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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 Skull(PAorAP) Skull(lateral)1 Chest(PA)1 Chest(lateral) Chest(PAandlateral) Thoracicspine(AP)1 Thoracicspine(lateral)1 Lumbarspine(AP) Lumbarspine(lateral)1 Abdomen(AP)1 Abdomen Pelvis(AP) Pelvisorhips3 Bitewingdentalfilm Limbsandjoints
3 3 1 3 1 2 1 1

EffectiveDose,mrem(mSv) 3(0.03) 1(0.01) 2(0.02) 4(0.04) 6(0.06) 40(0.4) 30(0.3) 70(0.7) 30(0.3) 70(0.7) 53(0.53) 70(0.7) 83(0.83) 0.4(0.004) 6(0.06)

Estimatesofthedoseanindividualmightreceiveifundergoinganentireprocedure(e.g.,alumbar spineseriestypicallyconsistsoffivefilms). CompleteExams Intravenouspyelogram(kidneys,6films) Bariumswallow(24images,106secfluoroscopy)1 Bariummeal(11images,121secfluoroscopy)1 Bariumfollowup(4images,78secfluoroscopy) Bariumenema(10images,137secfluoroscopy) CThead1 CTchest1 CTabdomen CTpelvis1 CT(headorchest)2 PTCA(heartstudy) Coronaryangiogram Mammogram3 Lumbarspineseries Thoracicspineseries Cervicalspineseries3
3 3 3 3 1 1 1 1

EffectiveDose,mrem(mSv) 250(2.5) 150(1.5) 300(3.0) 300(3.0) 700(7.0) 200(2.0) 800(8.0) 1,000(10) 1,000(10) 1,110(11.1) 7505,700(7.557) 4601,580(4.615.8) 13(0.13) 180(1.8) 140(1.4) 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.