Portable XRF Technology to Quantify Pb in Bone In Vivo

Portable x-ray fluorescence for bone lead measurement: Current approaches and future directions

PURPOSE OF REVIEW

Legacy lead exposures persist as a widespread problem. Blood lead is traditionally used for lead exposure surveillance; however, bone lead proves to be a cheaper, more accessible, and more revealing tool for surveillance that can be measured using portable x-ray fluorescence techniques. We outline how this approach excels for bone lead measurements.

RECENT FINDINGS

Portable XRF offers quick, non-invasive in vivo quantification of bone lead. Compared to traditional KXRF systems, pXRF is limited to cortical bone but allows for quicker and similar results. Current methodologies of lead exposure need re-evaluation as lead-related disease burden and trends are dependent on both cumulative and acute impacts. We examined the evolution of XRF techniques for measuring bone lead, comparing current methods with previous ones. We assessed their accuracy, identified limitations, and discussed potential advances in future techniques. Legacy lead exposures call for a revitalization of lead surveillance methods, and pXRF measurement of bone lead offers such a solution.

Using portable X-ray fluorescence elemental analysis to explore porous skeletal lesions: Interplay of sex, age at death, and cause of death

OBJECTIVES

Search for possible associations between bone elemental concentration and the presence of porous skeletal lesions (PSLs), considering the sex, age, and cause of death (COD) of the individuals.

MATERIALS AND METHODS

The sample comprised 107 non-adult individuals (56 females, 51 males) aged 0-20 (x̄ = 13.2, SD = 5.8) from the Coimbra and Lisbon Identified Skeletal Collections. Cribra cranii, orbitalia, humeralis, and femoralis were recorded as present/absent, and elemental concentrations were assessed by portable x-ray fluorescence (pXRF). A multivariate statistical approach was applied.

RESULTS

Well-preserved skeletons with minimal diagenesis showed no sex-related elemental variations or PSL associations. In contrast, age-at-death correlated with elevated Ca, P, Sr, and Pb levels. Cribra cranii increased with age while other cribra declined post-adolescence. Higher concentrations of Fe and lower of S were linked to cribra cranii. Respiratory infections as COD increased the odds of expressing cribra femoralis (OR = 5.25, CI = 1.25-15.14), cribra cranii (OR = 2.91, CI = 0.97-8.69), and cribra orbitalia (OR = 2.76, CI = 1.06-7.24).

DISCUSSION

Feasible pXRF results and low cribra intraobserver error assure replicability. Elevated Ca, P, and Sr in older individuals may relate to skeletal growth, while increased Pb suggests bioaccumulation. Cribra's increase with age reflects different rates of marrow conversion and bone remodeling. Higher Fe and lower S in individuals with cribra cranii possibly reflects poor nutrition, early alcohol use, and sideroblastic anemia, aligning with 19th-20th-century Portugal's living conditions. Respiratory infections increased cribra expression, revealing intricate interplays among inflammation, anemia(s), marrow expansion, and diet. This research highlights a complex scenario and blazes a new path for cribra interpretation.

Elevated Metal Levels in U.S. Honeys: Is There a Concern for Human Health?

Honey is a bioactive food used for millennia to improve health and treat diseases. More recently, researchers employ honey as a tool to assess local environmental pollution. Honeybees effectively 'sample' their environment within a ~ 7 km radius, actively collecting nectar, pollen, and water to bring to their hive. Foraging honeybees also sample the air as dust particles accumulate on their pubescence, adding to the hive's contaminant load. Many studies from around the world report elevated metal levels in honey, with the most reports from Iran, Italy, and Turkey, but only two reports have measured metal levels in honey from the United States (U.S.). We report levels of 20 metals from 28 honeys collected from 15 U.S. states between 2022-2023. We then focus on four toxic metals recognized as hazards in foodstuffs when the concentrations are above safety recommendations - lead, cadmium, arsenic, and mercury. Two of these metals (lead and mercury) are regulated in honey by the European Union (EU), though the U.S. currently lacks defined regulations for metal levels in honey. We consider the levels of these toxic metals by state, then compare the U.S. mean honey level for these metals against the provisional tolerable weekly intake (PTWI). Our results suggest U.S. honey have levels metal that exceed the PWTI and EU regulations and may be hazardous to human health. Further research is needed to determine if the effects of these toxic metal at measured levels outweigh the health benefits from consumption of honey.

Lead exposure across the life course and age at death

BACKGROUND

Lead (Pb) exposure has been associated with an increased risk of all-cause mortality, even at low levels. Little is known about how the timing of Pb exposure throughout life may influence these relationships. Quantifying the amount of Pb present in various tissues of the body provides measurements of exposure from different periods of life. These include bone, tooth enamel, which is the hard outer layer of the crown, and tooth cementum, which is the calcified connective tissue covering the tooth root. The purpose of the study was to examine Pb exposure at multiple periods throughout life, including childhood (enamel), adulthood (cementum), and later life (bone), and to estimate their associations with age at death.

METHODS

208 skeleton donors (born 1910-1960) from an ongoing case-control study were included in this study. Pb was measured in tibia (shin), bone using X-Ray Florescence and in teeth using Laser-Ablation Inductively Coupled Plasma Mass Spectroscopy. After excluding unusually high measurements (>2sd), this resulted in a final sample of 111 with all exposure measures. Correlations across measures were determined using partial Spearman correlations. Associations between Pb exposure and age at death were estimated using Multivariable Linear Regression.

RESULTS

Pb measures across exposure periods were all significantly correlated, with the highest correlation between cementum and tibia measures (r = 0.61). Donors were largely female (63.0 %), White (97.3 %), and attended some college (49.5 %). Single exposure models found that higher tooth cementum Pb (-1.27; 95 % CI: -2.48, -0.06) and tibia bone Pb (-0.91; 95 % CI: -1.67, -0.15) were significantly associated with an earlier age at death. When considered simultaneously, only cementum Pb remained significant (-1.51; 95 % CI: -2.92, -0.11). Secondary analyses suggest that the outer cementum Pb may be especially associated with an earlier age at death.

CONCLUSION

Results suggest that higher Pb exposure is associated with an earlier age at death, with adulthood as the life period of most relevance. Additional studies using Pb exposure measures from different life stages should be conducted.

Benchtop x-ray fluorescence to quantify elemental content in nails non-destructively

Metals continue to impose health issues among world populations. A non-invasive alternative biomarker for assessment of metals and other elements has been explored in other studies using toenail samples. Some benefits of using toenails as biomarkers over blood samples include cost efficiency, ease of collection, and a longer biological half-life within samples. The objective of this study was to employ desktop XRF for the purpose of measuring metal concentrations in human nail samples, thus conducting a non-destructive assessment. These benefits paired with comparable accuracy in exposure detection could prove toenail samples to be a preferred biomarker for many studies. Current elemental quantification techniques in toenail samples could be improved. The standard practice for measuring metal exposure in toenails, inductively coupled plasma mass spectrometry (ICP-MS), has a counterpart in x-ray fluorescence. While maintaining similar quantification capabilities, x-ray fluorescence could provide decreased cost, preservation of samples, and ease of operation. Portable XRF machines have been tested for measuring toenail samples, but they have drastically increased detection limits in comparison to ICP-MS. New benchtop XRF systems should give comparable detection limits to ICP-MS. This study compares the benchtop XRF measurements of lead (Pb), copper (Cu), iron (Fe), and Selenium (Se) levels to that of ICP-MS measurements of toenail samples and calculates estimated detection limits for 23 other elements. We found strong correlations for the toenail lead (R2 = 0.92), copper (R2 = 0.95), selenium (R2 = 0.60), and iron (R2 = 0.77) comparison between desktop XRF and ICP-MS measurements. Median minimum detection limits over the 23 elements were found to be 0.2 μg/g using a 7.5-min measurement. Benchtop XRF provides a lower detection limit than previously studied portable XRF machines, which gives it the capability of accurately detecting almost any desired element in nail samples. Benchtop XRF provides a non-destructive alternative to ICP-MS in surveillance of nail samples.

Elemental analysis using portable X-ray fluorescence: Guidelines for the study of dry human bone

OBJECTIVE

X-ray fluorescence (XRF) is a non-destructive technique that measures the elemental concentration of different materials, including human bone. Recently, it began to be applied to paleopathological studies due to the development of portable devices and their relative ease of use. However, the lack of uniform procedures hampers comparability and reproducibility. This paper aims to provide guidelines for an efficient and standardized evaluation of bone elemental composition with a portable XRF (pXRF) device.

MATERIALS

This technical note is based on the application of the Thermo Scientific Niton XL3t 900 GOLDD+.

METHODS

This work includes suggestions for the choice and preparation of human bone samples, both from archaeological context and documented collections, and methodological procedures in pXRF setup, such as choice of calibration, assessment of accuracy, and analysis run time. Additionally, recommendations for data validation and statistical analysis are also included.

CONCLUSIONS

This technique has great potential in paleopathology since bone chemical variations may be associated with different pathological conditions, environmental contamination (e.g., lead), and/or administered treatments, such as mercury. Following an expected increase in the number of studies, it is essential to establish good practices that allow results from different researchers to be comparable.

SIGNIFICANCE

X-ray fluorescence is a non-destructive technique that measures small concentrations (ppm) of elements from magnesium (12Mg) through bismuth (83Bi).

LIMITATIONS

pXRF does not detect elements lighter than Mg, and its lower energy excitation penetrates less than other techniques.

SUGGESTIONS FOR FURTHER RESEARCH

Other research groups should test these guidelines and comment on their usefulness and replicability.

Bone lead variability in bone repository skeletal samples measured with portable x-ray fluorescence

Bone lead serves as a better, more accessible biomarker to many communities experiencing chronic exposure to lead. A new method using low energy x-ray fluorescence in a handheld device (portable XRF) allows us to measure this chronic biomarker in only a few minutes. However, many unknowns remain about this biomarker measured using a new low energy x-ray technique. The low energy of the new method was theorized to measure a slightly different portion of the bone than previous techniques, which could influence measurements at different bone sites and types. We tested how bone measurements varied across five bone sites: mid-tibial shaft, proximal tibia, distal tibia (ankle), ilium, and cranium. We found bone lead measurements are not significantly different between skeletal elements when measured using a portable XRF. On average, bone lead in the repository samples was measured to be 21.6 ± 21.3 μg/g with an XRF detection limit of 2.1 ± 0.5 μg/g. Cumulative lead exposure can be effectively measured using the portable XRF on a variety of bone types, but the tibia should be preferentially measured to compare between studies and individuals.

In vivo quantification of strontium in bone among adults using portable x-ray fluorescence

BACKGROUND AND OBJECTIVE

Bone strontium (Sr) is a reliable biomarker for studying related bone health outcomes and the effectiveness of Sr supplements in osteoporosis disease treatment. In this study, we evaluated the sensitivity of portable x-ray fluorescence (XRF) technology for in vivo bone Sr quantification among adults.

MATERIALS AND METHODS

Sr-doped bone-equivalent phantoms were used for system calibration. Using the portable XRF, we measured bone Sr levels in vivo in mid-tibia bone in 76 adults, 38-95 years of age, living in Indiana, US; we also analyzed bone data of 29 adults, 53-82 years of age, living in Shanghai, China. The same portable XRF device and system settings were used in measuring their mid-tibia bone. We compared bone Sr concentrations by sex, age, and recruitment site. We also used multiple linear regression model to estimate the association of age with bone Sr concentration, adjusting for sex and recruitment site.

RESULTS

The uncertainty of in vivo individual measurement increased with higher soft tissue thickness overlying bone, and it ranged from 1.0 ug/g dry bone (ppm) to 2.4 ppm with thickness ranging from 2 to 7 mm, with a measurement time of 5 min. Geometric mean (95% confidence interval (CI)) of the bone Sr concentration was 79.1 (70.1, 89.3) ppm. After adjustment for recruitment site and sex, an increase in five years of age was associated with a 8.9% (95% CI: 2.5%, 15.6%) increase in geometric mean bone Sr concentration.

DISCUSSION AND CONCLUSION

Sr concentrations were consistently well above detection limits of the portable XRF, and exhibited an expected increase with age. These data suggest that the portable XRF can be a valuable technology to quantify Sr concentration in bone, and in the study of Sr-related health outcomes among adults, such as bone mineral density (BMD) and bone fracture risk.

Machine Learning Enhanced Optical Spectroscopy for Disease Detection

Optical spectroscopy plays an important role in disease detection. Improving the sensitivity and specificity of spectral detection has great importance in the development of accurate diagnosis. The development of artificial intelligence technology provides a great opportunity to improve the detection accuracy through machine learning methods. In this Perspective, we focus on the combination of machine learning methods with the optical spectroscopy methods widely used for disease detection, including absorbance, fluorescence, scattering, FTIR, terahertz, etc. By comparing the spectral analysis with different machine learning methods, we illustrate that the support vector machine and convolutional neural network are most effective, which have potential to further improve the classification accuracy to distinguish disease subtypes if these machine learning methods are used. This Perspective broadens the scope of optical spectroscopy enhanced by machine learning and will be useful for the development of disease detection.

Portable X-ray Fluorescence as a Rapid Determination Tool to Detect Parts per Million Levels of Ni, Zn, As, Se, and Pb in Human Toenails: A South India Case Study

Chronic exposure to inorganic pollutants adversely affects human health. Inductively coupled plasma mass spectrometry (ICP-MS) is the most common method used for trace metal(loid) analysis of human biomarkers. However, it leads to sample destruction, generation of secondary waste, and significant recurring costs. Portable X-ray fluorescence (XRF) instruments can rapidly and nondestructively determine low concentrations of metal(loid)s. In this work, we evaluated the applicability of portable XRF as a rapid method for analyzing trace metal(loid)s in toenail samples from three populations (n = 97) near the city of Chennai, India. A Passing-Bablok regression analysis of results from both methods revealed that there was no proportional bias among the two methods for nickel (measurement range ∼25 to 420 mg/kg), zinc (10 to 890 mg/kg), and lead (0.29 to 4.47 mg/kg). There was a small absolute bias between the two methods. There was a strong proportional bias (slope = 0.253, 95% CI: 0.027, 0.614) between the two methods for arsenic (below detection to 3.8 mg/kg) and for selenium when the concentrations were lower than 2 mg/kg. Limits of agreement between the two methods using Bland-Altman analysis were derived for nickel, zinc, and lead. Overall, a suitably calibrated and evaluated portable XRF shows promise in making high-throughput assessments at population scales.

Comparative analysis of the dust retention capacity and leaf microstructure of 11 Sophora japonica clones

We used fresh leaves of Sophora japonica L. variety 'Qingyun 1' (A0) and 10 superior clones of the same species (A1-A10) to explore leaf morphological characteristics and total particle retention per unit leaf area under natural and artificial simulated dust deposition treatments. Our objectives were to explore the relationship between the two methods and to assess particle size distribution, X-ray fluorescence (XRF) heavy metal content, and scanning electron and atomic force microscopy (SEM and AFM) characteristics of leaf surface microstructure. Using the membership function method, we evaluated the dust retention capacity of each clone based on the mean degree of membership of its dust retention index. Using correlation analysis, we selected leaf morphological and SEM and AFM indices related significantly to dust retention capacity. Sophora japonica showed excellent overall dust retention capacity, although this capacity differed among clones. A5 had the strongest overall retention capacity, A2 had the strongest retention capacity for PM2.5, A9 had the strongest retention capacity for PM2.5-10, A0 had the strongest retention capacity for PM>10, and A2 had the strongest specific surface area (SSA) and heavy metal adsorption capacity. Overall, A1 had the strongest comprehensive dust retention ability, A5 was intermediate, and A7 had the weakest capacity. Certain leaf morphological and SEM and AFM characteristic indices correlated significantly with the dust retention capacity.

Elemental Composition in Female Dry Femora Using Portable X-Ray Fluorescence (pXRF): Association with Age and Osteoporosis

Pathophysiological conditions can modify the skeletal chemical concentration. This study analyzes the elemental composition in two anatomical regions from dry femoral bone using a portable X-Ray Fluorescence (pXRF) and evaluates its impact in the bone mineral density (BMD). The left femora of 97 female skeletons (21-95 years old individuals) from the Coimbra Identified Skeletal Collection were studied. Diagenetic biases were discarded at the outset and BMD was determined with Dual-energy X-ray absorptiometry. Chemical measurements were performed at the midpoint of the femoral neck and at the midshaft using a pXRF device, and comparisons were made considering the age and the BMD values. Only elements with a Technical Measurement Error ≤ 5% were selected: P, S, Ca, Fe, Zn, As, Sr, Pb and the Ca/P ratio. Statistically significant differences were found between regions, with higher concentrations of P, Ca, Zn and S at the midshaft, and the Ca/P ratio at the femoral neck. The concentration of P is higher in individuals < 50 years, while S and Ca/P ratio increase in individuals ≥ 50 years. The decrease of P with age can be simultaneously related to the decline of its concentration in osteoporosis. Decreased BMD is also associated with higher levels of S and Pb. Osteoporosis enhances the absorption of osteolytic elements in specific locations. This fast and non-destructive technique has proved effective for the comprehension of chemical changes related to bone mass loss. This study highlights the potential of identified skeletal collections to improve the knowledge about bone fragility.

A novel calibration for L-shell x-ray fluorescence measurements of bone lead concentration using the strontium Kβ/Kαratio

Objective. Lead (Pb) is a well-known toxic element.In vivobone Pb concentration measurement is a long-term exposure metric complementary to blood Pb concentration measurement which is a metric of recent exposure.In vivohuman tibia bone Pb measurements using Pb K-shell or L-shell x-ray fluorescence (KXRF or LXRF) emissions were developed in the 1980s. KXRF bone Pb measurements using Cd-109 gamma rays and coherent-to-fluorescence ratio to account for differences between phantom andin vivomeasurements, was employed in human studies. Bone Pb LXRF method employed x-ray tubes. However, calibration procedures using ultrasound measurements of the soft tissue thickness (STT) proved inaccurate.Approach. In this study, bone and soft tissue (ST) phantoms simulatedin vivobone Pb measurements. Seven plaster-of-Paris cylindrical bone phantoms containing 1.01 mg g-1of strontium (Sr) were doped with Pb in 0, 8, 16, 29, 44, 59, and 74 μg g-1concentrations. Polyoxymethylene (POM), resin, and wax were each used to fabricate four ST phantoms in the approximate 1-4 mm thickness range. Pb LXRF measurements were performed using a previously developed optimal grazing incidence position method.Main results. Linear attenuation coefficients measurements of ST materials indicated that POM and resin mimicked well attenuation of Pb x-rays in skin and adipose tissue, respectively. POM and resin data indicated a bone Pb detection limit of 20 μg g-1for a 2 mm STT. Derived relationships between the Pb concentration, Pb LXRF and Sr Kβ/Kαratio data did not require STT knowledge. Applied to POM and resin data, the new calibration method yielded unbiased results.Significance.In vivobone Pb measurements in children were suggested following considerations of radiation dose, STT, detectability and distribution of Pb and Sr in bone. This research meets with the concerns regarding the negative effects of low levels of Pb exposure on neurodevelopment of children.

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.

Lead exposure and association with angiogenic factors and hypertensive disorders of pregnancy

OBJECTIVES

Lead exposure has been associated with hypertensive disorders of pregnancy. Angiogenic factors, including soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), are aberrant in preeclampsia, but have not been correlated with lead levels. We evaluated the association of lead exposure with angiogenic factors.

STUDY DESIGN

This cross sectional study utilized a convenience sample of singleton pregnancies ≥34 weeks' gestation. Blood lead and angiogenic factors were measured before delivery; bone lead was measured postpartum. We dichotomized bone and blood lead into the top tertile versus the bottom tertiles and used log-binomial regression to assess the association between lead and a high angiogenic ratio.

MAIN OUTCOME MEASURES

The outcomes were high sFlt1 to PlGF ratio and development of a hypertensive disorder of pregnancy.

RESULTS

We enrolled 102 participants, of whom 98 had at least one lead measurement and an angiogenic factor result. Median bone lead was 3.8 ug/g (2.0 - 6.6) and median blood lead was 0.2 ug/dL (0.2 - 0.4). Incidence of hypertensive disorders of pregnancy was 31%. When comparing the highest tertile of bone lead to the bottom two tertiles, there was no association with a high sFlt1/PlGF ratio or hypertensive disorders of pregnancy. Similar results were observed for the exposure of blood lead.

CONCLUSIONS

Lead exposure was not an important contributor to an elevated angiogenic factor ratio or hypertensive disorders of pregnancy in our U.S.

POPULATION

However, lead exposure was modest in our population and we cannot exclude a relationship with hypertensive disorders of pregnancy.

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.

Comparison of bone lead measured via portable x-ray fluorescence across and within bones

BACKGROUND

Bone lead measured via x-ray fluorescence (XRF) has been used for decades in health studies. A portable XRF device for bone lead measurement is gaining in popularity for its ease of use and shorter measurement times. Previous XRF devices have measured different bone types in order to sample both cortical and trabecular bone, in which lead has different half residence times.

OBJECTIVE

The portable XRF uses lower energy to measure bone lead than previous devices, and, thus, only measures the surface of the bone. Because all bones have a cortical shell, we hypothesized that portable XRF bone lead measurements would be similar regardless of the bone measured.

METHODS

This study tested differences in portable XRF bone lead measurements across different cortical and trabecular bones in measurements made on 31 cadavers. We also compared tissue thicknesses overlying different bones, which can impact portable XRF measurements.

RESULTS

The correlation coefficients found between bones were higher (rho ~0.4) than previous K-shell XRF bone measurements in cortical and trabecular over the same range of values (rho~0.2). The concentrations were shown to vary non-significantly across different bones within individuals.

A Dosimetry Study of Portable X-ray Fluorescence in Vivo Metal Measurements

Portable x-ray fluorescence devices have grown in popularity for possible metal exposure assessment using in vivo measurements of bone and toenail. These measurements are accompanied by a small radiation dose, which is typically assessed by radiation safety committees to be minimal. However, an understanding of precise dose under different instrument conditions is still needed. This study set out to do a thorough investigation of the exact dose measurements using optically stimulated dosimeters, thermoluminescent dosimeters, and simulation with a Monte Carlo N-Particle transport code to assess the skin and total-body effective dose typical of portable x-ray fluorescence devices. We showed normal linear relationships between measurement time, x-ray tube current, and radiation dose with the device, and we showed a second order polynomial relationship with increasing voltage and radiation dose. Dose was quantified using thermoluminescent dosimeters, optically stimulated dosimeters, and simulations, which gave similar dose estimations. Skin dose for a standard 50-kV, 40-μA measurement for bone and toenail in vivo was 48.5 and 28.7 mSv, respectively, according to simulation results. Total-body effective dose was shown as 3.4 and 2.0 μSv for in vivo bone and toenail measurements, respectively, for adults using the portable x-ray fluorescence device.

Blood lead, bone lead and child attention-deficit-hyperactivity-disorder-like behavior

BACKGROUND AND OBJECTIVE

Mounting evidence showed that lead exposure increased the risk of child attention-deficit-hyperactivity disorder (ADHD). Epidemiologic studies have typically used the blood-lead as a biomarker of lead exposure; blood-lead levels mostly reflect recent lead exposure. However, few studies have examined the relationship between bone-lead, a biomarker of cumulative exposure, and ADHD. Therefore, we aimed to compare the associations of bone-lead vs blood-lead levels with child ADHD symptoms and comorbidities.

METHODS

A total of 164 children aged 3-15 years were enrolled during 2014-2015. The Vanderbilt-ADHD-Diagnostic-Parent-Rating Scale (VADPRS) was used to evaluate the children's ADHD symptoms and comorbidities. Children's blood and bone lead concentrations were assessed, the latter using a non-invasive K-X-ray-fluorescence technique. According to blood-lead levels, children were classified into high (blood-lead ≥ 10.0 μg/dL) and low (blood-lead < 10.0 μg/dL) blood-lead groups. According to bone-lead levels, children were classified into high (bone-lead ≥ 2.66 μg/g) and low (bone-lead < 2.66 μg/g) bone-lead groups. We associated blood/bone lead with VADPRS data using multi-variable binary logistic regression models.

RESULTS

Children in the high blood-lead group had higher hyperactivity/impulsivity (P = 0.02) scores than the corresponding low blood-lead group. Children in the high bone-lead group had higher hyperactivity/impulsivity (P = 0.02) and oppositional-defiant-disorder (ODD) (P = 0.03) scores than the corresponding low bone-lead group. After adjusting for relevant confounders, children in the high bone-lead group were more likely to have ODD-behavior than the low group (OR = 6.7, 95%CI: 1.2-36.5). However, no adjusted association was observed between blood-lead and any ADHD-domain score.

CONCLUSION

High levels of cumulative lead exposure in children may be an independent risk factor of ODD-behavior.

Childhood lead biokinetics and associations with age among a group of lead-poisoned children in China

Childhood lead exposure has been shown to have a significant effect on neurodevelopment. Many of the biokinetics involved with lead biomarkers in children still remain unknown. Two hundred fifty (157 in the exposed group and 93 controls) children were enrolled in our study and lead exposed children returned for multiple visits for measurement of blood and bone lead and chelation treatment. We demonstrated that the correlation between blood and bone lead increased with subsequent visits. We calculated the blood lead half-life for 50 patients, and found a significant (p-value < 0.001) positive correlation with age. For ages 1-3 years (N = 17), the blood lead half-life was found to be 6.9 ± 4.0 days and for 3+ years it was found to be (N = 33) 19.3 ± 14.1 days. In conclusion, the turnover of lead in children is faster than in adults. Our results indicate that blood lead is a more acute biomarker of exposure than previously thought, which will impact studies of children's health using blood lead as a biomarker.

Lead exposure biomarkers in the Common Loon

Lead in fishing tackle is a significant source of exposure to the environment, wildlife, and potentially humans. Common Loons (Gavia immer) are exposed to lead by eating fish which have lead tackle, or ingesting fishing weights or spent ammunition when they ingest small stones to aid in digestion. Blood lead is traditionally used as a biomarker of exposure in loons, but it only reflects recent exposures. Cumulative exposure measured via bone lead may better reflect the overall health of loons and their aquatic habitat. This study compared a portable x-ray fluorescence (XRF) device for measurement of bone lead with and without tissue overlying the bone on loon cadavers with measurements made by inductively coupled plasma mass spectrometry (ICP-MS) of different tissues from the loons. For this study we had 75 bone samples, 19 body fluid samples, and 17 liver lead samples. We found significant correlations between portable XRF bone lead measurements made with overlying tissue and ICP-MS measures of bone lead (R = 0.88), body fluid lead (R = 0.65), and liver lead (R = 0.71). Bone lead was found to be higher in loons collected from non-coastal regions. In assessing lead-related cause of death, bone lead proved more predictive than liver lead. Future studies should investigate the value of these biomarkers for both aquatic health and loon health to further validate our findings.

Improvements and reproducibility of an optimal grazing-incidence position method to L-shell x-ray fluorescence measurements of lead in bone and soft tissue phantoms

L-shell x-ray fluorescence (LXRF) is a non-invasive approach to lead (Pb) concentration measurements in human bone. The method is based on the detection of the characteristic x-ray photons of Pb at 10.5 and 12.6 keV and experimental studies were designed to perform in vivo human bone Pb measurements. In later studies, however, the initial LXRF methodology was shown to have poor accuracy and precision. In a recent publication, we investigated an optimal grazing-incidence position (OGIP) approach using a submillimeter x-ray beam from an integrated x-ray tube and polycapillary x-ray lens table-top system. The OGIP method effectively reduced the x-ray scatter and produced a Pb detection limit of ~5 μg/g for a 2 mm soft tissue phantom thickness. In this study, the OGIP methodology was improved by using 10 s x-ray spectra acquisitions at sequential positions 0.5 mm apart. The measured Sr K_α peak height versus position data was used to spectroscopically identify the bone phantom and the OGIP. The data was fitted with the analytical convolution between a Gaussian and an exponential decay. The position corresponding to the maximum of the fitted convolution function was then selected as the OGIP. Four phantom sets were used. A cylindrical plaster-of-Paris bone phantom doped with Pb in a concentration of 74 μg/g was used as a bare bone phantom or with one of the three overlying polyoxymethylene cylindrical shell soft tissue phantoms of 1, 2, and 3 mm thickness. The reproducibility of the OGIP method was assessed in five independent trials using each of the four phantom sets. The coefficient of variation (COV) percentage values of the Sr K_α peak height measurements were below 5%. The new procedure decreased by more than threefold the duration and radiation dose of the earlier approach.

Validation of x-ray fluorescence measurements of metals in toenail clippings against inductively coupled plasma mass spectrometry in a Nigerian population<sup/>

OBJECTIVE

Metal exposures have been linked with many adverse health outcomes affecting nearly every system in the body. Exposure to metals has been tracked primarily using blood. Blood metal concentrations have drawbacks as biomarkers stemming from the metals' short biologic half-lives, shipping and storage requirements, and invasive collection procedures. Toenails, which capture a longer exposure period, can be collected non-invasively and stored at room temperature, and can be more feasible and cost-effective for large-scale population studies.

APPROACH

Inductively coupled plasma mass spectrometry (ICP-MS) has been used for analysis of toenail metal concentrations, but x-ray fluorescence (XRF) has many advantages in versatility and cost effectiveness over these analyses. This study compared toenail concentrations of manganese (Mn) and lead (Pb) measured with XRF against ICP-MS, in samples collected from 20 adults in Nigeria. To do this we developed a novel calibration method that corrects XRF measurements for toenail weight and thickness to reduce the variability in XRF measurements of toenail clippings.

MAIN RESULTS

We found a high correlation (R  =  0.91) between toenail manganese metal measurements made with XRF and ICP-MS and a correlation of (R  =  0.32) between toenail lead XRF and ICP-MS with over half of the lead results below the detection limit of the instrumentation.

SIGNIFICANCE

XRF can be used effectively to quantify metals at the part per million level or lower depending on the XRF equipment used in the measurements.

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.

The decrease in population bone lead levels in Canada between 1993 and 2010 as assessed by in vivo XRF

Objective and Approach: A study, conducted in Toronto, Canada, between 2009 and 2011, measured the bone lead concentrations of volunteers aged 1-82 years using in vivo x-ray fluorescence (XRF) technology.

MAIN RESULTS

Bone lead levels were lower compared to Ontario in vivo XRF studies from the early 1990s. In adults, the slope of tibia lead content versus age was reduced by 36-56%, i.e. bone lead levels for a given age group were approximately half compared to the same age group 17 years prior. Further, bone lead levels of individuals fell over that time period. In 2010, an average person aged 57 years had a bone lead level approximately 1/3 less than their bone lead level age 40 years in 1993. Using this data, the half-lives of lead in the tibia were estimated as 7-26 years. Tibia lead levels were found to be low in children. The reduction in bone tibia content in children was not significant (p  =  0.07), but using data from additional north eastern US studies, there is evidence that childhood tibia stores are lower than in the 1990s.

SIGNIFICANCE

In vivo XRF analysis shows that there has been a reduction in the level of lead in bone in Canada over the last two decades. Public health measures have been very successful in reducing ongoing exposure to lead and in reducing bone lead stores.

Quantification of manganese and mercury in toenail in vivo using portable X-ray fluorescence (XRF)

BACKGROUND AND OBJECTIVE

Toenail is an advantageous biomarker to assess exposure to metals such as manganese and mercury. Toenail Mn and Hg are in general analyzed by chemical methods such as inductively coupled plasma mass spectrometry and atomic absorption spectrophotometry. In this project, a practical and convenient technology-portable X-ray florescence (XRF)-is studied for the noninvasive in vivo quantification of manganese and mercury in toenail.

MATERIAL AND METHODS

The portable XRF method has advantages in that it does not require toenail clipping and it can be done in 3 min, which will greatly benefit human studies involving the assessment of manganese and mercury exposures. This study mainly focused on the methodology development and validation which includes spectral analysis, system calibration, the effect of toenail thickness, and the detection limit of the system. Manganese- and mercury-doped toenail phantoms were made. Calibration lines were established for these measurements.

RESULTS

The results show that the detection limit for manganese is 3.65 μg/g (ppm) and for mercury is 0.55 μg/g (ppm) using 1 mm thick nail phantoms with 10 mm soft tissue underneath.

DISCUSSION AND CONCLUSION

We conclude that portable XRF is a valuable and sensitive technology to quantify toenail manganese and mercury in vivo.

Measurements of Strontium Levels in Human Bone In Vivo Using Portable X-ray Fluorescence (XRF)

Measurement of bone strontium (Sr) is vital to determining the effectiveness of Sr supplementation, which is commonly used for the treatment of osteoporosis. Previous technology uses radioisotope sources and bulky equipment to measure bone Sr. This study demonstrates the effectiveness of portable X-ray fluorescence (XRF) for bone Sr measurement and validates it using data from a population of 238 children. We identified correlations between bone Sr and age in our participants.

Calibration of the 125I-induced x-ray fluorescence spectrometry-based system of in vivo bone strontium determinations using hydroxyapatite as a phantom material: a simulation study

OBJECTIVE

The calibration of in vivo x-ray fluorescence systems of bone strontium quantification, based on ¹²⁵I excitation, is dependent on a coherent normalization procedure. Application of this procedure with the use of plaster of Paris (poP) as a phantom material requires the application of a coherent conversion factor (CCF) to make the calibration functions transferable between the phantom material and human bone. In this work we evaluate, with the use of Monte Carlo simulation, the potential benefit of employing a newly developed hydroxyapatite phantom material into the calibration protocol.

APPROACH

Simulations being performed on bare bone phantoms, as the emission spectrum in this case is equivalent to an emission spectrum of an adequately corrected measurement for soft tissue attenuation of emitted strontium signal. We report that the application of hydroxyapatite phantoms does in fact remove the need for a coherent correction factor (CCF).

MAIN RESULTS

The newly developed phantoms can thus be used for the calibration of in vivo bone strontium systems removing one step of the calibration protocol. Calibration is, however, limited to cases in which the concentration is relative to the amount of calcium in the specimen, which is, the most useful quantity in a clinical sense. Determining concentrations on a per-mass-of-material basis, that is, a concentration not normalized to the calcium content of the phantom/bone, results in large biases in estimated bone strontium content.

SIGNIFICANCE

The use of an HAp phantom material was found to remove the need for a CCF. It was also found that in the case of an incomplete conversion ratio when preparing the phantom material that there would be little effect on the differential coherent cross-section and thereby the coherent normalization-based calibration protocol.

Theoretical modeling of a portable x-ray tube based KXRF system to measure lead in bone

OBJECTIVE

K-shell x-ray fluorescence (KXRF) techniques have been used to identify health effects resulting from exposure to metals for decades, but the equipment is bulky and requires significant maintenance and licensing procedures. A portable x-ray fluorescence (XRF) device was developed to overcome these disadvantages, but introduced a measurement dependency on soft tissue thickness. With recent advances to detector technology, an XRF device utilizing the advantages of both systems should be feasible.

APPROACH

In this study, we used Monte Carlo simulations to test the feasibility of an XRF device with a high-energy x-ray tube and detector operable at room temperature.

MAIN RESULTS

We first validated the use of Monte Carlo N-particle transport code (MCNP) for x-ray tube simulations, and found good agreement between experimental and simulated results. Then, we optimized x-ray tube settings and found the detection limit of the high-energy x-ray tube based XRF device for bone lead measurements to be 6.91 µg g^-1 bone mineral using a cadmium zinc telluride detector.

SIGNIFICANCE

In conclusion, this study validated the use of MCNP in simulations of x-ray tube physics and XRF applications, and demonstrated the feasibility of a high-energy x-ray tube based XRF for metal exposure assessment.

Detection of lead in bone phantoms and arsenic in soft tissue phantoms using synchrotron radiation and a portable x-ray fluorescence system

The differences and commonalities between x-ray fluorescence results obtained using synchrotron radiation and a portable x-ray fluorescence device were examined using arsenic in soft tissue phantoms and lead in bone phantoms. A monochromatic beam energy of 15.8 keV was used with the synchrotron, while the portable device employed a rhodium anode x-ray tube operated at 40 kV. Bone phantoms, dosed with varying quantities of lead, were made of Plaster of Paris and placed underneath skin phantoms of either 3.1 mm or 3.9 mm thickness. These skin phantoms were constructed from polyester resin, and dosed with varying amounts of arsenic. Using an irradiation time of 120 s, arsenic Kα and Kβ, and lead Lα and Lβ characteristic x-ray peaks were analysed. This information was used to calculate calibration line slopes and minimum detection limits for each data set. As expected, minimum detection limits were much lower at the synchrotron for detecting arsenic and lead. Both approaches produced lower detection limits for arsenic in soft tissue than for lead in bone when simultaneous detection was attempted. Although arsenic Kα and lead Lα emissions share similar energies, it was possible to detect both elements in isolation by using the arsenic Kβ and lead Lβ characteristic x-rays. Greater thickness of soft tissue phantom reduced the ability to detect the underlying lead. Experiments with synchrotron radiation could help guide future efforts toward optimizing a portable x-ray fluorescence in vivo measurement device.

Microdistribution of lead in human teeth using microbeam synchrotron radiation X-ray fluorescence (μ-SRXRF)

Lead (Pb) exposure is known to be associated with adverse effects on human health, especially during the prenatal period and early childhood. The Pb content in teeth has been suggested as a useful biomarker for the evaluation of cumulative Pb exposure. This study was designed to employ the microbeam synchrotron radiation X-ray fluorescence technique to determine the microdistribution of Pb within the tooth to evaluate the reliability of the technique and the effectiveness of tooth Pb as a biomarker of Pb exposure. The results showed that in the incisor sample, Pb primarily deposited in secondary dentine region close to the pulp and secondarily at enamel exterior. In addition, Pb colocalised with Zn, indicating a positive correlation between Pb and Zn. By contrast,in the two molar samples, Pb accumulated principally in the pulp, and secondarily in the enamel. At the same time, Pb in these two molar samples colocalised with Ca instead of Zn as was observed in the incisor sample. Several batches of line scans further confirmed the conclusions. The feasibility of using microbeam synchrotron radiation X-ray fluorescence to determine the microdistribution of Pb in teeth and of using the tooth Pb, especially in dentine, as a biomarker was discussed.

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.