Introduction

• Several quantities and units are used in the field of

diagnostic radiology to measure and describe radiation
dose
• Some can be measured directly while others can only
be mathematically estimated

Understanding radiation units 1

 Two types of radiation effects
Stochastic effects
– Where the severity of the result is the same but the
probability of occurrence increases with radiation dose, e.g.,
development of cancer
– There is no threshold for stochastic effects
– Examples: cancer, hereditary effects
Deterministic effects
– Where the severity depends upon the radiation dose, e.g.,
skin burns
– The higher the dose, the greater the effect
– There is a threshold for deterministic effects
– Examples: skin burns, cataract

Radiation Protection in Paediatric

Understanding radiationRadiology
units L02. Understanding radiation units 2
 Dose of Radiation

• Radiation energy
absorbed by a body per
unit mass.

Understanding radiation units 3

 Dose Quantities and Radiation units

- Dose quantities external to the patient’s body.

- Dose quantities to estimate risks of skin injuries and

effects that have threshold.

- Dose quantities to estimate stochastic risks.

Understanding radiation units

 Basic Radiation Quantities

• Used to quantify a beam

of X or γ-rays
• There are:
– Quantities to express Total radiation Radiation at a
specific point
total amount of •Total photons
•Photon fluence
radiation. •Integral dose
•Absorbed dose
– Quantities to express •Kerma
radiation at a specific •Dose equivalent
point

Understanding radiation units 5

 Exposure: X
• Exposure is a dosimetric quantity for measuring ionizing
electromagnetic radiation (X-rays & Ɣ-rays), based on
the ability of the radiation to produce ionization in air.

Units:
coulomb/kg (C/kg)
or
roentgen (R)

1 R = 0.000258 C/kg

Understanding radiation units

 KERMA
KERMA (Kinetic Energy Released in a Material):
– Is the sum of the initial kinetic energies of all charged ionizing
particles liberated by uncharged ionizing particles in a
material of unit mass
 This is a simple measure of how much radiation is present in
the air and is a quantity that is easily measured using an
appropriate instrument.
 The output from your X-ray set is usually measured in air
kerma.
– For medical imaging use, KERMA is usually expressed in air
SI unit = joule per kilogram (J/kg)
or gray (Gy)
1 J/kg = 1 Gy
Understanding radiation units
 Absorbed dose: D

Absorbed dose, D, is the mean energy

imparted by ionizing radiation to matter per
unit mass.

SI unit = joule per kg (J/kg) or gray (Gy).

Harold Gray

In diagnostic radiology, KERMA and D are

equal.

Understanding radiation units

 Mean absorbed dose in a tissue or
organ
The mean absorbed dose in a tissue or organ DT is the
energy deposited in the organ divided by the mass of
that organ.

Understanding radiation units

 Radiation Dose Quantities
• Primary physical quantities are not used directly for
dose limitation
• The International Council on Radiation Protection
(ICRP) has defined values for dose limits in
occupational exposure

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 Radiation Dose Quantities
Equivalent Dose:

• Accounts for the type of radiation

• Different radiation types have different level of
biologic damage per unit absorbed dose

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units L02. Understanding radiation units
 Radiation Weighting Factors, wR

Radiation type Radiation weighting factor, wR

Photons 1
Electrons and muons 1
Protons and charged pions 2
Alpha particle, fission fragments, 20
heavy ions
Neutrons A continuous curve
as a function of
neutron energy
Radiation Protection in Paediatric
Understanding radiationRadiology
units (Source:
L02. ICRP 103)radiation units
Understanding
 Equivalent Dose : HT,R

The absorbed dose in an organ or tissue multiplied by

the relevant radiation weighting factor :

H T , R  wR  DT , R

where DT,R is the average absorbed dose in the organ or

tissue T, and wR is the radiation weighting factor for
radiation R.

Understanding radiation units

 Radiation Quantities and Units

Equivalent dose (Unit = sievert, Sv )

– Compares the biological effects for
different types of radiation, X-rays, Ɣ-
rays, electrons, neutrons, protons, α-
particles etc.
– For X-rays, Ɣ-rays, electrons : absorbed Rolph Sievert
dose and equivalent dose have the
same value Gy = Sv.

Understanding radiation units 14

 Detriment
• Radiation exposure to different organs and tissues in
the body results in different probabilities of harm and
different levels of severity.
• The combination of probability and severity of harm is
called “detriment”.
• Effective dose reflects the combined detriment from
stochastic effects due to the equivalent doses in all the
organs and tissues of the body.

Understanding radiation units

Effective Dose: ET

• Effective dose takes into account the organ specific

radio-sensitivity to develop cancer and hereditary
effects from radiation

• Unit = sievert, Sv

Understanding radiation units 16

 Effective Dose: ET

A summation of the tissue equivalent doses, each

multiplied by the appropriate tissue weighting factor:

E   wT H T
T
where HT is the equivalent dose in tissue T and wT is
the tissue weighting factor for tissue T.

Understanding radiation units

 Tissue Weighting Factors, wT

• The organs have different weighting factors, wT.

• These factors are published in ICRP 103 (2007) and

have been changed over the years due to increased
knowledge.

Understanding radiation units 18

 Tissue Weighting Factors

• The weighting factors sum up to 1.0.

• They are relative and compares one organ with the
other.
• They are the same for children and adults!

Radiation Protection in Paediatric

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units L02. Understanding radiation units 19
 Tissue Weighting Factors

• Data is primarily taken from

knowledge derived from
studying the Japanese
population exposed to
atomic bombs in Hiroshima
and Nagasaki
• On going research has
changed the weighting
factors from 1990 (ICRP 60)
to 2007 (ICRP 103).

Understanding radiation units 20

 Tissue Weighting Factors
Multipliers of the equivalent dose to an organ or tissue to account for the
different sensitivities to the induction of stochastic effects of radiation.
weighting
Tissue ∑ wT
factor
wT *

Bone-marrow (red), Colon, Lung, Stomach, Breast, 0.12 0.72

Remainder Tissues**(nominal weighting factor applied
to the average dose to 14 tissues)
Gonads 0.08 0.08
Bladder, Esophagus, Liver, Thyroid 0.04 0.16

Bone surface, Brain, Salivary glands, Skin 0.01 0.04

*ICRP 103
**Remainder Tissues (14 in total): Adrenals, Extrathoracic (ET) region, Gall bladder,Heart, Kidneys, Lymphatic
nodes, Muscle, Oral mucosa, Pancreas, Prostate, Small intestine, Spleen, Thymus, Uterus/cervix..

Understanding radiation units

Effective Dose (E)
Dose to lungs times their weighting
factor; DL x wL
+
Dose (mean absorbed dose) to
gastrointestinal tract times their
weighting factor; DGI x wGI
+
....(summation over organ after
organ)
=
Effective dose
E  w
T
T HT

where T stands for tissue

Understanding radiation units 22

 Dose Measurement

Kerma in X-ray field can be

measured using calibrated:

• Ionization chamber

• Semiconductor dosimeter

• Thermoluminescent dosimeter
(TLD)

Understanding radiation units 23

 Kerma-Area Product: KAP

• The kerma - area product (KAP) is

defined as the kerma in air in a
plane perpendicular to the incident
beam axis, integrated over the
area of interest.

• This is the dose related quantity

measured and displayed on all
modern X-ray equipment
excluding CT.
KAP meter

Understanding radiation units

 Kerma-Area Product: KAP
• The KAP (Gy·cm2) is constant
with distance since the cross
section of the beam is a
quadratic function which
cancels the inverse quadratic
dependence on dose .

• KAP remains constant along

the beam axis as long as it is
not measured close to the
patient/phantom surface
which introduces backscatter.

Understanding radiation units

 Kerma-Area Product: KAP

d1=1

KAP = K x Area Area = 1

Dose = 1

the SI unit of KAP is the d2=2

Gy·cm2 Area = 4
Dose = 1/4

Understanding radiation units 26

 Kerma-Area Product: KAP

KAP is independent of distance

from the X-ray source, as: d1=1

Area = 1
 Air Kerma decreases with the inverse Dose = 1

square law. d2=2

Area = 4
Dose = 1/4
 Area increase with the square distance

KAP is usually measured at the level

of the tube diaphragms

Understanding radiation units 27

 KAP (ke rma -are a product)

This is a picture of a KAP meter which measures the kerma area product
Unit: Gy·cm 2

Understanding radiation units

 Example of a dose display during
fluoroscopy or cine runs with dose
rate as shown

Understanding radiation units 29

 Kerma-Area Product

In paediatric radiology KAP may be used for:

– Diagnostic reference levels (DRLs)

– By use of conversion factors, it can be converted to
skin dose and/or effective dose

Understanding radiation units 30

 Other related dose parameters
Fluoroscopy time:
• Has a weak correlation with KAP
• But, in a quality assurance programme it can be
adopted as a starting unit for
– comparison between operators, centres,
procedures
– for the evaluation of protocol
optimization, and
– to evaluate operator skill

Understanding radiation units 31

Other related dose parameters
Number of acquired images and number of series:
– Patient dose is a function of total acquired
images
– But dose/image can have big variations
– There is an evidence of large variation in
protocols adopted in different centres

Understanding radiation units 32

 Quantities and Units for Staff Dose
Assessment
• Personal dosimetry services typically provide
monthly estimates of Hp(10) (mSv), the dose
equivalent in soft tissue at 10 mm depth. This is in
most of the cases used to estimate the effective
dose.
• Sometimes, Hp(0.07) (mSv) is also reported: the dose
equivalent in soft tissue at 0.07 mm depth)
• Personal dosememters (film, thermoluminescent...)

Understanding radiation units

 Summary
Air Kerma
•This is a simple measure of how much radiation
is present in the air and is a quantity that is
easily measured using an appropriate
instrument. It is measured using the unit ‘Gray’
which is abbreviated to Gy.
The output from your X-ray set is usually
measured in air kerma.
Absorbed Dose
•This is a measure of the energy deposited in a specific
material (such as body tissue) by the incident radiation.
•In practice, for dental X-rays, the absorbed dose in body
tissue is approximately the same as the air kerma value.
Equivalent and Effective Dose
•The quantities used to evaluate radiation doses to workers
and patients, and the relative health risks that result, are
equivalent doses and effective doses.
•These are not directly measured but are calculated using
the absorbed dose and applying weighting factors.
 Equivalent dose is the absorbed dose
multiplied by a ‘radiation weighting factor’,
which considers how damaging the type of
radiation is.
 The quantity effective dose is the sum of the
tissue-weighted equivalent doses and is a
measure of the radiation dose to the whole
body.
 Effective dose and equivalent dose are both
measured using the unit Sievert which is
abbreviated to Sv.
Quantity Description Unit Commonly Used for

Air Kerma Amount of radiation Gray(Gy) Output from an X-ray set,

measured in air Comparison with
diagnostic reference level

Absorbed Dose Energy deposited in tissue Gray(Gy) Measurement of skin

by radiation dose to staff or patient

Equivalent Dose Single organ/tissue dose, Sievert(Svi) Estimate dose to thyroid

calculated from absorbed gland of staff or patient
dose, modified according
to how damaging the type
of radiation is

Effective Dose Whole body dose, Sivert(Sv) Estimate of whole body

calculated from the sum dose to staff or patient,
of tissue weighting comparison with dose
equivalent dose investigation level