Fetus-Specific Hematopoietic Stem Cell Dosimetry Framework for Leukemia-Relevant Target Cells During Prenatal Development

OBJECTIVE: Hematopoietic stem cells (HSCs) are the primary target cells for radiation-induced leukemia. In postnatal individuals, red bone marrow (RBM) is commonly used as a surrogate dosimetric target region for the HSCs. During fetal development, however, HSCs are distributed across multiple hematopoietic organs, including the liver and bone marrow, raising the question of whether RBM-only dosimetric approach provides a biased estimate of radiation dose to leukemia-relevant target cells. This study aimed to develop a fetus-specific HSC dosimetry framework, capturing age- and organ-specific HSC distributions across different fetal ages. APPROACH: Fetal HSC distributions were updated based on developmental biology evidence, with a focus on the liver and bone marrow. Monte Carlo simulations were performed using the ICRP pregnant-female mesh-type reference computational phantoms (MRCPs) coupled with Geant4 code to calculate photon dose coefficients for external exposures in antero-posterior direction and photon specific absorbed fractions for internal exposures with maternal urinary bladder contents as the source region. MAIN RESULTS: Compared with conventional RBM-only approach, in the 8-week phantom, HSCs were assumed to be localized entirely in the liver, resulting in zero RBM dose values while HSC doses remained substantial. Between 10 and 20 weeks, the HSC and RBM doses showed substantial discrepancies, with maximum differences of up to 7.2-fold for external exposures due to the dominant contribution of HSCs in the fetal liver. At 25-30 weeks, discrepancies decreased as HSCs progressively colonized the bone marrow, and at 35-38 weeks, HSC and RBM doses became identical. SIGNIFICANCE: The fetus-specific HSC dosimetry provides biologically informed estimates of doses to leukemia-relevant target cells and highlights the limitations of RBM-only approach at early and mid-fetal ages. The proposed dosimetry supports prenatal radiation risk assessment for both external and internal exposures and provides a more robust basis for evaluating radiation-induced leukemia risk in the developing fetus.