dL at the end of inpatient chelation.

DISCUSSION

Long-term neurologic disability from in utero lead exposure is well described, but the optimal treatment of elevated neonatal BLLs in healthy-appearing infants at the time of birth is not established. This strategy of combined chelation and exchange transfusion therapy was well tolerated and resulted in decreased lead levels, but the long-term neurologic efficacy of our combination strategy remains to be seen.

CONCLUSIONS

Combined exchange transfusion and chelation therapy resulted in rapidly decreased lead levels in a neonate with chronic in utero lead exposure.

Calculating the uncertainty in lead concentration for in vivo bone lead x-ray fluorescence

A revised mathematical treatment of the calibration line intercept has been published for in vivo bone lead measurements using 109Cd-based K-shell x-ray fluorescence. The revised calibration line treatment prompts changes, presented herein, to the method for calculating the measurement uncertainty.