DosesfromMedicalXRayProcedures
Standardizedradiationdoseestimatescanbegiven
foranumberoftypicaldiagnosticmedical
procedures.Wearenotabletogiveradiationdose
estimatesforproceduresinvolvingradiationtherapy;
theseneedtobehandledverycarefullyonacaseby
casebasis.
Thetablesbelowgivedoseestimatesfortypical
diagnosticradiologyexamsforadults.Doseswill
changedependingonanumberofvariablesincluding
thespecificmachineandmanufacturer,study
techniques(thesettingsofthemachineusedto
producetheradiationinradiologyand,innuclear
medicine,theamountofactivityadministeredand
thepatientsmetabolism),andotherissues.
Forcomparison,allofusreceiveabout300mrem(3
mSv)ofradiationexposuretonaturalbackground
radiationeveryyear.
Amedicalimagingexamthatinvolvesexposureto
ionizingradiationmustbejustifiedonthebasisof
benefittothepatient.Nopracticeinvolvingexposure
toionizingradiationshouldoccurunlessitproduces
sufficientbenefittotheexposedindividual(ICRP
1991).
Toassistindeterminingwhatappropriatepracticeis,
theAmericanCollegeofRadiologyhasdeveloped
PracticeGuidelinesandAppropriatenessCriteria.
Practiceguidelinesareaneducationaltooldesigned
toassistpractitionersinprovidingappropriatecare
forpatients.Appropriatenesscriteriaareevidence
basedguidelinestoassistreferringphysiciansand
otherprovidersinmakingthemostappropriate
imagingortreatmentdecision.
Theuseofmedicalexamsthatwouldexposechildren
toionizingradiationneedsspecialconsideration.
Childrenhavea35timeslargerradiationinduced
cancermortalityriskthanadults(ICRP1991).Most
organizationsadjusttheparametersettingsonanx
raymachineortheamountofradioactivity
administered(fornuclearmedicinescans)when
performingexamsonchildren;however,itis
importanttoaffirmthatreducedfactorsforchildrens
examshavebeenadoptedbythefacilityinquestion.
TheAmericanCollegeofRadiologyhasdeveloped
pediatricCTprotocolguidancetoassistfacilities
workingtoreducethedosesdelivered.

Estimatesofthedoseanindividualmightreceivefromonexray.
SingleRadiograph EffectiveDose,mrem(mSv)
Skull(PAorAP) 1 3(0.03)
Skull(lateral)1 1(0.01)
Chest(PA)1 2(0.02)
Chest(lateral) 1 4(0.04)
Chest(PAandlateral) 2 6(0.06)
Thoracicspine(AP)1 40(0.4)
Thoracicspine(lateral)1 30(0.3)
Lumbarspine(AP) 1 70(0.7)
Lumbarspine(lateral)1 30(0.3)
Abdomen(AP)1 70(0.7)
Abdomen 3 53(0.53)
Pelvis(AP) 1 70(0.7)
Pelvisorhips3 83(0.83)
Bitewingdentalfilm 3 0.4(0.004)
Limbsandjoints 3 6(0.06)

Estimatesofthedoseanindividualmightreceiveifundergoinganentireprocedure(e.g.,alumbar
spineseriestypicallyconsistsoffivefilms).
CompleteExams EffectiveDose,mrem(mSv)
Intravenouspyelogram(kidneys,6films) 1 250(2.5)
Bariumswallow(24images,106secfluoroscopy)1 150(1.5)
Bariummeal(11images,121secfluoroscopy)1 300(3.0)
Bariumfollowup(4images,78secfluoroscopy) 1 300(3.0)
Bariumenema(10images,137secfluoroscopy) 1 700(7.0)
CThead1 200(2.0)
CTchest1 800(8.0)
CTabdomen 1 1,000(10)
CTpelvis1 1,000(10)
CT(headorchest)2 1,110(11.1)
PTCA(heartstudy) 3 7505,700(7.557)
Coronaryangiogram 3 4601,580(4.615.8)
Mammogram3 13(0.13)
Lumbarspineseries 3 180(1.8)
Thoracicspineseries 3 140(1.4)
Cervicalspineseries3 27(0.27)

Referencesforthetwotables
1. WallBF,HartD.Revisedradiationdosesfortypicalxrayexaminations.TheBritishJournalofRadiology
70:437439;1997(5,000patientdosemeasurementsfrom375hospitals).
2. NationalCouncilonRadiationProtectionandMeasurements.Sourcesandmagnitudeofoccupationaland
publicexposuresfromnuclearmedicineprocedures.Bethesda,MD:NationalCouncilonRadiation
ProtectionandMeasurements;NCRPReport124;1996.
3. UnitedNationsScientificCommitteeontheEffectsofAtomicRadiation.Sourcesandeffectsofionizing
radiation,Vol.1:Sources.NewYork,NY:UnitedNationsPublishing;2000.

Otherreferencesandresources
AmericanCollegeofRadiologywhitepaperonradiationdoseinmedicine:
http://www.acr.org/SecondaryMainMenuCategories/quality_safety/white_paper_dose.aspx

AmericanCollegeofRadiologypracticeguidelinefordiagnosticreferencelevelsinmedicalxrayimaging:
http://www.acr.org/SecondaryMainMenuCategories/quality_safety/RadSafety/RadiationSafety/guideline
diagnosticreference.aspx

InternationalCommissiononRadiologicalProtection.1990recommendationsoftheInternationalCommissionon
RadiologicalProtection.Oxford:PergamonPress;ICRPPublication60;AnnICRP21(13);1991.

Glossary
backgroundradiation:Backgroundradiationincludesradiationfromcosmicsources,naturallyoccurringradioactive

materials(includingradon),andglobalfallout(fromthetestingofnuclearexplosivedevices).Thetypicallyquoted

averageindividualexposurefrombackgroundradiationis0.30remperyear.

becquerel:Thebecquerel(Bq)istheunitintheInternationalSystemofUnitstoreplacethecurie(seecurie).

curie:Thecurie(Ci)istheoriginaltermusedtodescribetheamountofradioactivematerialpresentorstrengthof

thesource.Itisbasedupontheradioactivedecayrateoftheradionuclide.Onecurieisequalto3.7x10 10

disintegrations(37trilliondecays)persecond(dps);onebecquerelisequalto1dps.Themostcommonactivity

levelsusedinlaboratoriesarethemillicurie(mCi)andmicrocurie(Ci).Amillicurie(mCi)is1/1,000thofacurieand

amicrocurie(Ci)is1/1,000,000thofacurie.IntheInternationalSystemofUnits,thebecquerel(Bq)describesthe

amountofradioactivematerialpresent.Onecurieisequalto3.7x109Bq.

diagnostic:Inmedicine,diagnosisordiagnosticsistheprocessofidentifyingamedicalconditionordiseasebyits

signsandsymptomsandfromtheresultsofvariousprocedures.Asusedwhenreferringtomedicalexams

involvingradiation,itistheuseofxraysorradioactivematerialstoidentifythemedicalcondition.

dose:Doseisageneraltermusedtoexpress(quantify)howmuchradiationexposuresomething(apersonorother

material)hasreceived.Theexposurecansubsequentlybeexpressedintermsoftheabsorbed,equivalent,

committed,and/oreffectivedosebasedontheamountofenergyabsorbedandinwhattissues.

effectivedose:Radiationexposurestothehumanbody,whetherfromexternalorinternalsources,caninvolveallora

portionofthebody.Thehealtheffectsofoneunitofdosetotheentirebodyaremoreharmfulthanthesamedoseto

onlyaportionofthebody,e.g.,thehandorthefoot.Toenableradiationprotectionspecialiststoexpresspartial

bodyexposures(andtheaccompanyingdoses)toportionsofthebodyintermsofanequaldosetothewholebody,

theconceptofeffectivedosewasdeveloped.Effectivedose,then,isthedosetothewholebodythatcarrieswithit

thesameriskasahigherdosetoaportionofthebody.Asanexample,8rem(80mSv)tothelungsisroughlythe

samepotentialdetrimentas1rem(10mSv)tothewholebodybasedonthisidea.

exposure:Exposureiscommonlyusedtorefertobeingaroundaradiationsource;e.g.,ifyouhaveachestxray,you

areexposedtoradiation.Bydefinition,exposureisameasureoftheamountofionizationsproducedinairby

photonradiation.

exposurerate:Exposurerateistheamountofexposureordoseyouarereceivingperunittime(e.g.,1mrem/hour).

gammarays:Gammaraysarehighenergyelectromagneticradiation(photons)emittedinanattemptbythe

radionuclidetobecomestable,i.e.,radioactivedecay.Gammarayshavemoderatetohighpenetratingpower,are

oftenabletopenetratedeepintothebody,andgenerallyrequiresomeformofshielding,suchasleadorconcrete.

Visiblelightisalsointheformofphotons.Gammaphotonsbehavesimilarlytolight,buttheyareinvisible.

highlevelradiation:Highlevelradiationreferstoradiationdosesgreaterthan10remtoahumanbody.

lowlevelradiation:Lowlevelradiationreferstoradiationdoseslessthan10remtoahumanbody.

observablehealtheffect:Anobservablehealtheffectisachangeinphysicalhealththatcanbedetectedmedically.

Observablehealtheffectsmayincludechangesinbloodcellcounts,skinreddening,cataracts,etc.Whetherornotit

isanobservableharmfulhealtheffectdependsonwhetherdamagetothebodyhasoccurredandwhetherthat

damageimpairshowthebodyisabletofunction.

radiation:Radiationisatermcommonlyusedtodescribeionizingradiation(i.e.,xandgammarays,alphaandbeta

particles,neutrons).Ionizingradiationisradiationthatiscapableofproducingionsbypassingthroughmatter.

rem:Remisthetermusedtodescribeequivalentoreffectiveradiationdose.IntheInternationalSystemofUnits,the

sievert(Sv)describesequivalentoreffectiveradiationdose.Onesievertisequalto100rem.Onemremisone

thousandthofarem.

risk:Riskisdefinedinmosthealthrelatedfieldsastheprobabilityoroddsofincurringinjury,disease,ordeath.

roentgen:Theroentgen(R)isthetermusedtodescriberadiationexposure.Thistermforexposureonlydescribesthe

amountofionizationinair.IntheInternationalSystemofUnits,thecoulomb/kilogram(C/kg)describesradiation

exposure.Oneroentgenisequalto2.58x10 4C/kg.

safe:Safe,asitisbeingusedintheinformationonthisWebsite,isdefinedasanactivitythatisgenerallyconsidered

acceptabletous.Thisisnottosaythereisabsolutelynoriskwithanactivitythatisconsideredsafe;theremaybea

riskfromtheactivityortheexposuretoradiation,butitisthesameorlowerthantherisksfromeverydayactions.

Atalevelofradiationthatisconsideredsafe,aneffectiseithernonexistentortoosmalltoobserve.

sievert:Sievert(Sv)istheunitintheInternationalSystemofUnitstoreplacetherem(seerem).

therapy:Therapyisthemedicaltreatmentofdiseaseordisorders.Withrespecttoradiationtherapy,therapeutic

doses(e.g.,externalbeamtreatmentsfortumors,radioiodinetreatmentforthyroiddisorders)aresignificantly

greaterthanthosereceivedfromdiagnosticprocedures(e.g.,chestxrays,CTscans,nuclearmedicineprocedures,

etc.).

xrays:Xraysareelectromagneticradiation(photons)thatcanbeemittedfromradionuclidesorfromcertaintypes

ofdevices.Generally,xrayshavelowerenergiesthangammarays,butlikegammarays,xrayscanpenetrateinto

thebody.Sometimesleadorconcretemaybeusedasshieldingforxrays.