Provide a systematic overview of assessment approaches for treatment decisions after internal contamination with plutonium, americium, or curium and the efficacy of decorporation treatment with diethylenetriamine pentaacetate (DTPA) among humans and animals.

MEDLINE, EMBASE, and Cochrane Library were searched until December 06, 2023. Controlled experimental animal studies and human studies were eligible. Hand search of relevant reports continued until December 24, 2024. Risk of bias was assessed with the OHAT and JBI critical appraisal tools. Narrative synthesis was performed.

A total of 37 studies and 1 report were included. Two studies reported averted dose in humans following DTPA ranging from 150 μSv to 1.1 Sv, but the contribution of rapid contamination assessments to treatment decisions was unclear. Numerous outcomes across different treatment schedules and observation periods were studied in animal populations. Studies provided very low certainty evidence of positive treatment effects.

Whether rapid dose assessment contributes to timely treatment decisions could not be assessed with the limited amount of informative studies. In animal studies, DTPA treatment seems to be effective in reducing radiation burden and other proximal outcomes, but risk of bias is high. Evidence for humans is based on a small number of case studies where reductions in body burden have been reported.