In vivo measurements of bone lead--a comparison of two x-ray fluorescence techniques used at three different bone sites

Evaluation of a portable XRF device for in vivo quantification of lead in bone among a US population

BACKGROUND

Lead (Pb) concentration in bone is a reliable biomarker for cumulative Pb exposure and studying associated health outcomes. However, the standard K-shell fluorescence (KXRF) bone Pb measurement technology has limitations in large-scale population studies.

OBJECTIVE

We compared measurements from a portable XRF device and a KXRF device.

METHODS

We measured bone Pb concentrations in vivo using portable XRF and KXRF, each measured at the mid-tibia bone in 71 people, 38-95 years of age (mean ± SD = 63 ± 11 years) living in or near three Indiana communities, US; 10 participants were occupationally exposed. We estimated the correlation between bone Pb concentrations measured by both devices. We also examined the extent to which the detection limit (DL) of the portable XRF was influenced by scan time and overlying soft tissue thickness. Finally, we quantified the associations of estimated bone Pb concentration with age and age with soft tissue thickness.

RESULTS

The mean bone Pb concentration measured via portable XRF was 12.3 ± 16.7 mg Pb/kg dry bone. The uncertainty of a 3-minute (N = 60) in vivo portable XRF measurement ranged from 1.8 to 6.3 mg/kg, in the context of soft tissue thickness ranging from 2 to 6 mm. This uncertainty was reduced by a factor of 1.4 with 5-minute measurements (N = 11). Bone Pb measurements via portable XRF and KXRF were significantly correlated: r = 0.48 for all participants, and r = 0.73 among participants with soft tissue thickness < 6 mm (72% of the sample). Bone Pb concentrations were higher among participants who were older or were occupationally exposed to Pb. Soft tissue thickness decreased with age.

CONCLUSION

With its ease of use, portability, and comparable sensitivity with conventional KXRF systems, the portable XRF could be a valuable tool for non-invasive quantification of bone Pb in vivo, especially for people with thinner soft tissue.

Elemental analysis in living human subjects using biomedical devices

Today, patients undergoing dialysis are at low risk for aluminum-induced dementia. Workers are unlikely to experience cadmium-induced emphysema and the public's exposure to lead is an order of magnitude lower than in 1970. The research field of in vivo elemental analysis has played a role in these occupational and environmental health improvements by allowing the effects of people's chronic exposure to elements to be studied using non-invasive, painless, and relatively low-cost technology. From the early 1960s to the present day, researchers have developed radiation-based systems to measure the elemental content of organs at risk or storage organs. This reduces the need for (sometimes painful) biopsy and the risk of infection. Research and development has been undertaken on forty-nine in vivo measurement system designs. Twenty-nine different in vivo elemental analysis systems, measuring 22 different elements, have been successfully taken from design and testing through to human measurement. The majority of these systems employ either neutron activation analysis or x-ray fluorescence analysis as the basis of the measurement. In this review, we discuss eight of the successful systems, explaining the rationale behind their development, the methodology, the health data that has resulted from application of these tools, and provide our opinion on potential future technical developments of these systems. We close by discussing four technologies that may lead to new directions and advances in the whole field.

In Vivo X-Ray Fluorescence of Lead and Other Toxic Trace Elements

The first in vivo x-ray fluorescence measurements of lead in bone used y-rays from a 57Co source to excite Pb K x-rays. Later systems used γ-rays from 109Cd to excite Pb K x-rays or polarized x-rays to excite Pb L x-rays. All three approaches involve an extremely low effective dose to the subject. Of the two K x-ray techniques, 109Cd is more precise and more flexible in choice of measurement site. Pb L x-ray fluorescence (L-XRF) effectively samples lead at bone surfaces, whereas Pb K x-ray fluorescence (K-XRF) samples through the bulk of a bone. Both the polarized L-XRF and 109Cd K-XRF achieve similar precision.

Renal mercury has recently been determined using a polarized x-ray source. Both renal and hepatic cadmium can be measured using polarized x-rays in conjunction with a Si(Li) detector. Platinum and gold have been measured both by radioisotopic source excitation and by using polarized x-rays, but the latter is to be preferred.

Applications of Pb K-XRF have shown that measured bone lead relates strongly to cumulative lead exposure. Secondly, biological half lives of lead in different bone types have been estimated from limited longitudinal data sets and from some cross sectional surveys. Thirdly, the effect of hone lead as an endogenous source of lead has been demonstrated and it has been shown that a majority of circulating blood lead can be mobilized from bone, rather than deriving from new exposure, in some retired lead workers.

Bone lead levels in an environmentally exposed elderly population in shanghai, China

This study looked at measurements of lead (Pb) in a pilot population of environmentally exposed elderly residents of Shanghai, China and presented the first set of bone Pb data on an elderly Chinese population. We found that with environmental exposures in this population using K-shell x-ray fluorescence (KXRF) bone Pb measurements 40% of the individuals had bone Pb levels above the nominal detection limit with an average bone lead level of 4.9 ± 3.6 μg/g. This bone lead level is lower than comparable values from previous studies of community dwelling adults in US cities. This population had a slightly higher geometric mean blood Pb of 2.6 μg/dL than the adult US population. The main conclusion of this data is that in Shanghai there is environmental exposure to Pb, measured through blood and bone, which should be further investigated to assess the health impact of this exposure.

Feasibility of a portable X-ray fluorescence device for bone lead measurements of condor bones

Lead based ammunition is a primary source of lead exposure, especially for scavenging wildlife. Lead poisoning remains the leading cause of diagnosed death for the critically endangered California condors, which are annually monitored via blood tests for lead exposure. The results of these tests are helpful in determining recent exposure in condors and in defining the potential for exposure to other species including humans. Since condors are victim to acute and chronic lead exposure, being able to measure both would lend valuable information on the rates of exposure and accumulation through time. A commercial portable X-ray fluorescence (XRF) device has been optimized to measure bone lead in vivo in humans, but this device could also be valuable for field measurements of bone lead in avian species. In this study, we performed measurements of bone Pb in excised, bare condor bones using inductively coupled plasma mass spectrometry (ICP-MS), a cadmium 109 (Cd-109) K-shell X-ray fluorescence (KXRF) system, and a portable XRF system. Both KXRF and portable XRF bone Pb measurement techniques demonstrated good correlations with ICP-MS results (r=0.93 and r=0.92 respectively), even with increasing skin thickness (r=0.86 between ICP-MS and portable XRF at 1.54mm of soft tissue). In conclusion, our results suggest that a portable XRF could be a useful option for measurement of bone Pb in avian species in the field.

XRF-measured bone lead (Pb) as a biomarker for Pb exposure and toxicity among children diagnosed with Pb poisoning

Childhood lead (Pb) poisoning remains a global issue, especially in industrial areas. In this study, 115 children with average age 5.7 years were recruited as either patient diagnosed with Pb poisoning or controls at Xinhua Hospital in China. The subjects' bone Pb was measured with a K-shell X-ray fluorescence (KXRF) and a portable X-ray fluorescence (XRF) system. A significant correlation between KXRF bone Pb and blood Pb and portable XRF and KXRF measurements were observed. The half-life of blood-lead was calculated to be 9.96 ± 3.92 d. Our results indicate that bone is a useful biomarker for Pb in children.

Portable XRF Technology to Quantify Pb in Bone In Vivo

Lead is a ubiquitous toxicant. Bone lead has been established as an important biomarker for cumulative lead exposures and has been correlated with adverse health effects on many systems in the body. K-shell X-ray fluorescence (KXRF) is the standard method for measuring bone lead, but this approach has many difficulties that have limited the widespread use of this exposure assessment method. With recent advancements in X-ray fluorescence (XRF) technology, we have developed a portable system that can quantify lead in bone in vivo within 3 minutes. Our study investigated improvements to the system, four calibration methods, and system validation for in vivo measurements. Our main results show that the detection limit of the system is 2.9 ppm with 2 mm soft tissue thickness, the best calibration method for in vivo measurement is background subtraction, and there is strong correlation between KXRF and portable LXRF bone lead results. Our results indicate that the technology is ready to be used in large human population studies to investigate adverse health effects of lead exposure. The portability of the system and fast measurement time should allow for this technology to greatly advance the research on lead exposure and public/environmental health.

Portable XRF Technology to Quantify Pb in Bone In Vivo

Lead is a ubiquitous toxicant. Bone lead has been established as an important biomarker for cumulative lead exposures and has been correlated with adverse health effects on many systems in the body. K-shell X-ray fluorescence (KXRF) is the standard method for measuring bone lead, but this approach has many difficulties that have limited the widespread use of this exposure assessment method. With recent advancements in X-ray fluorescence (XRF) technology, we have developed a portable system that can quantify lead in bone in vivo within 3 minutes. Our study investigated improvements to the system, four calibration methods, and system validation for in vivo measurements. Our main results show that the detection limit of the system is 2.9 ppm with 2 mm soft tissue thickness, the best calibration method for in vivo measurement is background subtraction, and there is strong correlation between KXRF and portable LXRF bone lead results. Our results indicate that the technology is ready to be used in large human population studies to investigate adverse health effects of lead exposure. The portability of the system and fast measurement time should allow for this technology to greatly advance the research on lead exposure and public/environmental health.

Pure hydroxyapatite phantoms for the calibration of in vivo X-ray fluorescence systems of bone lead and strontium quantification

Plaster of Paris [poP, CaSO4·(1)/(2) H2O] is the standard phantom material used for the calibration of in vivo X-ray fluorescence (IVXRF)-based systems of bone metal quantification (i.e bone strontium and lead). Calibration of IVXRF systems of bone metal quantification employs the use of a coherent normalization procedure which requires the application of a coherent correction factor (CCF) to the data, calculated as the ratio of the relativistic form factors of the phantom material and bone mineral. Various issues have been raised as to the suitability of poP for the calibration of IVXRF systems of bone metal quantification which include its chemical purity and its chemical difference from bone mineral (a calcium phosphate). This work describes the preparation of a chemically pure hydroxyapatite phantom material, of known composition and stoichiometry, proposed for the purpose of calibrating IVXRF systems of bone strontium and lead quantification as a replacement for poP. The issue with contamination by the analyte was resolved by preparing pure Ca(OH)2 by hydroxide precipitation, which was found to bring strontium and lead levels to <0.7 and <0.3 μg/g Ca, respectively. HAp phantoms were prepared from known quantities of chemically pure Ca(OH)2, CaHPO4·2H2O prepared from pure Ca(OH)2, the analyte, and a HPO4(2-) containing setting solution. The final crystal structure of the material was found to be similar to that of the bone mineral component of NIST SRM 1486 (bone meal), as determined by powder X-ray diffraction spectrometry.

Nonlinearity in the relationship between bone lead concentrations and CBLI for lead smelter employees

494 smelter employees from New Brunswick participated in a bone lead survey conducted by McMaster University in 2008, using the four element "clover-leaf" geometry germanium detector system. The employees were measured at two different bone sites, tibia and calcaneus, each measurement lasting 30 minutes. Scattered photons, including Pb X-rays, were collected by the germanium detectors located behind the ¹⁰⁹Cd source. A strong positive correlation was observed between tibia and calcaneus lead concentrations. Having been provided with blood lead levels, a cumulative blood lead index (CBLI) was generated. The employees were classified into four groups based on their date of hire, and their CBLI levels were compared to their tibia and calcaneus lead concentrations in the different groups. The slopes of bone Pb versus CBLI varied amongst groups, with those hired earliest showing the steepest slopes. This could be taken to imply a non-linearity in the uptake of Pb by bone from blood. In this paper, the association of the bone lead concentrations versus CBLI has been expressed by a polynomial function for the whole group of employees.

Comparison of lead residues among avian bones

To determine if significant differences exist in lead (Pb) accumulation in different bones, especially those most often used for bone-Pb studies in wildlife, we compared Pb concentrations in radius, ulna, humerus, femur, and tibia of Common Eider (Somateria mollissima); and radius/ulna (combined), femur, and tibia of American Woodcock (Scolopax minor). There were no significant differences in bone-Pb concentrations among woodcock bones over a wide range of Pb concentrations (3-311 microg/g). In eider, where bone-Pb concentrations were low (<10 microg/g), leg bones had significantly higher Pb concentrations (approximately 30-40%) than wing bones from the same individuals. The variation among individual birds was greater than the variation among different bones within a bird. Based on our findings, we conclude that one type of bone may be substituted for another in bone-Pb studies although the same bone type should be analyzed for all birds within a study, whenever possible.

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.

Contrasting effects of age on the plasma/whole blood lead ratio in men and women with a history of lead exposure

We examined the effect of age and sex on the relationship between the concentrations of Pb in blood (Pb-B) and in plasma (Pb-P) in an adult population with a history of lead exposure. Pb-P was determined by inductively coupled plasma mass spectrometry (ICP-MS) and Pb-B by graphite furnace atomic absorption spectrometry (GF AAS). We studied 154 adults (56 men and 98 women) from 18 to 60-year old. Pb-B levels varied from 10.0 to 428.0 microg/L, with a mean of 76 microg/L. Blood lead levels varied from 10.0 to 428.0 microg/L in men (mean, 98.3 microg/L) and from 10.0 to 263.0 microg/L (mean, 62.8 microg/L) in women. Corresponding Pb-Ps were 0.02-2.9 microg/L (mean, 0.66 microg/L) and 0.02-1.5 microg/L (mean, 0.42 microg/L) in men and women, respectively. The relationship between Pb-B and Pb-P was found to be curvilinear (r = 0.757, P < 0.001 Spearman's correlation). The two quantities are related by the line y = 0.0006x(1492) (y = Pb-P, and x = Pb-B). The %Pb-P/Pb-B ratio ranged from 0.03% to 1.85%. A positive association was found between %Pb-P/Pb-B ratio and Pb-B levels. When data were separated by sex, this association was also relevant for men (y = 0.0184x(0.702)) and women (y = 0.0534x(0.5209)) (y = %Pb-P/Pb-B and x = Pb-B). Moreover, we found an interesting positive correlation between Log (Pb-P/Pb-B) and age for women (r = 0.31, P < 0.0001) and a negative correlation for men (r = -0.164, P = 0.07). Taken together, these results suggest contrasting effects of age on the plasma/whole blood lead ratio in men and women with a history of lead exposure. Moreover, sex might play an important role in the metabolism of lead, implying further consideration on the kinetic models constructed of lead toxicity.

Assessment of lead exposure risk in locksmiths

Exposure to lead has been well recognized in a number of work environments, but little is known about lead exposure associated with machining brass keys containing lead. The brass that is widely used for key manufacturing usually contains 1.5% – 2.5 % of lead. Six (6) licensed locksmiths and 6 case-matched controls successfully completed the pilot study to assess the prevalence of increased body lead burden of professional locksmiths. We measured both Blood Lead (atomic absorption spectrometry), bone-lead (KXRF) and had each subject complete a health and lead exposure risk questionnaire. One locksmith had not cut keys during the past two years, therefore this subject and case-matched control was excluded from the blood lead analysis only. The average blood-lead concentration (±SEM) for the 5 paired subjects was 3.1 (± 0.4) μg/dL and 2.2 (± 0.3) μg /dL for controls. Bone measurements, including all 6 paired subjects, showed tibia lead concentration (±SEM) for locksmiths and controls was 27.8 (± 2.3) μg /g and 13.7 (± 3.3) μg /g, respectively; average calcaneus lead concentration for locksmiths and controls was 31.9 (± 3.7) μg /g and 22.6 (± 4.1) μg /g, respectively: The t-test shows a significantly higher tibia lead (p<0.05) and blood lead (p<0.05) for locksmiths than for their matched controls, but no significant difference for calcaneus lead (p>0.10). Given that the mean tibia bone lead concentration was 13.1μg/g higher in locksmiths than in their matched controls, this average difference in the two groups would translate to an OR of increased hypertension in locksmiths of between 1.1 and 2.3, based on the published literature. Even with the very small number of subjects participating in this pilot study, we were able to demonstrate that locksmiths had significantly higher current exposure to lead (blood lead concentration) and significantly higher past exposure to lead (tibia lead concentration) than their age, sex and ethnically matched controls. Additional research is needed to fully identify the prevalence and associated risk factors for occupational exposure of lead in this previously understudied profession.

Lead in finger bone, whole blood, plasma and urine in lead-smelter workers: extended exposure range

OBJECTIVES

To assess the historical exposure and to study the relationships between lead concentrations in whole blood (B-Pb), plasma (P-Pb), urine (U-Pb), finger bone (Bone-Pb) and duration of employment in workers at a secondary lead smelter and to compare the relationships between B-Pb and P-Pb with results from previous studies of populations with a wide range of lead exposure.

METHODS

In 39 lead workers (29 active, ten retired), recruited from those with the highest exposure at a German secondary lead smelter, levels of B-Pb, P-Pb and U-Pb were determined by inductively coupled plasma mass spectrometry (ICP-MS). Bone-Pb was determined by in vivo X-ray fluorescence (XRF). Results were compared with data from a previous study on 90 workers (71 active, 19 retired) with lower exposure, from a Swedish secondary lead smelter, as well as with previously collected data from 42 active Russian lead workers and 34 Ecuadorian lead-exposed subjects.

RESULTS

The median values in the active/retired German lead workers were: age 44/59 years, duration of employment 20/38 years, Bone-Pb 71/150 microg/g, B-Pb 500/330 microg/l, P-Pb 2.7/1.1 microg/l, and U-Pb 25/13 micromol/mol creatinine. Bone-Pb increased with duration of employment by 4.2 microg/g per year and 1.6 microg/g per year in German and Swedish workers, respectively. The median Bone-Pb was three times higher in both active and retired German workers than in Swedish smelter workers with essentially the same age distribution and duration of employment. The linear regression equation between B-Pb and log P-Pb in the combined group of Ecuadorian, German, Russian and Swedish lead-exposed subjects (n=176) was B-Pb=545 x log[P-Pb] + 258 (r(s)=0.94; P<0.001).

CONCLUSIONS

The high Bone-Pb values recorded for the German smelters implied a historical lead exposure of considerable magnitude. The long-term high lead exposure also showed up in the B-Pb levels for both active and retired workers, leading to the implementation of necessary industrial safety measures in order to respond to biological threshold limits. The suggested equation describing the relationship between B-Pb and P-Pb in the combined group of subjects with a wide range of lead exposure can be useful in future cross-sectional and longitudinal studies of lead-exposed populations, relating, e.g., lead exposure to adverse health outcomes.

Lead concentrations in cortical and trabecular bones in deceased smelter workers

The aim of the study was to compare bone lead concentrations in cortical and trabecular bones in long-term exposed primary copper and lead smelter workers, and to relate the measured concentrations to the previous lead exposure of the workers. Lead concentrations in seven bones (trabecular: sternum, vertebrae, iliac crest, rib; cortical: femur, left forefinger, and temporal bone) were determined by electrothermal atomic absorption spectrometry in 32 male, long-term exposed copper and lead smelter workers, and compared with levels in 10 male occupationally unexposed reference persons. A time-integrated blood lead index (cumulative blood lead index, CBLI) was calculated for each worker. The lead levels in the seven studied bones were all significantly higher in active and retired lead workers as compared with the reference group (p<or=0.003). The highest lead concentrations among the workers were observed in finger bone (median 106 microg/g), followed in order by vertebrae, iliac crest and sternum. The highest quotients between median bone lead concentrations of workers vs. reference group were observed for trabecular bones (sternum 12.3, iliac crest 11.8, rib 8.8 and vertebrae 8.5). In retired workers, strong positive correlations were noted between lead levels in sternum and iliac crest (rs=0.91; p<0.001) and femur and temporal bone (rs=0.88, p<0.001). Neither CBLI nor exposure-time was related to the bone lead concentrations in any of the studied groups. The findings indicate similarities in the metabolism for bones with the same basic structure. The highest lead concentrations were found in finger bone, which can be used for retrospective exposure evaluations in lead exposed populations, e.g. through XRF-measurements.

Monte Carlo investigations of distance-dependent effects on energy deposition in K-shell x-ray fluorescence bone lead measurement

Radiation energy deposition results are presented from a Monte Carlo code simulating the lower part of a leg during an in vivo 109Cd K-shell x-ray fluorescence (KXRF) bone lead measurement. The simulations were run for a leg phantom model representing an adult subject, assuming concentrations of 10 microg Pb per gram bone mineral and tracing 500 million photons in each simulation. Trials were performed over a range (0.5-6.0 cm) of source-to-sample (S-S) distances. Energies deposited due to Compton and photoelectric processes occurring in the bone and the soft tissue were obtained. The data show an increase in the amount of energy deposited in the bone as the sample is moved closer to the source (from 2.0 cm to 0.5 cm). However, there is a decrease in the amount of energy deposited in the soft tissue as the sample is moved closer to the source over the same distance interval. In decreasing the S-S distance from 2.0 cm to 0.5 cm, the amount of energy deposited in the sample as a whole was found to increase by 11%. By calculating the energy deposition in the bone and in the soft tissue as a fraction of the total energy deposited in the sample, the corresponding changes are quantified as a function of S-S distance. Similarly, the proportions of energy deposited via the photoelectric effect and Compton scattering are presented as a function of S-S distance.

Cognitive effects of chronic exposure to lead and solvents

BACKGROUND

Occupational exposure to lead and solvents has declined steadily over the past 20 years, however, construction workers continue to be exposed to these neurotoxicants. The purpose of this study was to investigate the cognitive effects of chronic occupational exposure to lead and solvents.

METHOD

Based on K-XRF of tibial bone lead and occupational history of solvent exposure, subjects were classified into four exposure groups: lead (N = 40), solvent (N = 39), lead/solvent (N = 45), and control (N = 33). All subjects completed tests to assess concentration, motor skills, memory, and mood.

RESULTS

Relative to controls, the lead, solvent, and lead/solvent groups performed significantly more poorly on a test of verbal memory, while the lead and lead/solvent groups were slower than the solvent and control groups on a task of processing speed. Bone lead was a significant predictor of information processing speed and latency of response while solvent exposure was a significant predictor of verbal learning and memory.

CONCLUSIONS

Bone lead was associated with slower speed of processing while exposure to lead and/or solvents reduced efficiency of verbal learning.

Patella lead x-ray fluorescence measurements are independent of sample orientation

In vivo x-ray fluorescence bone lead measurements assess long-term lead exposure. Tibia, calcaneus, and patella are the most commonly sampled bones. Patella measurements also include lead signals from the distal femur, proximal tibia, and synovium. It is therefore important to know whether the orientation of the patella relative to the measurement system substantially affects the measured patella lead concentrations and their measurement uncertainties. This study examined whether these parameters exhibited a dependence on the orientation of the patella with respect to the measurement system, a dependence that could arise from varying nonpatella contributions. There was no effect of orientation on measured patella lead concentration, but there was a highly significant effect of orientation on the measurement uncertainty. These data do not conclusively show that there are no nonpatella contributions to a patella lead measurement; rather, that any such contributions are not a function of measurement orientation over the range of orientations considered. Further study is required if the contribution of nonpatella tissues to a patella lead XRF-measured concentration is to be fully addressed. This study also filled a gap in the literature by quantifying the within-patella (29%) and between-patella (71%) variability of measured patella lead concentrations from replicate measures of nine patellae.

Kidney cadmium as compared to other markers of cadmium exposure in workers at a secondary metal smelter

BACKGROUND

The aim of the study was to evaluate whether cadmium concentrations in kidney (K-Cd), blood (B-Cd) or urine (U-Cd) could reveal previous occupational cadmium exposure at a metal smelter.

METHODS

The study included 90 smelters and 35 controls (B-Cd and U-Cd determination). In a subgroup (N = 33), K-Cd was also determined.

RESULTS

B-Cd (median 4.6; range 0.5-53 nmol/L), U-Cd (0. 29; 0.04-1.9 micromol/mol creatinine) and K-Cd (14; 3-61 microg/g wet weight) were similar to reported concentrations in the general Swedish population. In the subgroup, significant associations (P<0. 001) were obtained between B-Cd and K-Cd (r = 0.70), U-Cd and K-Cd (r = 0.60) and between U-Cd and B-Cd (r = 0.62). Multiple regression analyses revealed smoking as the major predictor of K-Cd, B-Cd, and U-Cd. B-Cd and U-Cd were both associated with the duration of employment at the smelter.

CONCLUSIONS

There was no statistically significant evidence of previous occupational exposure at the smelter from measurement of K-Cd.

Performance appraisals of digital spectroscopy systems for the measurement of bone lead

The performances of two new digital spectroscopy systems are compared to a conventional analogue amplifier ADC system for the 109Cd based K X-ray fluorescence in vivo measurement of bone lead. Canberra's DSA-2000 and ORTEC's DSPEC(PLUS) were found to show 27.3 and 10.8% improvements in measurement precision respectively, when compared to an optimized conventional system. The resulting improvements in minimum detection limit, compared with the conventional limit of 6-10 microg Pb/g bone mineral, were reductions of 1.5-2.5 microg Pb/g bone mineral for the DSA-2000, and 0.5-1.0 microg Pb/g bone mineral for the DSPEC(PLUS).

Determinants of bone and blood lead concentrations in the early postpartum period

OBJECTIVE

This study investigated determinants of bone and blood lead concentrations in 430 lactating Mexican women during the early postpartum period and the contribution of bone lead to blood lead.

METHODS

Maternal venous lead was measured at delivery and postpartum, and bone lead concentrations, measured with in vivo K-x ray fluorescence, were measured post partum. Data on environmental exposure, demographic characteristics, and maternal factors related to exposure to lead were collected by questionnaire. Linear regression was used to examine the relations between bone and blood lead, demographics, and environmental exposure variables.

RESULTS

Mean (SD) blood, tibial, and patellar lead concentrations were 9.5 (4.5) microg/dl, 10.2 (10.1) microg Pb/g bone mineral, and 15.2 (15.1) microg Pb/g bone mineral respectively. These values are considerably higher than values for women in the United States. Older age, the cumulative use of lead glazed pottery, and higher proportion of life spent in Mexico City were powerful predictors of higher bone lead concentrations. Use of lead glazed ceramics to cook food in the past week and increased patellar lead concentrations were significant predictors of increased blood lead. Patellar lead concentrations explained one third of the variance accounted for by the final blood lead model. Women in the 90th percentile for patella lead had an untransformed predicted mean blood lead concentration 3.6 microg/dl higher than those in the 10th percentile.

CONCLUSIONS

This study identified the use of lead glazed ceramics as a major source of cumulative exposure to lead, as reflected by bone lead concentrations, as well as current exposure, reflected by blood lead, in Mexico. A higher proportion of life spent in Mexico City, a proxy for exposure to leaded gasoline emissions, was identified as the other major source of cumulative lead exposure. The influence of bone lead on blood lead coupled with the long half life of lead in bone has implications for other populations and suggests that bone stores may pose a threat to women of reproductive age long after exposure has declined.

The O'Flaherty model of lead kinetics: an evaluation using data from a lead smelter population

The O'Flaherty model of lead kinetics is a physiologically based computer model of lead disposition in humans. The model is based on an age-dependent approach to human growth, with particular attention devoted to bone metabolism. As such, model output is well suited for comparison with noninvasive bone lead measurements made via X-ray fluorescence. A subset of workers from a lead smelter population were selected for an initial evaluation of the O'Flaherty model. Detailed blood lead records were used to define input. Simulated bone lead and blood lead output were compared with observation, enabling a refinement of model parameters. A revised version of the O'Flaherty model was then evaluated for the smelter population as a whole. Previously observed trends for the accumulation of lead in cortical bone and the release of lead from bone stores were well explained by the revised model. Model predictions for the accumulation of lead in trabecular bone were not in accord with observed levels in the calcaneus. Model results from the smelter population are consistent with the hypothesis that a polymorphism in the delta-aminolevulinate dehydratase enzyme modifies the kinetics of lead in humans. Further refinements are suggested, which may enhance the ability of the model to explain the underlying relationships between lead exposure and the distribution of lead in the body.

Chelated lead in relation to lead in bone and ALAD genotype

In order to assess whether lead in bone is available for chelation by 2,3 meso-dimercaptosuccinic acid (DMSA), 21 workers (10 active and 11 retired) from a secondary lead smeltery were studied. A morning urine sample was obtained from all participants, followed by ingestion of 10 mg per kg body weight of the chelating agent DMSA. All urine produced during the following 24 h was collected in consecutive 6- and 18-h portions. Concentrations of lead in blood (B-Pb) and urine were determined by flameless atomic absorption spectrometry (AAS), in plasma (P-Pb) by inductively coupled plasma mass spectrometry (ICP-MS), and in finger bone (Bone-Pb) by K X-ray fluorescence technique (XRF). DMSA-chelatable lead excreted in the 24-h portion correlated well with the excretion in the 6-h portion (U-Pb6h; rs=0.95; P<0.001). U-Pb6h showed a non-linear relationship to B-Pb (rs=0.84; P<0.001) and linear relationships to P-Pb (rs=0. 91; P<0.001) and lead in morning urine (rs=0.95; P<0.001). In active workers, but not in retired ones, P-Pb and U-Pb6h showed some relationship to Bone-Pb. In alternative multiple regression models B-Pb or P-Pb were both significant predictors of U-Pb6h, while Bone-Pb did not significantly improve the models. It can, thus, be concluded that DMSA-chelatable lead mainly reflects lead concentrations in blood, soft tissues, and possibly also trabecular bone. It is not a good index of total body burden and long-term exposure. For such estimations cortical Bone-Pb is more valid, as it contains the major fraction of long-term accumulated lead in the body. Further, the mobilization test did not give better information than measurements of lead levels in blood, plasma, or urine without chelation.

The feasibility of a sensitive low-dose method for the in vivo evaluation of Fe in skin using K-shell x-ray fluorescence (XRF)

An x-ray fluorescence (XRF) system designed for monitoring of skin Fe concentrations has been performance tested for use on patients treated for beta-thalassaemia. The essentials of the system are: a collimated x-ray tube operated at 20 kV and 20 mA; energy selection of the x-ray beam by means of a Cu K-edge filter; use of skin phantoms containing concentrations of Fe in the range 10 to 100 parts per million (ppm); and a high-purity germanium detector placed at 90 degrees to the incident beam. For a Cu K-edge filter of 0.15 mm thickness a quasi-monoenergetic beam of approximately 8.4 keV is obtained which is close to the absorption edge of Fe (7.11 keV). For a real-time counting period of 400s the systemis capable of detecting Fe concentrations of 15+/-2 ppm at a skin dose of the order of 5 mSv. This level of Fe is at the higher end of the normal range found in the skin. In using the same system and operating parameters, measurements on a sample of ferritin obtained from a rat's liver yield an Fe concentration of 36+/-3 ppm for a measurement time of 500 s; this can be compared with suppliers' data indicating an Fe level of 36 ppm.

In vivo monitoring of bone-Pb and retrospective exposure: an assessment in occupationally exposed subjects

In this work we present the preliminary results of an investigation in to the bone burden of lead in occupationally exposed subjects. The assessment of bone lead levels normalised to the mineral content (mg/kg bone mineral) were carried out by means of an in vivo X ray fluorescence techniques (Pb-XRF). The measurements were performed on the second phalanx of the right index finger and the minimum detectable limits of the XRF techniques was estimated around 25-30 mg/kg. Although the blood lead level monitoring over long time seems to indicate working activities in environments with low sources of lead contamination, high Pb-XRF levels, and not well correlated with the exposure time, were found. These anomalous values could be explained in term of the dependence of zinc protoporphyrin assessment against the measurement time.

Lead in fingerbone: a tool for retrospective exposure assessment

Exposure to inorganic lead may cause many adverse health effects. When absorbed, lead is accumulated in large part in bone. In this study, we investigated the relationship between lead concentration in fingerbone, exposure time, and lead in blood. We also sought to design a model that made it possible to use fingerbone lead as an indicator of earlier exposure. The study comprised 137 active workers from a secondary lead smeltery. Workers had undergone regular determinations of blood lead (i.e., up to 6 times/y) for up to 24 y. In addition, during the period 1979-1992, workers underwent up to four fingerbone lead assessments via noninvasive x-ray fluorescence. We calculated cumulative blood lead, adjusted for time-related reduction of bone lead according to a transfer of lead from bone to blood, for each worker. We obtained the best fit of bone lead to cumulative adjusted blood lead when we assumed a 14-y half-time for the transfer coefficient. This half-time was similar to the terminal half-time for lead in bone in retired smelters, whom we studied earlier by longitudinal in vivo measurements. We described models for the accumulation of bone lead on blood lead and exposure time. The combined data on bone lead and exposure time may be used to estimate a mean blood lead during previous exposure. Such estimates will be valuable in epidemiological studies aimed at evaluating the toxic effects of long-term lead exposure in lead workers for whom data on previous blood lead levels are lacking.

Further experience with bone lead content measurements in residents of southern Ontario

Bone lead content of the mid-tibia was measured by in vivo fluorescence excitation in 90 females and 59 males aged between 6 and 81. The cross-sectionally derived rate of increase of tibia lead content was 0.24 +/- 0.03 microgram [g mineral]-1 yr-1. In 93 adult women, the corresponding rate of increase for calcaneus lead content was 0.12 +/- 0.11 microgram [g mineral]-1 yr-1. Comparison with European values show that, in Canada, the rates of lead accumulation are greater than those found in N. Sweden and Finland, similar to those of S. Sweden and less than values measured in England.

Toxicology; in vivo x-ray fluorescence for the assessment of heavy metal concentrations in man

x-Ray fluorescence (XRF) analysis and neutron activation analysis (NAA) are the two main methods for non-invasive in vivo determination of heavy metal concentrations in man. This paper describes various XRF-techniques developed for the measurements of cadmium, mercury and lead, primarily in occupationally exposed persons. Measurements have revealed cadmium concentrations close to 400 micrograms/g in the kidneys of exposed workers. Today, the technique can also be used for measuring kidney cadmium levels in the general population. Significantly different cadmium concentrations between groups of smokers and non-smokers have been observed. For workers with current lead exposure, there is no correlation between lead in finger bone and lead in blood. However, for retired lead workers, there is a relation between these levels, due to the endogenous excretion of lead from the skeleton. From a longitudinal study of retired lead workers, the biological half-time for bone lead was estimated to about 16 yr. Recently, the XRF-technique was shown to be capable of measuring mercury in vivo. On a group of chloralkali workers, we found kidney mercury concentrations ranging from non-detectable to over 50 micrograms/g.

An improved instrument for the in vivo detection of lead in bone

An improved instrument for the fluorescence excitation measurement of concentrations of lead in bone has been developed. This is based on a large area high purity germanium detector and a point source of 109Cd. The source is positioned in a tungsten shield at the centre of the detector face such that 88keV photons cannot enter the detector directly. In vivo measurements are calibrated with plaster of Paris phantoms. Occupationally non-exposed men show a minimum detectable concentration of about 6 micrograms/g bone mineral. Measurements of tibia lead concentrations in 30 non-occupationally exposed men between the ages of 23 and 73 showed an annual increment of 0.46 microgram/g bone mineral/year. The mean deviation from the regression of tibia lead upon age was 3.5 micrograms/g bone mineral. Tibia lead concentration in one subject with a history of exposure to lead was 69.6 (SD 3.5) micrograms/g bone mineral. The improved precision of the point source large detector system means that greater confidence can be placed on the results of in vivo measurements of lead concentration. This will allow studies of the natural history of non-occupational lead accumulation in normal subjects and should permit investigations of the efficacy of therapeutic interventions in subjects poisoned with lead.

In vivo measurements of lead in bone in long-term exposed lead smelter workers

In-vivo measurements of lead concentrations in calcaneus (mainly trabecular bone) and tibia (mainly cortical bone) were performed by x-ray fluorescence (XRF) in 70 active and 30 retired lead smelter workers who had long-term exposure to lead. Comparison was made with 31 active and 10 retired truck assembly workers who had no known occupational exposure to lead. After physical examination, all participants provided blood and urine samples and answered a computerized questionnaire. Since 1950, blood lead has been determined repeatedly in lead workers at the smelter, which made it possible to calculate a time-integrated blood lead index for each worker. Lead concentrations in blood, urine, calcaneus, and tibia in active and retired lead workers were significantly higher than in the corresponding control groups (p < .001). The highest bone lead concentrations were found among retired lead workers (p < .001), which was the result of considerably higher lead exposure during 1940 to 1960. Lead concentrations in calcaneus in active lead workers were significantly higher than in tibia when expressed in ug of lead per gram of bone mineral, which suggests a quicker absorption over time in this mainly trabecular bone. The estimated biological half-times were 16 y in calcaneus (95% confidence interval [95% CI] = 11-29 y) and 27 y in tibia (95% CI = 16-98 y). A strong positive correlation was found between lead concentrations in calcaneus and tibia for all lead workers (r = 0.54; p < .001). A strong positive correlation was also found between the bone lead concentrations and the cumulative blood lead index. Blood lead, at the time of study, correlated well with bone lead concentrations in retired--but not in active--workers, reflecting the importance of the endogenous (skeletal) lead exposure. The findings in this study indicate that bone lead measurements by XRF can give a good index of long-term lead exposure. Tibia measurements offer a higher precision than calcaneus measurements. The method is of particular interest in epidemiologic studies of adverse health effects caused by long-term lead exposure.

An enhanced sensitivity K-shell x-ray fluorescence technique for tibial lead determination

A novel irradiation-detection geometry capable of enhancing sensitivity for the measurement of tibial lead content by K-shell x-ray fluorescence (XRF) is described. The high-count-rate system comprised a small-area high-specific-activity (0.147 GBq mm-2) 109Cd source and a large-area (nominally 20 cm2) uncollimated detector, forming an axially symmetric back-scattering arrangement. Precisions in the range +/- 4.9 to +/- 14.2 micrograms Pb (g bone mineral)-1 have been obtained in a study of a cohort of 63 controls and 73 workers industrially exposed to lead. These precisions are comparable with those obtained in results using earlier systems, but at reduced source activities (less than 50% of the activity of other systems) and with significant reduction in measurement time (some 30% less than the measurement times of other systems). Subsequent investigation of detector collimation resulted in a marginal improvement in energy resolution, but the restriction in detected photon fluence meant that there was an insignificant change in detection sensitivity. For the resistive feedback preamplifier used in this study a maximum energy rate of the order of 7000 MeV s-1 was found to limit measurement precisions significantly. Higher-count-rate detector systems offer a basis for obtaining mean precisions down to +/- 3 micrograms Pb (g bone mineral)-1 at one standard deviation.

Assessment of accumulated body burden of metals

Knowledge of the body burden of a metal is important for evaluation of exposure and risk. Traditionally, the burden has been estimated through levels in blood, urine, hair, or shed teeth, or by mobilization tests. However, all these methods have limitations. In vivo methods for determination of cadmium in kidney by neutron activation analysis or X-ray fluorescence (XRF) reflect the burden, long-term exposure, and risk of toxic effect. In vivo determination by XRF of lead in fingerbone, tibia, or calcaneus reflect the long-term exposure, and should become a valuable tool in epidemiological studies, especially of chronic effects.

Bone lead measurements in patients with chronic renal disease studied over time

Results of longitudinal studies that involved the measurement of lead by different methodologies are presented for two groups of patients with chronic renal disease. Methodologies for all patients included x-ray fluorescence measurements of finger-bone lead. These measurements were conducted 5 y apart for one group of patients (n = 15). Initial measurements for the other group (n = 15) were supplemented by bone lead levels obtained either from skull at craniotomy or from skull, and sometimes rib, at autopsy. Most subjects also underwent ethylenediaminetetraacetic acid (specifically CaNa2 EDTA) lead-mobilization testing. A correlation between rate of decrease in finger-bone lead and immunoreactive parathormone levels was suggested. Renal patients were compared with age-matched controls, and their bone half-lives did not differ. The data are discussed and related to other results obtained from clinical and nonclinical populations in which trabecular and cortical bones were studied, and our results were consistent with evidence that more rapid turnover of lead occurs in trabecular bone than in cortical bone. No support was found for the hypothesis that patients who undergo renal dialysis accumulate lead in bone.

In vivo measurements of lead in bone at four anatomical sites: long term occupational and consequent endogenous exposure

Measurements of bone lead concentrations in the tibia, wrist, sternum, and calcaneus were performed in vivo by x ray fluorescence on active and retired lead workers from two acid battery factories, office personnel in the two factories under study, and control subjects. Altogether 171 persons were included. Lead concentrations in the tibia and ulna (representative of cortical bone) appeared to behave similarly with respect to time but the ulnar measurement was much less precise. In an analogous fashion, lead in the calcaneus and sternum (representative of trabecular bone) behaved in the same way, but sternal measurement was less precise. Groups occupationally exposed to lead were well separated from the office workers and the controls on the basis of calculated skeletal lead burdens, whereas the differences in blood lead concentrations were not as great, suggesting that the use of concentrations of lead in blood might seriously underestimate lead body burden. The exposures encountered in the study were modest, however. The mean blood lead value among active lead workers was 1.45 mumol l-1 and the mean tibial lead concentration 21.1 micrograms (g bone mineral)-1. The kinetics of lead in the tibia appeared to be noticeably different from that in the calcaneus. Tibial lead concentration increased consistently both as a function of intensity of exposure and of duration of exposure. Calcaneal lead concentration, by contrast, was strongly dependent on the intensity rather than duration of exposure. This indicated that the biological half life of lead in calcaneus was less than the seven to eight year periods into which the duration of exposure was split. Findings for retired workers clearly showed that endogenous exposure to lead arising from skeletal burdens accumulated over a working lifetime can easily produce the dominant contribution to systemic lead concentrations once occupational exposure has ceased.

Repeated measurements of tibia lead concentrations by in vivo x ray fluorescence in occupational exposure

A group of workers occupationally exposed to lead have had measurements of their tibia lead concentrations made on two occasions separated by five years; on the second occasion calcaneus lead concentrations were also measured. The results serve to confirm the reliability of the measurement technique and to illustrate the improved precision achieved through technical improvements. More importantly, the relation between tibia lead concentration and cumulative blood lead found in this longitudinal study was entirely consistent with that previously reported, which had been based on cross sectional studies. Furthermore, the relation between lead concentrations in the tibia and in calcaneus found here was similar to that previously found in a larger cross sectional survey. It is concluded that this technique of measuring bone lead concentrations non-invasively is likely to be used increasingly as a biological monitor of cumulative exposure to lead.

Kinetics of lead in bone and blood after end of occupational exposure

In 14 retired lead workers, followed for over 18 years after end of exposure, repeated analyses of lead levels in finger bone by an in vivo X-ray fluorescence method revealed a decrease of lead concentration. The data were analysed using an exponential retention model. For the whole group the biological half-time was 16 (asymptotic 95% confidence interval, CI 12,23) years. The median of the estimated bone lead levels at the end of exposure was 85 micrograms.g-1 above the "background" (3 micrograms.g-1). A simultaneous follow-up of blood lead levels displayed a decrease, which could be described by a tri-exponential retention model with group half-times of 34 (CI 29,41) days, 1.2 (CI 0.9,1.8) years, and 13 (CI 10,18) years, respectively. The median of the estimated blood lead levels at the end of exposure for the three components were 0.49, 0.61, and 1.1 mumol.l-1 above the "background" (0.38-0.56 mumol.l-1), respectively. The well-documented decrease of lead exposure in the general population over the years, urged the use of a decreasing "background" of blood lead during the time of the study. The slowest of the three components represented the skeleton (probably mainly cortical bone), as did mainly probably also the intermediate one (trabecular bone). The data show the rather slow turnover of lead in the skeleton, the usefulnes of in vivo skeletal lead measurements as a long-term exposure index, and the importance of bone as a source of "endogenous" lead exposure.

Compton scattering profile for in vivo XRF techniques

The contribution from single Compton scattered photons to the background in in vivo x-ray fluorescence analysis is evaluated by taking into account the energy broadening of the scattered photons which reflects the momentum distribution of the target electrons. A general-purpose Monte Carlo evaluation of multiple scattering components, as well as accurate experimental verifications with 59.54 keV photons impinging on various targets of interest for real-life irradiation, confirm that the single Compton scattering profiles of the elements composing the biological matrix dominate the trend and amplitude of the background in the region of interest with near-backscatter configurations. Step features are likewise explained in terms of single Compton phenomenology. Other probable sources of background, such as photoelectron Bremsstrahlung and pile-up distribution, are studied both theoretically and experimentally in order to compare their amplitude and features with those of single Compton scattered photon profiles.

Effect of repeated occupational exposure to lead, cessation of exposure, and chelation on levels of lead in bone

A sensitive K-X-ray fluorescence (K-XRF) instrument was used to measure lead levels in the tibia and patella on a series of twelve subjects who had relatively well-documented histories of lead exposure and blood lead levels. For some subjects, K-XRF measurements were taken at multiple points in time, and before and after chelation with EDTA (ethylenediamine tetraacetic acid). Results confirm that K-XRF measured bone lead levels correspond to cumulative blood lead indices and not to current blood lead levels. Moreover, the data suggest that bone lead levels; (1) correspond to urinary lead following the EDTA mobilization test unless previous chelation has occurred; (2) rise initially after lead exposure ceases and blood lead levels decrease, probably from redistribution from soft tissue, and then fall; and (3) do not decrease with a 3- to 5-day course of therapeutic EDTA chelation. K-XRF levels in the patella were noted to decrease more rapidly than levels in the tibia after cessation of lead exposure, a finding that probably reflects the greater turnover of lead in trabecular bone than in cortical bone.